Biomedical subjects

Mark R Mercurio

Publications and source records attributed to Mark R Mercurio.

3 recordsLinked to original sources

PubMed2005

Physicians' refusal to resuscitate at borderline gestational age.

Most neonatologists believe there is a minimal gestational age, below which it is appropriate to refuse to provide resuscitation or intensive care. Determination of this threshold should involve knowledge of the outcome data, but also an understanding of the potential for misuse of these data. In particular, there is a risk of deception, of the parents and of ourselves, due to the uncertainty of the true gestational age, and the "self-fulfilling prophecy" that may occur when a center refuses to try below a certain gestational age because they have had no survivors below that age. Finally, any refusal to treat requires ethical justification. Concepts such as futility and patient's best interest should play a role in the determination of the gestational age threshold, applied in light of the data's inherent weaknesses.

Adult↗

PubMed2005

The Conscientious Practice Policy: a futility policy for acute care hospitals.

Much attention has been paid in recent years to the conflict that may occur when patients or their families insist on a therapy that the physician feels would be futile. In 1999 the Council on Ethical and Judicial Affairs of the American Medical Association recommended that all health-care institutions adopt a policy on medical futility that follows a fair process. Development of such a policy has proved problematic for many hospitals. The Conscientious Practice Policy at Lawrence & Memorial Hospital was developed as a response to the AMA recommendation. It outlines a specific process to be followed in the event that a physician wishes to refuse to provide a requested therapy, whether that refusal is based on perceived futility or other concerns. The policy was subsequently modified slightly and adopted by two other Connecticut acute care hospitals.

American Medical Association↗

PubMed2003

Deciding for neonates: whose authority, whose interests?

Two principles are commonly perceived as being central to decision-making for critically ill newborns: the patient's best interest standard, and the authority of the parents to speak for the newborn as the surrogate decision-makers. In this essay, these 2 principles are examined in the context of a particular setting, that of a critically ill newborn with a mother in early adolescence. Alternatives to the patient's best interest standard are explored, including consideration of other interests in addition to those of the patient, such as the interests of the young mother and other family members. Also, we discuss a model of shared decision-making, wherein "parental authority" may be shared between the young adolescent mother and an adult relative, such as her own mother.

Adolescent↗