Bioethics

Approaching Ventilator Withdrawal

The decision to extubate a patient who is ventilator-dependent is usually difficult. Problems may arise in communication with the patient and/or family, issues of differences in beliefs and culture with regard to life-sustaining treatment, certainty of prognosis, practical issues of location (in the ICU, on a med-surg floor, at home, or referral to a hospice inpatient care center) and care delivery. The following case illustrates some of these.

Challenging Symptoms? Expert Advice.

“In California, 75 percent of adults over 65 have at least one chronic condition that requires ongoing care. And in just three years, the nation’s 78 million Baby Boomers will begin turning 65.” (The Institute of Medicine of the National Academies, May 2008)

Myrtle’s Story

[Click Here to Access the 2009 California POLST Form in PDF]

Model Hospital Policy on Non-beneficial Treatment and Conflict Resolution

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I. Abstract

Frequently, conflicts arise when parties disagree on the best course of action in the care of a patient. If the treating team believes that:

Model Policy on “Non-beneficial Treatment”

[Click here to go to SDCMS' Bioethics Commission "Model Hospital Policy on Non-beneficial Treatment and Conflict Resolution."]

With Liberty and Justice for All

Note: May I acknowledge my belief (and bias), based on my life experience, that a single-payer system would best serve the nation.

Liberty and justice. Let us look at each of these two core values of the American experience in light of the current access to healthcare crisis.

July 2009 "San Diego Physician" • Ethics in Medicine

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Features With Liberty and Justice for All Ellen Beck, MD Approaching Ventilator Withdrawal Laurel H. Herbst, MD, and Steven Oppenheim, MD Commercial Credit Is Available Benjamin Pimentel Eric J. Topol, MD Pandemics Brian Snyder, MD Reflections on Leaving San Diego Joseph E. Scherger, MD, MPH Remembering Jan Niousha Moini, MS IV Challenging Symptoms? Expert Advice. Laurel H. Herbst, MD Myrtle’s Story Adapted by Lynette Cederquist, MD, and Paula Goodman-Crews Charging for Medical Record Copies • Reporting Tuberculosis • Buying the "CPLH" Marisol Gonzalez You’ve Reported a Disease to Public Health Michele M. Ginsberg, MD Model Hospital Policy on Non-beneficial Treatment and Conflict Resolution SDCMS Bioethics Commission Model Policy on “Non-beneficial Treatment” Lynette Cederquist, MD Interview With Nick Macchione, MS, MPH, FACHE "San Diego Physician"

Physician Assistance-in-Dying

This past June, testimony from the California Medical Association contributed to a missed opportunity for California patients and their physicians. Legal counsel for CMA told members of the Senate Judiciary Committee that AB 651, the California Compassionate Choices Act, would be bad medicine. By a 3-to-2 vote, the committee killed the bill. Speaking as a doctor who has practiced medicine in this state for 36 years, I think that’s a shame.

A 68-year-old Man Is Hospitalized With Acute Stroke

Ethics Case: 68-year-old man is hospitalized with acute stroke after collapsing on the golf course. Upon admission, patient was treated with TPA. His stroke subsequently became hemorrhagic, requiring emergent craniotomy. The patient never regained consciousness. After two weeks, his wife consented for tracheostomy and gastrostomy tube insertion. One month after admission, he remains unresponsive. He has non-purposeful movements of his left side. He does not follow commands. His pupils are equal but unresponsive to light.

Whether or Not to Engage in Further Treatment

Reason for Bioethics Consultation