Medicine (Abingdon, England : UK ed.)最新文献

Alcohol dependence is commonly encountered in clinical practice. Accurate diagnosis using structured screening tools facilitates appropriate intervention, early screening for liver disease and referral to specialist services and mutual aid. For patients admitted to hospital, assessment of the risk of withdrawal and assertive treatment with benzodiazepines, particularly in the first 24 hours, improves patient safety by preventing withdrawal complications such as seizures and delirium. Similarly, detecting individuals at risk of, or who have, Wernicke–Korsakoff syndrome, and prescribing parenteral thiamine in adequate quantities, prevents the development of long-standing cognitive impairment. Hospital admission is an opportunity for reflection and building motivation for behaviour change, and efforts to engage with patients, establish what successes they have had in their recovery journey, and link them into local specialist and peer-led support structures ensures they have the best chance of lasting recovery.

This article explores the rapid shift of genomic technologies from biomedical research to medical applications. This has led to the development of precision medicine, which can use genetic testing, gene therapy and gene editing for targeted care based on genetic information. The evolution of this targeted approach has advanced from using genetic information to inform care to developing care tailored to individual genomic information. Physicians are compelled to integrate genomic technologies for optimal patient care. Through multiple case studies, the authors highlight ethical considerations that physicians face when incorporating these technologies, emphasizing informed consent for transparent integration. Subsequently, addressing broader societal concerns, the article underscores the importance of equitable access. This exploration aims to provide physicians with a foundation to ethically facilitate access to these technologies that meet the needs of all patients.

Religion, belief and culture should be recognized as potential sources of moral purpose and personal strength in healthcare, enhancing the welfare of both clinicians and patients amidst the experience of ill-health, healing, suffering and dying. Communication between doctors and patients and between healthcare staff should attend sensitively to the welfare benefits of religion, belief and culture. Doctors should respect personal religious and cultural commitments, taking account of their significance for treatment and care preferences. Good doctors understand their own beliefs and those of others. They hold that patient welfare is best served by understanding the importance of religion, belief and culture to patients and colleagues. The sensitive navigation of differences between people's religions, beliefs and cultures is part of doctors' civic obligations and in the UK should follow the guidance of the General Medical Council and Department of Health and Social Care. In particular, apparent conflict between clinical judgement or normal practices and a patient's culture, religion and belief should be considered carefully. Doctors' own religion or culture may play an important role in promoting adherence to this good practice, complementing the role of chaplaincy. In all matters, doctors' conduct should be governed by the law and arrangements for conscientious objection that are in effect. The strongest ethical arguments in favour of conscientious objection provisions concern the moral integrity of professionals, the objectives and values of the medical profession, the nature of healthcare in liberal democracy and the welfare of patients. In practice, arguments mounted against conscientious objection have not been found persuasive.

In this article I briefly consider the limitations of principlism, before considering how elements of Kant's philosophy can support medical ethics. I highlight the difference between the medical profession and other jobs, and consider how Kant's political philosophy potentially offers support to universal healthcare. I then consider how science and technology studies are essential for a more robust approach toward biomedical ethics.

Consent is central to the delivery of healthcare, and all healthcare professionals must obtain consent before proceeding with any interventions. The nature of informed consent allows the patient to fully participate in any proposed healthcare interventions. Informed consent requires high-quality information to be given that enables the patient to fully understand all the benefits as well as the risks associated with proposed interventions. This approach respects the right of the patient to self-determine what happens to their body provided they have the relevant capacity to understand the nature of the proposed intervention. Although consent may be seen as a procedural ‘must’, the importance of the dialogue that takes place between the patient and the clinician is what determines the validity of the consent as advocated by the Supreme Court ruling in Montgomery v Lanarkshire Health Board (Scotland) [2015]. It is noted that the number of legal cases related to consent has risen since the Montgomery decision.

The essence of risk communication is to provide patients with a clear understanding of the benefits, harms, trade-offs and uncertainties of any proposed treatment. Doctors often assume that they do this well but can overestimate the comprehension of even well-educated patients. We all make complex decisions using intuitive and deliberative thinking and there are hidden sources of bias in decision-making that apply to both doctor and patient. Recent research suggests that patients are best equipped to understand risk when they are simply able to ‘get the gist’ of the risks involved in their treatment as accurately as possible. This can be achieved by a process of thinking out loud in which the doctor outlines the nature of the problem and the factors they think might be important to the individual patient, while checking carefully for shared understanding along the way. We have an ethical obligation to keep on developing skills in how to convey knowledge with honesty, empathy and respect.

This is an overview of issues relating to consent in donation and transplantation, including the types of consent currently in use in organ donation. There is a discussion of altruistic consent, opt-in, opt-out and deemed consent, and mandated choice. Donation of organs after cardiac death and after brain death is described. Reference is made to current guidance from the UK National Health Service, the Human Tissue Authority, the UK Government and the Spanish model of Organ Donation and Transplantation.

End-of-life care has always been prominent in discussions of clinical ethics. Almost 30% of hospital inpatients are in their last year of life. Doctors frequently encounter people with end-of-life care needs and should to be equipped to respond. However, what has been written about it leaves many doctors, other healthcare workers and the public uncertain and confused. What key things should doctors know and understand? The principles are the same as in any area of medicine, but they have to be applied in a different context. Some goals (e.g. long-term survival) can no longer be achieved, but new ones (e.g. new ways to improve quality of life) become available. By clearly understanding the ethics, we can learn how to do good end-of-life care. This article addresses key areas including why ethics matters in end-of-life care, how to apply familiar principles, how we can overcome barriers to respect for autonomy, applying the doctrine of double effect and understanding the application of ethics in the last days of life. It also gives pointers to further detailed reading.

In this article, the authors look at the current literature and studies around ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) discussions and decisions, and how the global coronavirus disease (COVID-19) pandemic brought increased focus on this area of practice. For patients with incurable, advancing illness, having discussions to ascertain their views about CPR, and suggesting and instituting advance care planning measures such as ‘Do Not Attempt CPR’ forms, is becoming part of normal practice in medical settings. Yet all decisions must be individualized to each patient. There was evidence of increased decision-making regarding DNACPR during the pandemic, with concerns raised in the press and on social media. Here, we discuss how this has changed with the global COVID-19 pandemic, where concerns about blanket decision-making and lack of candour in discussing DNACPR decisions with patients and those close to them were raised.