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Biomedical subjects

R D Orr

Publications and source records attributed to R D Orr.

At least 37 records · Page 2Linked to original sources
PubMed1999

Beyond justice.

Bioethicists have generally looked after the contractual and fiduciary obligations of health care professionals to patients by their adherence to and insistence on the principles of ethical action--autonomy, nonmaleficence, beneficence, and justice. But these principles, while necessary, only serve the best interests of people already recognized as patients. If we truly want to help vulnerable populations--those who fall outside the margin--then we need to go beyond justice to embrace the theological principles of mercy and grace; that is, we need to rely more completely on the way medicine was before secularization and commercialism. Competency and compassion intertwine in western medicine.

Beneficence↗
PubMed1998

Atlantoaxial instability complicating radiation therapy for recurrent nasopharyngeal carcinoma. A case report.

STUDY DESIGN: A case report of a patient in whom atlantoaxial instability developed secondary to repeat radiation therapy for recurrent nasopharyngeal carcinoma. OBJECTIVES: To illustrate a dramatic and previously unreported complication of local radiation to the posterior nasopharynx. SUMMARY OF BACKGROUND DATA: Nasopharyngeal carcinoma is an unusual tumor that usually is managed with local, external-beam radiation. It is not thought to involve the cervical spine directly, although local invasion of the skull base is common. METHODS: A review of the medical records and radiographs of the only patient known to develop this complication of radiation used to manage nasopharyngeal carcinoma. RESULTS: Atlantoaxial instability developed in a patient as a result of repeat radiation for a locally recurrent tumor. The instability was associated with intrusion of the anterior arch of C1 into the posterior nasopharynx and was managed successfully with a posterior stabilization using transarticular screws and supplemental wiring. CONCLUSIONS: Patients who have undergone local irradiation for nasopharyngeal carcinoma may be at risk for developing atlantoaxial instability.

Adult↗
PubMed1998

Medicine, ethics and religion: rational or irrational?

Savulescu maintains that our paper, which encourages clinicians to honour requests for "inappropriate treatment" is prejudicial to his atheistic beliefs, and therefore wrong. In this paper we clarify and expand on our ideas, and respond to his assertion that medicine, ethics and atheism are objective, rational and true, while religion is irrational and false.

Cultural Diversity↗
PubMed1998

Why psychiatrists should not participate in euthanasia and physician-assisted suicide.

Public and professional discussions have recently raised the question of whether the long-standing proscription against physician-assisted suicide for terminally ill patients should be eliminated or changed. In this article we first review the history of the centuries-long debate, and repeat the arguments stated for and against such a change. We present our opposition to such a change based on the adverse consequences which would occur in the patient-doctor relationship, and the very likely extension of the practice from only terminally ill patients to some who are suffering but not dying, including patients with intractable mental suffering. We review the 10-year social experiment with public toleration of euthanasia in the Netherlands, and note its considerable expansion beyond the clear guidelines. We then discuss why we believe psychiatrists should continue to oppose the legalization of physician-assisted suicide. In addition to our concern about the extension to assisted-suicide for mental suffering, we point out the adverse affect such changes would have on both the psychiatrist's and the patient's perception of the role of the therapist in other suicide situations, and the difficulty of uncovering a competent patient's motivation for a request for such assistance.

Euthanasia↗
PubMed1997

Reanimation: overcoming objections and obstacles to organ retrieval from non-heart-beating cadaver donors.

Interest in the retrieval of organs from non-heart-beating cadaver donors has been rekindled by the success of transplantation of solid organs and the insufficient supply of donor organs currently obtained from heart-beating cadaver donors. There are currently two retrieval techniques being evaluated, the in situ cold perfusion approach and the controlled death approach. Both, however, raise ethical concerns. Reanimation is a new method which has been used successfully in animals. We believe this new approach overcomes the ethical objections raised to these other methods.

Animals↗
PubMed1997

Requests for "inappropriate" treatment based on religious beliefs.

Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured.

Adult↗
PubMed1997

Stress and distress in pediatric nurses: lessons from Baby K.

BACKGROUND: Nurses experience stress and suffering when they care for critically ill and dying patients. Moral distress occurs when nurses are unable to translate their moral choices into moral action. In response to this stress, nurses may experience burnout. OBJECTIVE: To investigate the attitudes and perceptions of the nurses who were ordered by the court to provide long-term care for Baby K, a female child with anencephaly. METHOD: A questionnaire was developed to provide descriptive insight into the stress and distress the nurses experienced while caring for Baby K. RESULTS: Nurses caring for Baby K experienced stress and suffering. Although they felt supported and respected as nurses in their workplace, they felt conflict with the legal system. To compensate for feelings of powerlessness, the nurses simply put on a professional face and continued to provide care. They feared making mistakes, many felt guilty and angry, and all felt that they were not included in decision making. CONCLUSIONS: (1) Suffering among caregivers occurs and must be recognized, (2) measures must be taken to reduce the stress and distress of healthcare professionals as they provide care to patients who cannot recover, and (3) in addition to these measures, society must provide guidance to healthcare professionals, especially concerning the care of patients who are permanently unconscious.

Anencephaly↗
PubMed1996

Evaluation of an ethics consultation service: patient and family perspective.

PURPOSE: The purpose of this study was to determine whether patients and their families found ethics consultations to be helpful and whether they were satisfied with the treatment decisions that were made in those cases where ethics consultation was requested. METHODS: Interviews were conducted with each patient (or surrogate) concerning whom an ethics consultation had been provided during a 1-year period at Loma Linda University Medical Center, excepting those who met exclusion criteria. The interview was done by telephone a few weeks after hospital discharge. It included multiple choice and open-ended questions. A content analysis was done on the solicited and spontaneous comments. RESULTS: Eighty-six ethics consultations were provided and interviews were completed for 56 of them (65%). Fifty-seven percent of interviewees found the ethics consultation to have been helpful, and only 4% found them to have been detrimental. Interviewees were more likely to have found the consultation helpful when they perceived that it had resulted in a significant change in treatment, and were less likely to have found it helpful when the patients were more seriously ill. In addition, 77% were satisfied with the treatment decisions made, and 11% showed some degree of dissatisfaction. CONCLUSIONS: Patients and families found ethics consultation provided by clinical ethicists at Loma Linda University Medical Center to be helpful in a majority of instances, and rarely found them detrimental. Based on an analysis of their comments, we believe ethics consultations were perceived as helpful in 7 ways: increased clinical clarity, increased moral or legal clarity, motivation to do what they believe is right, facilitation of the process of decision-making, implementation of a decision, interpretation of technical language, and consolation and support.

Adolescent↗
PubMed1996

Guidelines for the use of placebo controls in clinical trials of psychopharmacologic agents. Loma Linda University Institutional Review Board.

Federal regulations governing pharmacologic research require scientific proof of efficacy. Although these regulations are often interpreted to mean that a placebo-controlled trial is necessary, it is difficult to justify use of placebo controls when effective standard therapy exists. Justification is especially problematic in psychopharmacologic research because of the added concern that subjects with compromised decision-making capacity cannot give valid consent. To promote discussion and consensus, this article presents guidelines for the ethically justifiable use of placebo controls in research with psychopharmacologic agents. The guidelines, developed by a university's institutional review board, are designed to help investigators design studies and to protect vulnerable subjects.

Clinical Trials as Topic↗
PubMed1995

Cross-cultural considerations in clinical ethics consultations.

Cross-cultural encounters between patients and physicians are now commonplace. Although increasing attention has been given to cultural issues in clinical medicine, there has been little discussion of cultural differences presenting as ethical dilemmas. We report four cases in which such differences led to requests for ethics consultations. In analyzing these cases, we identify four elements that are essential for successful resolution of such dilemmas: (1) an ability to communicate effectively with patients and their families; (2) a sufficient understanding of the patient's cultural background; (3) identification of culturally relevant value conflicts; and (4) a willingness to pursue discussion of the ethical dilemma until a compromise is reached or an otherwise satisfactory resolution of the problem is achieved. We conclude with several practical guidelines for clinicians facing ethical dilemmas in cross-cultural interactions with patients.

Adult↗