Jacqueline J. Glover

Dialysis patients' preferences for family-based advance care planning.

Patients generally do not want to participate in advance care planning with physicians. On the basis of face-to-face interviews with dialysis patients, this study found that most patients wanted to...

Professionalism in Pediatrics

The purpose of this report is to provide a concrete overview of the ideal standards of behavior and professional practice to which pediatricians should aspire and by which students and residents can be evaluated. Recognizing that the ideal is not always achievable in the practical sense, this document details the key components of professionalism in pediatric practice with an emphasis on core professional values for which pediatricians should strive and that will serve as a moral compass needed to provide quality care for children and their families.

An Overview of Allocation and Rationing: Implications for Geriatrics

Geriatricians are faced with increasing pressure from insurers and the public to control costs. At the same time, sub‐specialist colleagues, patients, and the courts often demand ever more costly high‐technology interventions. This conflict will only intensify given the sustained increase in the percentage of GNP spent on medical care. A number of prominent biomedical ethicists and others have explored rationing of medical care services as one response to these concerns.

Ethical Issues in Treating Infants With Very Low Birth Weight

The purpose of this report is to provide pediatric surgeons with an ethical framework and a process for ethical decision making that can be applied to the difficult issues that arise in the care of infants with very low birth weight (VLBW). Clinical ethical issues focus around choices for surgical intervention, the use of total parenteral nutrition (TPN), recommendations for bowel transplantation, and management of dying infants. The role of family in decision making and the appropriate use of common distinctions including active or passive, withholding or withdrawing, and ordinary or extraordinary in decisions about life-sustaining treatments are discussed. A clinical case discussion illustrates the application of the process for ethical decision making.

Rationing dialysis in the United States: possible implications of capitated systems.

The application of managed care to dialysis raises concerns that dialysis will be rationed in the United States. Rationing means the implicit or explicit denial of beneficial or marginally beneficial medical treatment as a result of insufficient resources to provide treatment to all. In this era of cost containment and budget cutting, rationing appears inevitable in the end-stage renal disease program because of its continued growth in numbers and cost and because many are questioning the benefit of dialysis to certain groups of patients. Rationing according to social worth, ability to pay, or age is not ethically justifiable, but it is justified to ration according to medical benefit. There is an important role for guidelines developed with broad input from patients, families, health care professionals, ethicists, health policy experts, and payers. Consensus statements exist in the literature, and the nephrology community is in the process of developing practice guidelines that will be available for future use. In the meantime, managed care companies should look to broader community input in the form of consensus statements and community dialogue. Managed care companies will need ethics committees to ensure that their policies and procedures for rationing are fair, principled, and subject to review and appeal.

Caring for the dying child.

In this paper we discuss the nutritional needs of terminally ill children. We delineate the physical, psychological, and developmental characteristics of children that differentiate them from adults vis a vis the nutritional aspects of their care. We highlight the special role of parents and suggest guidelines for dealing with the common nutritional needs of the dying child. We discuss ethical issues emphasizing the Baby Doe regulations, decision making for minors, and the benefits and burdens associated with permanently unconscious children.

Ethics and the Identification and Response to Child Abuse and Neglect

Healthcare professionals, communities, and families face ethical issues as they struggle to make good choices on behalf of children who may be victims of child abuse and neglect. This chapter includes the identification of an ethical framework and its application to the following clinical issues: thresholds of mandatory reporting (including three sample cases), family as decision makers, end-of-life decision making, visitation and placement, funding priorities, research, and two emerging and controversial issues of reporting pregnant women whose substance use behaviors put their fetuses at risk and obesity as medical neglect.