Extracorporeal membrane oxygenation and the ethics of clinical research in pediatrics

Article Abstract:

When a new and innovative medical treatment becomes available, it may be designated as either experimental or nonexperimental, the latter meaning it is the standard, or most effective therapy. There are many legal, ethical, and economic consequences of the designation given a new treatment, especially in pediatrics, because the patients cannot give their own consent to receive a particular therapy. If a procedure is considered standard, and parents refuse to have it used on their child, they can be prosecuted for neglect. However, if the procedure is considered experimental, parents may freely refuse to have their child participate, since the treatment is actually a research study. The economic aspects of this issue center on the refusal of many insurance companies to pay for experimental procedures. The introduction of extracorporeal membrane oxygenation (ECMO) in 1972 provides a good example of the ethical dilemmas described above. ECMO is used in newborn babies with respiratory failure. The blood is passed through a device outside the body that oxygenates the blood and then returns it to the body. Studies in which babies given ECMO can be compared with similar infants not given the new treatment have been needed to assess the risks and effectiveness of the treatment, but as soon as either group shows a better survival rate it appears unethical to deny the other group of infants the better treatment. The history of the use and an evaluation of ECMO is described, along with the various ethical debates involved. While some may argue that ECMO has not been adequately evaluated according to rigid standards of research, its benefits in certain medical circumstances are well accepted. The authors conclude that it is wiser to accept some uncertainty about the ECMO technique and to continue its use, rather than violate important ethical standards by adhering too closely to scientific theories that force a designation as either experimental or standard therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Ethical aspects, Medical research, Blood oxygenation, Extracorporeal, Extracorporeal membrane oxygenation, Neonatology, Informed consent (Medical law), Informed consent, Infant health services, Medicine, Experimental

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Cardiopulmonary resuscitation on television: miracles and misinformation

Article Abstract:

Physicians may need to discuss cardiopulmonary resuscitation (CPR) with their elderly patients to counter misconceptions their patients may have received from television. Researchers analyzed 25 episodes of ER, 22 of Chicago Hope and 50 of Rescue 911 to determine how these medical dramas portray CPR. Altogether, 60 "patients" received CPR. Most of the cardiac arrests were caused by trauma and 65% occurred in children, teenagers or young adults. Seventy-five percent of the patients recovered from the immediate arrest and 67% survived long-term. Almost all recovered completely with no obvious disability. These depictions contradict real-life, in which most CPR is performed on elderly patients who have had a heart attack. Real-life survival rates are much lower, ranging from 2% to 30%, and many patients have severe disability. Many of the shows depict family members clinging to hope after their doctors have given up. This could lead many people to reject medical advice, believing that a miracle will pull them through.

Portrayals, Media coverage, CPR (First aid), Cardiopulmonary resuscitation, ER (Television program), Chicago Hope (Television program), Rescue 911 (Television program)

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Religion, conscience, and controversial clinical practices

Article Abstract:

A cross-sectional survey was conducted to find out how physicians think about their ethical rights and obligations when moral conflicts emerge in clinical practice. It was found that many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures and patients who want information might need to inquire proactively to determine whether their physicians would accommodate such requests.

United States, Public affairs, Offices & clinics of medical doctors, Physicians & Surgeons, Offices of Physicians (except Mental Health Specialists), Medicine, Physicians, Surveys, Religious aspects, Medical practice

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