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DECISION MEDICALE

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Cardiopulmonary resuscitation, informed consent, and rescue - what provides moral justification for the provision of CPR?

BESTER, Johan ; KODISH, Eric
The journal of clinical ethics, 2019, vol.30, n°1, p. 67-73

Thème : Ethique et déontologie.

REANIMATION ; CONSENTEMENT ECLAIRE ; TESTAMENT VIE ; ETHIQUE SOIN ; PRISE DECISION ; DECISION MEDICALE

Questions related to end-of-life decision making are common in clinical ethics and may be exceedingly difficult. Chief among these are the provision of cardiopulmonary resuscitation (CPR) and do-not-resuscitate orders (DNRs). To better address such questions, clarity is needed on the values of medical ethics that underlie CPR and the relevant moral framework for making treatment decisions. An informed consent model is insufficient to provide justification for CPR. Instead, ethical justification for CPR rests on the rule of rescue and on substituted interest judgments. Patients' known wishes and values are relevant, particularly in protecting them from unwanted CPR. Clinicians should rescue patients with the means at their disposal, as a prima facie moral imperative, unless there are compelling reasons to refrain. We present a moral framework for making decisions regarding CPR and DNR.

Origine : PubMed

Assessing relationships between Muslim physicians' religiosity and end-of-life health-care attitudes and treatment recommendations - an exploratory national survey

DUIVENBODE, Rosie ; HALL, Stephen ; PADELA, Aasim I.
The American journal of hospice and palliative care, 27/02/2019, Pagination inconnue

Thème : Soins.

MEDECIN ; ISLAM ; ATTITUDE ; FIN VIE ; ETATS-UNIS ; DECISION MEDICALE

BACKGROUND: Research demonstrates that the attitudes of religious physicians toward end-of-life care treatment can differ substantially from their nonreligious colleagues. While there are various religious perspectives regarding treatment near the end of life, the attitudes of Muslim physicians in this area are largely unknown.
OBJECTIVE: This article attempts to fill in this gap by presenting American Muslim physician attitudes toward end-of-life care decision-making and by examining associations between physician religiosity and these attitudes.
METHODS: A randomized national sample of 626 Muslim physicians completed a mailed questionnaire assessing religiosity and end-of-life care attitudes. Religiosity, religious practice, and bioethics resource utilization were analyzed as predictors of quality-of-life considerations, attitudes regarding withholding and withdrawing life-sustaining treatment, and end-of-life treatment recommendations at the bivariate and multivariable level.
RESULTS: Two-hundred fifty-five (41% response rate) respondents completed surveys. Most physicians reported that religion was either very or the most important part of their life (89%). Physicians who reported consulting Islamic bioethics literature more often had higher odds of recommending active treatment over hospice care in an end-of-life case vignette. Physicians who were more religious had higher odds of viewing withdrawal of life-sustaining treatment more ethically and psychologically challenging than withholding it and had lower odds of agreeing that one should always comply with a competent patient's request to withdraw life-sustaining treatment.
DISCUSSION: Religiosity appears to impact Muslim physician attitudes toward various aspects of end-of-life health-care decision-making. Greater research is needed to evaluate how this relationship manifests itself in patient care conversations and shared clinical decision-making in the hospital.

Origine : PubMed