David Barnard

Ethical considerations in the conduct of electronic surveillance research.

The extant clinical literature indicates profound problems in the assessment, monitoring, and documentation of care in long-term care facilities. The lack of adequate resources to accommodate higher staff-to-resident ratios adds additional urgency to the goal of identifying more cost-effective mechanisms to provide care oversight. The ever expanding array of electronic monitoring technologies in the clinical research arena demands a conceptual and pragmatic framework for the resolution of ethical tensions inherent in the use of such innovative tools. CareMedia is a project that explores the utility of video, audio and sensor technologies as a continuous real-time assessment and outcomes measurement tool. In this paper, the authors describe the seminal ethical challenges encountered during the implementation phase of this project, namely privacy and confidentiality protection, and the strategies employed to resolve the ethical tensions by applying principles of the interest theory of rights.

The Introduction of Palliative Care in Uganda

Hospice Uganda was established in Kampala, September 27, 1993. Since then the hospice has served over 3,000 patients with cancer, and referrals of patients with HIV/AIDS are increasing steadily. The concepts of hospice and palliative care are well accepted in Uganda, but the delivery of services has been severely constrained by limited resources. Possibilities for growth, both in service provision and education of health professionals, were improved significantly with the incorporation of palliative care objectives into the Ministry of Health 5-year strategic plan.

Teaching palliative care to critical care medicine trainees

ObjectivesPalliative care is an important component of critical care medicine. Few fellowship programs have developed a curriculum designed to teach palliative care precepts to trainees. We describe our 2-yr experience in teaching palliative care to multidisciplinary critical care medicine fellows. DesignTwo-consecutive-year palliative care training for unselected critical care medicine fellows at a large, urban, university, tertiary care medical center. InterventionsWe 1) identified palliative care skills and knowledge that first-year critical care fellows should acquire; 2) developed a curriculum to teach those skills and knowledge, including required readings, small group lectures and skills sessions that included role-playing to modify skills and attitudes, and (in year 2) experiential learning on a hospital-based palliative care rotation; and 3) attempted to evaluate the curriculum with attitude and knowledge assessments. ResultsA total of 35 fellows participated in the palliative care training during the 2 yrs reported. Seven fellows participated in a clinical rotation in palliative care. Fellows evaluated usefulness of the small group sessions between 4.4 and 4.9 on a 5-point Likert scale. Four of seven fellows rated the clinical rotation quality at 3/5. Pretest and posttest knowledge mean scores were 58% and 69%, respectively. Problems included providing time for fellows to participate in the clinical rotation and negative attitudes regarding the relevance of palliative care to their future in critical care. ConclusionsPalliative care training for critical care fellows is feasible. Fellows value skills training more than a clinical rotation in palliative care. Baseline knowledge of palliative care is low.

Advances in Palliative Care in Latin America and the Caribbean: Ongoing Projects of the Pan American Health Organization (PAHO)

The Pan American Health Organization (PAHO) is engaged in field demonstration projects in Latin America and the Caribbean to expand the availability and effectiveness of palliative care services. Workshops and calls for proposals address the multiple causes of inadequate palliative care services that are typical for countries in the developing world. These include regulatory barriers and drug interdiction policies that interfere with the medical use of opioids, lack of education among health professionals, and insufficient palliative care infrastructure.

Teaching Medical Ethics in its Contexts: Penn State College of Medicine.

&NA; Ethics teaching at The Pennsylvania State University College of Medicine began when the medical school accepted its first students in 1967. The ethics program co‐evolved with the school and the Department of Humanities without guidelines or models, since neither medical ethics nor medical humanities had yet been invented as fields of study. The focus of the article is on two key differences between the Penn State ethics program and most other such programs: the teaching of medical ethics within the context of other issues of value and meaning in medicine, and the fact that the humanities faculty is involved in the activities and structures of the medical center of which the medical school is a part. The authors close with a description of successful factors in their program that they maintain could apply to other programs.

The Physician as Priest, Revisited

Despite much resistance from the medical profession, the notion persists in our culture that the physician plays a priestly role. Medical resistance must be taken seriously. It stems from legitimate concerns that the priestly role implies an unwelcome broadening of medical responsibilities, expectations of moral expertise, and being on the receiving end of peoples most intense existential hopes. On the other hand, the nature of illness and healing makes it inevitable that physicianswill take on ministerial functions in their medical work. This essay attempts to recover the notion of the physician as priest on the basis of theological and religious reflection on the nature of ministry and pastoral care.

Politics, palliation, and Canadian progress in end-of-life care.

How do health care consumers, private sector organizations, professionals, and government agencies work toward ensuring quality end-of-life care? This challenge is by no means uniquely Canadian; our approach may thus have applications that extend well beyond our national borders. Raising the profile of palliative care in Canada has occurred on many fronts. Local, provincial, and national efforts in end-of-life care have long been underway. The Canadian Palliative Care Association has been particularly active, recently organizing various stakeholder groups to develop a strong national advocacy partnership for quality end-of-life care. Perhaps most distinctive has been the involvement and nationwide visibility of Canadas Senate. Their report, Quality End-of-Life Care: The Right of Every Canadian has seen Canadian palliative care gain unprecedented momentum. The federal government recently took the unprecedented step of creating a new office to represent palliative care within the federal cabinet. In Canada, it would appear that palliative care is an idea whose time has come.

“Ship? What Ship? I Thought I was Going to the Doctor!”: Patient-Centered Perspectives on the Health Care Team

Whatever other virtues it may have, the leading metaphor of this volume is definitely not patient-centered. The image of the physician as the captain of a ship, or of illness and treatment as an ocean voyage requiring the coordination of deck-hands, mates, officers, and nautical machinery, is a bureaucrat’s image. It reflects a preoccupation with administrative structure, organizational behavior, and the rational deployment of people and technology. It does not reflect the patient’s experience of illness.

Illness as a crisis of meaning: Psycho-spiritual agendas in health care

The term “psychosocial” has come to refer to a host of issues in health care. Its wide, indiscriminate usage in referring to almost any non-biophysical aspect of illness obscures or distorts the experience of illness as a “crisis of meaning.” The term “psycho-spiritual agenda” is introduced to emphasize the problems of meaning associated with illness, and to avoid the potential reductionism, pathological skew, and interventionist bias of conventional “psychosocial” analyses of the illness experience.

Living with doubt

Imagine yourself lying semi-comatose in an intensive care unit (ICU) bed, attached to a ventilator, seven days after a severe stroke. Even before the stroke you have been moderately disabled by som...