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As the gap between the need for and supply of human organs continues to widen, the aim of securing additional sources of these 'gifts of the body' has become a seemingly overriding moral imperative, one that could--and some argue, should--override the widespread ban on organ markets. As a medical practice, organ transplantation entails the inherent risk that one human being, a donor, will become little more than a means to the end of healing for another human being and that he or she will come to have a purely instrumental value. With the establishment of organ markets, not only will the harms of instrumentalization be a reality--the ends of medicine will be further compromised and confused. Keywords: bodily integrity, dignity, ends of medicine, organ markets, organ transplantation doi: 10.1093/jmp/jhp047

Objectives: In the last two decades, several organizational initiatives have moved Geisinger into closer alignment with the key characteristics of the learning health system (LHS) model. The intent of this experience report is to provide a firsthand view of the potential of the model and of the complex, multifaceted nature of any endeavor designed and implemented to realize that potential. Methods: After describing Geisinger, we offer a critical self‐assessment of our progress toward the goal of becoming an LHS, followed by an account of the challenges. Results: Geisinger has made incremental but measurable progress in implementing the LHS model, especially in two key domains: in patient‐clinician engagement and science and informatics. Other challenges, however, present significant opportunities for additional forward movement, especially with respect to incentives, culture, and leadership. Conclusion: Becoming a fully realized LHS is and will be a long‐term challenge for any organization that embraces this aspiration. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing policies for pandemics differ by institution, health system, and applicable law. Most seem to agree that a patient's ability to benefit from treatment and to survive are first-order considerations. However, there is debate about what clinical measures should be used to make that determination and about other factors that might be ethically appropriate to consider. In this paper, we discuss resource allocation and several related ethical challenges to the healthcare system and society, including how to define benefit, how to handle informed consent, the special needs of pediatric patients, how to engage communities in these difficult decisions, and how to mitigate concerns of discrimination and the effects of structural inequities. [ABSTRACT FROM AUTHOR]

The article informs about hastened death and the ethics of involuntary hospitalization. Topics discussed include moral dilemma for medical professionals, especially psychiatrists; standard of care has been justified as a necessary subordination of a patient's freedom to promote the patient's long-term benefit; and serious medical illness who express a desire for hastened death.

Little evidence is available to guide returning genomic results in children without medical indication for sequencing. Professional guidelines for returning information on adult-onset conditions are conflicting. The goal of this study was to provide preliminary information on parental attitudes and expectations about returning medically actionable genomic results in children who have been sequenced as part of a population biobank. Four focus groups of parents with a child enrolled in a population biobank were conducted. A deliberative engagement format included education about professional guidelines and ethical issues around returning results to children. Parents were presented two scenarios where their healthy child has a pathogenic variant for: (a) a medically actionable childhood condition; (b) a hereditary cancer syndrome with no medical management until adulthood. Thematic analysis was conducted on verbatim transcripts. Regardless of the scenario, parents stated that the genomic information was important, was like other unexpected medical information, and disclosure should be tailored to the child's age and result. Parents wanted the results in their child's medical record. Reasons for learning adult-onset results in their healthy children included to prepare their child for necessary medical action in adulthood. Parents also provided suggestions for program design. This preliminary evidence suggests that parents desire genomic results and expect to use this information to protect their child's health. More empirical research on psychosocial adjustment to such information with continued engagement of parents and children is needed to further inform how to best support families in the communication and use of genomic information. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare leaders need operational strategies that support organizational learning for continued improvement and value generation. The learning health system (LHS) model may provide leaders with such strategies; however, little is known about leaders' perspectives on the value and application of system-wide operationalization of the LHS model. The objective of this project was to solicit and analyze senior health system leaders' perspectives on the LHS and learning activities in an integrated delivery system., Methods: A series of interviews were conducted with 41 system leaders from a broad range of clinical and administrative areas across an integrated delivery system. Leaders' responses were categorized into themes., Findings: Ten major themes emerged from our conversations with leaders. While leaders generally expressed support for the concept of the LHS and enhanced system-wide learning, their concerns and suggestions for operationalization where strongly aligned with their functional area and strategic goals., Discussion: Our findings suggests that leaders tend to adopt a very pragmatic approach to learning. Leaders expressed a dichotomy between the operational imperative to execute operational objectives efficiently and the need for rigorous evaluation. Alignment of learning activities with system-wide strategic and operational priorities is important to gain leadership support and resources. Practical approaches to addressing opportunities and challenges identified in the themes are discussed., Conclusion: Continuous learning is an ongoing, multi-disciplinary function of a health care delivery system. Findings from this and other research may be used to inform and prioritize system-wide learning objectives and strategies which support reliable, high value care delivery.