A teenager’s death after two sets of transplants raises questions of procedure and ethics.
Papildomos nuorodos
A teenager’s death after two sets of transplants raises questions of procedure and ethics.
In an editorial in The New England Journal of Medicine, Dr. Howard Brody, professor of family medicine and director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston, writes that the medical profession, unlike other groups, has made little effort to curtail future medical costs. Physicians, Dr. Brody maintains, are not “innocent bystanders” to spiraling health care costs but have been complicit in their failure to take an active role in curtailing them.
Once a patient becomes terminally ill, relationships between patients, their caregivers and their primary doctors can change. Now a study offers an unusual glimpse of what patients and their doctors are thinking as the end of life approaches — and it shows that patients sometimes feel abandoned.
Doctors spend years learning how to heal, but most are fairly ignorant about how to act toward patients when they run out of treatments, suggests a study today. Often, once doctors refer a patient to hospice care, they end all contact, leaving patients and their families feeling abandoned, says lead author Anthony Back, a professor of medicine at the University of Washington.
I have learned since then that the best way to inform a patient of test results, especially results that indicate bad news, is a subject of debate among doctors. This is especially true outside the hospital setting. Many doctors have specific policies about never giving results over the phone; others are more flexible and approach each case individually.
Yet some medical ethicists warn against practicing medicine too empathetically or becoming too involved in patients’ lives, saying it compromises treatment and the profession as a whole. Others argue personalized care will become extinct if physicians are not able to set aside the business of doctoring and resurrect the art of medicine.
The doctor wants to know who determines if the patient is ‘terminal’, and what he should say to the „hostile and angry“ family. The ethicist tells him that deciding if a cancer is in its terminal phase is a clinical matter. As for the family, the ethicist offers to discuss the issue with them.
David I. Shalowitz, a bioethicist, said that expecting surgeons and hospitals to disclose information about other doctors and medical centers would create an untenable conflict of interest for them and should be avoided. The question of what the doctor’s obligation is remains unresolved.
Child protection work is back in the spotlight after the case of Baby P who died after suffering months of abuse. Doctors play a key role in this process giving expert opinion on injuries as well as treating them. But as one leading paediatrician explains, it is a very challenging job.
Doctors in training sometimes confront situations in which they worry that their supervising physicians are making mistakes or bending the truth. Yet even though such acts can jeopardize patients, the inclination and ability of young doctors to speak up is hampered by the hierarchies in teaching hospitals.