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Biomedical subjects

Laurence B McCullough

Publications and source records attributed to Laurence B McCullough.

At least 19 recordsLinked to original sources
PubMed2006

Ethics, a neglected dimension of power relationships of physician leaders.

OBJECTIVE: Physician leaders in obstetrics and gynecology find themselves in complex power relationships with administrative subordinates, administrative peers, and administrative superiors. The ethical dimensions of these power relationships have not been examined previously. STUDY DESIGN: The authors draw on the work of 3 major historic figures (John Gregory, Thomas Hobbes, and Friedrich Hoffmann) to identify for the first time 3 major types of power relationships and organizational cultures. Gregorian power relationships and organizational cultures are characterized by shared fiduciary responsibility that advances the core mission of a health care organization. Hobbesian power relationships and organizational cultures are characterized by relentless self-interest in a zero-sum game. Hoffmannian power relationships and organizational cultures are characterized by enlightened self-interest in a win-win game. RESULTS: The authors analyze the ethical dimensions of power relationships of physician leaders with subordinates, peers, and superiors and of organizational cultures. CONCLUSION: The authors support transformational leadership toward Gregorian power relationships and organizational cultures, using, when necessary, Hoffmannian power relationships and organizational cultures as a way station.

Administrative Personnel↗
PubMed2006

Preventive ethics for including women of childbearing potential in clinical trials.

OBJECTIVE: We present a preventive ethics approach for including women of childbearing potential in clinical trials. STUDY DESIGN: We explain the concept of preventive ethics and identify its implications for study design, the informed consent process, and study management. RESULTS: We identify and address ethically significant questions for investigators and institutional review boards to address, to responsibly enroll women of childbearing potential in clinical trials. These questions concern preventive ethics for study design, for the informed consent process, and for study management. Distinctive components of this preventive ethics approach include the distinction between directive and nondirective counseling, the recognition of the concept of moral risk for women as research subjects, and the distinction between professional and individual conscience. We identify ethical considerations for physicians considering referral of their patients to clinical trials. CONCLUSION: A comprehensive, preventive ethics approach to the ethical challenges in clinical trials related to the prevention and occurrence of pregnancy is essential for responsibly enrolling women of childbearing potential.

Adolescent↗
PubMed2006

Clinical concepts of futility and ethically justified limits on neonatal care: a case presentation of an infant with Apgar scores of 0 at 1, 5, and 10 minutes.

Appropriate length of delivery room resuscitative efforts for infants born without signs of life is controversial. We present the case of a preterm infant with Apgar scores of 0 at 1, 5, and 10 minutes but with a recovered heartbeat at 15 minutes. Using the clinically relevant conceptions of the principle of futility, we examine the ethical justification for the successive decisions to initiate, continue, and ultimately limit care for this patient. This difficult case highlights the importance of understanding the ethical justification for clinical interventions that are made in the neonatal intensive care unit.

Apgar Score↗
PubMed2006

Decision making in pediatric oncology: who should take the lead? The decisional priority in pediatric oncology model.

Decision making in pediatric oncology can look different to the ethicist and the clinician. Popular ethical theories argue that clinicians should not make decisions for patients, but rather provide information so that patients can make their own decisions. However, this theory does not always reflect clinical reality. We present a new model of decision making that reconciles this apparent discrepancy. We first distinguish decisional priority from decisional authority. The person (parent, child, or clinician) who first identifies a preferred choice exercises decisional priority. In contrast, decisional authority is a nondelegable parental right and duty, in which a mature child may join. This distinction enables us to analyze decisional priority without diminishing parental authority. This model analyzes decisions according to two continuous underlying characteristics. One dominant characteristic is the likelihood of cure. Because cure, when possible, is the ultimate goal, the clinician is in a better position to assume decisional priority when a child probably can be cured. The second characteristic is whether there is more than one reasonable treatment option. The interaction of these two complex continual results in distinctive types of decisional situations. This model explains why clinicians sometimes justifiably assume decisional priority when there is one best medical choice. It also suggests that clinicians should particularly encourage parents (and children, when appropriate) to assume decisional priority when there are two or more clinically reasonable choices. In this circumstance, the family, with its deeper understanding of the child's nature and preferences, is better positioned to take the lead.

Child↗
PubMed2006

Ethically justified clinical strategies for promoting geriatric assent.

OBJECTIVE: To develop ethically justified clinical strategies for promoting geriatric assent with a focus on the application of professional virtues. METHOD: The concept of geriatric assent was extended to all geriatric patients incapacitated by cognitive impairments, including dementias, and practical clinical steps for promoting geriatric assent were developed. RESULTS: A four step-process for promoting geriatric assent is proposed by balancing the principles of beneficence and respect for autonomy within the context of the psychiatrist's virtues. These four steps include identifying the patient's long-standing values and preferences; assessing plans of care in terms of biopsychosocial safety and independence along with the patient's values and preferences; protecting remaining autonomy; and cultivating the professional virtues of steadiness, self-effacement, and self-sacrifice when making decisions that risk the patient's future health and safety. CONCLUSIONS: In promoting geriatric assent, psychiatrists are obligated to support and directively counsel the patient's surrogate to adopt care plans that promote the patient's values and preferences to the extent possible. These clinical strategies for promoting geriatric assent should serve to enhance the patient's remaining sense of integrity and dignity. These strategies should also protect remaining health status and therefore protect remaining autonomy.

Aged↗
PubMed2006

Consultation or corruption? The ethics of signing on to the medical-industrial complex.

A prominent vascular surgeon is approached by a representative of a large medical device company with a proposal to implant a new self-sealing patch for closing open carotid endarterectomies. The patch is made of a new synthetic material that establishes immediate hemostasis and inhibits restenosis in animal studies. It has just been approved for human use by the Food and Drug Administration. The cost of the new patch is much higher than for established comparable products, even when potential long-term benefits are considered, but using it would reduce the operative time required for achieving hemostasis. The manufacturer's representative tells you that the company will pay a selected group of vascular surgeons $500 apiece each time they insert the patch on their patients and complete a one-page report. Surgeons with the highest volume of cases utilizing the patch will be offered a paid clinical consultancy with the company. You've used another company's product for several years and found it entirely satisfactory, but have followed development of the new patch with interest and considered trying it in your patients having carotid endarterectomies. What should you do? A. Join the study. You probably would have used the new patch on your patients anyway. B. If the early data warrant, implant the patch on a trial basis without enrolling in the project, and finally decide whether to continue using it based on your clinical experience and additional published reports. C. Call some of the other investigators who have already enrolled in the project and ask them about their experience. D. Decline the invitation immediately. Refuse to ever speak to the representative again. E. Estimate the ability of your patients to sustain the high cost of the new product and decide accordingly whether to use it.

Conflict of Interest↗