Search PubMed⌕ Search

Biomedical subjects

John C Fletcher

Publications and source records attributed to John C Fletcher.

At least 19 recordsLinked to original sources
PubMed2002

In focus. Has patient autonomy gone to far? Geneticists' views in 36 nations.

We surveyed genetics professionals, patients, and the public about rights to information, to requested services, and to parenthood, posing difficult cases found in practice. In all, 2906 genetics professionals (63%), 499 primary care physicians (59%), 476 North American genetics patients (67%), 394 French patients (51%), 593 German patients (65%), and 988 members of the American public (99%) returned anonymous questionnaires. Results suggest a trend toward increased respect for patient autonomy since an earlier survey in 1985; in most nations more would perform prenatal diagnosis for a couple with 4 daughters who desire a son. A minority (35% in U.S., 14% elsewhere) would perform PND for a deaf couple who want a deaf child, but most (94% in U.S., 62% elsewhere) would do prenatal paternity testing in the absence of rape or incest. About half (51%) would support a woman with fragile X who wants children. The trend to respect patient autonomy was greatest in the U.S. and was least evident in China and India. In general, responses to these cases illustrate a shift away from population or eugenic concerns to a model of genetics focused on the individual.

Abortion, Eugenic↗
PubMed1996

Responding to JCAHO standards: everybody's business.

At this stage, JCAHO [Joint Commission on Accreditation of Healthcare Organizations] site visitors simply want to know how the institution plans to respond to the organization ethics standard. In the near future, however, they will expect data on how ethical issues have been addressed that faced the organization in marketing, billing, managed care contracts, and so on. Pointing to an organizational code of ethics will not be enough. Examples of leadership utilizing the processes of the committee or an appropriate consultant or group, to the ends of education, policy studies, and consultation on specific choices will meet the standard. Organizations that evade or choose not to supply data along these lines will presumably be negatively evaluated. Noncompliance presumably means a risk to accreditation. The message to the clinical ethics committee is a serious one. We must engage in the regional planning and organization needed to provide education and training needed by ethics committees for these two tasks, within the constraints of realism, that is, that these are requirements that are primarily expected of the clinical community and the organizations that provide care to patients.

Administrative Personnel↗
PubMed1993

Constructiveness where it counts.

CONCLUSION: I hope that this response to Scofield's paper has accomplished two goals: 1) it helps put to rest unreal discussion of a "profession" of clinical ethics and 2) it helps to focus on the most important issues raised by Scofield upon which action can be taken. It is true that "ethics is everybody's business" and ethicists must restrain their bias when it comes to the decision-making process. But special knowledge and skills are required to nurture the elements of a clinical ethics program, to unite the efforts of its multitalented members, and to relate the literature of a rapidly growing activity in healthcare to practical projects. The issues raised in the constructive parts of Scofield's paper are an excellent point of departure for debate on how best to shape the education, training, and standards of practice for clinical ethics.

Bioethics↗
PubMed1992

Ethics committees and due process.

I have three points to make about due process and an IEC's responsibility to provide ethics consultation on request: 1) the problem of due process needs to be put into the context of ethics consultation, for which committees are responsible but which they are ill-equipped to deliver as a whole group, except in certain circumstances; 2) IECs that attempt to provide consultation without an early stage of bedside consultation, involving the key decision-makers and especially the patient, attending physician and nurse(s), are inviting due process problems as well as a general "failure to thrive"; and 3) due process issues are important to resolve at two levels: a) initial contacts with patient, family and other decision-makers at an early stage of consultation close to the bedside, and b) especially at a second level of conflict resolution, when part or all of the IEC may be involved, because no resolution of the ethical problem(s) has been found at the primary level of consultation and the level of conflict will probably be higher. I propose a two-stage or two-step model for due process issues, i.e., obligations exist at both levels to respect the patient's rights and his or her priority in the decision-making process. My recommendation will be that IECs and their consultants need to be especially meticulous in carrying out these obligations at a second level of conflict resolution, when all or part of the IEC will be involved.

Civil Rights↗
PubMed1991

Privacy and disclosure in medical genetics examined in an ethics of care.

The progress of genetic knowledge magnifies existing ethical problems in medical genetics. Among the most troubling types of problems -- for medicine, patients, and the larger society -- are those of privacy and disclosure. Examples of the range of problems involving privacy and disclosure are: 1) disclosure of false paternity to an unsuspecting husband; 2) disclosure of a patient's genetic make-up to his or her unknowing spouse; 3) disclosure of information, against a patient's wishes, to relatives at genetic risk; 4) disclosure of ambiguous test results; 5) disclosure of adventitious nonmedical information, e.g., fetal sex; and 6) disclosure to institutional third parties, such as employers and insurers....

Attitude↗
PubMed1991

Ethics is everybody's business, especially in regard to confidentiality.

... Every hospital needs a policy statement devoted to confidentiality. This task is a good assignment for a hospital ethics committee. In drafting such a statement, one area that should not be overlooked is respect for confidentiality in cases used for teaching, patient conferences, and interdisciplinary meetings, including the teaching of clinical ethics! The University of Virginia's (UVA) Hospital Ethics Committee is considering a new policy statement on confidentiality....

Confidentiality↗
PubMed1990

Brain death and the anencephalic newborn.

We will set the stage for our analysis by reviewing selected medical aspects of anencephaly, outlining the history of the use of anencephalics as organ sources, and summarising the results of an important study recently completed at Loma Linda University. We will then employ some of the arguments and justifications underlying the Uniform Determination of Death Act (UDDA) to claim that anencephaly is morally equivalent to brain death, i.e., the reasons for considering brain-dead patients to be dead also apply to anencephalics. Finally, we will critique our proposal and discuss its implications.

Aborted Fetus↗