Consideration of what constitutes sufficient information about how donation protocols can interfere with a patient’s dying process is a key feature of consent processes.
AMA J Ethics. 2018;20(8):E708-716. doi:
10.1001/amajethics.2018.708.
Clinical momentum—increasingly aggressive treatment in intensive care settings that can violate a patient’s wishes—is charged by ritually intensifying efforts to “save” a patient, reimbursement patterns that privilege acute interventions, and technology-driven health care.
AMA J Ethics. 2018;20(8):E732-737. doi:
10.1001/amajethics.2018.732.
As billable procedures, advance care planning (ACP) conversations need measurable outcomes and training support. Integrating ACP into standard practice is key to ensuring clinicians deliver care that matters to patients.
AMA J Ethics. 2018;20(8):E750-756. doi:
10.1001/amajethics.2018.750.
Alexander Craig, MPhil and Elizabeth Dzeng, MD, PhD, MPH
Eliciting the patient’s motives and goals and helping the patient and her loved ones explore alternatives are essential to maintaining trusting relationships and open communication.
AMA J Ethics. 2018;20(8):E690-698. doi:
10.1001/amajethics.2018.690.
Physicians new to a case might object to an established care plan. Practice variation, clinical momentum, and how value is assigned by different parties to acute care and comfort measures can each contribute to conflict in these cases.
AMA J Ethics. 2018;20(8):E699-707. doi:
10.1001/amajethics.2018.699.
Awareness of transference reactions, practicing active listening and reflection, pausing, and articulating one’s understanding of another’s emotional motivations can help cultivate deeper patient-clinician relationships at the end of life.
AMA J Ethics. 2018;20(8):E717-723. doi:
10.1001/amajethics.2018.717.
Mark Pfeifer, MD and Barbara A. Head, PhD, CHPN, ACSW
Interdisciplinary support, securing reliable information from a patient’s health record, and taking a “who, what, when, where, and how” approach to conversation can improve care planning with dying patients and their loved ones.
AMA J Ethics. 2018;20(8):E724-731. doi:
10.1001/amajethics.2018.724.
End-of-life conversations can be delayed by some physicians’ emotional investment in their patients, as in this case of patient with new onset refractory status epilepticus.
AMA J Ethics. 2018;20(8):E782-786. doi:
10.1001/amajethics.2018.782.
Undocumented patients in the United States with end-stage renal disease receive “compassionate” dialysis. Such patients oscillate between being marginally well and “ill enough” to receive dialysis while clinicians wrestle with complicity in a system that both offers and withholds life-saving therapy.
AMA J Ethics. 2018;20(8):E778-779. doi:
10.1001/amajethics.2018.778.
