Daniel P Sulmasy

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

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Publications (168)1140.32 Total impact

  • Lois Snyder Sulmasy · Daniel P. Sulmasy

    No preview · Article · Feb 2016 · Annals of internal medicine

  • No preview · Article · Feb 2016
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    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
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    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
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    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
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    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
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    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
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    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
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    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
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    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
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    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
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    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
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    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
  • Reshma Jagsi · Daniel P Sulmasy · Beverly Moy
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    ABSTRACT: The value of cancer care has emerged at the center of a national discourse on fiscal responsibility and resource allocation. The cost of cancer care is rising at a higher pace than any other area of health care. As we struggle to address this unsustainable rise in cancer expenditures, oncology providers are forced to examine our practice patterns and our contributions to the overall health care cost burden. This article provides an oncologist-centered examination of our duties to individual patients and how they may seem at odds with our duties to society. It also discusses how oncology providers can do their part to contain health care costs while honoring their professional obligation to do their best for each patient.
    No preview · Article · May 2014
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    Article: Chronicity
    Daniel P Sulmasy

    Preview · Article · Nov 2013 · Journal of General Internal Medicine
  • Kevin E Hodges · Daniel P Sulmasy
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    ABSTRACT: The theory of principlism elaborated by Beauchamp and Childress in Principles of Biomedical Ethics has become extremely influential in bioethics. The theory employs the idea of the common morality as a foundation for the principles of autonomy, beneficence, nonmaleficence, and justice. According to this account, the content of the common morality is universal and constant, while variability in morals is due to the fact that the issue of who is included within the scope of moral status evolves over time. This suggests that issues of moral status are not part of the common morality at all, and this presents a conundrum: questions of moral status seem central to any substantive account of justice, and any conception of the common morality that excludes moral status therefore seems inadequate for supporting a robust principle of justice. We argue that proponents of common morality theory are left with four options: (1) making moral status a part of the objective common morality and ignoring evidence that views about moral status do seem to vary over time and place; (2) excluding justice from the substantive content of the common morality; (3) taking common morality to be an imperfect approximation of an independently justified and universal foundationalist ethic against which the common morality is judged; or (4) weakening claims about the universality of common morality, thereby allowing the common morality to support a variety of principles of justice applicable only within particular communities that have specified the scope of moral status. We suspect that proponents of common morality theory will not view any of these options favorably, which raises questions about the ultimate contribution of that account.
    No preview · Article · Sep 2013 · Kennedy Institute of Ethics journal
  • Daniel P Sulmasy
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    ABSTRACT: Every ethos implies a mythos in the sense that every systematic approach to ethics is inevitably based on some fundamental religious or religion-like story that gives answers to questions such as: Where did I come from? Where am I going? How am I to live? These narratives generally lay hidden beneath the plane of the interpersonal interactions that characterize all clinical encounters, but caring for patients who are approaching death brings them closer to the surface. For many patients and practitioners, these narratives will be expressed in explicitly religious language; others may invoke a sense of "immanent transcendence" that affords a spiritual perspective without requiring theism or notions of eternity. In caring for patients at the end of life, practitioners should strive to be more conscious of the narratives that undergird their own spiritual and ethical positions as well as seek to understand those of the patients they serve.
    No preview · Article · Jun 2013 · Journal of pain and symptom management

Publication Stats

4k Citations
1,140.32 Total Impact Points

Institutions

  • 2015
    • The University of Chicago Medical Center
      Chicago, Illinois, United States
  • 2009-2015
    • University of Chicago
      • Department of Medicine
      Chicago, Illinois, United States
  • 2011
    • University of Illinois at Chicago
      Chicago, Illinois, United States
  • 2001-2009
    • St. Vincent Hospital
      Green Bay, Wisconsin, United States
  • 1999-2009
    • New York Medical College
      • Department of Medicine
      New York, New York, United States
  • 2008
    • St. Vincent Medical Center
      Bridgeport, Connecticut, United States
  • 2006-2008
    • Saint Luke's Hospital (NY, USA)
      New York, New York, United States
  • 2007
    • Maimonides Medical Center
      Brooklyn, New York, United States
  • 1992-2007
    • Johns Hopkins University
      • • School of Nursing
      • • Department of Medicine
      Baltimore, MD, United States
  • 2003
    • St. Vincent Health
      Indianapolis, Indiana, United States
  • 2000
    • Memorial Sloan-Kettering Cancer Center
      New York, New York, United States
  • 1992-1998
    • Georgetown University
      • Center for Clinical Bioethics
      Washington, Washington, D.C., United States
  • 1997
    • American University Washington D.C.
      Washington, Washington, D.C., United States