The Mount Sinai journal of medicine, New York
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This article examines the ethics of egg donation. It begins by looking at objections to noncommercial gamete donation, and then takes up criticism of commercial egg donation. ⋯ Donors should not be paid for their eggs, but rather they should be compensated for the burdens of egg retrieval. Making the distinction between compensation for burdens and payment for a product has the advantages of limiting payment, not distinguishing between donors on the basis of their traits, and ensuring that donors are paid regardless of the number or quality of eggs retrieved.
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This article reviews the legal standards and ethical dilemmas surrounding the provision of care to adolescent patients. Uncertainty and ambiguity in this area has contributed to the underserving of the adolescent population. Usually, the legal right to consent to treatment resides with the adolescent's parent or legal guardian; however, there are many cases in which adolescents may provide their own consent. ⋯ The issue of confidentiality poses legal and ethical challenges to the provider in five discussed areas. Providers should be aware of the laws specific to their state, while keeping foremost the best interest of their patients. Providers should also encourage parental involvement and communication concerning treatment, while respecting adolescents' right to confidentiality.
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Children in foster care have many health needs. This article presents the model of the Children's Aid Society (CAS) of New York City in addressing these needs. In addition to their regular foster care program, CAS developed the Medical Foster Care (MFC) in response to the growing number of boarder babies (children with medical conditions who are abandoned at hospitals), and the Therapeutic Foster Care (TFC) for foster children with emotional and behavioral mental health problems. ⋯ In addition, systems of information maintenance and exchange surrounding the health care of foster children need to be improved. Often agencies are ill-equipped to do adequate background checks on these young people and as a result deliver them to foster care situations where their health needs are not revealed and therefore not addressed. Health care providers also need to stay informed on the overall subject of foster care, as their voices will probably be crucial in ensuring that the extensive needs of these children are adequately represented to government, medical and other service providers.
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Emergency prophylaxis following needle-stick and sexual exposures includes HIV post-exposure prophylaxis, hepatitis B prophylaxis and emergency contraception. The Centers for Disease Control and Prevention endorse HIV post-exposure and hepatitis B prophylaxis for health care workers, and hepatitis B prophylaxis and emergency contraception after sexual assault. The New York State Department of Health advocates HIV post-exposure prophylaxis after sexual assault. This study compares emergency department practitioners in New York State (NYS) with those from other states in their willingness to offer emergency prophylaxis after needle-stick and sexual exposures, and their self-reported history of prescribing and using HIV post-exposure prophylaxis. ⋯ Compared to their national colleagues, NYS emergency department practitioners were generally more willing to offer all forms of emergency prophylaxis after sexual assault. They also reported having had more experience than other practitioners in prescribing HIV post-exposure prophylaxis. Although most practitioners were clearly willing to offer HIV post-exposure prophylaxis for nonoccupational exposures, NYS practitioners were less willing to offer emergency prophylaxis following consensual sex than after sexual assault. These findings suggest that the NYS guidelines for HIV post-exposure prophylaxis after sexual assault may have influenced emergency practitioners willingness to offer and prescribe prophylaxis.
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The concept of vital organ transplantation is critically analyzed by considering how traditional transplantation modifies the commitment to saving lives. Problems such as those associated with immunosuppression might seem to provide a compelling reason to oppose extension of transplantation to non-lifesaving situations. A closer examination, however, shows that immunosuppression does not present an intractable objection. ⋯ Informed consent provides a limited, but important, component in justifying extended transplantation. Such justification, however, does not rest on patient autonomy, but on the reasonable prospect of benefit. Transplant programs considering an extension of traditional transplantation should develop formal protocols that include assessment of costs, benefits, quality of life, and the adequacy of informed consent.