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Clinical Discussion of Medical Aid-in-Dying: Minimizing Harms and Ensuring Informed Choice

March 23, 2021
Objective The implementation of medical aid-in-dying (MAID) poses new challenges for clinical communication and counseling. Among these, health care providers must consider whether to initiate a discussion of MAID with eligible patients who do not directly ask about it. Norms and policies concerning this issue vary tremendously across jurisdictions where...

Reconsidering Scarce Drug Rationing: Implications for Clinical Research

March 15, 2021
Hospital systems commonly face the challenge of determining just ways to allocate scarce drugs during national shortages. There is no standardised approach of how this should be instituted, but principles of distributive justice are commonly used so that patients who are most likely to benefit from the drug receive it....

The Costs of Contradictory Messages About Live Vaccines in Pregnancy

February 10, 2021
The increased risk of harm from COVID-19 infection in pregnancy highlights the importance of including pregnant people in COVID-19 vaccine development and deployment. Promising vaccines being developed include replication-competent platforms, which are typically contraindicated during pregnancy because of theoretical risk. However, replicating vaccines are administered in and around pregnancy, either...

Surrogate Decision Making for Incarcerated Patients

May 21, 2019
When patients are too ill to make their own health care decisions and lack a previously designated decision maker, identifying the appropriate surrogate can be a complex process. For example, clinicians may use surrogacy ladders (hierarchical lists of individuals who could serve as decision makers), which are delineated in state...

Attitudes Toward Genetics and Genetic Testing Among Participants in the Jackson and Framingham Heart Studies

May 9, 2019
Genetic analysis has become integral to many large cohort studies. However, little is known about longitudinal cohort study participants’ attitudes toward genetics and genetic testing. We analyzed data from a survey of participants in the Jackson Heart Study (n = 960), Framingham Heart Study (n = 955), and Framingham Heart...

Educating Resident and Fellow Physicians on the Ethics of Mechanical Circulatory Support

May 8, 2019
Mechanical circulatory support (MCS) such as extracorporeal membrane oxygenation, left ventricular assist devices and total artificial hearts have altered the natural history of heart failure, and specialists in the fields of cardiology and cardiothoracic surgery are faced with more complex ethical considerations than ever before. Residency and fellowship training programs,...

When Clinical Advances Outpace Ethics

May 2, 2019
In the United States, about 6.5 million adults are living with heart failure, and about half of those patients will die within 5 years of diagnosis.1 For patients with advanced chronic heart failure or acute unrecoverable decompensation, heart transplantation offers a cure. However, the number of patients with end-stage heart...

Health Care Providers’ Experiences with Implementing Medical Aid-in-Dying in Vermont: A Qualitative Study

February 19, 2019
The legal landscape for medical aid-in-dying (AID) in theUSA has shifted dramatically over the past 5 years. Vermont(2013), California (2015), Colorado (2016), the District ofColumbia (2016), and Hawaii (2018) have joined Oregon(1997), Washington (2008), and Montana (2009) in permittingphysicians to prescribe a lethal dose of medication to a termi-nally ill...

Caring for the Wounded—the Ethics of Trauma Surgery

May 1, 2018
In a fraction of a second, trauma changes us. Trauma injures organs, fractures bones, and makes us bleed, but it also leads to suffering, demoralization, and fear. While physical injuries can often be neatly classified, emotional and spiritual injuries cannot. These burdens are shouldered by many, not just those who...

Lack of Information on Surgical Care for Incarcerated Persons

April 18, 2018
With 2.2 million incarcerated people, the United States imprisons more people than any other country in the world.1 This mass incarceration is recent, arising from the war on drugs and punitive sentencing policies that began in the 1970s.1 Ethnic minorities and the poor have been disproportionately affected by this increase:...