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Biomedical subjects

R Dresser

Publications and source records attributed to R Dresser.

At least 37 records · Page 2Linked to original sources
PubMed1993

Sanctions for research misconduct: a legal perspective.

The author discusses the legal principles that could assist in the design and administration of the official response to conduct found to threaten the integrity of the scientific process. The primary emphasis is on the principles that shape decisions about punishment. In the present climate of uncertainty about misconduct, it is difficult to adopt fair and consistent approaches to the selection of sanctions and other remedial actions. Officials have taken a variety of actions in response to unacceptable research behavior. Some federal actions have involved proceedings to recover the offending grant recipients' federal funds, prohibiting them from receiving federal grants or contracts for a set period, terminating or withholding ongoing grant support, and mandating future supervision of the offenders' research conduct; and universities have denied or revoked tenure, required or accepted retirement, and disclosed misconduct findings to potential future employers. Three types of legal remedies seem to have influenced the selection of sanctions in past cases: (1) the quasi-contractual legal remedy of restitution, (2) the philosophy of "just deserts," or retribution, based on the largely intuitive idea that the individual who engages in criminal conduct deserves punishment, and (3) deterrence of misconduct. Each type has a range of considerations and implications, and officials should thoughtfully consider the appropriate role of each, because their selection of sanctions will probably have a significant effect on the research community's perceptions of the system's fairness and efficacy.

Biomedical Research↗
PubMed1991

Hypercalcemia of advanced malignancy: decision making and the quality of death.

Hypercalcemia is a common complication of certain advanced malignancies and although not therapeutically difficult, its presence raises complex ethical issues. Treatment of this condition is most easily justified when the patient is not terminal, the benefits are tangible, and the patient agrees with therapy. Withholding treatment is defensible medically, legally, and morally when a terminal situation is present, when drawbacks exceed the benefits, and when an informed patient declines therapy. Hypercalcemia is one of a number of conditions of dying that can be controlled by the physician. The physician's decision to treat such a condition, in part, depends upon his or her view of a good death. Further study is needed to clarify and avoid those situations of dying which involve suffering. Physicians must begin this difficult analysis and dialogue if they are to fulfill their obligation to minimize suffering in all patients.

Ethics, Medical↗
PubMed1989

Developing standards in animal research review.

Thirty-two institutional animal care and use committees reviewed 4 hypothetic protocols involving experimental procedures frequently conducted on animals. Committees were in general agreement on the need to refine hypothetic protocols to minimize pain, distress, and other harm to laboratory animals. All but 2 committees sought modifications in each protocol, and in numerous instances, committees would not approve a protocol without major modifications. The committee responses delineated emerging standards governing specific areas of animal use, such as antibody production, induced disease, surgery, physical restraint, and behavioral conditioning. Committees had less consensus in their approach to assessing the justification for laboratory animal use. Apparently, this component of committee responsibilities presented the major conceptual and practical difficulties for committees engaged in animal research review.

Animal Care Committees↗
PubMed1989

Measuring merit in animal research.

Merit review of scientific projects involving laboratory animals is a central issue in the current debate over the ethics of animal experimentation. In this essay, I examine several conceptual, regulatory, and practical problems inherent in the merit review process. Contemporary challenges to the existing merit review system and suggestions for reform are also discussed. The essay concludes with comments on legal and political questions relevant to the future of merit assessment.

Animal Care Committees↗
PubMed1988

Standards for animal research: looking at the middle.

Much of the public debate over laboratory animal use has focused on either the scientist's demand for absolute freedom of inquiry, or the abolitionist's demand for an end to animal use in science. Yet many recent proposals for reform seek instead to balance the interests of laboratory animals in avoiding harm against the interests of research beneficiaries in continued animal use. This essay is an analysis of the intermediate reform positions and their underlying ethical principles.

Animal Care Committees↗
PubMed1988

Withholding medical treatment from the severely demented patient. Decisional processes and cost implications.

We performed an observational study to determine the prevalence of severe dementia in a general medicine unit, the categories of acute medical care provided to these patients, the process by which treatment decisions are made, and their cost implications. The prevalence of severe dementia was 4.4%. The patients from whom some form of acute medical care was withheld (26 [45.6%] of 57) were more severely ill at admission and had a mortality rate five times higher than those who received full care. Physicians cited family wishes in 75.9% of the decisions to limit care but in only 10.9% of the decisions to give full care. The only differences in charges incurred were due to differential mortality rates in individuals from whom care was withheld. We recommend that hospitals develop and implement protocols for decision making in the care of the severely demented to promote open discussions among providers and families and to increase family contributions to decision making. We believe that the extension of this consultative approach to decisions involving severely demented patients may have the virtue of combining more humane care with more cost-effective care.

Acute Disease↗
PubMed1987

Informed consent in emergency care: illusion and reform.

Many patients seeking care in the modern emergency center are capable of participating in treatment decision making. In the traditional emergency center consent process, the patient or a surrogate is asked to sign a general consent form purporting to authorize any treatment the emergency physician deems necessary. We discuss the ethical and legal inadequacy of this procedure. In addition, we present the results of a questionnaire assessing the comprehension of emergency center patients who participated in the general consent process. We found that few patients understood the purpose of the consent form and that patients in general had little understanding of their decision making authority. In light of our analysis and findings, we offer suggestions for improving the emergency center consent process.

Adolescent↗
PubMed1985

When patients resist feeding. Medical, ethical, and legal considerations.

In the recent past, public and professional attention has focused on the question of whether and when it is appropriate to discontinue nutritional support from patients unable or unwilling to ingest food orally. This article addresses the special problems raised by patients who resist medical feeding. It discusses the following issues relevant to this patient group: competency to make treatment choices, decision making on behalf of incompetent patients, the competent patient's right of self-determination, and procedures for reviewing treatment decisions. Legal decisions bearing on the nourishment question are analyzed as well. Although the author concludes that cessation of nourishment is morally and legally permissible in a few cases, she also cautions that the option should be carefully and narrowly applied.

Aged↗