Legal and Ethical Issues in Healthcare

Legal and Ethical Issue in Healthcare
Numerous patients are kept alive for quite a long time, even as it is vague regardless of whether their condition may progress. The capacity to make accurate judgments and forecasts about results would assume a fundamental part in such choices and would enable specialists to decide how best to distribute limited social insurance assets. A standout amongst the most noteworthy inquiries is regardless of whether life merits living in such a state. ADDIN CSL_CITATION { “citationItems” : [ { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1016/S1474-4422(12)70154-0”, “ISBN” : “1474-4465 (Electronic)\r1474-4422 (Linking)”, “ISSN” : “14744422”, “PMID” : “22814543”, “abstract” : “Severe brain injury can leave patients with chronic disorders of consciousness. Because of impaired responsiveness, many of these patients have traditionally been regarded as unaware. However, findings from recent clinical studies herald a potential paradigm shift: functional imaging and neurophysiological studies have identified ways to assess awareness and have revealed astounding cases of awareness despite clinical unresponsiveness. Hence, diagnostic classifications have been rewritten, prognostic knowledge is improving, and therapeutic studies have regained momentum, showing for the first time some therapeutic effects on responsiveness. Clinicians must increasingly respond to requests by patients’ families and surrogate decision makers to use novel techniques for diagnosis, prognosis, and treatment, and in doing so several ethical and social issues need to be considered.

Such requests provide an opportunity for clinicians to learn about patients’ values and preferences and to maintain clinical acumen for changes in patient status with the patients’ best interests in mind. u00a9 2012 Elsevier Ltd.”, “author” : [ { “dropping-particle” : “”, “family” : “Jox”, “given” : “Ralf J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Bernat”, “given” : “James L.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Laureys”, “given” : “Steven”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Racine”, “given” : “Eric”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } ], “container-title” : “The Lancet Neurology”, “id” : “ITEM-1”, “issue” : “8”, “issued” : { “date-parts” : [ [ “2012” ] ] }, “page” : “732-738”, “title” : “Disorders of consciousness: Responding to requests for novel diagnostic and therapeutic interventions”, “type” : “article”, “volume” : “11” }, “uris” : [ “http://www.mendeley.com/documents/?uuid=f4925184-532d-4a83-8440-c548c0a2a04d”, “http://www.mendeley.com/documents/?uuid=7b5c2450-a9e4-4480-afc0-08ccdace8eb3” ] } ], “mendeley” : { “formattedCitation” : “(Jox <i>et al.</i>, 2012)”, “manualFormatting” : “Jox et al., (2012)”, “plainTextFormattedCitation” : “(Jox et al., 2012)”, “previouslyFormattedCitation” : “(Jox <i>et al.</i>, 2012)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }Jox et al., (2012) contends that undue good noteworthiness is set on proof of consciousness and that there might be a significantly more grounded moral motivation to pull back treatment from those patients in whom higher subjective capacities are generally in place.
ADDIN CSL_CITATION { “citationItems” : [ { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1038/nrneurol.2013.279”, “ISBN” : “1759-4758”, “ISSN” : “17594758”, “PMID” : “24468878”, “abstract” : “The concept of consciousness continues to defy definition and elude the grasp of philosophical and scientific efforts to formulate a testable construct that maps to human experience. Severe acquired brain injury results in the dissolution of consciousness, providing a natural model from which key insights about consciousness may be drawn. In the clinical setting, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate through word or gesture, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate and inappropriate care. In this Review, we describe the state of the science with regard to clinical management of patients with prolonged disorders of consciousness. We review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. We conclude with a provocative discussion of bioethical and medicolegal issues that are unique to this population and have a profound impact on care, as well as raising questions of broad societal interest.”, “author” : [ { “dropping-particle” : “”, “family” : “Giacino”, “given” : “Joseph T.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Fins”, “given” : “Joseph J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Laureys”, “given” : “Steven”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Schiff”, “given” : “Nicholas D.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } ], “container-title” : “Nature Reviews Neurology”, “id” : “ITEM-1”, “issue” : “2”, “issued” : { “date-parts” : [ [ “2014” ] ] }, “page” : “99-114”, “title” : “Disorders of consciousness after acquired brain injury: The state of the science”, “type” : “article”, “volume” : “10” }, “uris” : [ “http://www.mendeley.com/documents/?uuid=d224d160-a6e2-4c8f-acb9-8cfdc4b1696c”, “http://www.mendeley.com/documents/?uuid=59521a2a-4703-40ae-a661-d7ff4ed51731” ] } ], “mendeley” : { “formattedCitation” : “(Giacino <i>et al.</i>, 2014)”, “manualFormatting” : “Giacino et al., (2014)”, “plainTextFormattedCitation” : “(Giacino et al., 2014)”, “previouslyFormattedCitation” : “(Giacino <i>et al.</i>, 2014)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }Giacino et al., (2014) show that vegetative and insignificantly conscious patients are uncommunicative, and by and large they don’t abandon assertions of purpose, leaving relatives to settle on end-of-life choices given suspicions about what they would have needed. Consequently, Patient independence or empowering patients to resolve their own decisions is an objective and question. In any case, numerous patients with consciousness issue have horrendous cerebrum wounds that influence the frontal cortex, which is engaged with high request mental capacities, for example, thinking and central leadership, and it is, like this, indistinct how in place their psychic abilities are ADDIN CSL_CITATION { “citationItems” : [ { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1007/s12152-011-9149-x”, “ISBN” : “1874-5490”, “ISSN” : “18745490”, “abstract” : “Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how health-care providers think about end-of-life options (e.g., withdrawal of artificial nutrition and hydration) in the presence or absence of pain in noncommunicative patients. Here, we aimed to better clarify this issue by reanalyzing previously published data on pain perception (Prog Brain Res 2009 177, 329-38) and end-of-life decisions (J Neurol 2010 258, 1058-65) in patients with disorders of consciousness. In a sample of 2259 European health-care professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) health-care providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments.”, “author” : [ { “dropping-particle” : “”, “family” : “Demertzi”, “given” : “A.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Racine”, “given” : “E.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Bruno”, “given” : “M. A.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Ledoux”, “given” : “D.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Gosseries”, “given” : “O.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Vanhaudenhuyse”, “given” : “A.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Thonnard”, “given” : “M.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Soddu”, “given” : “A.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Moonen”, “given” : “G.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Laureys”, “given” : “S.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } ], “container-title” : “Neuroethics”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : [ [ “2013” ] ] }, “page” : “37-50”, “title” : “Pain perception in disorders of consciousness: Neuroscience, clinical care, and ethics in dialogue”, “type” : “article-journal”, “volume” : “6” }, “uris” : [ “http://www.mendeley.com/documents/?uuid=8bb4ea97-96bb-4501-bb8b-13a1fe151b80”, “http://www.mendeley.com/documents/?uuid=3dc0d799-8a04-4aa8-82c5-5993f058cffb” ] } ], “mendeley” : { “formattedCitation” : “(Demertzi <i>et al.</i>, 2013)”, “plainTextFormattedCitation” : “(Demertzi et al., 2013)”, “previouslyFormattedCitation” : “(Demertzi <i>et al.</i>, 2013)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Demertzi et al., 2013). In such cases, the decision to continue or discontinue life support may be reliant on the subjective wishes of the family members. It is essential that the family comprehend the clinical condition entirely to settle on an educated choice if there is no propel order set up. However, ADDIN CSL_CITATION { “citationItems” : [ { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1016/B978-0-444-53501-6.
00030-5”, “ISBN” : “0072-9752”, “ISSN” : “00729752”, “PMID” : “24182392”, “abstract” : “In this chapter, evolution of ethics and bioethics is traced to show how an abstract and individualistic paradigm was at the core of mainstream ethics prior to the advent of bioethics and applied ethics. Bioethics has transformed this individualistic paradigm because of its inherent interdisciplinarity and real-world connection. This evolution has raised questions regarding how nonabstract (e.g., experiential) and nonindividualistic (e.g., social, relational) components of ethics could be married to normative theory and ethics reflection, the latter usually not amenable to empiric research. In the first part of this chapter, pragmatism is introduced as an approach offering perspectives on the integration of social, nonindividualistic aspects of ethics, supporting the use of social science methods within ethics and neuroethics. In the second part of this chapter, using the example of disorders of consciousness, a pragmatic perspective is explored to reframe questions and help foster nonreductionistic understandings of ethical questions and ethical dilemmas. This chapter aims to generate reflections on a set of specific clinical contexts that will also stimulate a discussion on the nature of ethical approaches. ?? 2013 Elsevier B.V.”, “author” : [ { “dropping-particle” : “”, “family” : “Racine”, “given” : “Eric”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } ], “container-title” : “Handbook of Clinical Neurology”, “id” : “ITEM-1”, “issued” : { “date-parts” : [ [ “2013” ] ] }, “page” : “357-372”, “title” : “Pragmatic neuroethics: The social aspects of ethics in disorders of consciousness”, “type” : “article-journal”, “volume” : “118” }, “uris” : [ “http://www.mendeley.com/documents/?uuid=6c4e9cd2-dcdc-4b0b-8098-fd08bc7d9e12”, “http://www.mendeley.com/documents/?uuid=cabc7b03-e14e-4712-95a0-6ef48d06cd30” ] } ], “mendeley” : { “formattedCitation” : “(Racine, 2013)”, “manualFormatting” : “Racine (2013)”, “plainTextFormattedCitation” : “(Racine, 2013)”, “previouslyFormattedCitation” : “(Racine, 2013)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }Racine (2013) argues that general emotions, expectation, and religious convictions can obstruct what ought to or should be improved in the situation of the patient when their brain is not functioning normally.

References
ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY Demertzi, A. et al. (2013) ‘Pain perception in disorders of consciousness: Neuroscience, clinical care, and ethics in dialogue’, Neuroethics, 6(1), pp. 37–50. doi: 10.1007/s12152-011-9149-x.
Giacino, J. T. et al. (2014) ‘Disorders of consciousness after acquired brain injury: The state of the science’, Nature Reviews Neurology, pp. 99–114. doi: 10.1038/nrneurol.2013.279.
Jox, R. J. et al. (2012) ‘Disorders of consciousness: Responding to requests for novel diagnostic and therapeutic interventions’, The Lancet Neurology, pp. 732–738. doi: 10.1016/S1474-4422(12)70154-0.
Racine, E. (2013) ‘Pragmatic neuroethics: The social aspects of ethics in disorders of consciousness’, Handbook of Clinical Neurology, 118, pp. 357–372. doi: 10.1016/B978-0-444-53501-6.00030-5.