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Biomedical subjects

Robert M Veatch

Publications and source records attributed to Robert M Veatch.

At least 37 records · Page 2Linked to original sources
PubMed2002

The nondirected live-kidney donor: ethical considerations and practice guidelines: A National Conference Report.

BACKGROUND: The success of kidney transplantation from a genetically unrelated living spouse or friend has influenced transplant physicians to consider the requests of individuals wishing to volunteer to be a kidney donor who have no intended recipient specified. Representatives of the transplant community gathered in Boston, MA, on May 31, 2001, to deliberate on the experience of live kidney donation from such volunteers, currently termed nondirected donors (NDD). OBJECTIVE OF CONFERENCE PARTICIPANTS: The objective of the conference was to recommend ethical and practice guidelines for health care professionals considering the transplantation of a kidney from a live NDD. CONFERENCE PARTICIPANTS: This conference was convened under the sponsorship of The National Kidney Foundation, with representation from The American Society of Transplantation and The American Society of Transplant Surgeons, The American Society of Nephrology, The United Resource Networks, The United Network for Organ Sharing, The Association of Organ Procurement Organizations, The National Institutes of Health, and The Division of Transplantation of the Health Resources and Services Administration (see Appendix). CONFERENCE REPORT: The suggested content of screening interviews, which provide information regarding the donation process, elicits pertinent medical and psychosocial history, and assesses NDD motivation are presented in this report. Approaches to identifying the center that would evaluate the suitability of the NDD, to performing the kidney recovery, and to selecting the NDD recipient are also proposed. Other ethical issues such as the use of prisoners as an NDD, compensation for the NDD, media involvement, and communication between the NDD and recipient are discussed. CONCLUSION: The willingness of health care professionals to consider NDD volunteers is driven by the compelling need to provide organs for an ever-expanding list of patients awaiting a kidney transplant. However, the psychological impact and emotional reward of donation has yet to be determined for NDD who may not have any relationship to the recipient or knowledge of the recipient's outcome. Transplant centers that accept NDD should document an informed consent process that details donor risks, assures donor safety, and determines that the goals and expectations of the NDD and the recipient can be realized.

Communication↗
PubMed2002

Withholding nutrition on the conscious mentally disabled patient: a review and commentary.

A recent important and poorly publicized legal case in California raised the question of whether the wife of a severely mentally disabled man could intentionally withhold medically supplied nutrition from him on the grounds that it was no longer providing benefits. Rita L. Marker has published a detailed case report and analysis. The readers of the Newsletter on Ethics and Intellectual Disability should know about her analysis. A summary is presented here together with some observations about the issues the case raises. Readers are encouraged to consult the original article: Rita L. Marker, "Mental Disability and Death by Dehydration." National Catholic Bioethics Quarterly 2 (Spring 2002): 125-36. All quotations are from the Marker analysis.

Adult↗
PubMed1997

Single payers and multiple lists: must everyone get the same coverage in a universal health plan?

In spite of recent political setbacks for the movement toward universal health insurance, considerable support remains for the idea. Among those supporting such plans, most assume that a universal insurance system, especially if it is a single-payer system, would offer a single list of basic covered services. This paper challenges that assumption and argues for the availability of multiple lists of services in a universal insurance system. The claim is made that multiple lists will be both more efficient and more fair. Any single list will fund some services that are quite attractive to some people, but only marginally attractive to others. Thus any single-list plan will fund some services that produce only marginal benefit for the resources used. Moreover, since some people will hold values quite compatible with the single list and others will hold values leading to preferences for unfunded services, some people will get much more benefit from any single list than other people will. Fairness and efficiency require providing an entitlement to universal access to health insurance that could be purchased by typical consumers for a fixed price of perhaps $3500. By permitting everyone to pick their preferred list of services available at that price, each person will efficiently use his or her entitlement while getting more equal opportunity for benefits.

Abortion, Induced↗
PubMed1997

Who should manage care? The case for patients.

After establishing that it is essential that health care be rationed in some fashion, the paper examines the arguments for and against clinicians as gatekeepers. It first argues that bedside clinicians do not have the information needed to make allocation decisions. Then it claims that physicians at the bedside can be expected to make the wrong choice for two reasons: their commitment to the Hippocratic ethic forces them to pursue the patient's best interest (even when resources will produce only very marginal benefit and could do much more good elsewhere) and their values will lead them to calculate the net value of treatments incorrectly. Alternative decision makers are considered. It is argued that both groups of physicians and administrators will also make allocations incorrectly and that leaving the allocation decisions to patients themselves is the best approach. Mechanisms for fair and efficient rationing by patients at the societal and individual level are examined.

Administrative Personnel↗
PubMed1995

Resolving conflicts among principles: ranking, balancing, and specifying.

While much attention has been given to the use of principles in biomedical ethics and increasing attention is given to alternative theoretical approaches, relatively little attention has been devoted to the critical task of how one resolves conflicts among competing principles. After summarizing the system of principles and some problems in conceptualizing the principles, several strategies for reconciling conflicts among principles are examined including the use of single-principle theories (pure libertarianism, pure utilitarianism, and pure Hippocratism), balancing theories, conflicting appeals theories, and lexical ordering. Then a mixed strategy is proposed in which consequentialist principles are balanced between themselves as are nonconsequentialist principles, after which the result of balancing the nonconsequentialist principles is lexically ranked over the result of balancing the consequentialist ones. Finally, strategies involving specifying and rule generation are discussed concluding that most current specification and rule-generating theories must involve some degree of lexical ordering of principles.

Altruism↗