Ethical issues in stroke management

2014 ◽  
pp. 123-134
Keyword(s):  
Ethical Issues ◽  
Stroke Management

scholarly journals Ethical issues in stroke management

2020 ◽  
pp. 10.1212/CPJ.0000000000000925
Author(s):  
James L. Bernat ◽  
Timothy G. Lukovits
Keyword(s):  
Ethical Issues ◽  
Treatment Preference ◽  
Treatment Refusal ◽  
Surrogate Decision Maker ◽  
Stroke Management ◽  
Nonfluent Aphasia ◽  
Decision Making Capacity ◽  
Life Sustaining Treatment ◽  
Surrogate Decision ◽  
Hemispheric Infarction

A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision-maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent aphasia may become an issue when he appears to understand but cannot communicate his treatment preference. Neurologists may be unsure whether to provide medical hydration and nutrition to an elderly patient admitted with a massive intracranial hemorrhage and incipient herniation whose advance directive states that life-sustaining treatment is to be withheld in the event of a hopeless prognosis. A patient with chronic locked-in syndrome from pontine infarction may order that further life-sustaining treatment be withdrawn but her neurologist may be unsure of the ethical adequacy of her treatment refusal because of communication limitations.

Confronting the grey zone after severe brain injury

2019 ◽  
Vol 3 (6) ◽  
pp. 707-711 ◽  
Author(s):  
Andrew Peterson ◽  
Adrian M. Owen
Keyword(s):  
Brain Injury ◽  
Ethical Issues ◽  
Vegetative State ◽  
Clinical Care ◽  
Grey Zone ◽  
Severe Brain Injury ◽  
New Methods ◽  
Legal Decision Making ◽  
Technological Developments ◽  
The Brain

In recent years, rapid technological developments in the field of neuroimaging have provided several new methods for revealing thoughts, actions and intentions based solely on the pattern of activity that is observed in the brain. In specialized centres, these methods are now being employed routinely to assess residual cognition, detect consciousness and even communicate with some behaviorally non-responsive patients who clinically appear to be comatose or in a vegetative state. In this article, we consider some of the ethical issues raised by these developments and the profound implications they have for clinical care, diagnosis, prognosis and medical-legal decision-making after severe brain injury.

Ethical Issues in Nursing: Nutrition of Premature New-borns in Intensive Neonatal Care – Nurses between Care and Autonomy

Pflege ◽  
2001 ◽  
Vol 14 (1) ◽  
pp. 13-16
Author(s):  
Monika Bobbert
Keyword(s):  
Ethical Issues ◽  
Neonatal Care ◽  
Ethische Konflikte ◽  
Ethische Probleme

Pflegeethik als relativ neuer Bereich der angewandten Ethik hat unter anderem die Aufgabe, auf ethische Probleme in der pflegerischen Praxis aufmerksam zu machen und diese zu reflektieren. An einem Fallbeispiel wird gezeigt, dass das pflegerische Vorgehen bei der Ernährung von Frühgeborenen ethische Konflikte bergen kann. Am konkreten Fall werden Fragen der Patientenautonomie und Fürsorge diskutiert, die auch für andere pflegerische Situationen relevant sind. Der Artikel leistet einen Beitrag zur Klärung der spezifischen Inhalte einer auf den Handlungsbereich der professionellen Pflege bezogenen Ethik.

Research Participation Experiences of Informants of Suicide and Control Cases

Crisis ◽  
2010 ◽  
Vol 31 (5) ◽  
pp. 238-246 ◽  
Author(s):  
Paul W. C. Wong ◽  
Wincy S. C. Chan ◽  
Philip S. L. Beh ◽  
Fiona W. S. Yau ◽  
Paul S. F. Yip ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Research Participation ◽  
Self Report ◽  
Initial Contact ◽  
Psychological Autopsy ◽  
Autopsy Study ◽  
The People ◽  
And Control ◽  
The Impact

Background: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. Aims: (1) To investigate whether informants of suicide cases recruited by two approaches (coroners’ court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. Methods: A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. Results: The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. Limitations: The acceptance rate for our original psychological autopsy study was modest. Conclusions: The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

Ethical Issues Relevant to the Assessment of Suicide Risk in Nonclinical Research Settings

Crisis ◽  
2012 ◽  
Vol 33 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Carolyn M. Wilson ◽  
Bruce K. Christensen
Keyword(s):  
Undergraduate Students ◽  
Suicide Risk ◽  
Ethical Issues ◽  
Current Paper ◽  
Self Report ◽  
Ethical Guidelines ◽  
Schizotypal Personality ◽  
Increased Risk ◽  
Genetic Features ◽  
Conducting Research

Background: Our laboratory recently confronted this issue while conducting research with undergraduate students at the University of Waterloo (UW). Although our main objective was to examine cognitive and genetic features of individuals with schizotypal personality disorder (SPD), the study protocol also entailed the completion of various self-report measures to identify participants deemed at increased risk for suicide. Aims and Methods: This paper seeks to review and discuss the relevant ethical guidelines and legislation that bear upon a psychologist’s obligation to further assess and intervene when research participants reveal that they are at increased risk for suicide. Results and Conclusions: In the current paper we argue that psychologists are ethically impelled to assess and appropriately intervene in cases of suicide risk, even when such risk is revealed within a research context. We also discuss how any such obligation may potentially be modulated by the research participant’s expectations of the role of a psychologist, within such a context. Although the focus of the current paper is on the ethical obligations of psychologists, specifically those practicing within Canada, the relevance of this paper extends to all regulated health professionals conducting research in nonclinical settings.

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