Daniel P Sulmasy

The University of Chicago Medical Center, Chicago, Illinois, United States

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Publications (189)1245.68 Total impact

  • Daniel P. Sulmasy
    [Show abstract] [Hide abstract] ABSTRACT: As interest in medicine and religion has grown, some have called for a more fervent and explicit “witnessing” by Christian physicians in their practices. This essay presents a theological understanding of witness and how this theology might be applied to the case of Christian witness in health care. Witness must be understood first linguistically as encompassing two nouns and two verbs, all of which have theological meaning. Based on linguistic, scriptural, and theological reflection, suggestions are made regarding how physicians and the Church can both witness Christ and give witness to Christ in the care of the sick. This theological exploration offers new insight into what it means to witness and to heal as a Christian.
    No preview · Article · Apr 2016 · Christian Bioethics
  • [Show abstract] [Hide abstract] ABSTRACT: Introduction: Many patients with advanced heart failure (HF) experience the life-extending benefits of implantable cardioverter-defibrillators (ICD), but at the end stage of HF, patients may experience shocks with increasing frequency and change the plan for end-of-life (EOL) care including the deactivation of the ICD. This report describes family members' experiences of patients with ICD making decisions at EOL. Understanding the decision-making of patients with ICD at EOL can promote informed decision-making and improve the quality of EOL care. Methods: This pilot study used a mixed methods approach to test the effects of a nurse-guided discussion in decision-making about ICD deactivation (turning off the defibrillation function) at the EOL. Interviews were conducted, audiotaped, and transcribed in 2012 to 2013 with 6 family members of patients with advanced HF and ICDs. Three researchers coded the data and identified themes in 2014. Results: Three main themes described family members' experiences related to patients having HF with ICDs making health-care decision at EOL: decision-making preferences, patients' perception on ICD deactivation, and communication methods. Discussion: Health-care providers need to have knowledge of patients' decision-making preferences. Preferences for decision-making include the allowing of appropriate people to involve and encourages direct conversation with family members even when advance directives is completed. Information of ICD function and the option of deactivation need to be clearly delivered to patients and family members. Education and guidelines will facilitate the communication of the preferences of EOL care.
    No preview · Article · Mar 2016 · American Journal of Hospice and Palliative Medicine
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Prior research has identified unrealistic optimism as a bias that might impair informed consent among patient-subjects in early-phase oncology trials. However, optimism is not a unitary construct; it also can be defined as a general disposition, or what is called dispositional optimism. The authors assessed whether dispositional optimism would be related to high expectations for personal therapeutic benefit reported by patient-subjects in these trials but not to the therapeutic misconception. The authors also assessed how dispositional optimism related to unrealistic optimism. Methods: Patient-subjects completed questionnaires designed to measure expectations for therapeutic benefit, dispositional optimism, unrealistic optimism, and the therapeutic misconception. Results: Dispositional optimism was found to be significantly associated with higher expectations for personal therapeutic benefit (Spearman rank correlation coefficient [r], 0.333; P<.0001), but was not associated with the therapeutic misconception (Spearman r, -0.075; P = .329). Dispositional optimism was found to be weakly associated with unrealistic optimism (Spearman r, 0.215; P = .005). On multivariate analysis, both dispositional optimism (P = .02) and unrealistic optimism (P<.0001) were found to be independently associated with high expectations for personal therapeutic benefit. Unrealistic optimism (P = .0001), but not dispositional optimism, was found to be independently associated with the therapeutic misconception. Conclusions: High expectations for therapeutic benefit among patient-subjects in early-phase oncology trials should not be assumed to result from misunderstanding of specific information regarding the trials. The data from the current study indicate that these expectations are associated with either a dispositionally positive outlook on life or biased expectations concerning specific aspects of trial participation. Not all manifestations of optimism are the same, and different types of optimism likely have different consequences for informed consent in early-phase oncology research. Cancer 2016. © 2016 American Cancer Society.
    No preview · Article · Feb 2016 · Cancer
  • Daniel P. Sulmasy
    [Show abstract] [Hide abstract] ABSTRACT: This article traces the history of the concept of dignity in Western thought, arguing that it became a formal Catholic theological concept only in the late nineteenth century. Three uses of the word are distinguished: intrinsic, attributed, and inflorescent dignity, of which, it is argued, the intrinsic conception is foundational. The moral norms associated with respect for intrinsic dignity are discussed briefly. The scriptural and theological bases for adopting the concept of dignity as a Christian idea are elucidated. The article concludes by discussing the relevance of this concept of dignity to the spiritual and ethical care of the dying.
    No preview · Article · Feb 2016 · Medicine Health Care and Philosophy
  • Lois Snyder Sulmasy · Daniel P. Sulmasy
    No preview · Article · Feb 2016 · Annals of internal medicine
  • No preview · Article · Feb 2016
  • [Show abstract] [Hide abstract] ABSTRACT: Aims and Objectives The purpose of this study was to consider how fear and symptom experience are perceived in patients with heart failure at the end of life.Background Heart failure is a burdensome condition and mortality rates are high globally. There is substantive literature describing suffering and unmet needs but description of the experience of fear and the relationship with symptom burden is limited.DesignA convergent mixed methods design was used.Methods Data from the McGill Quality of Life Questionnaire (N = 55) were compared to data from in-depth interviews (N = 5).ResultsPatients denied fear when asked directly, but frequently referred to moments of being afraid when they were experiencing symptoms. In addition, patients reported few troublesome symptoms on the survey, but mentioned many more symptoms during interviews.Conclusions These data not only identify the relationship between psychological issues and symptom experience but also elucidate the benefit of a mixed method approach in describing such experiences from the perspective of the patient. Future research should examine relationships between and among symptom experience, fear and other psychological constructs across the illness trajectory.Relevance to Clinical PracticeConversations about the interaction of symptom burden and fear can lead to both a more robust assessment of symptoms and lead to patient centred interventions.
    No preview · Article · Sep 2015 · Journal of Clinical Nursing
  • Kyle E. Karches · Daniel P. Sulmasy
    [Show abstract] [Hide abstract] ABSTRACT: The 2010 guidelines regarding management of cardiovascular implantable electronic devices (CIEDs) conclude that patient requests to deactivate these devices at the end of life should be honored. Nevertheless, many clinicians and patients report feeling uncomfortable discontinuing such therapies, particularly pacemakers. If the principles of clinical ethics are followed, turning off CIEDs at the end of life is morally permissible. Clinicians managing CIEDs should discuss the option of deactivation with the patient at the time of implantation and be prepared to reopen the question as warranted by the patient's clinical course and respect for the patient's authentic values. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · Cardiac electrophysiology clinics
  • Micah T Prochaska · Daniel P Sulmasy
    [Show abstract] [Hide abstract] ABSTRACT: Physician recommendations have historically been a part of shared decision making. Recent literature has challenged the idea that physician recommendations should be part of shared decision making at the end of life, particularly the making of recommendations to surrogates of incapacitated patients. Close examination of the studies and the available data on surrogate preferences for decisional authority at the end of life, however, provide an empirical foundation for a style of shared decision making that includes a physician recommendation. Moreover, there are independent ethical reasons for arguing that physician recommendations enhance rather than detract from shared decision making. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
    No preview · Article · May 2015 · Journal of pain and symptom management
  • Kelly Wolenberg · Daniel Kim · Farr Curlin · Daniel Sulmasy
    No preview · Article · May 2015 · Academic Medicine
  • Kelly Wolenberg · Daniel Kim · Farr Curlin · Daniel Sulmasy
    No preview · Article · May 2015 · Academic medicine: journal of the Association of American Medical Colleges
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: National reports on end-of-life symptom management reveal a gap in the evidence regarding symptoms other than pain and studies of diseases other than cancer. This study examines the frequency and severity of symptoms and quality of life (QOL) in persons with advanced cancer, amyotrophic lateral sclerosis (ALS), and congestive heart failure (CHF). Methods: The present study is a cross-sectional examination of symptoms and QOL measured using the McGill QOL Questionnaire, among 147 participants. Results: Forty one percent of participants had advanced cancer, 22% had ALS, and 37% had advanced CHF. A total of 266 symptoms were reported, with the common symptom categories being discomfort/pain, weakness/fatigue/sleep, and respiratory. Participants with CHF had the highest mean symptom severity and the lowest QOL. Conclusion: Clinicians should be aware and attentive for symptoms other than pain in patients with advanced illness. Studies on diseases other than cancer, such as CHF and ALS, are important to improve symptom management in all disease groups.
    No preview · Article · Mar 2015 · Applied Nursing Research
  • Daniel P Sulmasy · Lois Snyder Sulmasy
    [Show abstract] [Hide abstract] ABSTRACT: In their essay, “Clarifying Substituted Judgment: the Endorsed Life Approach,”1 Wendler and Phillips add to a growing body of literature that acknowledges what has been apparent to many clinicians and commentators for a long time: something is seriously wrong with the contemporary US approach to surrogate decision making. Their essay summarises background that has been more extensively reviewed elsewhere: the history of how we came to this impasse, and the many theoretical and empirical critiques of substituted judgement.2 Drawing on this background, they propose an alternative to substituted judgement that differs little from the Substituted Interests Model that we proposed in 2010,3 doing so, in part, by misrepresenting our published views. The overlap between their model and ours is befuddling, but by calling their approach an attempt to ‘clarify’ rather than replace the substituted judgement standard, they only further muddy the waters. The approach they advocate is so similar to our Substituted Interests Model that giving it a different name and calling it an ‘interpretation’ of substituted judgement will only wind up being confusing for surrogates, clinicians and policy makers. Their primary motivation seems to be to ‘save’ substituted judgement since it is so well established in law and bioethical education. After noting some of the many problems with substituted judgement, they nonetheless both propose retaining the name and advise asking the surrogate to provide ‘the decision the patient would make for herself, if competent.’ They give two reasons for this: (1) they believe this directive is a useful approximation of the standard they think is really the correct one, namely, to provide the decision most consistent with the life the patient seems to have endorsed for herself, and (2) they think substituted judgement has become so ensconced in policy and practice that it would … [Full text of this article]
    No preview · Article · Feb 2015 · Journal of Medical Ethics
  • Daniel P Sulmasy · Christopher Brick · Philip A Mackowiak
    [Show abstract] [Hide abstract] ABSTRACT: When Eleanor Roosevelt died in 1962, she was widely regarded as "the greatest woman in the world." In spite of her celebrity, or more likely because of it, she was forced to endure a protracted period of intense suffering and humiliation before dying. On critical analysis, her end-of-life care violated most of the ethical standards of care for the dying we hold dear today. However, caring for dying celebrities continues to be especially difficult. In at least some instances, the terminal care given to recently deceased world leaders has been no more consistent with these standards than that given to Eleanor Roosevelt over 50 years ago. Copyright © 2014 Elsevier Inc. All rights reserved.
    No preview · Article · Nov 2014 · The American Journal of Medicine
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    Daniel Sulmasy · Beverly Moy
    Preview · Article · Nov 2014 · Journal of Clinical Oncology
  • Daniel P Sulmasy
    [Show abstract] [Hide abstract] ABSTRACT: Genetic exceptionalism, the view that genomic information is different from other types of sensitive information and deserves exceptional types of protections, has been roundly criticized. However, the public still expresses special fears about the access others might have to their genomic information. In this article, it is argued that there may be a basis for the public perception that genomic information is special, even if it cannot be said that policies could or should be enacted to protect the privacy and confidentiality of genomic information that would be exceptional relative to the protections one would enact to protect other types of sensitive information. The special nature of genomic information lies in understanding that it is neither personal property nor mere information. A genome is, at one and the same time, a physical aspect of a person and information about that person. Genomic data are embodied information that partially constitutes as well as describes individuals and that connects them in physical ways to their ancestors and their relatives. All forms of privacy need to be protected, but some intimate aspects of our lives command special respect. To see a genome is more analogous to seeing a naked body than to seeing a social security number. This metaphor suggests that clinicians and investigators ought to respect the special concerns of patients regarding genomic information while not claiming that there are any exceptional measures one could take to protect genomic privacy. Suggestions are given for how this view might affect patient interactions, consent discussions, public policy, and public trust in genomic research and clinical genetics.Genet Med advance online publication 18 September 2014Genetics in Medicine (2014); doi:10.1038/gim.2014.111.
    No preview · Article · Sep 2014 · Genetics in medicine: official journal of the American College of Medical Genetics
  • Daniel P. Sulmasy
    [Show abstract] [Hide abstract] ABSTRACT: Engelhardt argues that the correct interpretation of the marginalization of Christian voices in the recent history of bioethics is best explained as the acquiescence of Christian bioethicists to secularizing trends rather than as Christian bioethicists having been pushed aside by the philosophers who came to dominate the field. He identifies the origins of this secularization with natural law thinking, which he dubs as “amphibious” with respect to religious thinking and worldly thinking. I argue that this interpretation is incorrect. First, natural law thinking has been an acceptable mode of Christian moral thinking dating back to the Church Fathers. Second, any form of theology requires a philosophical framework, even one’s interpretation of scripture, so that there is no “pure” theology untainted by “worldly” reasoning. Third, Engelhardt’s account of this history commits the secular fallacy and strains credulity. Fourth, his interpretations of Ramsey and McCormick are idiosyncratic at best. By contrast, it is argued that in accepting Christianity one does not thereby reject reason and philosophy. Some guidelines for being “an amphibian”—for example, for doing natural law bioethics as a Christian— are proposed.
    No preview · Article · Jul 2014 · Christian Bioethics
  • Daniel T Kim · Farr A Curlin · Kelly M Wolenberg · Daniel P Sulmasy
    [Show abstract] [Hide abstract] ABSTRACT: U.S. medical scholarship and education regarding religion and spirituality has been growing rapidly in recent years. This rising interest, however, is not new; it is a renewal of significant interweavings that date back to the mid-20th century. In this Perspective, the authors draw attention to the little-known history of organized medicine's engagement with religion from 1961 to 1974. Relying on primary source documents, they recount the dramatic rise and fall of the Committee on Medicine and Religion (CMR) at the American Medical Association (AMA). At its height, there were state-level committees on medicine and religion in 49 states, the District of Columbia, and Puerto Rico, and there were county-level committees in over 800 county medical societies. Thousands of physicians attended annual conferences for clinicians and clergy, and direct outreach to patients included a film viewed by millions. The CMR arose in the context of rapid medical advances, the growth of professional chaplaincy, and concern for declining "humanism" in medicine-conditions with parallels in medicine today. The CMR was brought to a puzzling end in 1972 by the AMA's Board of Trustees. The authors argue that this termination was linked to the AMA's long and contentious debate on abortion. They conclude with the story's significance for today's explorations of the intersection of spirituality, religion, and medicine, focusing on the need for mutual respect, transparency, and dialogue around the needs of patients and physicians.
    No preview · Article · Jun 2014 · Academic medicine: journal of the Association of American Medical Colleges
  • Daniel Kim · Farr Curlin · Kelly Wolenberg · Daniel Sulmasy
    [Show abstract] [Hide abstract] ABSTRACT: The history commonly told of the relationship between modern medicine and religion is one of steady, even inevitable, separation rooted in the Enlightenment. The divorce between medicine and religion, it is thought, had become nearly total before a recent surge of interest in the spiritual and religious dimensions of health care. This narrative, however, misjudges a persistent sense of spiritual need in illness that medical practice, even today, is unable to entirely ignore. Relying on primary sources, we recount here the little known story of the rise and fall of the Committee on Medicine and Religion and the Department of Medicine and Religion at the American Medical Association between 1961 and 1974. Arising in a context of a widely perceived dehumanization of care and the emergence of new ethical dilemmas at the bedside-concerns with significant parallels today-the initiative garnered striking physician enthusiasm and achieved dramatic successes nationally before coming to a puzzling end in 1972. We argue that its demise was linked to the AMA's contentious internal debate on abortion, and conclude with a note of caution regarding the status of normative concerns in medicine's ongoing efforts to address the spiritual and religious dimensions of its practices.
    No preview · Article · Jun 2014 · Perspectives in Biology and Medicine
  • Daniel P Sulmasy
    [Show abstract] [Hide abstract] ABSTRACT: It might seem ironic that the author in this mini-symposium who knew Edmund Pellegrino the best should be the one whose essay is the least personal, eschewing anecdote and reminiscence and concentrating on the substance of his scholarly contribution. I think, however, that for Ed, an exposition of his ideas would be the most fitting tribute one could offer. Accordingly, I will attempt to outline his main ideas and bring together his disparate writings in a constructive manner. I do this firstly because there really is no other such brief exposition of his main ideas anywhere in the bioethics literature. Moreover, Pellegrino himself made no attempt to provide an explicit synthesis of his various writings on various topics, and so I will attempt to make explicit a number of implicit connections. Lastly, inasmuch as bioethics has developed dramatically as a field over the last 40 years, there may be young scholars who are unfamiliar with Pellegrino’s truly seminal work. A brief overview of his body of scholarship might spur them to go to the primary sources. If I succeed in interesting such persons in reading the work of Edmund Pellegrino, or inspire others to look again at that work with fresh eyes, I believe they will be richly rewarded.
    No preview · Article · Jun 2014 · Kennedy Institute of Ethics Journal

Publication Stats

5k Citations
1,245.68 Total Impact Points

Institutions

  • 2015
    • The University of Chicago Medical Center
      Chicago, Illinois, United States
  • 2010-2015
    • University of Chicago
      Chicago, Illinois, United States
  • 2007
    • OFM Research
      Redmond, Washington, United States
  • 2003
    • St. Vincent Health
      Indianapolis, Indiana, United States
  • 2002
    • Saint Luke's Hospital (NY, USA)
      New York, New York, United States
    • St. Vincent Medical Center
      Bridgeport, Connecticut, United States
    • New York Medical College
      • Department of Medicine
      New York City, New York, United States
  • 2000
    • Memorial Sloan-Kettering Cancer Center
      New York, New York, United States
  • 1999
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 1997
    • American University Washington D.C.
      Washington, Washington, D.C., United States