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Ethics

Aging and death | End of life issues | Law and policy | Managed care | Patient encounters | Professionalism | Religion and spirituality


Aging and death

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Patients and prayer amid medical practice

It’s more important than ever to recognize and understand cultures and spiritual beliefs, including and beyond the end of life. More

Lack of kidneys for transplant raises debates

A shortage of transplantable organs has led to previously unthought-of issues that entangle ethics, policy, costs and clinical complications. Internists now must consider transplant tourists, long waits and “donation chains” as factors in their patient counseling. More

Ethics in medicine

Doctors debate the ethics of assisted suicide

The medical community and the world at large are looking at how physician-assisted suicide is playing out in Washington, Oregon and Montana. Are these states a bellwether or a death knell for legalizing the issue elsewhere? And how should physicians respond when presented with such requests from their patients? More

Ethical Dilemmas
Son’s plea to prolong life at any cost sparks ethical quandary
Physicians aren’t obligated to provide end-of-life care that is ineffective or harmful, by Lachlan Forrow, FACP
September ’08

Ethical Dilemmas, by Lachlan Forrow, FACP
A case study examines how a hospitalist handled confusing and conflicting demands placed by a do-not-resuscitate order.
April ’08

Organ donation: balancing patient duties and public health
Ethical considerations to weigh when broaching the issue of organ donation. (June 2006)

Issues to consider when ending life support
Hospital—or hospice—based caregivers must make tough decisions in order to ease the dying process for terminally ill patients (May 2001)

How to avoid conflicts with patients and families during end-of-life care
Begin discussions while patients are still healthy, and work patiently with families when the dying process begins (June 2000)

Dealing with older, impaired drivers
Balancing patient autonomy with public safety (April 2000)

Deciding how much care is too much
Ethics case study explores futility and appropriate treatment (March 1997)

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End of life issues

Ethics in medicine

Doctors debate the ethics of assisted suicide

The medical community and the world at large are looking at how physician-assisted suicide is playing out in Washington, Oregon and Montana. Are these states a bellwether or a death knell for legalizing the issue elsewhere? And how should physicians respond when presented with such requests from their patients? More

'Futile to whom' challenges views on reasonable recovery
A reader responds to a previous column that addresses how health care providers handle life-saving medical treatment despite no hope for recovery. More

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Law and policy

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Ethics in medicine

Doctors debate the ethics of assisted suicide

The medical community and the world at large are looking at how physician-assisted suicide is playing out in Washington, Oregon and Montana. Are these states a bellwether or a death knell for legalizing the issue elsewhere? And how should physicians respond when presented with such requests from their patients? More

In-office research can trip up even the most ethical doctors (January 2008)

Why the nation's toughest elder abuse laws make some California physicians nervous
Problems include onerous reporting requirements and threats from malpractice attorneys (March 2003)

Ethics case study: Documenting sensitive information poses dilemma for physicians
As access to medical records increases, patients become fearful (December 1996)

Checking up on immigrants: a job for physicians?
California law can cause immigrants to avoid getting needed care (October 1996)

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Managed Care

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Epiphanies and the human side of health care policy
The looming crisis in health care goes beyond affordable access to acute medical services. The real trouble ahead lies in caring for chronically ill patients. (January 2002)

Are health plan incentives hurting generalist-specialist relationships?
Some worry that HMOs force generalists to act as marginal specialists. (June 2001)

Is there an ethical doctor in the house?
Let's talk about everyday moral dilemmas in practice—not just dramatic headline-grabbing issues (October 1997)

Why for-profit managed care fails you and your patients
HMOs exacerbate the problems they claim to cure (November 1996)

To refer or not to refer?
When you and your patient disagree—an ethics case study (March 1995)

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Patient encounters

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Dismissing patients always a last resort

Stopping the physician-patient relationship can be seen as abandonment if not done properly. More

How to handle talking politics with patients

While physicians should not inflict their political opinions on patients, how this plays out in the exam room depends on the doctor. More

Ethics in medicine

Doctors debate the ethics of assisted suicide

The medical community and the world at large are looking at how physician-assisted suicide is playing out in Washington, Oregon and Montana. Are these states a bellwether or a death knell for legalizing the issue elsewhere? And how should physicians respond when presented with such requests from their patients? More

Internist searches for answers when test results go missing

An internist is surprised by a patient's previous blood work, which shows a dramatic rise in PSA levels. There is no evidence in the medical record that the patient was informed of, or that the internist acted upon, the prior abnormal PSA result. However, the internist is certain she never saw it. What should she do next? More

Do placebos have a place in clinical practice?

Placebo use is common in internal medicine. But is it ethical? Experts examine the disconnect between the standards of medicine, and how it's actually practiced in the office. More

Ethical Dilemmas, by Lachlan Forrow, FACP
Case study: Cultural differences complicate a terminal cancer diagnosis
March ’08

Examining the ethical dilemmas that occur in everyday practice, by Lachlan Forrow, FACP
A Harvard expert moderates a new column on ethical case studies and suggests some practical strategies for handling and preventing conflicts
Case study: The ethics of end-of-life care erupt in the ICU
February '08

Examining the ethical dilemmas that occur in everyday practice, by Lachlan Forrow, FACP
A Harvard expert moderates a new column on ethical case studies and suggests some practical strategies for handling and preventing conflicts
Case study: How should a physician react when an elderly patient refuses life-saving treatment contrary to the wishes of her family? (January 2008)

Getting the most out of community-based research
By paying attention to ethics and logistics, physicians can find intellectual and financial rewards in research. (April 2004)

Letters
Readers discuss HIPAA compliance problems, error disclosures. (January-February 2004)

Must you disclose mistakes made by other physicians?
Your colleague never recommended a follow-up X-ray, and now you have to tell the patient he has cancer. (November 2003)

Do you need to talk to patients about mistakes?
If a mistake had no lasting harm, will disclosing it help or hurt the physician-patient relationship? (March 2002)

How to practice within ethical boundaries
Dealing with gifts and sexual misconduct (June 2000)

Consumer ads: How should you handle the pressure?
Instead of educating patients in need, consumer ads create need (March 2000)

Is physician decision-making as ethical as we think?
A patient's accusation made this doctor re-examine whether he really takes the moral high ground (November 1999)

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Professionalism

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Dismissing patients always a last resort

Stopping the physician-patient relationship can be seen as abandonment if not done properly. More

Guidelines getting tougher on industry, but physicians are not

A survey of physicians found that respondents were comfortable with industry-sponsored lunches and other gifts, despite their institutions’ prohibition against such practices. One physician discusses how to align medicine’s ethical goals with physicians’ attitudes. More

Ethical Dilemmas
Considering a sexual relationship with a former patient, however brief the doctor’s visit, raises issues after a romantic break-up. More

Ethical Dilemmas, by Paul S. Mueller, FACP
A case study addresses ways to handle turning off an implanted cardioverter-defibrilator when a patient finds the shocks worse than the prospect of dying.
June ’08

Ethical Dilemmas, by Neil J. Farber, FACP
A physician's refusal to turn over the records of a patient with an outstanding bill may be seen as abandonment.
May '08

Ethical Dilemmas, by Lachlan Forrow, FACP
Case study: Cultural differences complicate a terminal cancer diagnosis
March ’08

Examining the ethical dilemmas that occur in everyday practice, by Lachlan Forrow, FACP
A Harvard expert moderates a new column on ethical case studies and suggests some practical strategies for handling and preventing conflicts
Case study: The ethics of end-of-life care erupt in the ICU
February '08

Examining the ethical dilemmas that occur in everyday practice, by Lachlan Forrow, FACP
A Harvard expert moderates a new column on ethical case studies and suggests some practical strategies for handling and preventing conflicts
Case study: How should a physician react when an elderly patient refuses life-saving treatment contrary to the wishes of her family? (January 2008)

From 'Marcus Welby' to 'ER': Is medicine losing professionalism?
The Keynote speaker at Annual Session argues that professionalism needs renewed attention. (June 2006)

No easy answers when managing financial conflicts
Physicians must navigate a barrage of conflicts in market-driven health care. (June 2005)

Letters
Readers discuss prisoner abuse, problem physicians, professional ethics. (September 2004)

Letters
Readers discuss medical mistakes. (October 2003)

Too close for comfort? How some physicians are re-examining their dealings with drug detailers
In the midst of greater attention on doctors' relationship with the drug industry, individual physicians' responses have been mixed. (July-August 2003)

What can physicians do to regain the public's trust?
Our only real means of repairing and preventing further damage to public trust is to renew our commitment to professionalism. (May 2003)

Doctors struggle to balance professionalism with the pressures of everyday practice
As practice pressures build, physicians are looking for ways to do right by patient care (April 2003)

When ethics collide in the practice parking lot
We are obligated to provide our patients with ethical advice, but is this responsibility restricted to medical matters? (February 2002)

Charter on medical professionalism addresses issues of finite resources Created by American and European internists, the charter looks at the larger responsibilities of the medical profession (July-August 2001)

Ethical issues in CME, clinical research
How pharmaceutical funding can affect education and for-profit clinical research. (May 2001)

When are industry-sponsored trials a good match for community doctors?
While it may be attractive to offer patients free medicine, physicians should consider other ramifications of joining an industry trial. (March 2001)

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Religion and spirituality

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Patients and prayer amid medical practice

It’s more important than ever to recognize and understand cultures and spiritual beliefs, including and beyond the end of life. More

How to address spirituality issues at the end of life
To provide patients truly compassionate care, physicians need to look beyond the medical aspects of dying. (June 2003)

'The last taboo'
Making the case for bringing religion to patient care (July/August 1997)

How housestaff blend spirituality and science
Religion is largely ignored in medical training, but bringing the subject to the fore can benefit patients and residents (December 1995)

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