Medical Ethics Advisor – November 1, 2023

New Ethical Guidance on Pediatric Decision-Making

According to the recommendations, ethical decision-making can factor in parents’ consideration of the child’s non-health interests (e.g., a child’s interest in playing football, even if it risks concussions), and also may consider the interests of other family members, provided those do not severely compromise the child’s health.

Many Ethics Committees Are Not Following AAP Guidance

In a survey of ethics consultant leaders at children’s hospitals, researchers found multiple practice gaps, including training needs; informing staff, patients, and family about ethics services; and scope of ethics service. These practice gaps could erode ethics quality and narrow ethics reach.

Early, Integrated Education May Prevent ‘Ethical Erosion’

Modalities such as ethics rounds or shadowing could help make these considerations a part of everyday practice.

Conflicts of Interest Are Prevalent in Clinical Guidelines

Even the appearance of bias in clinical practice guidelines is problematic, since it could diminish public trust in medicine. Ensuring there are functioning systems in place to keep practice guidelines objective and free of this influence must be a priority.

When Surrogate Decision-Makers Misunderstand Patients’ Condition

In the view of clinicians, surrogates of patients with higher acuity of illness could better understand the clinical situation. However, those surrogates might be less likely to correctly identify all the affected organ systems. Surrogates who seem to strongly grasp the situation may not actually feel as secure in their understanding.

Patient or Family May Need Translator During Ethics Consult

A good rule of thumb is to stop and check for comprehension after sharing a key point, especially when that point will influence decision-making or may change an individual’s perspective on the situation.

Lack of Trust and Knowledge Hinders Genetic Research Recruitment

Try using lay language to better explain genetic research as part of the informed consent process. Addressing participants’ concerns carefully may help gain participants’ trust in research, and thus improve recruitment of diverse patient populations.

Researchers Are Boosting Study Recruitment with ‘Cold Contact’ Processes

The Medical University of South Carolina recently switched to a new patient outreach recruitment model. Now, researchers can contact patients unless they opt out. The new process has dramatically increased the number of potential study participants who can be contacted, from 52,000 to more than 1.7 million patients.

Study Recruitment Incorporated Into Check-In Process

Recruitment through patient portals has become more common, but actual enrollment rates remain low. As part of patients' routine appointment check-ins, researchers included a study information sheet and a HIPAA authorization form. This led to a 37% enrollment rate, which was seven to eight times higher than what researchers expected.

Ethics Committees Need Successful Recruitment Tactics

Leaders share tips on how they managed to successfully recruit more colleagues to serve.

Plastic Surgeon Ethics Complaints: Expert Testimony, Marketing

Allegations concerned deceptive advertising, including using altered pictures and making claims that could not be verified. Also, some surgeons have been accused of exaggerating their expertise or scope of practice to cash in on lucrative expert testimony opportunities.