/pdf/lying-moral-choice-in-public-and-private-life-52gzwr5asg.pdf

Lying: Moral Choice in Public and Private Life

Dr. A is sitting at home enjoying dinner when the phone rings. The caller is Mr. B, an acquaintance. He is distraught. He asks how much air must be injected into an intravenous line to cause a person to die. When asked why he wants to know, he explains that his 72-year-old father, currently a patient in a local hospital, has end-stage metastatic lung cancer and is in excruciating pain. Mr. B cannot bear to see his father in such pain and wants to end his suffering by means of an air embolism. Mr. C, a 68-year-old man with a 100 pack-per-year history of smoking and known chronic obstructive pulmonary disease, presents to the emergency department with pneumonia and respiratory failure. He has been intubated four times before for respiratory failure. He uses oxygen at home and is dyspneic at rest. He has hypoxemia, hypercapnia, and is delirious. The emergency physician, Dr. D, tries to stabilize his condition with oxygen, bronchodilators, steroids, and non-invasive ventilation, but Mr. C's respiratory status worsens. Dr. D cannot locate Mr. C's family. She calls Mr. C's family physician and respirologist to find out whether they have ever discussed re-intubation, but unfortunately neither has done so. Although she is uncomfortable with this situation because of the uncertainty about the patient's wishes, Dr. D decides to perform the intubation.

Quality end-of-life care.

Objective Disclosure of HIV status among children and adolescents living with HIV has both beneficial and challenging aspects. To address existing knowledge gaps and update the literature on childhood disclosure, we conducted a systematic review on caregivers' perceptions and practices of HIV disclosure in low- and middle-income countries (LMICs). Methods Standard databases were searched for studies conducted in LMICs, published in English between 2004 and 2015. Excluded articles were reviews or case reports, and those not reporting childhood disclosure. Data regarding prevalence, correlates and impact of disclosure, were presented as frequencies. Results Two authors independently screened 982 articles. After applying eligibility criteria, 22 articles representing 12 countries and 2,843 children were reviewed. The proportion of fully disclosed children ranged from 1.7% to 41.0%. Up to 49.5% children were provided "deflected" information (use of a non-HIV-related reason for explaining illness and health care visits). Factors associated with full disclosure included antiretroviral treatment initiation and caregivers' felt need for maintaining optimal adherence. Barriers to disclosure included fear of negative psychological reactions and inadvertent disclosure to others. Caregivers perceived a strong need for active participation from health care providers to aid the process of disclosure. Conclusions Full disclosure of HIV status was not common among children and adolescents in LMICs, while the practice of deflected disclosure was prominent. Caregivers perceived the need for support from health care providers during the disclosure process. Evidence-based guidelines incorporating the developmental status of the child, locally prevalent cultures, and caregiver perceptions are prerequisite to enhancing disclosure in these settings.

/pdf/prevalence-and-correlates-of-hiv-disclosure-among-children-5bjseih1lu.pdf

Prevalence and Correlates of HIV Disclosure Among Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review.

Due to advancement and innovations in biotechnologies lunch genetic screening applications of stem cell in medicine and sophioticated life- support technologies, many bioethical challenges have been raised. Advances in medicine have greatly improved possibilities to treat seriously ill patients and to prolong life. Medical decision-making for patients with life-threatening diseases increasingly entails a balanced consideration of medical, ethical, psychosocial, and societal aspects. Currently, end of life issues are one of the top 10 health care ethics challenges facing the public. Euthanasia, withholding and withdrawing treatments, physician-assisted suicide, do not resuscitate (DNR) orders, advance care planning, refusal of treatments, consent, quality of end of life care and advance directives are the main debates in this field. In this paper, we have discussed briefly the main ethical issues of ending life in brief, including the religious. We have also applied a case-based approach to clarify Islamic perspective on the issues.

End of life ethical issues and islamic views

BIOETHICS IS NOW TAUGHT IN EVERY CANADIAN MEDICAL SCHOOL. Canada needs a cadre of teachers who can help clinicians learn bioethics. Our purpose is to encourage clinician teachers to accept this important responsibility and to provide practical advice about teaching bioethics to clinicians as an integral part of good clinical medicine. We use 5 questions to focus the discussion: Why should I teach? What should I teach? How should I teach? How should I evaluate? How should I learn?

/pdf/bioethics-for-clinicians-25-teaching-bioethics-in-the-4dwooso90u.pdf

Bioethics for clinicians: 25. Teaching bioethics in the clinical setting.

The standard of professional candour with patients has undergone a significant change over the past 30 years. Independent of their obligation to disclose information necessary for informed consent, physicians are increasingly expected to communicate important information to patients that is not immediately related to treatment decisions. The purpose of truth telling is not simply to enable patients to make informed choices about health care and other aspects of their lives but also to inform them about their situation. Truth telling fosters trust in the medical profession and rests on the respect owed to patients as persons. It also prevents harm, as patients who are uninformed about their situation may fail to get medical help when they should.

/pdf/bioethics-for-clinicians-7-truth-telling-48813hhuqm.pdf

Bioethics for clinicians: 7. Truth telling

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Bioethics for clinicians: 7. Truth telling