A qualitative report of dual palliative care/ethics consultations: intersecting dilemmas and paradigmatic cases.

Department of Internal Medicine, University of Rochester, Strong Memorial Hospital, Rochester, New York, USA.
The Journal of clinical ethics (Impact Factor: 0.47). 02/2008; 19(3):204-13.
Source: PubMed
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    ABSTRACT: BACKGROUND: The purpose of this study was to describe the impact of clinical ethics consultations among patients with head and neck cancer in order to better anticipate and manage clinical challenges. METHODS: A database was queried to identify patients with head and neck cancer for whom ethics consultation was performed at a comprehensive cancer center (n = 14). Information from the database was verified via data abstraction and analyzed qualitatively and quantitatively. RESULTS: Common requests for ethics consultation involved code status (6 of 14) and withdrawal/withholding life-sustaining treatments (6 of 14). Common contextual features were interpersonal conflicts (6 of 14) and communication barriers (5 of 14). Airway management concerns were frequent (5 of 14). Whereas 21% of patients had do not resuscitate (DNR) orders before ethics consultation, 79% were DNR subsequently. CONCLUSION: Ethics consultations among patients with head and neck cancer reflect distinctive complexities inherent to their disease, but are entirely consistent with global clinical ethical themes. Consideration of communication barriers, social isolation/stigma, symptom control, and airway management are critical. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
    Head & Neck 11/2013; 35(11). DOI:10.1002/hed.23204 · 2.83 Impact Factor
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    ABSTRACT: The term medical futility is frequently used when discussing complex clinical scenarios and throughout the medical, legal, and ethics literature. However, we propose that health care professionals and others often use this term inaccurately and imprecisely, without fully appreciating the powerful, often visceral, response that the term can evoke. This article introduces and answers 10 common questions regarding medical futility in an effort to define, clarify, and explore the implications of the term. We discuss multiple domains related to futility, including the biological, ethical, legal, societal, and financial considerations that have a bearing on definitions and actions. Finally, we encourage empathetic communication among clinicians, patients, and families and emphasize how dialogue that seeks an understanding of multiple points of view is critically important in preventing or attenuating conflict among the involved parties.
    Mayo Clinic Proceedings 04/2014; 89(7). DOI:10.1016/j.mayocp.2014.02.005 · 5.79 Impact Factor


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Jan 7, 2015