Best practice & research. Clinical anaesthesiology
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Society and the culture of health care delivery have radically changed over the last thirty years, the rate of change increasing exponentially towards the present time. Maternity care has been part of that change. Previously paternalistic obstetricians told women whether they should or should not become pregnant, advised hospital confinements, kept women in hospital for days after their confinements, and discussed little of their management with the women themselves. ⋯ This was, and to a certain extent still is, threatening to obstetricians. But there are also genuine concerns as to whether these changes will adversely influence the morbidity and mortality of mother and child. This chapter deals with issues of maternal choice from pre conception through to the post natal period, looking at how the exercise of maternal choice may conflict with the advice of the medical profession, potentially leaving accountability and responsibility a very grey area and how all this impinges on the anaesthetist.
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Individuals have different values. They seek to express their individuality even when receiving medical care. It is a part of modern medical practice and respect for patient autonomy to show respect for different values. ⋯ However, in some other cases, controversial choices are irrational and are not expressions of our autonomy. Doctors should assist patients to make rational if individual choices. The patient also bears the responsibility for bringing his beliefs to the attention of the clinician.
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Best Pract Res Clin Anaesthesiol · Dec 2006
Limiting and rationing treatment in paediatric and neonatal intensive care.
In this chapter I consider the ethical decisions surrounding the provision and limitation of treatment offered to children requiring intensive care. I focus on the processes surrounding end of life decision making and consider how the concepts of futility, burden and uncertainty should impact upon these decisions. ⋯ It does take a practical approach to the issues faced by considering why we should engage in life limiting discussions; When they should occur; Who should be involved; How they should be carried out; and where and by what means withholding or withdrawal should occur. I have drawn the discussions closer to clinical practice with the intention of making them more useful, for those engaged in direct patient care, than those focused around philosophical principles.
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The incidence of substance abuse amongst anaesthetists in the United Kingdom is unknown. In the interests of patient safety, it is essential that the dependent doctor is identified and entered into a treatment regime. No national strategy is in place to treat and, where possible, return the anaesthetist in recovery to work. ⋯ Residential care probably provides the greatest hope of success. In the United States, Canada, Australia and New Zealand 'impaired physician' programmes are in place which allow some doctors to return to work, initially under strict supervision. Registration with a self-help organisation is essential; a list of such groups in the United Kingdom is appended.
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Best Pract Res Clin Anaesthesiol · Dec 2006
Confidentiality, 'no blame culture' and whistleblowing, non-physician practice and accountability.
Confidentiality is a core tenet of medical professionalism, which enables the maintenance of trust in a doctor-patient relationship. However, both the amount of personal data stored and the number of third parties who might access this data have increased dramatically in the digital age, necessitating the introduction of various national data protection acts. ⋯ This article explores the evolution of the law and ethics in this area, and draws attention to the difficulties in balancing confidentiality against freedom of information. In addition, the role and responsibilities of the non-physician anaesthetist are examined.