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K V Iserson

Publications and source records attributed to K V Iserson.

At least 55 records · Page 3Linked to original sources
PubMed1993

Standards and limits: emergency physicians' attitude toward prehospital resuscitation.

The attitudes of emergency physicians toward using medical techniques in out-of-hospital medical cardiac arrest scenarios were assessed. The physicians' willingness to further limit the use of these techniques through prehospital Do Not Attempt Resuscitation (DNAR) protocols and their personal use of advance directives were also assessed. Questionnaires were distributed to the 1990 Council of the American College of Emergency Physicians, San Francisco, CA, to elicit demographic and clinical information. Of the 172 ACEP Council members (emergency physicians) asked to participate, 136 (79%) returned a questionnaire. These physicians represented all of the 50 United States, Puerto Rico, and two Canadian provinces. In two scenarios, most respondents recognized the uselessness of continued resuscitation for themselves, their spouse, and their parent. However, in these same situations approximately half of them would continue treating their child. Although nearly two thirds of the respondents did not have a prehospital DNAR policy in their emergency medicine system (EMS), 95% felt that they needed such a protocol. Only one-third of respondents had any type of advance directive for themselves. Experienced emergency physicians recognize that there are limits to the application of medical techniques, but are less willing to stop pediatric resuscitations, than they are to stop adult resuscitations. Emergency physicians agree on the need for prehospital DNAR protocols, but few have completed their own advance directives.

Adult↗
PubMed1993

A simplified prehospital advance directive law: Arizona's approach.

Many of the approximately 400,000 deaths that occur outside of hospitals or chronic care facilities each year in the United States are not only expected but also welcomed as relief from terminal disease. However, patients who lack decision-making capacity cannot communicate to emergency medical services system and emergency department personnel their wish not to be the recipient of advanced life support procedures. Prehospital advance directives (PHAD) offer that opportunity. Arizona is only the fourth state to pass a PHAD statute and the first to simplify the law so it is interpreted easily by both providers and patients. PHAD laws need not be complex, either in their language or in their implementation requirements. Simple and easily understood statues and their resulting directives increase the likelihood that those most likely to need and use this directive will be able to comply with its provisions. Arizona's law addresses several controversial areas yet to be worked out by other states. Placing the PHAD in statute ensures that a statewide attempt will be made to comply with its provisions, and as a law it should be more permanent than advance directive protocols based on administrative fiat. Physicians in other states may want to follow Arizona's lead and employ a joint effort by their state's bar association, hospital association, and medical association to smooth the passage of similar legislation. All parties involved, however, must not seek a perfect statute. Arizona's experience suggests that legislators will need to strike a balance between the needs of the citizens and the fears of lawyers wary of any potential liability for the state or the emergency medical services system.

Advance Directives↗
PubMed1993

Postmortem procedures in the emergency department: using the recently dead to practise and teach.

In generations past, it was common practice for doctors to learn lifesaving technical skills on patients who had recently died. But this practice has lately been criticised on religious, legal, and ethical grounds, and has fallen into disuse in many hospitals and emergency departments. This paper uses four questions to resolve whether doctors in emergency departments should practise and teach non-invasive and minimally invasive procedures on the newly dead: Is it ethically and legally permissible to practise and teach non-invasive and minimally invasive procedures on the newly dead emergency-department patient? What are the alternatives or possible consequences of not practising non-invasive and minimally invasive procedures on newly dead patients? Is consent from relatives required? Should doctors in emergency departments allow or even encourage this use of newly dead patients?

Autopsy↗
PubMed1993

Ethical dilemmas in hematologic/oncologic emergencies.

Clinicians use ethical decision making in their practice by applying professional and societal values in an organized way to solve moral dilemmas. Moral dilemmas are those situations in which a decision must be made between conflicting goods or evils or rights or wrongs. Clinicians must understand the medical profession's and society's values and be able to apply them within ethical systems. This article describes those values, basic ethical systems, a rapid ethical decision-making model, and specific ethical dilemmas faced by emergency physicians who treat patients with hematologic and oncologic emergencies.

Beneficence↗
PubMed1992

The bottom line.

Explore the source record for details and available documents.

Decision Making↗
PubMed1992

Acute care research: is it ethical?

BACKGROUND: Research in acute care is a troubling area for Institutional Review Board (IRB) approval and informed consent. Confusion about ethical and legal requirements has hampered research efforts and subsequent patient benefits. ANALYSIS: Acute care patients are the relatively few critical care patients who have suffered unexpected events that carry a high probability of mortality or severe morbidity unless immediate medical intervention is provided. We argue that acute care research is justified if the usual ethical requirements for research are modified to reflect the uniqueness of the situation. CONCLUSIONS: Our recommendations are to: a) use an explicit definition of acute care as distinct from other modes of critical care; b) eliminate the requirement for informed consent (as it is usually understood); and c) require stringent IRB oversight, regarding the unique ethical problems raised by this area of research. We further suggest that IRB oversight includes review of the protocol by a panel of individuals who represent possible enrollees in the proposed study.

Beneficence↗