Media Watch 546

Attached is the current issue of Media Watch (#546)

Of particular interest in this week's issue:

Error trawling and fringe decision competence: Ethical hazards in monitoring and address patient decision capacity in clinical practice

CLINICAL ETHICS | Online – 10 January 2018 – This article addresses how health professionals should monitor and safeguard their patients’ ability to participate in making clinical decisions and making subsequent decisions regarding the implementation of their treatment plan. Patient participation in clinical decision-making is essential, e.g., in self-care, where patients are responsible for most ongoing care. The authors argue that one common, fact-oriented patient education strategy may in practice easily tend to take a destructive form that they call error trawling. They argue on independent grounds that this strategy not only risks to overlook significant weaknesses in patient decision competence, but also to undermine patient capacity for decision-making and implementing care. In effect, this strategy for clinically monitoring and addressing the problem of fragile decision-making capacity brings hazards in need of address. The authors close by suggesting complementary and alternative strategies, and comment on how these may call for broadened competency among clinical health professionals. 


Voluntarily stopping eating and drinking: A normative comparison with refusing lifesaving treatment and advance directives

JOURNAL OF LAW, MEDICINE & ETHICS | Online – 10 January 2018 – Refusal of lifesaving treatment, and such refusal by advance directive, are widely recognized as ethically and legally permissible. Voluntarily stopping eating and drinking (VSED) is not. Ethically and legally, how does VSED compare with these two more established ways for patients to control the end of life? Is it more questionable because with VSED the patient intends to cause her death, or because those who assist it with palliative care could be assisting a suicide? In fact the ethical and legal basis for VSED is virtually as strong as for refusing lifesaving treatment and less problematic than the basis for refusing treatment by advance directive. VSED should take its proper place among the accepted, permissible ways by which people can control the time and manner of death. 


Patients’ and oncologists’ views on family involvement in goals-of-care conversations

Psycho-Oncology | Online – 5 January 2018 – Research on patient and physician perspectives about family involvement and influence on goals-of-care conversations is limited. The authors conducted semi-structured interviews at academic, community and municipal hospitals with patients with advanced cancer and their oncologists. They identified four themes: 1) Presence and duration of family involvement; 2) Family expectations; 3) Protecting patients’/family members’ feelings; and, 4) Patient-family disagreement. For patients, the authors identified two additional themes: 1) Family and oncologist relationship; and, 2) Effects of cancer on family. Both patients and oncologists emphasized the importance of family support for the patient’s understanding of their illness and on patients’ emotions. The authors also identified ways in which family involvement may benefit or prove challenging to goals-of-care conversations.