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HOODIA GORDONI DOCTOR–PATIENT RELATIONSHIP

Saturday, February 20th, 2010

Continued spread of ethics committee consultation to more hospitals and nonhospital settings is indirect evidence
that the challenges to competence and authority are being met successfully. Furthermore, most published concerns
about the competence of committees or individuals are from the 1970s “first wave” of writing about institutional ethics
committees, at a time when the idea of ethics consultation was new and controversial. The literature of the 1980s and
1990s displays a growing confidence about the concept of ethics consultation and more attention to resolving specific
problems. Apparently, committees had learned to negotiate without conformism or loss of principle. Individuals have
been acquiring the proper expertise: clinicians gaining the  analytic techniques of ethicists, and ethicists learning to

apply their analyses in clinically relevant ways. Gender-related questions have not been raised directlyin the bioethics literature on ethics committees. However, they are raised indirectly when the focus is on the role of nurses, given the fact that most nurses are women. Nurseshave been excluded from some committees, could not access them for consultation, or have found their special ethical
concerns omitted from consideration. In addition to the gender issue, this situation raises questions of professional
status in relation to other healthcare providers. In some hoodia diet pills, these problems have been addressed by the formation of nursing ethics committees (Edwards and Haddad). There has also been a suggestion in the literature that ethics committees, especially those that are or function as infant-care review committees, should include persons with disabilities on the committee (Mahowald). This step could
help ensure that the quality of life of persons with disabilities is not undervalued in deliberations about treatment decisions.

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COMPETENCE AND AUTHORITY

Saturday, February 20th, 2010

Third, many institutional ethics committees offer ethics consultations, prospectively or retrospectively, on difficult clinical cases, often those involving the withholding or withdrawal of life-support measures. This last function ethics consultation, especially for ongoing cases—has been the main focus of discussion in the bioethics literature. Seven issues have dominated these discussions: questions of competence and authority; impact on the doctor-patient relationship; access to consultation; recordkeeping and charting; problems of evaluation; unsettled legal questions; and questions about the purpose or purposes of consultations.
COMPETENCE AND AUTHORITY. Some committees that offer consultation services, generally smaller committees,
consult as a committee of the whole. Larger committees typically have a subcommittee that consults prospectively
and reports to the committee as a whole for retrospective review of its work. Some committees offer consultation
through a single hoodia diet pills consultant who may be on the committee or have a formal relationship with it. Some critics
have expressed concern that when committees consult, difficult ethical choices will be affected by compromise,
hospital politics, professional rivalries, and conformism(Wikler). Concerns about competence have been raised
when individuals provide consultations. Clinicians typically have few of the skills of trained ethicists and vice versa.

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Hoodia Diet ethics conclusion

Wednesday, February 17th, 2010

Clinical ethics consultation arose in the United States in the latter half of the twentieth century amid the moral and legal
uncertainty spawned by the rapid expansion of choices produced by medical advances, the emergence of the tertiarycare medical center, and the individual-rights movement that challenged traditional authority structures. Although it holds great promise, clinical ethics consultation remains a nascent profession. Many of the theoretical and practical questions about its goals, training, evaluation, accountability, and support remain unanswered. Nonetheless, clinical ethics consultation is growing and even flourishing. As the U.S. health system evolves over the coming years, the role and place of clinical hoodia diet ethics consultation in the healthcare system certainly will be addressed.

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Access to Hoodia Diet Ethics Consultation

Sunday, February 14th, 2010

Who should be able to request an ethics consultation? The answer to this question has political as well as moral implications. On the one hand, if only physicians have access to ethics consultation, many important ethical issues may never be examined (Tulsky and Lo). On the other hand,
permitting patients, families, and other health professionals to request ethics consultation, especially without the physician’s concurrence, might discourage more direct communication, disrupt physician-patient relationships, or undermine physician authority. The last possibility would be most threatening to authoritarian-minded physicians and very likely would challenge the traditional power structure of
many hospitals. This may explain the gap between the argument in the literature for the ideal—that patients,
families, and nurses should be able to request an ethics consultation—and the impression that many institutions do
not permit, and almost none actively encourage, patient, family, or other health professional requests for ethics
consultation. The ability to ask for consultation is only one question concerning patient and family access to and control over the
consultation process. Other hoodia diet questions include whether the patient or family should have authority to (1) call a consultation when the physician refuses to do so; (2) be informed routinely when consultations are requested by physicians; (3) veto physician-initiated consultation requests; (4) participate in all ethics consultations if they wish; and (5) receive verbal or written information about the consultant’s
findings and recommendations. Some argue that an insistence on a rights-based approach to these questions would
doom ethics consultation services to failure in modern hospitals because of political considerations (Agich and Youngner).

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Hoodia diet movement

Friday, January 29th, 2010

By the mid-1980s, a movement had begun to establish institutional ethics committees in healthcare facilities, especially in hospitals. In 1982, only 1 percent of all U.S. hospitals had diet ethics committees; by 1987, over 60 percent
did (Fleetwood et al.). Ethics committees were endorsed in this period by leading professional groups, including the
American Medical Association, the American Hospital Association, the American Academy of Pediatrics, and the American Academy of Neurologists. Growth in the number of institutional ethics committees continued into the 1990s
and spread to nursing homes and hospices (Glaser). It is likely that the number and influence of these committees
will grow as the length of stay in hospitals continues to decline and more patient days are spent outside hospitals.
Moreover, with the shift of many kinds of care to alternative sites, it is likely that other institutional ethics committees
will develop and spread—in home-healthcare agencies and managed-care networks, for example. Hospital ethics committees remain, however, the most common institutional ethics committees and the most closely analyzed in bioethics literature.

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INSTITUTIONAL ETHICS COMMITTEES

Friday, January 29th, 2010

Ethics committees have played clinically relevant roles in U.S. healthcare contexts since the 1960s. At that time, some
hospitals established committees to approve requests for abortion and sterilization and to allocate scarce dialysis
machines. Universities and hospitals created human subjects committees to scrutinize research protocols and consent
forms; in the 1970s, these committees became federally mandated institutional review boards (IRBs).
In the 1976 Quinlan case, in which parents won the authority to remove a ventilator from an incompetent adult
child, the New Jersey Supreme Court recommended that hospitals establish ethics committees to confirm prognoses
in cases involving withdrawal of life support. The 1982 “Baby Doe” ruling that allowed parents to withhold a lifesaving operation from an infant with Down syndrome led to the establishment of infant-care review committees in cases
of withholding or withdrawing life support from disabled newborns. In 1983, a report from the U.S. President’s
Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research encouraged the
formation of hospital hoodia gordoni ethics committees to review cases that raised ethical dilemmas and to resolve ethical conflict.

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Hoodia gordonii consultation

Friday, January 29th, 2010

Clinical ethics consultation arose in the United States in the latter half of the twentieth century amid the moral and legal
uncertainty spawned by the rapid expansion of choices produced by medical advances, the emergence of the tertiarycare medical center, and the individual-rights movement that challenged traditional authority structures. Although it holds great promise, clinical ethics consultation remains a nascent profession. Many of the theoretical and practical
questions about its goals, training, evaluation, accountability, and support remain unanswered. Nonetheless, clinical
ethics consultation is growing and even flourishing. As the U.S. health system evolves over the coming years, the role
and place of clinical ethics consultation in the healthcare system certainly will be addressed.

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Fees for hoodia gordonii diet consultation

Monday, January 18th, 2010

By and large, ethics consultants have not charged patients or third-party payers for their services. This may be explained
by at least two factors. First, the efficacy of ethics consultations has not been clearly demonstrated; and second, ethics
consultations are called as frequently to assist health professionals as they are to help patients.

Generally, ethics consultants have been paid by the institutions where they practice, either directly for their consultations or indirectly, as part of
their overall responsibility in directing ethics programs or committees.  As our healthcare system becomes increasingly constrained by economic factors, healthcare institutions may find it more difficult to support clinical ethics consultation.

This will put pressure on ethics consultants to charge patients or third-party payers or to demonstrate that their activities save money by decreasing litigation or reducing resource consumption.

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Credentialing and Accreditation

Monday, January 18th, 2010

As ethics consultation becomes more widespread and perceived as part of the standard of medical care, society will hold accountable its practitioners and the institutions that employ them.

Individual institutions and national accrediting bodies, such as the Joint Commission for the Accreditation of Health Care Organizations, will undoubtedly become more concerned with setting standards for clinical ethics consultation: consultation through traditional professional methods, such as standardized education and training, accreditation of training programs, and credentialing of ethics consultants. This process will be a major challenge to an interdisciplinary field that has yet to agree on its goals and how to evaluate them.

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Medical tradition and contributed methods

Thursday, January 14th, 2010

The medical tradition has contributed methods, assumptions, and traditions of clinical practice: a combination of technical knowledge and clinical experience (La Puma and Toulmin). Some argue that physicians are best suited to provide clinical ethics consultation because (1) their advice will be easily accepted by their medical colleagues, because they have clinical experience and speak the same language;
and (2) only physicians can understand the ethos of physicianpatient relationships.

Critics caution that because they are “insiders,” physicians may promote the values of medicine rather than those of their patients or the larger community. They argue that the ethics consultant should serve as a bridge between medical and other values, and cannot function properly from a position entirely within medicine (Glover et al.; Churchill). Moral philosophy has offered three major approaches to clinical ethics consultation. The first is principle-based ethics, which argues that the answer to a given ethical question or dilemma may be discovered by applying the correct ethical theory (e.g., utilitarianism) or principle (e.g., autonomy) to the case. The second is virtue ethics, which

emphasizes that the possession of certain virtues (e.g., honesty, loyalty, compassion) is essential to sound ethical decision making. The third is a case-based or casuistic ethic, which holds that by examining the particulars of a given caseand comparing them with similar cases, a moral maxim that applies to the case can be discovered. An advantage of casuistry is that it sues a decision-making method already
employed by clinicians (Jonsen and Toulmin). Casuistry relies upon teachable medical moral maxims that build upon
experience.

Because casuistry is not principle-based, it has been criticized as “situational,” that is, pragmatically driven
to solve individual problems without reference to a broader moral framework. While principle-based clinical ethics reasoning has the
advantage of providing a consistent moral reference point, its principles are necessarily abstract, often conflict with each
other, and may create a rigid paradigm that is insensitive to differences in specific cases. Theology and religion contribute to clinical ethics
consultation by recognizing that specific religious positions may either facilitate the resolution of an ethical question or
contribute to its intensity.

For example, the Jehovah’s Witness position on blood transfusions can create serious ethical dilemmas in the case of a Jehovah’s Witness patient who is in urgent need of extensive, lifesaving surgery but
refuses blood. One of the disadvantages of this perspective is that many physicians are suspicious of or even hostile to
religious or theological interpretations of medical problems. However, insight into the religious morality of patients,
family members, and healthcare professionals is useful in establishing communication and reaching understanding among physicians, patients, and family members.

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