Posts Tagged ‘diet gordonii’

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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Functions of Diet Ethics Committees

Wednesday, February 17th, 2010

There 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.

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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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The Role of the Clinical Ethics Consultant

Saturday, January 9th, 2010

Despite 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.

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