Basic information about the two principal instruments used for assessing patients' decision-making competence and learn why both fall short of reliable, objective assessment.
Specific advocate guidelines are needed for the protection of children in state custody who are potential research subjects in trials that would expose them to greater-than-minimal risk but also hold the prospect of direct benefit.
Chris Feudtner, MD, PhD, MPH, David Munson, MD, and Wynne Morrison, MD
The way that we choose how to frame the conversation with parents about halting or continuing such therapy for their children who will not recover has special importance in medicine and in society.
In “Ethics of International Research: What Does Responsiveness Mean?” Christine Grady explains how developing countries are vulnerable to exploitation by researchers and explores what “responsiveness” to the needs of those populations might entail.
Frank A. Chervenak, MD and Laurence B. McCullough, PhD
Clinical facts and physicians’ ethical obligations are critical in resolving disagreements between parents and physicians about resuscitation of an extremely premature infant.
Nonlegal, judicial, and statutory courses of action are available to patient surrogates and physicians who cannot agree on withdrawal of life-sustaining treatment.
Clinical trials for the blood substitute PolyHeme exposed the possibility for ambiguous interpretation of the FDA’s waiver of informed consent for emergency research.
Physicians need to manage expectations and clearly explain the prognosis of ICU patients to their families, particularly when the outcome is a negative one.
Lorraine M. Stone, MD, MSPH and James A. Tulsky, MD
Physicians should develop a specific strategy for talking to relatively healthy patients about their CPR preferences in the event they become seriously ill in the future.
Physicians and surrogates should take patients' preferences into account in making clinical intervention decisions, even if the patients have been found to lack decision-making capacity.