Advertisement

Ethics in Clinical Practice

  • Margaret Drickamer

Abstract

The physician-patient relationship is based on several sequential and interlocking principles that guide the process by which decision-making occurs. If everything is going well, these processes are hardly noticed; but in difficult situations and times of crisis it is important to be able to structure one’s response and actions on the basis of accepted principles and guidelines. The process of medical decision-making is grounded in the ethical principles of truth-telling, informed consent, autonomy, professionalism, competence, and confidentiality.

Keywords

Advance Directive Health Care Decision Voluntary Euthanasia Incapacitate Patient Health Care Proxy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Fitts, WT, Ravdin IS. What Philadelphia physicians tell patients with cancer. JAMA 1953;153:901–904.CrossRefGoogle Scholar
  2. 2.
    Oken D. What to tell cancer patients: a study of medical attitudes. JAMA 1961;175:1120–1128.PubMedCrossRefGoogle Scholar
  3. 3.
    Novack DH, Olumer R, Smith RL, Ochitill H, Morrow GR, Bennett JM. Changes in physicians’ attitudes toward telling the cancer patient. JAMA 1979;241:897–900.PubMedCrossRefGoogle Scholar
  4. 4.
    Drickamer MA, Lachs LS. Should patients with Alzheimer’s disease be told their diagnosis? N Engl J Med 1992; 336:947–951.CrossRefGoogle Scholar
  5. 5.
    Blackhall LJ, Murphy ST, Frank G, Michel V, Azen S. Ethnicity and attitudes toward patient autonomy. JAMA 1995; 274:820–825.PubMedCrossRefGoogle Scholar
  6. 6.
    Drickamer MA, Lachs LS. Telling the diagnosis of Alzheimer’s disease. N Engl J Med 1993;328:442.Google Scholar
  7. 7.
    Lo B, Steinbrook R. Beyond the Cruzan case: the U.S. Supreme Court and medical practice. Ann Intern Med 1991;114:895–901.PubMedCrossRefGoogle Scholar
  8. 8.
    Uhlmann R, Pearlman R, Cain KL. Physicians’ and spouses’ predictions of elderly patient’s resuscitation preferences. J Gerontol 1988;43:M115-M121.CrossRefGoogle Scholar
  9. 9.
    Mazur D, Merz JF. How older patients’ treatment preferences are influenced by disclosures about therapeutic uncertainty: surgery versus expectant management for localized prostate cancer. J Am Geriatr 1996;44:934–937.Google Scholar
  10. 10.
    Mazur DJ, Hickam DH. Patients’ preferences for risk disclosure and role in decision making for invasive medical procedures. J Gen Intern Med 1997;12:14–17.CrossRefGoogle Scholar
  11. 11.
    Meisel A, Kuczewski M. Legal and ethical myths about informed consent. Arch Intern Med 1996;156:2521–2526.PubMedCrossRefGoogle Scholar
  12. 12.
    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Summing up: final report on studies of the ethical and legal problems in medicine and biomedical and behavioral research, March 1983. Government Printing Office: Washington, DC, 1983:65–81.Google Scholar
  13. 13.
    American Thoracic Society. Withholding and withdrawing life-sustaining therapy. Ann Intern Med 1991;115: 478–485.Google Scholar
  14. 14.
    Schneiderman LJ, Spragg RG. Ethical decisions in discontinuing mechanical ventilation. N Engl J Med 1988;318: 984–988.PubMedCrossRefGoogle Scholar
  15. 15.
    Sullivan RJ. Accepting death without artificial nutrition or hydration. J Gen Intern Med 1993;8:220–224.PubMedCrossRefGoogle Scholar
  16. 16.
    Annas GJ. The health care proxy and the living will. N Engl J Med 1991;324:1210–1213.PubMedCrossRefGoogle Scholar
  17. 17.
    Sehgal A, Galbraith A, Chesney M, Schoenfeld P, Charles G, Lo B. How strictly do dialysis patients want their advance directive followed? JAMA 1992;267:59–63.PubMedCrossRefGoogle Scholar
  18. 18.
    Walker RM. DNR in the OR: resuscitation as an operative risk. JAMA 1991;266:2407–2412.PubMedCrossRefGoogle Scholar
  19. 19.
    Appelbaum PS, Grisso T. Assessing patients’ capacities to consent to treatment. N Engl J Med 1988;319:1635–1638.PubMedCrossRefGoogle Scholar
  20. 20.
    Brock DW, Wartman SA. When competent patients make irrational choices. N Engl J Med 1990;322:1595–1599.PubMedCrossRefGoogle Scholar
  21. 21.
    Hastings Center. Guidelines on the Termination of Life-sustaining Treatment and the Care of the Dying. Indiana University Press: Indianapolis, 1987.Google Scholar
  22. 22.
    Quill TE, Brody H. Physician recommendations and patient autonomy: finding a balance between physician power and patient choice. Ann Intern Med 1996;125:763–769.PubMedCrossRefGoogle Scholar
  23. 23.
    Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system: risk predication of hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619–1636.PubMedCrossRefGoogle Scholar
  24. 24.
    Lynn J, Teno JM, Harrell FE Jr. Accurate prognostication of death: opportunities and challenges for clinicians. West J Med 1995;163:250–257.PubMedGoogle Scholar
  25. 25.
    Sugarman J, Powers M. How the doctor got gagged: the disintegrating right to privacy in the physician patient relationship. JAMA 1991;266:3323–3327.PubMedCrossRefGoogle Scholar
  26. 26.
    Drickamer MA, Lee MA, Ganzini L. Practical issues in physician-assisted suicide. Ann Intern Med 1997;126: 146–151.PubMedCrossRefGoogle Scholar
  27. 27.
    Blendon RJ, Szalay US, Knox RA. Should physicians aid their patients in dying? The public perspective. JAMA 1996;267:2229–2233.Google Scholar
  28. 28.
    Bachman JG, Alcser KH, Doukas DJ, Lichtenstein RL, Corning AD, Brody H. Attitudes of Michigan physicians and public toward legalizing physician-assisted suicide and voluntary euthanasia. N Engl J Med 1996;334:303–309.PubMedCrossRefGoogle Scholar
  29. 29.
    Ubel PA, Zell MM, Miller DJ, Fischer GS, Peters-Stefani D, Arnold RM. Elevator talk: observational study of inappropriate comments in a public space. Am J Med 1995; 99:190–194.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Margaret Drickamer

There are no affiliations available

Personalised recommendations