Medical Ethics Advisor – July 1, 2023

Patients’ Race, Insurance Status Affect Likelihood of Ethics Consult

More frequent ethics consults in a given patient population could be a signal of more ethical dilemmas, or more conflict, communication issues, or bias. Regardless of the reason, the fact that a group of patients is going through more ethics consults is not necessarily harmful.

Ethical Concerns if Study Participants Use Electronic Wearables

Study participants should clearly understand who owns the data collected and how they can exercise control over its use. Participants should know privacy will be maintained when researchers share data with third parties or when publishing research findings.

Some Hospice Medical Aid in Dying Policies Require Staff to Leave Room

Ethicists recommend hospices consider revising policies so nurses can support their patients clinically and emotionally at a critical moment.

The Complicated Ethics of Medical Aid in Dying

Some patients and staff alike do not know what the process is, which can lead to misconceptions. Others might not want to ask about it, while some might object on moral grounds. Researchers are working on better education.

Ethical Approach to Informed Consent for Adults with Intellectual Disabilities

The criteria to demonstrate sufficient capacity to consent should be flexible — and proportional to the complexity and risks of each individual study. Researchers must consider individual differences and be prepared to use a variety of methods.

Researchers Often Exclude Adults Living with Intellectual Disabilities

Historically, adults living with intellectual disabilities have not been considered among potential participants in the recruitment phase of studies, or have been presumed to lack capacity for first-person consent and excluded on that basis. While there is a contemporary trend toward greater inclusion, these barriers to research participation remain important concerns.

Sham Surgeries: Should Researchers Offer the Real Procedure After the Trial?

There are legitimate concerns when investigators conduct sham-controlled trials. Researchers need a way to effectively determine if the surgery works, but designing this kind of ethically sound and efficacious clinical trial is difficult.

Ethics Consults Depend on Ability to Absorb Multiple Viewpoints

An important role for the ethicist is to clarify the values people hold that inform their decision-making. Thus, ethicists must develop skills that encourage patients, families, or surrogates to openly express these values. But these skills do not always come naturally.

Ethicists Debate Withdrawing ECMO Over Patient’s Objections

The commonly used ethical justifications for unilateral withdrawal over the objection of a patient with decision-making capacity are problematic. The ethicists’ task is to help stakeholders examine the underlying assumptions in light of the available empirical evidence or potential counterarguments.

Many Seriously Ill Older Adults Lack Documented Goals-of-Care Discussions

Benign nudges may advance those discussions. These conversations do not need to be lengthy. A few short inquiries asked by a respectful, attentive provider is all that is needed to help many patients share concerns and preferences for care.