Evan G. DeRenzo

Scarce resources for nuclear detonation: project overview and challenges.

Aterrorist nuclear detonation of 10 kilotons would have catastrophic physical, medical, and psychological consequences and could be accomplished with a device in a small truck. Tens of thousands of injured and ill survivors and uninjured, concerned citizens would require medical care or at least an assessment and instructions. In proximity to the incident location, there would be a huge imbalance between the demand for medical resources and their availability.1-3 Beyond the immediate blast area, much of the infrastructure would remain intact. Most people would reach medical care by selfreferral and require sorting and assessment to determine what medical intervention is necessary, appropriate, and possible.

Medical Planning and Response for a Nuclear Detonation: A Practical Guide

This article summarizes major points from a newly released guide published online by the Office of the Assistant Secretary for Preparedness and Response (ASPR). The article reviews basic principles about radiation and its measurement, short-term and long-term effects of radiation, and medical countermeasures as well as essential information about how to prepare for and respond to a nuclear detonation. A link is provided to the manual itself, which in turn is heavily referenced for readers who wish to have more detail.

Curbside consultation re-imagined: Borrowing from the conflict management toolkit

Curbside ethics consultations occur when an ethics consultant provides guidance to a party who seeks assistance over ethical concerns in a case, without the consultant involving other stakeholders, conducting his or her own comprehensive review of the case, or writing a chart note. Some have argued that curbside consultation is problematic because the consultant, in focusing on a single narrative offered by the party seeking advice, necessarily fails to account for the full range of moral perspectives. Their concern is that any guidance offered by the ethics consultant will privilege and empower one party’s viewpoint over—and to the exclusion of—other stakeholders. This could lead to serious harms, such as the ethicist being reduced to a means to an end for a clinician seeking to achieve his or her own preferred outcome, the ethicist denying the broader array of stakeholders input in the process, or the ethicist providing wrongheaded or biased advice, posing dangers to the ethical quality of decision-making. Although these concerns are important and must be addressed, we suggest that they are manageable. This paper proposes using conflict coaching, a practice developed within the discipline of conflict management, to mitigate the risks posed by curbside consultation, and thereby create new “spaces” for moral discourse in the care of patients. Thinking of curbside consultations as an opportunity for “clinical ethics conflict coaching” can more fully integrate ethics committee members into the daily ethics of patient care and reduce the frequency of ethically harmful outcomes.

Hiring a Hospital Staff Clinical Ethicist: Creating a Formalized Behavioral Interview Model

This paper presents the behavioral interview model that we developed to formalize our hiring practices when we, most recently, needed to hire a new clinical ethicist to join our staff at the Center for Ethics at Washington Hospital Center.

Building Clinical Ethics Expertise through Mentored Training at the Bedside

Shadowing in clinical ethics is the activity that most closely mimics the kind of mentored learning that clinicians of other varieties, such as physicians, nurses, and respiratory therapists, go through before such clinicians are let loose to independently care for patients. Regardless of how much academic training one may have, without shadowing an experienced clinical ethicist the inexperienced clinical ethicist has no hope of developing real expertise. Acting in clinical ethics on one’s own accord is possible, even perhaps the norm. It is, however, dangerous to patients, families, institutions and the profession. Without some semblance of the kind of mentored training all clinicians obtain, expertise in clinical ethics will be elusive. The chapter concludes with what shadowing entails, addresses how long the author recommends shadowing continue before budding clinical ethicists begin creeping towards independence, why independence does not yet equate with expertise, and when mastery might be expected.

Journey to Refine Acute Care Hospital Process Improvement Projects for Ethically Complex Patients: Applying Complexity Tools to the Problem of Identifying Which Patients Need a Little More Attention than Most

Clinical medicine and clinical medicine ethics differs from clinical research and clinical research ethics, primarily, in that clinical medicine is much messier. That is, clinical research seeks to avoid confounders in the study by stripping the study population of as many extraneous variables as is safe for the research participants. In clinical medicine, there is no such correlate. The messiness of clinical medicine is simply a fact of patient care that contributes majorly to the medical, psychosocial, and ethical complexities of the care of clinical patients.