Items in AFP with MESH term: Ethics, Medical

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Making Decisions with Families at the End of Life - Article

ABSTRACT: Because advance directives are not yet the norm, end-of-life decisions for patients without medical decision-making capacity are made regularly within discussions between the patient's physician and family. Communication and decision making in these situations require a complex integration of relevant conceptual knowledge of ethical implications, the principle of surrogate decision making, and legal considerations; and communication skills that address the highly charged emotional issues under discussion. The most common pitfalls in establishing plans of care for patients who lack decision-making capacity include failure to reach a shared appreciation of the patient's condition and prognosis; failure to apply the principle of substituted judgment; offering the choice between care and no care, rather than offering the choice between prolonging life and quality of life; too literal an interpretation of an isolated, out-of-context, patient statement made earlier in life; and failure to address the full range of end-of-life decisions from do-not-resuscitate orders to exclusive palliative care.


Screening for Cancer: Evaluating the Evidence - Article

ABSTRACT: Many patients expect to undergo screening tests for cancer. In evaluating screening procedures, physicians must take into account the known effects of lead time, length and screening biases, all of which can result in an overestimation of the benefits of screening. The gold standard by which a screening test is evaluated remains the prospective, randomized controlled trial, demonstrating reduced morbidity and mortality. The magnitude of benefit from screening is best expressed in terms of the number of patients needed to screen. This value ranges from approximately 500 to 1,100 for proven screening interventions. These concepts are illustrated by controversies in current screening recommendations for cancers of the cervix, lung, colon, breast and prostate, which together account for more than 50 percent of cancer deaths in the United States.


Placebo and Placebo Effects: Practical Considerations, Ethical Concerns - Curbside Consultation


Ethical Considerations of Patients with Pacemakers - Curbside Consultation


Two Ways of Looking at a Healthy Practice - Editor's Page


Paging Dr. Colombo: When Physicians Become Instruments of the Law - Opinion


The Power of Apology - The Last Word


Providing Basic Spiritual Care for Patients: Should It Be the Exclusive Domain of Pastoral Professionals? - Medicine and Society


Spirituality and Medical Practice: A Look at the Evidence - Editorials


A Major Medical Error - Curbside Consultation


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