Download Ethical and Legal Issues in Neurology Ebook PDF

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
A Book

by James L. Bernat,Richard Beresford

  • Publisher : Newnes
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0444535047
  • Language : En, Es, Fr & De
GET BOOK

Advances in our understanding of the brain and rapid advances in the medical practice of neurology are creating questions and concerns from an ethical and legal perspective. Ethical and Legal Issues in Neurology provides a detailed review of various general aspects of neuroethics, and contains chapters dealing with a vast array of specific issues such as the role of religion, the ethics of invasive neuroscience research, and the impact of potential misconduct in neurologic practice. The book focuses particular attention on problems related to palliative care, euthanasia, dementia, and neurogenetic disorders, and concludes with examinations of consciousness, personal identity, and the definition of death. This volume focuses on practices not only in North America but also in Europe and the developing world. It is a useful resource for all neuroscience and neurology professionals, researchers, students, scholars, practicing clinical neurologists, mental health professionals, and psychiatrists. A comprehensive introduction and reference on neuroethics Includes coverage of how best to understand the ethics and legal aspects of dementia, palliative care, euthanasia and neurogenetic disorders Brings clarity to issues regarding ethics and legal responsibilities in the age of rapidly evolving brain science and related clinical practice

Ethical Issues in Neurology

Ethical Issues in Neurology
A Book

by James L. Bernat

  • Publisher : Lippincott Williams & Wilkins
  • Release : 2008
  • Pages : 524
  • ISBN : 9780781790604
  • Language : En, Es, Fr & De
GET BOOK

Written by an eminent authority from the American Academy of Neurology's Committee on Ethics, Law, and Humanities, this book is an excellent text for all clinicians interested in ethical decision-making. The book features outstanding presentations on dying and palliative care, physician-assisted suicide and voluntary active euthanasia, medical futility, and the relationship between ethics and the law. New chapters in this edition discuss how clinicians resolve ethical dilemmas in practice and explore ethical issues in neuroscience research. Other highlights include updated material on palliative sedation, advance directives, ICU withdrawal of life-sustaining therapy, gene therapy, the very-low-birth-weight premature infant, the developmentally disabled patient, informed consent, organizational ethics, brain death controversies, and fMRI and PET studies relating to persistent vegetative state.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 2. The analysis and resolution of ethical dilemmas

by Robert C. Macauley

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080647
  • Language : En, Es, Fr & De
GET BOOK

Perhaps no other field of medicine illustrates the ethical dilemmas occasioned by the explosion of technology more than neurology. Many dilemmas which at first appear to be ethical, however, are actually biotechnical, informational, or interpersonal in nature. For those which are, indeed, ethical, a review of existing information and acquisition of additional data can often serve to identify the proper response. When the optimal course of action remains unclear, the comprehensive, structured approach described in this chapter is both philosophically rigorous and clinically relevant. It takes into account a variety of critical considerations – including rights, duties, consequences, virtues, and similar cases – while utilizing both inductive and deductive methods. The end result is the “least bad” of available options, or, at the very least, a practical response which preserves future options and avoids crucial mistakes.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 1. Ethical principles and concepts in medicine

by Robert M. Taylor

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080639
  • Language : En, Es, Fr & De
GET BOOK

Clinical ethics is the application of ethical theories, principles, rules, and guidelines to clinical situations in medicine. Therefore, clinical ethics is analogous to clinical medicine in that general principles and concepts must be applied intelligently and thoughtfully to unique clinical circumstances. The three major ethical theories are consequentialism, whereby the consequences of an action determine whether it is ethical; deontology, whereby to be ethical is to do one’s duty, and virtue ethics, whereby ethics is a matter of cultivating appropriate virtues. In the real world of medicine, most people find that all three perspectives offer useful insights and are complementary rather than contradictory. The most common approach to clinical ethical analysis is principlism. According to principlism, the medical practitioner must attempt to uphold four important principles: respect for patient autonomy, beneficence, nonmaleficence, and justice. When these principles conflict, resolving them depends on the details of the case. Alternative approaches to medical ethics, including the primacy of beneficence, care-based ethics, feminist ethics, and narrative ethics, help to define the limitations of principlism and provide a broader perspective on medical ethics.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 25. The ethics of clinical research in low- and middle-income countries

by Timothy Lahey

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080876
  • Language : En, Es, Fr & De
GET BOOK

The increasing conduct of clinical research in low- and middle-income countries (LMIC) is motivated by the desire to promote host country access to biomedical research, to enhance LMIC access to modern clinical care, and opportunities to conduct research with simpler regulatory requirements and at lower cost. Yet clinical research in LMIC is associated with ethical risks beyond those of clinical research conducted in high-income countries (HIC). Ethical challenges particular to clinical research in LMIC include the conduct of placebo-controlled clinical trials in LMIC despite HIC availability of effective comparator interventions, obtaining informed consent despite power inequities, and the obligation of HIC researchers to redress health disparities in LMIC. This chapter covers these and additional ethical challenges of clinical research in LMIC, and proposes ways to navigate these challenges through awareness, regulatory oversight, consultation, and collaboration with LMIC investigators and community representatives. With its ethical challenges properly managed, clinical research in LMIC provides historic opportunities to bring biomedical research and better healthcare infrastructure to countries previously left behind in the modern rush to biomedical innovation.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 24. Research involving human subjects: ethical and regulatory issues

by Jerry Menikoff

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080868
  • Language : En, Es, Fr & De
GET BOOK

A history of past abuses on research with human subjects has led to various sets of rules that are designed to insure ethical practices to protect research subjects appropriately. To understand these rules, it is important to appreciate the significant differences between being a patient, where protecting the best interests of that patient is the primary goal, and being a research subject, where that is generally not the case. In the research setting, there can be a conflict between attempting to answer the research question, and doing what is best for the subject. The rules for conducting research with human subjects attempt to manage this conflict in an ethically acceptable manner. This chapter provides an overview of those rules, including a somewhat extended discussion of the U.S. “Common Rule” as a particular example.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 3. Ethics committees and consultants

by C. Christopher Hook,Keith M. Swetz,Paul S. Mueller

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080655
  • Language : En, Es, Fr & De
GET BOOK

The increasing complexity of healthcare creates numerous ethical challenges in patient care and in institutional functions and policies. During the past several decades, clinical ethics consultation services and institutional ethics committees have been developed to assist patients, medical professionals, and institutions in addressing ethical challenges. This chapter discusses the nature of clinical ethics consultation and the training of ethics consultants and committees. The authors review the experience at their institution (Mayo Clinic). Finally, the value of ethics consultation, as described in the medical literature, is reviewed.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 12. Withdrawing and withholding life-sustaining treatment

by Thomas I. Cochrane

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080744
  • Language : En, Es, Fr & De
GET BOOK

The ethics of decisions to withhold or withdraw life-sustaining therapies are reviewed. Special attention is paid to the ethical and moral distinctions – or lack thereof – between withholding and withdrawing. The ethical principles informing decisions to forgo life-sustaining therapy are covered, along with the difficulty of making such decisions in the face of prognostic uncertainty. Specific advice is provided regarding the decision-making process, and recent literature regarding decision-making in the neurologic intensive care unit is reviewed.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 5. Law, ethics, and the clinical neurologist

by Lois Margaret Nora

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080671
  • Language : En, Es, Fr & De
GET BOOK

There is dynamic interplay between the disciplines of law and ethics, and the result is often laws and regulation that impact the practice of clinical neurology. This chapter explores how the disciplines of law and ethics inform and intersect with each other, and how resulting law impacts the everyday work of the clinical neurologist. Examples of how the core bioethical principles of nonmaleficence, beneficence, respect for autonomy, and justice are manifest in legislative, common, and administrative laws are presented. Examples of how these laws, in turn, impact the practice of neurology through protection of patient privacy, the avoidance of conflict of interest, and informed consent and other issues are offered.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 30. Pragmatic neuroethics: the social aspects of ethics in disorders of consciousness

by Eric Racine

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080922
  • Language : En, Es, Fr & De
GET BOOK

In this chapter, evolution of ethics and bioethics is traced to show how an abstract and individualistic paradigm was at the core of mainstream ethics prior to the advent of bioethics and applied ethics. Bioethics has transformed this individualistic paradigm because of its inherent interdisciplinarity and real-world connection. This evolution has raised questions regarding how nonabstract (e.g., experiential) and nonindividualistic (e.g., social, relational) components of ethics could be married to normative theory and ethics reflection, the latter usually not amenable to empiric research. In the first part of this chapter, pragmatism is introduced as an approach offering perspectives on the integration of social, nonindividualistic aspects of ethics, supporting the use of social science methods within ethics and neuroethics. In the second part of this chapter, using the example of disorders of consciousness, a pragmatic perspective is explored to reframe questions and help foster nonreductionistic understandings of ethical questions and ethical dilemmas. This chapter aims to generate reflections on a set of specific clinical contexts that will also stimulate a discussion on the nature of ethical approaches.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 28. Neuroethical issues in clinical neuroscience research

by James A. Anderson,Marleen Eijkholt,Judy Illes

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080906
  • Language : En, Es, Fr & De
GET BOOK

In this chapter, we use the special features of neuroimaging to illustrate research ethics issues for the clinical neurologic sciences, and focus on one particularly compelling case: studies involving first-episode schizophrenic treatment-naïve individuals (FESTNIs) (). FESTNIs are scanned prior to the administration of medication in order to control for the confounding effects of treatment. By concentrating on this program of research, we capture the distinctive ethical challenges associated with neuroimaging research overall, and foreground the issues particular to neuroimaging research involving FESTNIs that have yet to receive sufficient attention in the literature. We highlight assessment of risks and burdens, including risks associated with treatment delays and incidental findings; assessment of benefit, including direct benefit, social value, and scientific quality; subject selection; justice questions related to responsiveness and poststudy access; and, finally, issues related to consent and capacity.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 20. Ethical issues in the neurology of aging and cognitive decline

by Eran Klein,Jason Karlawish

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080825
  • Language : En, Es, Fr & De
GET BOOK

Caring for persons with Alzheimer’s disease presents neurologists with ethical challenges. Some of these, such as end-of-life care or research participation, are well known and have significant overlap with challenges in other areas of medicine or other neurologic diseases, such as cancer or traumatic brain injury, while others, such as the rise of biomarker-based diagnostics, are more novel and reflect the impact of developments in the science and clinical care of Alzheimer’s disease. A thoughtful and systematic approach to these challenges, from the preclinical to the late symptomatic stage of this disease, is required and will help clinicians be better advocates and stewards of their patients. This chapter addresses a number of the most pressing ethical problems facing patients, caregivers, and clinicians during this disease, including early and presymptomatic testing, assessment of decision-making capacity for treatment or research participation, restriction of driving, remote monitoring, assisted suicide, and treatment of disruptive behaviors.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 21. Ethics in neurodevelopmental disability

by Eric Racine,Emily Bell,Michael Shevell

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080833
  • Language : En, Es, Fr & De
GET BOOK

Neurodevelopmental disabilities, like autism spectrum disorders and cerebral palsy are a common health problem in children. Given the impact of these conditions on children, families, and healthcare and social systems, the care of developmentally challenged children raises questions related to values and ethical principles. We review the common features of neurodevelopmental disorders that help understand the associated ethical questions. We focus on three major areas where ethical questions arise for clinicians and those involved in making decisions for or caring for these children: (1) the principles of decision-making and autonomy as they relate to developmental disability; (2) the issues related to quality of life that have long intersected with developmental disability; and (3) the use of unproven therapies and diagnostics that are particularly controversial given the extent that neurodevelopmental disabilities impact children and their families, yet active treatments options are limited.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 18. Ethical issues in the care of the neurologically devastated infant

by Tracy K. Koogler

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080809
  • Language : En, Es, Fr & De
GET BOOK

The debate surrounding neurologically devastated newborns, whether due to severe prematurity or genetic malformations, has continued for over 40 years. Duff and Campbell (1973) first discussed allowing these children to die in the 1970s. In the 1980s, others fought to make sure these children with disabilities were afforded all the rights of other children. Recently, some commentators have advocated for withdrawal of therapies and even euthanasia in the Netherlands. Who is right? What are the ethical principles that should be followed? What decisions are appropriate for distraught parents to make? This chapter reviews international views, laws, and guidelines surrounding the therapies and limitations of care for these imperiled newborns. An ethical argument is presented for how to determine best interests for these special children utilizing the best interest standard. Parents and physicians need to use their individual expertise and values to work together to determine each individual child’s best interests. Physicians may have to carry the burden for making final determinations to alleviate the guilt families may have in deciding to limit therapies.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 17. Coma and disorders of consciousness

by Marie-Aurélie Bruno,Steven Laureys,Athena Demertzi

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080795
  • Language : En, Es, Fr & De
GET BOOK

Patients in coma, vegetative state/unresponsive wakefulness syndrome, and in minimally conscious states pose medical, scientific, and ethical challenges. As patients with disorders of consciousness are by definition unable to communicate, the assessment of pain, quality of life, and end-of-life preferences in these conditions can only be approached by adopting a third-person perspective. Surveys of healthcare workers’ attitudes towards pain and end of life in disorders of consciousness shed light on the background of clinical reality, where no standard medical-legal framework is widely accepted. On the other hand, patients with locked-in syndrome, who are severely paralyzed but fully conscious, can inform about subjective quality of life in serious disability and help us to understand better the underlying factors influencing happiness in disease. In the medico-legal arena, such ethical issues may be resolved by previously drafted advance directives and, when absent, by surrogate representation. Lately, functional medical imaging and electrophysiology provide alternative means to communicate with these challenging patients and will potentially mediate to extract responses of medical-ethical content. Eventually, the clinical translation of these advanced technologies in the medical routine is of paramount importance for the promotion of medical management of these challenging patients.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 19. Ethical issues in states of impaired communication with intact consciousness and language

by Leo Mccluskey

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080817
  • Language : En, Es, Fr & De
GET BOOK

Acute and chronic peripheral and/or central disorders of the voluntary motor system can produce profound paresis or paralysis, at times with ophthalmoplegia, while preserving consciousness and language function. Although at times appearing to be unconscious, these patients are awake and alert but unable to communicate, manipulate their environment, or participate in medical decision-making. Clinicians caring for these patients are ethically tasked with recognizing this clinical reality, enacting measures to facilitate communication, and abiding by ethical and legal principles that support autonomous patient-centered decision-making. This chapter reviews the various disorders that may cause this state while using three exemplary disorders – locked-in syndrome, caused by an anterior pontine lesion; high cervical spinal cord lesion; and amyotrophic lateral sclerosis – to discuss the management of these patients.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 26. The ethics of surgically invasive neuroscience research

by Paul J. Ford,Abhishek Deshpande

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080884
  • Language : En, Es, Fr & De
GET BOOK

A clear understanding of distinctions and definitions is necessary before determining which types of surgically invasive neuroscience research should be permitted and how the experimental protocols can properly be undertaken. A failure to clarify the ethical distinctions in invasive neuroscience research hinders attempts at ethical analysis and guidance. At least four main distinctions need to be addressed: “invasiveness” as an important moral characteristic; special brain–mind-related risks; research participant selection; and ideologic interpretation of human function. Harm and not invasiveness is the metric by which to measure the ethical permissibility of research. Because of a class of harms to minds and selves, special attention should be paid to value considerations. These considerations need to be addressed by researchers, funders, and review boards to create proper safeguards from conception of research through final application of results.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 8. Medical error and disclosure

by Andrew A. White,Thomas H. Gallagher

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080701
  • Language : En, Es, Fr & De
GET BOOK

Errors occur commonly in healthcare and can cause significant harm to patients. Most errors arise from a combination of individual, system, and communication failures. Neurologists may be involved in harmful errors in any practice setting and should familiarize themselves with tools to prevent, report, and examine errors. Although physicians, patients, and ethicists endorse candid disclosure of harmful medical errors to patients, many physicians express uncertainty about how to approach these conversations. A growing body of research indicates physicians often fail to meet patient expectations for timely and open disclosure. Patients desire information about the error, an apology, and a plan for preventing recurrence of the error. To meet these expectations, physicians should participate in event investigations and plan thoroughly for each disclosure conversation, preferably with a disclosure coach. Physicians should also anticipate and attend to the ongoing medical and emotional needs of the patient. A cultural change towards greater transparency following medical errors is in motion. Substantial progress is still required, but neurologists can further this movement by promoting policies and environments conducive to open reporting, respectful disclosure to patients, and support for the healthcare workers involved.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 13. European perspectives on ethics and law in end-of-life care

by Ralf J. Jox,Ruth J. Horn,Richard Huxtable

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080752
  • Language : En, Es, Fr & De
GET BOOK

End-of-life care practices and attitudes in Europe are highly diverse, which is unsurprising given the variety of cultural and religious patterns across this region. The most marked differences are in the legal and ethical stances towards assisted dying, although there are also variations in limitation of life-sustaining treatment and the authority of advance directives to decline such treatment. Palliative care has made a rapid and impressive development in many European countries over the last decade, and alleviating symptoms at the end of life is permitted, even if the drugs used might (in the rare case) not only relieve suffering but also shorten life. Fueled by the politically led process of European harmonization, future policies and laws on end-of-life care might converge. However, at the base of many ethical conflicts there remain deeply rooted differences about promoting the sanctity of life, eradicating suffering, and respecting patients’ autonomous wishes.

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Chapter 4. Legal process, litigation, and judicial decisions

by H. Richard Beresford

  • Publisher : Elsevier Inc. Chapters
  • Release : 2014-01-09
  • Pages : 472
  • ISBN : 0128080663
  • Language : En, Es, Fr & De
GET BOOK

Ethically salient issues in neurologic care may have important legal overtones. This chapter considers some of these, emphasizing how law may influence the outcome of controversies over how best to promote autonomy, beneficence, and justice in the care of individuals with neurologic disorders. Constitutional, statutory, and judicial dimensions are addressed. With respect to autonomy, discussion emphasizes legal dimensions of the doctrine of informed consent and the obligations of medical professionals to protect the privacy and confidentiality of their patients. The discussion of beneficence focuses on issues relating to actual or potential conflicts of interest in the care of patients and on the conduct of research involving human subjects. The section on justice considers how law aims to define protectable rights and interests of individuals and to provide a fair and efficient process for resolving disputes. Applications of legal principles and doctrines are illustrated primarily through the examples afforded by judicial decisions. These cases demonstrate how law both promotes ethical decision-making and protects the rights and interests of those affected. The cases also highlight some of the ethical quandaries that evoke resort to litigation and the limits of law in advancing ethically appropriate outcomes.