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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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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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Contributions to the Practice of Ethics Consultation

Thursday, January 14th, 2010

While the general purpose of clinical ethics consultation is to help resolve ethical questions or dilemmas in patient care, persons who perform ethics consultation come from diverse professional backgrounds and do not share the same problemsolving methods or theoretical assumptions. This diversity has left its stamp on the way clinical ethics consultation is performed, and has profound implications not only for the
practice of clinical ethics consultation but also for the training of its practitioners.

Despite this diversity, a common ground can be seen in
the shared goal of identifying an ethically supportable solution to a clinical ethical question or dilemma, and in a recognition that the process of arriving at a solution requires knowledge of law, ethics, medicine, psychosocial issues, and  at times, religion.

The legal tradition has influenced clinical ethics consultation by placing emphasis on rights and on formal mechanisms of decision making and arbitration, such as due process. The protection and nurturing of individual rights are central to this style (Wolf). Strict adherence to this style, however, may encourage adversarial rather than collaborative or nurturing relationships between patients and healthcare professionals (Agich and Youngner).

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Reasons for Diet Ethics Consultation

Saturday, January 9th, 2010

Diet Ethics consultations are requested for a variety of reasons that include prevention of litigation; mediation of disputes and resolution of conflicts between or among the patient, healthcare professional, and family; confirmation of or challenges to decisions already made; emotional support for difficult decisions; and identification of morally acceptable alternatives.

For example, diet ethics consultation may be requested because physicians and family members disagree about how aggressively to treat a dying, incompetent cancer patient, or because there is difficulty interpreting a patient’s living will.Diet ethics consultants may be called because there is disagreement about the acceptability of a family request to stop tube feeding an Alzheimer patient who refuses to eat. Requests for ethics consultation may come because nurses or house officers are concerned that competent patients are being left out of the decision-making process.

Goals of Diet Ethics Consultation

There is disagreement about the appropriate goals of ethics consultation. John La Puma and E. Rush Priest have suggested that ethics consultations’s primary goal should be “to effect ethical outcomes in particular cases and to teach physicians to construct their own frameworks for ethical decisions making” (La Puma and Priest, p. 17).

Patientrights advocates disagree. They argue that the primary goal of ethics consultation is the promotion of patient autonomy by encouraging shared decision making (Tulsky and Lo). John Fletcher takes a broader view.

He identifies four goals of ethics consultation: (1) to protect and enhance shared decision making in the resolution of ethical problems; (2) to prevent poor outcomes; (3) to increase knowledge of clinical ethics; and (4) to increase knowledge of self and others through participation in resolving conflicts (Fletcher, 1992).

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Structures of Clinical Ethics Consultation

Saturday, January 9th, 2010

Clinical diet ethics case consultation is provided in several ways: by an diet ethics consultative group as a whole (such as an ethics committee), by a subgroup of the consultative group, or by individual consultants. Clinical ethics case consultation by a large group has the potential for having diffused accountability and being depersonalized, bureaucratic, insensitive, closed-ended, and removed from the clinical setting.

But it has the advantage of providing multiple perspectives and opportunities for queries from persons of diverse backgrounds, and for correcting the potential for narrow or idiosyncratic views of an individual consultant. In contrast, clinical ethics case consultation by an individual consultant is an open-ended process that can extend over a period of time, and permit ongoing discussion and pursuit of issues that require clarification.

The individual consultant can decide what information is necessary and obtain it firsthand. Interviews with patients, families, and health professionals can be scheduled flexibly and conducted in private settings more conducive to diminishing apprehension, establishing trust, sharing information, and allowing the kind of give-and-take that is so important to exploring emotionally powerful and intensely personal issues. Further more, an individual diet ethics consultant is more visible and accountable than a committee (Agich and Youngner).

Forthese reasons, many ethics consultative groups and healthcare professionals have found the individual clinical ethics consultant more effective than the committee. Many ethics consultative groups have created a middle ground that involves small teams who serve as an extension of the ethics consultation group or ethics committee.

Some see an advantage to a relationship between the ethics consultant and an ethics consultative group or committee because the large group regularly can review the individual consultant’s activities.

This arrangement provides peer review and quality assurance for the consultant as well as education for the larger group or committee. The ethics consultant or consultation team can ask the entire group to become involved in particularly controversial or complex cases.

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CLINICAL ETHICS CONSULTATION

Sunday, January 3rd, 2010

The 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.

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Examples of ethics

Sunday, January 3rd, 2010

In the face of this rich methodological diversity, clinical ethics, far from being fragmented, is held together by a profoundly practical aim: to make contributions to clinical practice and to policy governing clinical practice. To the extent that it is able to achieve this, clinical ethics must pay careful attention to and take into account certain features of the clinical context.

As mentioned at the outset, these features include complex psychosocial, medical, legal, cultural, and political dimensions that have implications both for the types of ethical issues that arise and how these issues may be resolved (Society for Health and Human Values). For example, in the United States, the pluralistic societal context, the rights of individuals to live according to their values, and the value-laden nature of clinical practice make ethical conflict or uncertainty an inevitable feature of the clinical setting. Indeed, these features, in conjunction with advances in medical technology, arguably have created the need for formal efforts in clinical ethics.

In the U.S. societal context, therefore, irrespective of the methodological approach employed by any particular person in working to address a given clinical ethics issue, the political rights of individuals must be taken into account if the approach is to make a contribution to actual clinical practice.

Thus, in a very real sense, methodological approaches in clinical ethics and the theoretical commitments ehind them are subordinated to the practical aim of this discipline.

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