Medical Ethics Advisor 2014-06-01

Patients’ end-of-life wishes often not included in EHRs

Electronic health records (EHRs) often do not contain advance directives, documentation of the advance care planning process, or other information that can help guide decision-making at the end of life.

All families of potential donors aren’t offered opportunity

The primary ethical consideration when approaching families for organ donation is to ensure that the donation authorization process is voluntary and that it respects the wishes of those who want to donate.

Discussions often don’t occur on use of sedation at the end of life

While most Dutch respondents to a 2011 survey indicated that they initiated open discussions about sedation proactively, American respondents reported fewer such discussions, with most occurring late in the dying process.

Public disclosure linked to far fewer payments to physicians

Patients will soon be able to access information about their physicians financial relationships, as a result of The Physician Payment Sunshine Act. It is unclear how this information will affect the patient-physician relationship.

Quality of palliative care training, bedside tools reduce end-of-life ICU use

The quality of palliative care training in critical care medicine programs and the use of bedside tools were independently associated with reduced intensive care unit (ICU) use at the end of life.

New recommendations on how to ethically manage findings

All practitioners should anticipate and plan for incidental findings so that patients, research participants, and consumers are informed ahead of time about what to expect, and so that incidental findings are aptly communicated if they are found, according to a report from the Presidential Commission for the Study of Bioethical Issues.

PC measures must be applicable across variety of illnesses, settings

Palliative care clinicians have been challenged to find measures of quality that are applicable to all patients in a variety of settings.

"Disclosure gap" remains, despite overall trend toward transparency

Disclosure after medical errors is still not done consistently, partly due to clinicians continued concerns regarding liability exposure.

Medical Ethics Advisor – June 1, 2014

June 1, 2014