Browsing by Subject "Moral Obligations"
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Item The "difficult patient" reconceived: an expanded moral mandate for clinical ethics(2020-10-13) Fiester, Autumn M.Between 15%-60% of patients are considered "difficult" by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed "difficult." But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as responses to problematic interactions related to healthcare delivery. If there are grounds to reconceive the "difficult" patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.Item Disorders of consciousness and neuroethics: why rights must come to mind (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)(2016-09-13) Fins, Joseph J.[Note: The slide presentation and video are not available from this event.] Over the past two decades neuroimaging has revealed the possibility of covert consciousness in patients once thought vegetative. This knowledge coupled with the ability of drugs, devices and neuroprosthetics to restore functional communication in patients with disorders of consciousness has the potential to reintegrate patients into the nexus of family and community. A worthy scientific pursuit, I will argue that this effort is a moral imperative which links respect for persons with the reemergence of voice out of covert consciousness. As I describe in my recently published book, "Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness" (Cambridge University Press, 2015), this is a human rights issue for a population too long marginalized. For rights to come to mind, patients will need greater access to medical care and research, the skilled engagement of the clinical community, and fuller protections under of the law.Item Physicians, healthcare costs, and society: who's responsible for what?(2015-10-13) Tilburt, Jon C.Physicians play a key role in the utilization of healthcare financial resources. The unsustainable rise in the cost of healthcare in the US implies physicians should be part of addressing rising costs to make them more sustainable. But how can they do so with integrity? Ancient vows of medicine require fidelity to individual best interests. Modern norms of social contract require attention to just distribution of societal resources. Both are important. If and when these responsibilities conflict how can they be reconciled? This talk will describe the problem of dual agency, the challenges it poses to contemporary US medical practice, and common solutions to address the challenge. These challenges will be illustrated with empirical data from recent research with doctors, and will outline empirical, normative, and policy opportunities to clarify and define what kind of role physicians can and should play in addressing healthcare costs with integrity.Item Serious ethical violations in medicine: dealing effectively with outlier peers(2020-02-11) DuBois, James M.[Note: The video is not available from this event.] This presentation will engage the problem of serious ethical violations in medicine (SEMs). Examples of SEMs include criminal prescribing of controlled substances, performing unnecessary surgeries for profit, and sexually abusing patients. SEMs harm patients, waste scarce resources, and profoundly damage trust in medicine, particularly when institutions are perceived as enabling abuse. Drawing from his NIH-funded study of more than 300 cases of SEMs, DuBois will share findings on the motives and environmental factors that enable violations to occur. While SEMs are relatively rare, the current oversight system is ineffective at preventing repeat instances of SEMs by offenders. DuBois will share consensus recommendations offered by a diverse panel of physician leaders and educators, lawyers, ethicists, and patient advocates, and explore the ethical and practical challenges involved in reforming oversight and disciplinary systems.