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PubMed1992

Medical futility. Committee on Bioethical Issues of the Medical Society of the State of New York.

The term futile is used in many different ways. It is therefore difficult to decide whether a procedure or treatment such as CPR or hemodialysis or blood transfusion would be futile in a given case. The AMA's guidelines on the appropriate use of DNR orders state that DNR decisions should be made openly. Institutions should have policies and physicians should elicit the patient's preferences about CPR. For physicians, the question is no longer whether we should discuss DNR orders with our patients; instead, the issue is how to do so with compassion and caring. Physicians should share with patients their judgment about what medicine can and cannot do. Then physicians must "make decisions about when to withhold or limit resuscitation openly" in honest and trusting conversation between doctor and patient. Often CPR is an exercise in futility. The medical profession should be vested with the authority to make futility decisions if they are the product of open discussion and shared deliberation between physician and patient, family, or surrogate. Rationing, triage, and medical futility in relation to AIDS patients require careful deliberation and consideration. What was considered medically futile five years ago for an AIDS patient may be appropriate care nowadays. The need for appropriate use or non-use of life-sustaining therapy for the elderly, the terminally ill, patients with AIDS and other incurable illnesses is evident to patients, health care providers, policy makers, and the public. CPR should only be administered if it is expected to confer lasting benefit to the patient. However, if 10% of elderly patients benefit from CPR in the case of out-of-hospital cardiac arrest, how can one consider this procedure futile? Although communication between physician and patient about difficult treatment limitation decisions has markedly improved in recent years, it remains a problem, largely because open dialogue with patients and families about futility is a demanding emotional and intellectual task. The medical profession is charged with setting standards for the proper implementation of judgments regarding futility.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiopulmonary Resuscitation↗
PubMed1996

[Bioethical issues in contemporary medical sciences].

Unprecedented advances in the natural sciences and in medical technology bring many moral issues unknown to previous generations. Very often in their medical practice physicians face problems in which the basic role is played by moral commitment. In this context, a set of qualitatively new questions emerges: Should we continue medical treatment when the patient asks that it be discontinued? Must we preserve the life of the irreversibly comatose patients? How to assess moral aspects of various forms of donating organs for transplants in evolving social-cultural situation? Does any religion provide a definition of biological death that would be inconsistent with the definition provided by the medical sciences? To answer such ethical questions that emerge in our evolving culture, there is an urgent need for interdisciplinary discussions developed by scientists, philosophers, and theologians. In a philosophically justified attitude of Christian personalism, any life has an unique value, though it cannot be regarded as an absolutely highest value (The Catechism of the Catholic Church, p. 2289). The donation of the organs should be regarded as an act of love. To be an act of human person, the decision of donation should be expressed in a free and deliberate, manne. In this perspective, the principle of the presumed consent is assessed critically because it implies hierarchy of values in which pure pragmatism is appreciated more than the love to our neighbours (The Catechism... p. 2296). Certainly, the standpoint of pragmatism as such must not be assessed negatively; the sacredness of life, its dignity, God-dependence and objective value cannot be, however, adequately expressed in purely pragmatic terms. The latter categories are basic also in providing Christman answer to may ethical questions raised in contemporary medical sciences.

Attitude to Health↗
PubMed2003

Issues in bioethics. Ethics and professional responsibilities.

The evolution of ethics in medicine has provided the concept of the learned physician who is trained in the scientific method (studying nature and philosophy), and who is wise, modest and humane. The physician's manner, deportment and character should be above reproach, and devotion to the productive art of medicine should supersede any desire for financial gain. Professionalism provides the organizational structure through which the medical doctor performs his/her healing role, and underscores the concept that medical professionals should be moral and devoted to the public good, displaying altruism at the expense of self-interest, and providing accountability. This article examines some of the obligations that arise within this milieu.

Bioethical Issues↗
PubMed1996

Spiritual issues and bioethics in the intensive care unit: the role of the chaplain.

This article familiarizes the reader with the contributions of a hospital chaplain regarding spiritual and ethical issues in the intensive care unit. The unique training and perspective of the hospital chaplain are reviewed to explain how the chaplain and the parish minister compare. Cases are presented to illustrate how the chaplain functions, and specific topics of concern that relate bioethical issues with spiritual issues, such as organ donation, are addressed. Faith in "miracles" is discussed within a framework for interpreting religious ideation, particularly when belief prolongs death.

Critical Care↗