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  1. Principles for allocation of scarce medical interventions.Govind Persad, Alan Wertheimer & Ezekiel J. Emanuel - 2009 - The Lancet 373 (9661):423--431.
    Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and (...)
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  • Are physicians willing to ration health care? Conflicting findings in a systematic review of survey research.Daniel Strech, Govind Persad, Georg Marckmann & Marion Danis - 2009 - Health Policy 90 (2):113-124.
    Several quantitative surveys have been conducted internationally to gather empirical information about physicians’ general attitudes towards health care rationing. Are physicians ready to accept and implement rationing, or are they rather reluctant? Do they prefer implicit bedside rationing that allows the physician–patient relationship broad leeway in individual decisions? Or do physicians prefer strategies that apply explicit criteria and rules?
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  • (1 other version)Medical futility: its meaning and ethical implications.Lawrence J. Schneiderman, Nancy S. Jecker & Albert R. Jonsen - forthcoming - Bioethics.
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  • The Value of Autonomy in Medical Ethics.Jukka Varelius - 2006 - Medicine, Health Care and Philosophy 9 (3):377-388.
    This articles assesses the arguments that bioethicists have presented for the view that patient’ autonomy has value over and beyond its instrumental value in promoting the patients’ wellbeing. It argues that this view should be rejected and concludes that patients’ autonomy should be taken to have only instrumental value in medicine.
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  • How Physicians Allocate Scarce Resources at the Bedside: A Systematic Review of Qualitative Studies.D. Strech, M. Synofzik & G. Marckmann - 2008 - Journal of Medicine and Philosophy 33 (1):80-99.
    Although rationing of scarce health-care resources is inevitable in clinical practice, there is still limited and scattered information about how physicians perceive and execute this bedside rationing (BSR) and how it can be performed in an ethically fair way. This review gives a systematic overview on physicians’ perspectives on influences, strategies, and consequences of health-care rationing. Relevant references as identified by systematically screening major electronic databases and manuscript references were synthesized by thematic analysis. Retrieved studies focused on themes that fell (...)
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  • (1 other version)The Problem of Proxies with Interests of Their Own: Toward a Better Theory of Proxy Decisions.John Hardwig - 1993 - Journal of Clinical Ethics 4 (1):20-27.
    A 78 year old married woman with progressive Alzheimer's disease was admitted to a local hospital with pneumonia and other medical problems. She recognized no one and had been incontinent for about a year. Despite aggressive treatment, the pneumonia failed to resolve and it seemed increasingly likely that this admission was to be for terminal care. The patient's husband (who had been taking care of her in their home) began requesting that the doctors be less aggressive in her treatment and, (...)
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  • Terminal sedation: Pulling the sheet over our eyes.Margaret P. Battin - 2008 - Hastings Center Report 38 (5):pp. 27-30.
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  • A framework for rationing by clinical judgment.Samia A. Hurst & Marion Danis - 2007 - Kennedy Institute of Ethics Journal 17 (3):247-266.
    Although rationing by clinical judgment is controversial, its acceptability partly depends on how it is practiced. In this paper, rationing by clinical judgment is defined in three different circumstances that represent increasingly wider circles of resource pools in which the rationing decision takes place: triage during acute shortage, comparison to other potential patients in a context of limited but not immediately strained resources, and determination of whether expected benefit of an intervention is deemed sufficient to warrant its cost by reference (...)
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  • Shifting the Emphasis to Meaningful Ethics Engagement in the Development of Health Policies.Jeffrey Kirby - 2012 - American Journal of Bioethics 12 (11):18-20.
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  • Bioethics for Clinicians: 16. Dealing with Demands for Inappropriate Treatment.Charles Weijer, Peter A. Singer, Bernard M. Dickens & Stephen Workman - unknown
    Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ineffective treatment and demand for an effective treatment that supports a controversial end (e.g., permanent unconsciousness). Medical futility is not necessary in (...)
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  • Customary Standard of Care: A Challenge for Regulation and Practice.Sandra H. Johnson - 2013 - Hastings Center Report 43 (6):9-10.
    Law wrangles with setting and applying standards for the practice of medicine in many different arenas. One of the most prominent is medical malpractice litigation in which the trial process examines a physician's performance and measures it against the standard of care. The profession's prevailing custom, with some substantial tolerance for “respectable minority” views, has been the gold standard for scrutinizing physician practice and treatment decisions in the malpractice context. Using the profession's custom as the measure against which a physician's (...)
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  • Casting Light and Doubt on Uncontrolled DCDD Protocols.David Rodríguez-Arias, Iván Ortega-Deballon, Maxwell J. Smith & Stuart J. Youngner - 2013 - Hastings Center Report 43 (1):27-30.
    The ever‐increasing demand for organs led Spain, France, and other European countries to promote uncontrolled donation after circulatory determination of death (uDCDD). For the same reason, New York City has recently developed its own uDCDD protocol, which differs from European programs in some key ways. The New York protocol incorporates a series of technical and management improvements that address some practical problems identified in response to European uDCDD protocols. However, the more fundamental issue of whether uDCDD donors are dead when (...)
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  • Hospital Policy on Appropriate Use of Life-sustaining Treatment.Peter A. Singer, Geoff Barker, Kerry W. Bowman, Christine Harrison, Philip Kernerman, Judy Kopelow, Neil Lazar, Charles Weijer & Stephen Workman - unknown
    OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining (...)
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  • Requests for "inappropriate" treatment based on religious beliefs.R. D. Orr & L. B. Genesen - 1997 - Journal of Medical Ethics 23 (3):142-147.
    Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith (...)
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  • Paper: Enhancing the fairness of pandemic critical care triage.Jeffrey Kirby - 2010 - Journal of Medical Ethics 36 (12):758-761.
    Historically, the triage of temporarily scarce health resources has served narrow utilitarian ends. The recent H1N1 pandemic experience provided an opportunity for expanding the theoretical foundations/understandings of critical care triage in the context of declared infectious pandemics. This paper briefly explores the ethics-related challenges associated with the development of modern critical care triage protocols and provides descriptions of some ‘enhanced fairness’ features which were developed through the use of an inclusive deliberative engagement process by a Canadian provincial Department of Health.
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  • Expert Testimony by Persons Trained in Ethical Reasoning: The Case of Andrew Sawatzky.Françoise Baylis - 2000 - Journal of Law, Medicine and Ethics 28 (3):224-231.
    In February 1999, I received a call from a lawyer at Hill Abra Dewar stating that she had instructions to retain my services as an expert witness in the case of Sawatzky v. Riverview Health Centre. She was representing the Manitoba League of Persons with Disabilities which had intervenor status.In Canada the admission of expert testimony depends upon the application of four criteria outlined in R. v. Mohan by Justice Sopinka. These criteria are: relevance; necessity in assisting the trier of (...)
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  • Patient Autonomy and Provider Beneficence Are Compatible.Howard Brody & Luana Colloca - 2013 - Hastings Center Report 43 (6):6-6.
    A commentary on “What's Not Being Shared in Shared Decision‐Making?” from the July‐August 2013.
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  • (1 other version)The problem of proxies with interests of their own: toward a better theory of proxy decisions.John Hardwig - 1992 - Journal of Clinical Ethics 4 (1):20-27.
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  • Patient autonomy and the challenge of clinical uncertainty.Mark Parascandola, Jennifer Susan Hawkins & Marion Danis - 2002 - Kennedy Institute of Ethics Journal 12 (3):245-264.
    : Bioethicists have articulated an ideal of shared decision making between physician and patient, but in doing so the role of clinical uncertainty has not been adequately confronted. In the face of uncertainty about the patient's prognosis and the best course of treatment, many physicians revert to a model of nondisclosure and nondiscussion, thus closing off opportunities for shared decision making. Empirical studies suggest that physicians find it more difficult to adhere to norms of disclosure in situations where there is (...)
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  • (1 other version)Miscellaneous.Leonard M. Fleck - 2002 - Hastings Center Report 32 (2):35-36.
    It's not only necessary, but possible, if the public can be educated.
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  • The principle of justice in patient priorities in the intensive care unit: the role of significant others.K. Halvorsen, R. Forde & P. Nortvedt - 2009 - Journal of Medical Ethics 35 (8):483-487.
    Background: Theoretically, the principle of justice is strong in healthcare priorities both nationally and internationally. Research, however, has indicated that questions can be raised as to how this principle is dealt with in clinical intensive care. Objective: The objective of this article is to examine how significant others may affect the principle of justice in the medical treatment and nursing care of intensive care patients. Method: Field observations and in-depth interviews with physicians and nurses in intensive care units (ICU). Emphasis (...)
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  • (1 other version)Miscellaneous.Leonard M. Fleck - 2012 - Hastings Center Report 32 (2):35-36.
    It's not only necessary, but possible, if the public can be educated.
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  • Familiar Interests and Strange Analogies: Baergen and Woodhouse on Extra-Familial Interests.James Lindemann Nelson - 2013 - Journal of Clinical Ethics 24 (4):338-342.
    The article by Professor Baergen and Dr. Woodhouse makes a succinct and serious contribution to progress in bioethical understanding of deciding for others. They begin with what is by now a familiar claim: family proxy decision makers may sometimes make decisions on behalf of incapacitated relatives that depart from what might be optimal from the patient’s point of view, since the well-being of family members, or of the family as such, may be substantially affected by the direction of a patient’s (...)
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