Cardiopulmonary Resuscitation and the Presumption of Informed Consent

2020 ◽  
Vol 20 (4) ◽  
pp. 683-693
Author(s):  
David J. Buckles ◽  
Keyword(s):  
Informed Consent ◽  
High Risk ◽  
Cardiopulmonary Resuscitation ◽  
Medical Intervention ◽  
Ethical Principle ◽  
Medical Procedure ◽  
Do Not Resuscitate ◽  
Potential Harm ◽  
Rule Of Rescue ◽  
Positive Results

Cardiopulmonary Resuscitation (CPR) is the default response for persons who suffer cardiac or pulmonary arrest, except in cases in which there exists a do-not-resuscitate order. This default mindset is based on the rule of rescue and the ethical principle of beneficence. However, due to the lack of efficacy and the high risk of potential harm inherent in CPR, this procedure should not be the default intervention for cardiac or pulmonary arrest. Although CPR is a lifesaving medical intervention, it has limited positive results and the potential for multiple harmful consequences. Given the limited potential of CPR as a medical procedure, clinicians and patients must be educated regarding its limited potential, and procedures must be developed to help determine when it is appropriate as a medical intervention.

Nigerian laws on informed consent before a surgical procedure

2019 ◽  
Vol 87 (4) ◽  
pp. 185-187
Author(s):  
Mabel Ijeoma Ezeuko
Keyword(s):  
Informed Consent ◽  
Medical Ethics ◽  
National Health ◽  
Surgical Procedure ◽  
Medical Intervention ◽  
Medical Procedure ◽  
Medical Negligence ◽  
Medical Practitioners ◽  
National Health Act

Informed consent is a process of communication between a clinician and a patient, which results in the patient's agreement to undergo a medical procedure. Rule 19 Part A: Code of Medical Ethics of Nigeria and Section 23 of the National Health Act 2004 prescribe the process of obtaining consent before a medical intervention. The equitable law of torts and/or criminal liabilities that deal with medical negligence should be invoked more often by patients whose right to informed consent is denied by medical practitioners.

The Empire of Death: How Culture and Economics Affect Informed Consent in the U.S., the U.K., and Japan

1994 ◽  
Vol 20 (4) ◽  
pp. 357-394 ◽  
Author(s):  
George J. Annas ◽  
Frances H. Miller
Keyword(s):  
New York ◽  
World War Ii ◽  
Informed Consent ◽  
Assisted Suicide ◽  
New York Times ◽  
The United States ◽  
Medical Intervention ◽  
Jack Kevorkian ◽  
Open Discussion ◽  
Legislative Changes

American culture reflects a paradox: the more openly we discuss death and its inevitability, the more money we spend to postpone and deny it. Sherwin Nuland's book How We Die, a frank description of the way our bodies deteriorate with and without medical intervention, topped the New York Times best seller list in the spring of 1994. At the same time, Jack Kevorkian, arguably the world 's best known physician, was being acquitted of violating Michigan 's law against assisted suicide, while a Michigan commission was debating legislative changes to permit physicians to help their terminally ill patients kill themselves. Despite such open discussion of death and expansion of the informed consent doctrine, U.S. medical expenditures at the end of life remain astronomically high. Most of this elevated spending is attributable to new medical technology.In J.G. Ballard 's Empire of the Sun, the United States, British and Japanese cultures are contrasted through the eyes of a young British boy incarcerated by the Japanese army in China during World War II.

Predictors of acute kidney injury in patients after extracorporeal cardiopulmonary resuscitation

Perfusion ◽  
2021 ◽  
pp. 026765912110497
Author(s):  
Christopher Gaisendrees ◽  
Borko Ivanov ◽  
Stephen Gerfer ◽  
Anton Sabashnikov ◽  
Kaveh Eghbalzadeh ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Creatine Kinase ◽  
High Risk ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Kidney Injury ◽  
Dialysis Patients ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Outcome Parameters

Objectives: Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly used due to its beneficial outcomes and results compared with conventional CPR. Data after eCPR for acute kidney injury (AKI) are lacking. We sought to investigate factors predicting AKI in patients who underwent eCPR. Methods: From January 2016 until December 2020, patients who underwent eCPR at our institution were retrospectively analyzed and divided into two groups: patients who developed AKI ( n = 60) and patients who did not develop AKI ( n = 35) and analyzed for outcome parameters. Results: Overall, 63% of patients suffered AKI after eCPR and 45% of patients who developed AKI needed subsequent dialysis. Patients who developed AKI showed higher values of creatinine (1.1 mg/dL vs 1.5 mg/dL, p ⩽ 0.01), urea (34 mg/dL vs 42 mg/dL, p = 0.04), CK (creatine kinase) (923 U/L vs 1707 U/L, p = 0.07) on admission, and CK after 24 hours of ECMO support (1705 U/L vs 4430 U/L, p = 0.01). ECMO explantation was significantly more often performed in patients who suffered AKI (24% vs 48%, p = 0.01). In-hospital mortality (86% vs 70%; p = 0.07) did not differ significantly. Conclusion: Patients after eCPR are at high risk for AKI, comparable to those after conventional CPR. Baseline urea levels predict the development of AKI during the hospital stay.

Should medical students perform pelvic exams on anaesthetised patients without explicit consent?

2021 ◽  
pp. 147775092110704
Author(s):  
Chloe Bell ◽  
Nathan Emmerich
Keyword(s):  
Medical Student ◽  
Informed Consent ◽  
Medical Students ◽  
Medical School ◽  
Consent Process ◽  
Potential Harm ◽  
Explicit Consent ◽  
Subsequent Discussion ◽  
Pelvic Examinations

There have been many reports of medical students performing pelvic exams on anaesthetised patients without the necessary consent being provided or even sought. These cases have led to an ongoing discussion regarding the need to ensure informed consent has been secured and furthermore, how it might be best obtained. We consider the importance of informed consent, the potential harm to both the patient and medical student risked by the suboptimal consent process, as well as alternatives to teaching pelvic examinations within medical school. The subsequent discussion focuses on whether medical students should perform pelvic examinations on anaesthetised patients without personally ensuring that they have given their explicit consent. Whilst we question the need to conduct pelvic examinations on anaesthetised patients in any circumstance, we argue that medical students should not perform such exams without personally securing the patients informed consent.

Ethical Issues Surrounding High-Risk Kidney Recipients: Implications for the Living Donor

2007 ◽  
Vol 17 (3) ◽  
pp. 180-182 ◽  
Author(s):  
Jerome F. O'Hara ◽  
Katrina Bramstedt ◽  
Stewart Flechner ◽  
David Goldfarb
Keyword(s):  
Informed Consent ◽  
High Risk ◽  
Ethical Issues ◽  
Family Members ◽  
Transplant Recipients ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Kidney Recipients ◽  
Medical Issues ◽  
Donor Transplant

Evaulating patients for living kidney donor transplantation involving a recipient with significant medical issues can create an ethical debate about whether to proceed with surgery. Donors must be informed of the surgical risk to proceed with donating a kidney and their decision must be a voluntary one. A detailed informed consent should be obtained from high-risk living kidney donor transplant recipients as well as donors and family members after the high perioperative risk potential has been explained to them. In addition, family members need to be informed of and acknowledge that a living kidney donor transplant recipient with pretransplant extrarenal morbidity has a higher risk of a serious adverse outcome event such as graft failure or recipient death. We review 2 cases involving living kidney donor transplant recipients with significant comorbidity and discuss ethical considerations, donor risk, and the need for an extended informed consent.

scholarly journals Gesondheidsvoorligting by swanger vroue

Curationis ◽  
1992 ◽  
Vol 15 (2) ◽  
Author(s):  
M.E. Bester
Keyword(s):  
Family Planning ◽  
High Risk ◽  
Health Education ◽  
Danger Signs ◽  
Hospital Patients ◽  
A Priority ◽  
Positive Results ◽  
Antenatal Services ◽  
In Pregnancy ◽  
Masters Degree

Health education and information in pregnancy must be a priority, despite the lack of instruments to evaluate the effectiveness of the education and the fact that positive results cannot be guaranteed. During research done for a Masters degree on the utilization of antenatal services by high risk primigravidae at the Tygerberg hospital, patients were interviewed on various aspects that are important during pregnancy, like family planning, breastfeeding, smoking and danger signs that may occur during pregnancy.

scholarly journals Informed consent di Instalasi Gawat Darurat RSUP Prof. Dr. R. D. Kandou Manado

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Christilia G. Wagiu ◽  
Erwin G. Kristanto ◽  
Theo Lumunon
Keyword(s):  
Informed Consent ◽  
Emergency Care ◽  
Field Observation ◽  
Qualitative Method ◽  
Secondary Data ◽  
Medical Intervention ◽  
Referral Hospital ◽  
Medical Doctors ◽  
Emergency Unit ◽  
Physical Handicap

Abstract: According to the Minister of Health regulation No. 290 Year 2008 article 1 which is relevant to medical intervention issues, informed consent has to be signed by the patient prior to any medical intervention after the patient has been informed completely about the purpose and the risk of certain intervention. In general, medical doctors already admits that informed consent is an important part of the ethical code of their profession. Albeit, in certain circumstances such as in emergency cases with life or physical handicap threatening, the medical doctors are demanded to do medical intervention ‘ignoring’ the informed consent. This study was aimed to obtain the implementation of informed consent in Emergency Care Unit at Prof. Dr. R. D. Kandou Hospital Manado, the central referral hospital in East Indonesia. In this study, we used qualitative method through interview, direct field observation, and document observation as secondary data. The results showed that informed consent was implemented at the Emergencey Care Unit, however, in emergency cases, informed consent was given orally, followed by signing it as soon as the intervention had been completely performed. Conclusion: Informed consent was implemented in every medical intervention at Prof. Dr. R. D. Kandou Hospital including the Emergency Care Unit.Keywords: informed consent, emergency care unitAbstrak: Menurut ketentuan Permenkes No. 290 tahun 2008 pasal 1 yang mengatur tentang tindakan medik disebutkan bahwa ijin melakukan tindakan medik diberi oleh pasien setelah terlebih dahulu pasien mendapat penjelasan tentang tujuan dan manfaat maupun risiko dari tindakan medik tersebut. Umumnya dokter telah mengetahui dan mengakui bahwa persetujuan tindakan medik atau informed consent ialah bagian kode etik profesi sebelum diatur dalam ketentuan undang-undang tentang rumah sakit, praktik kedokteran, maupun peraturan menteri kesehatan. Dalam keadaan tertentu dokter juga dituntut untuk dapat segera melaksanakan tindakan medis dan mengesampingkan informed consent antara lain dalam keadaan gawat darurat dimana terdapat ancaman kematian atau kecacatan. Penelitian ini bertujuan untuk mengetahui penyelenggaran persetujuan tindakan medik di Instalasi Gawat Darurat RSUP Prof. Dr. R. D. Kandou yang merupakan rumah sakit pusat rujukan di Indonesia Timur. Pada penelitian ini digunakan metode kualitatif melalui wawancara, pengamatan langsung di lapangan, dan observasi dokumen sebagai data sekunder. Hasil penelitian mendapatkan bahwa informed consent di Instalasi Gawat Darurat masih tetap dipakai, walaupun pada keadaan gawat darurat persetujuan diberikan secara lisan baru setelah selesai tindakan baru dimintakan tanda tangan pada lembar informed consent. Simpulan: Informed consent tetap diperlukan untuk setiap tindakan kedokteran yang dilakukan di RSUP Prof. Dr. R. D. Kandou termasuk pada Instalasi Gawat Darurat.Kata kunci: informed consent, emergency unit care

Abstract 187: Cardiac Arrest Incidence, Bystander Cardiopulmonary Resuscitation Rates, and Community Characteristics Differ by High and Low Risk Areas

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Rebecca Cash ◽  
Madison K Rivard ◽  
Eric Cortez ◽  
David Keseg ◽  
Ashish Panchal
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Cardiopulmonary Resuscitation ◽  
Low Risk ◽  
Poverty Level ◽  
Community Characteristics ◽  
Franklin County ◽  
Census Tracts ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Risk Areas

Introduction: Survival from out-of-hospital cardiac arrest (OHCA) has significant variation which may be due to differing rates of bystander cardiopulmonary resuscitation (BCPR). Defining and understanding the community characteristics of high-risk areas (census tracts with low BCPR rates and high OHCA incidence) can help inform novel interventions to improve outcomes. Our objectives were to identify high and low risk census tracts in Franklin County, Ohio and to compare the OHCA incidence, BCPR rates, and community characteristics. Methods: This was a cross-sectional analysis of OHCA events treated by Columbus Division of Fire in Franklin County, Ohio from the Cardiac Arrest Registry to Enhance Survival between 1/1/2010-12/31/2017. Included cases were 18 and older, with a cardiac etiology OHCA in a non-healthcare setting, with EMS resuscitation attempted. After geocoding to census tracts, Local Moran’s I and quartiles were used to determine clustering in high risk areas based on spatial Empirical Bayes smoothed rates. Community characteristics, from the 2014 American Community Survey, were compared between high and low risk areas. Results: From the 3,841 included OHCA cases, the mean adjusted OHCA incidence per census tract was 0.67 per 1,000 with a mean adjusted BCPR rate of 31% and mean adjusted survival to discharge of 9.4%. In the 25 census tracts identified as high-risk areas, there were significant differences in characteristics compared to low-risk areas, including a higher proportion of African Americans (64% vs. 21%, p<0.001), lower median household income ($30,948 vs. $54,388, p<0.001), and a higher proportion living below the poverty level (36% vs. 20%, p<0.001). There was a 3-fold increase in the adjusted OHCA incidence between high and low risk areas (1.68 vs. 0.57 per 1,000, p<0.001) with BCPR rates of 27% and 31% (p=0.31), respectively. Compared to a previous analysis, 9 (36%) census tracts persisted as high-risk but an additional 16 were newly identified. Conclusions: Neighborhood-level variations in OHCA incidence are dramatic with marked disparities in characteristics between high and low risk areas. It is possible that improving OHCA outcomes requires multifaceted interventions to address social determinants of health.

High risk of false positive results with breast screening

BMJ ◽  
1998 ◽  
Vol 316 (7140) ◽  
pp. 1261-1261
Author(s):  
D. Josefson
Keyword(s):  
High Risk ◽  
False Positive ◽  
Breast Screening ◽  
Positive Results
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