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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COMPETENCE AND AUTHORITY
Saturday, February 20th, 2010Functions of Diet Ethics Committees
Wednesday, February 17th, 2010There is a paucity of empirical studies of hospital ethics committees. Committees have a “grass-roots” character, reflecting a variety of local circumstances and personalities. These factors make it hard to generalize. Nevertheless, some typical features have emerged. One of these features is interdisciplinary composition. Generally, committees are composed of doctors, nurses, social workers, pastoral-care
professionals, and philosophers or theologians trained in ethics. Committee members can also include administrators, hospital attorneys, and consumer or community representatives. Committees are sometimes authorized by the medical staff; sometimes by the hospital governing board; sometimes by the administration.Committee functions vary but generally include one, two, or all three of the following. First, institutional ethics committees create a vehicle for education on ethical dimensions of patient care. Committees typically have dual efforts in this respect: education of the committee itself, through discussion of current bioethics literature, for example; and education of the medical staff and hospital employees, by organizing periodic lectures, panel discussions, and “ethics grand rounds.”
Second, committees draft institutional policies on hoodia diet ethical questions. This may arise through committee initiative. For example, a hospital panel discussion may reveal the need for a new policy on withholding resuscitation from dying patients, and the ethics committee takes the lead by preparing a first draft. New policies or review of existing policies may also be requested from the ethics committee by the hospital administration, or other hospital committees may route drafts of proposed policies and revisions of existing
policies to the committee for review and comment.
Access to Hoodia Diet Ethics Consultation
Sunday, February 14th, 2010Who 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).
Credentialing and Accreditation
Monday, January 18th, 2010As 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.
The Role of the Clinical Ethics Consultant
Saturday, January 9th, 2010Despite the growing interest in and practice of clinical ethics consultation, important questions remain about its purpose, requisite skills, methods, specific responsibilities, evalua tion, and effect. Unlike traditional medical consultants, clinical ethics consultants are not subject to widely accepted standards and procedures for training, credentialing, maintaining accountability, charging fees, obtaining informed
consent, or providing liability coverage (Purtilo; Agich).
While the role of the ethics consultant generally has been pragmatic, that is, to provide practical assistance with actual patient-care decisions (Cranford; Glover et al.; Siegler and Singer; Fletcher, 1986), there has been little consensus about how this role should be implemented. For example, although some see the ethics consultant, like the traditional medical consultant, as an expert who uses specific skills and knowledge to help “answer” ethical questions, exactly what constitutes the appropriate skills and knowledge base is a matter of debate.
Does the expertise come from the wisdom of practical clinical experience (La Puma et al.), or is it derived from a knowledge of moral theory and ethical principles? Others see the clinical ethics consultant’s role not so much as an expert but as someone who facilitates decisions
in a “community of reflective persons” (Glover et al., p. 24). This approach stresses the importance of involving all persons connected with the case—the patient, family members, physicians, nurses, medical students and residents, social workers, friends, and clergy. In this view, a shared
decision-making process should extend beyond the physician–patient dyad so that a greater range of personal values and interests can be considered.
This view is less compatible with the traditional model of medical consultation, which focuses more narrowly on the physician as decision maker.
Some commentators have worried that the individual ethics consultant, the ethics consultative group, or the ethics committee will act as moral “police” or “God Squad” (Siegler and Singer, p. 759), and erode the decision-making authority of the physician. Troyen Brennan has voiced a
more subtle concern: that by turning increasingly to ethics consultants and ethics committees, we “run the risk of forcing the ethics of the caring relationship to the periphery of clinical practice as something that is best left to experts” (Brennan, p. 4).
Furthermore, the role of the ethics consultant may be confused with other institutional roles, such as risk management, peer review, quality assurance, or resource
allocation. Taking on these roles could create a conflict of interest for the ethics consultant.
CLINICAL ETHICS CONSULTATION
Sunday, January 3rd, 2010The dictionary defines consulting as “providing professional or expert advice.” A clinical ethics consultant is defined here as a person who upon request provides expert advice to identify, analyze, and help resolve ethical questions or dilemmas that arise in the care of patients. Although the ethics consultant also may provide ethics education and help formulate policy, the bedside role is central to the definition of an ethics consultant (Jonsen).
In the United States, clinical ethics consultation began in some academic medical centers in the late 1960s and early 1970s (La Puma and Schiedermayer), and was given great impetus by the development of hospital ethics committees in the late 1970s and 1980s. During this period the rapid growth of medical technology confronted critically ill patients, their families, and health professionals with difficult ethical choices.
At the same time, the traditional authority of the physician was challenged not only by the patient-rights and consumer-rights movements, but also by changes in the way medical care was delivered in tertiary-care hospitals, where patients were often treated by teams consisting of physicians, nurses, social workers, medical technicians, and others.
Decisions about forgoing life-sustaining treatment for incompetent adults or premature infants were being made in a legal vacuum often filled by the fears of civil and even criminal litigation. In this atmosphere there was considerable uncertainty about the optimum process for resolving difficult ethical decisions without resorting to the public arena of the courts.
Why Lose Weight?
Sunday, December 27th, 2009Nowadays you can find tons of information in media about how to lose weight, million types of diets and all of them are concerning your appearance – Lose your weight fast! How to lose 5 cm in your waist in 5 days? Get slim hip for beach season! And many more. But few of them focus on health issues.
This time I would like to talk about losing weight as a tool to become healthy and not only good looking. If you are dead nobody would care how you look like…. Today we need to realize that the main reason to lose weight is health, not appearance.
Here are some points which will make you stronger in your fight with calories:
• Thousands of deaths per year may be assigned to obesity.
• The risk of death rises with increasing weight.
• Obesity is now recognized as a major risk factor for coronary heart disease, which can lead to heart attack.
• The incidence of heart disease is higher in persons who are overweight or obese (BMI greater than 25).
• Adults who are obese suffer high blood pressure more often than those who are at a healthy weight.
• Safety of Hoodia Gordonii Absolute
• More than 80 percent of people suffering from diabetes are overweight or obese.
• Overweight and obesity are associated with an increased risk for some types of cancer including endometrial (cancer of the lining of the uterus), colon, gall bladder, prostate, kidney and postmenopausal breast cancer.
• Women who gain more than 20 pounds from age 18 to midlife double their risk of postmenopausal breast cancer, compared to women whose weight remains stable.
• Sleep apnea (interrupted breathing while sleeping) is more common in obese persons.
• Obesity is associated with a higher prevalence of asthma.
• Symptoms of arthritis can improve with weight loss.