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New York City is on the cutting edge with a very controversial program. It has two centers operating as overdose prevention centers, where individuals can come who are using drugs [...]

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2010.03031.x Byline: Peter P. Reese (*[dagger][double dagger]), Arthur L. Caplan (s.), Roy D. Bloom (*), Peter L. Abt ([parallel]), Jason H. Karlawish (s.#) Keywords: health policy; kidney transplantation; geriatrics Abstract: Competing visions for health reform in the United States and renewed interest in health technology assessment (HTA) have led to fierce national debates about the appropriateness of rationing. Because of a limited supply of organs, kidney transplantation has always required rationing and overt discussion of the ethics that guide it, but the field of transplantation has also contended recently with internal calls for a new rationing system. The aim of the Life Years from Transplantation (LYFT) proposal is to allocate kidneys to patients who obtain the greatest survival benefit from transplantation, which would lengthen the lives of kidney transplant recipients but restrict the ability of older Americans to obtain a transplant. The debate around the LYFT proposal reveals the ethical and policy challenges of identifying which patients should receive a treatment based on the results of cost-effectiveness and other HTA studies. This article argues that attempts to use HTA for healthcare rationing are likely to disadvantage older patients. Guiding principles to help ensure that resources such as kidneys are justly allocated across the life span are proposed. Author Affiliation: From the(*)Renal Division (#)Division of Geriatrics, Department of Medicine ([dagger])Center for Clinical Epidemiology and Biostatistics ([double dagger])Leonard Davis Institute of Health Economics (s.)Department of Medical Ethics ([parallel])Transplant Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Article note: Address correspondence to Peter P. Reese, Renal Division, HUP, 1 Founders, 3400 Spruce Street, Philadelphia, PA 19104. E-mail: Peter.Reese@uphs.upenn.edu

In 2006, the National Conference of Commissioners on Uniform State Laws rewrote the Uniform Anatomical Gift Act. To overcome the problem of family members prohibiting organ donation from their deceased loved ones even when a donor card existed, the commissioners modified the act to prevent end-of-life care from precluding organ donation. An unintended consequence of the new wording creates the potential for end-of-life care that prioritizes care of the potential donor organs over care and comfort of the dying person. The commissioners have now revised the act, but the original version has already been legislated in many states, with others poised to follow. To protect dying patients' wishes about their end-of-life care, states that have legislated or are considering the original act must replace it with the revised version. A longterm and important ethical precept must stand: Care of dying patients takes precedence over organs. Another laudable goal must be promoted as well: Organ donation is an important part of end-of-life care.

1 Many states have already passed Right-to-Try drug laws, which give critically ill patients the right to try medications that have not been approved by the US Food and Drug [...]

* Objective: To determine why Required Request policies, which mandate that hospitals request donation from donor-eligible families, have not resulted in increased organ procurement. * Setting: Stratified sample of 23 acute-care general hospitals in two metropolitan areas. * Design: Chart review identified all eligible donors in study hospitals during a 20-month period. Health care professionals who spoke with the families of eligible donors after death were interviewed to determine families' and health care providers' behaviors after patients' deaths with reference to the donation process. * Participants: All patient deaths (n = 10 681) were reviewed, and 841 donor-eligible cases were chosen for in-depth study; 1809 health care professionals who provided care to these patients were interviewed. * Measurements: The ability of health care providers to identify donor-eligible patients, approach families about donation, and obtain families' consent to donation. * Results: 83% of health care professionals correctly identified donor-eligible patients. The families of donor-eligible patients were approached about donation in 73.0% of the cases. Families were more likely to be approached about organ (86.6%) donation than either tissue (69.5%) or cornea (67.3%) donation (P < 0.001). The families of organ-eligible patients were less likely to be approached if the patient was female, was on a general medical or surgical floor, or was being cared for by internists. Only 46.5% of families of eligible donors agreed to donate organs, 34.5% agreed to donate tissues, and 23.5% agreed to donate corneas. * Conclusions: Although health care professionals do request that families donate, families consent to donation less frequently than was previously assumed. Empirically based education campaigns are needed so that health care professionals can improve their communication skills and so that discussion about this important issue can be stimulated among family members., Improved public health education may increase the low rate of organ and tissue donation. Legislation mandates that hospital staff inquire about the willingness to donate. Analysts interviewed 1,809 health care professionals in 23 acute-care hospitals with respect to their practice of requesting donations. Based on 841 eligible patient deaths, health care providers correctly identified more than 80 percent of eligible donors after the fact. Health care team members approached 86.6% of the families regarding organ donations. Families of patients who were younger, female, and received care in a medical or surgical ward received fewer donation requests. Tissue and cornea donation requests happened much less frequently, in about two-thirds of all eligible cases. Only 79 of 170 approached families agreed to donate organs. The overall willingness to donate was about 34%. More educational efforts need to address the reluctance of families to donate organs and tissues of their deceased.

Genes are being cloned and DNA tests developed at a dazzling pace. How will this explosion of information affect your relationship with patients? And how will you deal with the [...]

Parents have to be a moral compass in the kids' lives. Young children learn ethics from seeing what their parents do.

Few topics have attracted so many authors writing with such remarkable verve and conviction to no substantial effect as the question of what to do about the shortage of organs [...]

The article critiques the wellness industry, highlighting its financial burden on consumers without providing proven health benefits. Topics discussed include the overwhelming spending on unregulated wellness products, the lack of oversight from the U.S. Food and Drug Administration (FDA), and the need for healthcare professionals to engage patients in conversations about their wellness expenditures.

Oregon has legalized and implemented physician-assisted suicide, while observers argue about the moral import of attempting to formulate guidelines; the utility any set of guidelines can have for physician practice, health care providers, patients, or families; and whether guidelines can really protect against harm or abuse. What were once theoretical questions have taken on new urgency. The debate over the value and power of guidelines includes the following questions: What has been the experience of efforts to implement physician-assisted suicide using consensus guidelines? What goals are guidelines intended to serve? Who should formulate guidelines? What features should be reflected in any proposed guidelines to make them practical and to permit achievement of their goals? Are there any fundamental obstacles to the creation or implementation of guidelines? Is dying a process that is amenable to direction under guidelines, be they issued by physicians, departments of health, blue ribbon panels, or other regulatory bodies? This paper explores these questions as physician-assisted suicide becomes legal.

It is a given in discussions of genetic engineering that no sensible person can be in favor of eugenics. The main reason for this presumption is that so much horror, [...]

Embryonic stem cell research has proved enormously controversial in the United States and in other nations such as Germany, France, and Japan. For the most part, the controversy over stem [...]

The concept of medical futility may only prove useful if patients trust their doctors' assessment that a treatment would be futile. Medical futility can be defined quantitatively and qualitatively. Its critics may dismiss the concept as the imposition of bioethicists' morality. Advocates of medical futility stress the physician's professional integrity to advise and inform patients of a treatment's futility. The concept will remain academic if physicians do not work to gain and maintain the trust of their patients. Patients who trust their doctors may relinquish their quest for long-shot treatments.

Soon after taking office, President George W. Bush appointed the Council on Bioethics to help guide him and the nation through the rocky moral terrain that new biomedical technologies require [...]

The Future of Human Reproduction: Ethics, Choice, and Regulation Eds John Harris, Soren Holm Oxford University Press, 35 £, pp 264 ISBN 0 19 823761 8 Rating: *** It is [...]