Showing papers by "Autumn Fiester published in 2013"

Incidental findings and the need for a revised informed consent process.

Abstract: OBJECTIVE. The current clinical practice with regard to incidental findings (IFs) is suboptimal in the domains of informed consent and patient education. We argue that a more robust informed consent process is needed to enable patients to anticipate incidentalomas and to correctly perceive the associated risks. CONCLUSION. Given that IFs are very common in high-resolution imaging, patients should be provided information about the possibility of an IF as part of radiologic informed consent. The frequency of IFs, the very high rates of false-positives among incidentalomas, the very low rates of malignancies among incidentalomas, and the potential financial and emotional costs to both patients and the health care system of monitoring IFs necessitate a thorough informed consent process. Further, because radiologists are the most knowledgeable professionals regarding the nature of IFs, they should be the specialists who conduct the informed consent discussion with patients.

A false sense of security: lesbian, gay, bisexual, and transgender (LGBT) surrogate health care decision-making rights.

Abstract: This article addresses the timely and ethically problematic issue of surrogate decision-making rights for lesbian, gay, bisexual, and transgender (LGBT) patients and their families in the American health care system. Despite multiple pro-LGBT recommendations that have been released in recent years by the Obama administration, the Institute of Medicine, and the US Department of Health and Human Services, such initiatives, while laudable, also have unfortunately occasioned a “false sense of security” for many LGBT patients, their families, and their caregivers. In particular, new regulations on surrogate decision making merely invoke a sense of universal patient rights rather than actually generating them. Therefore, it is imperative that primary care physicians urge all LGBT patients to take proactive steps to protect themselves and their loved ones by naming proxy decision makers well before the crises that would necessitate such decisions.

Communicating findings: a justification and framework for direct radiologic disclosure to patients.

Abstract: OBJECTIVE. Radiologists' delivery of imaging results to patients remains controversial. One model of communication suggests limiting disclosure to normal results. We argue that disclosing radiologic findings to patients is justified in all categories of results. CONCLUSION. Once a doctor-patient relationship has been established, we claim that it is morally justifiable for radiologists to communicate findings directly to their patients. The practice guidelines that we advocate employ a sliding scale based on the diagnostic confidence of imaging results.

Induced lactation for the nongestating mother in a lesbian couple.

Abstract: There is no cause for ethical reservation about inducing lactation in nongestating lesbian mothers.

Pedagogical goals for academic bioethics programs.

Abstract: Scientists, healthcare providers, and members of institutional review and ethics boards find themselves confronting bioethical issues without sufficient expertise to address them. In response, academic bioethics programs have proliferated and specialized to meet the needs of these diverse professionals and scholars. Inspired by and written for the Second Cambridge Consortium for Bioethics Education in April 2012, in this article we articulate general pedagogical goals for various academic bioethics programs. These goals have been influenced by debates in the bioethics literature, scholarly presentations and publications, and insights gained from designing curricula at our institutions. This publication is intended as a preliminary proposal—a point of reference for veteran and burgeoning academic bioethics programs. Because the authors are most familiar with U.S. bioethics programs, we have focused on what we know. We expect that this article will spark a discussion about similarities and differences among U.S. and international programs. We ask readers to consider how our suggestions can be improved upon and refined. In the United States bioethics education in the health sciences tends to be linked to various competencies— behaviors and skills that can be demonstrated and measured. This emphasis on measurement may seem to diminish the importance of education designed to enrich moral sensibilities. We believe all bioethics programs must attend to character development, knowledge, and skills; however, we recognize that programs may place emphasis on one or another of these components. Bioethics is taught both in educational programs and in an ad hoc fashion. For example, observation of mentors and colleagues undoubtedly shapes moral behavior; however, the focus of this article is on academic programs in which bioethics education occurs by design. Although the settings may include classrooms, clinical and research arenas, and professional contexts, academic bioethics programs always involve curricula and pedagogical objectives. Additionally, although some academic programs focus on physician education, the objectives and pedagogical approaches are often easily adapted to training for other healthcare professionals. Our intention is to be inclusive rather than exclusive. This article was inspired and informed by the Second Cambridge Consortium for Bioethics Education. We are grateful to Thomasine Kushner, Ph.D., Editor of Cambridge Quarterly of Healthcare Ethics, and Mark Zadrozny, Publisher at Cambridge University Press, as well as the participants in the Second Cambridge Consortium for Bioethics Education for their support, suggestions, and engagement with this project.

ETHICS CASE Induced Lactation for the Nongestating Mother in a Lesbian Couple

Abstract: There is no cause for ethical reservation about inducing lactation in nongestating lesbian mothers.

De-escalating conflict: mediation and the "difficult" patient.

Abstract: In their very interesting case study of a “difficult” sickle cell patient, authors Bergman and Diamond (2013) provide a compelling application of my claim that ethics consult services (ECSs) should...

Skin Bleaching as a Dermatologic Intervention: Complicity or Service?

Abstract: Case Scenario A 21-year-old African American college student has disliked her dark complexion for years. She believes that black women with light complexions have a better life—better grades, better boyfriends, better job opportunities. In her view, these women are treated better by society in every way. She believes her chances of being successful in life would be appreciably improved if her skin were a few shades lighter. She tries some creams available at a beauty supply store that claim to lighten complexion, and she notices a very slight lightening of her skin. She is encouraged by this change, but wants something stronger. She has heard from a friend that dermatologists can give prescriptions for stronger products, so she makes an appointment to see a dermatologist for further assistance in lightening the color of her skin. There is strong evidence suggesting that lighter skin correlates with a range of social, professional, and even health care advantages over individuals who have darker skin tones. While skin-lightening treatment appears to be reasonably safe and efficacious,1,2 it raises a weighty ethical dilemma for dermatologists asked to prescribe them to lighten one’s complexion. On the one hand, skinbleaching treatment can be understood as a valuable service to the patient, who may very well improve her life prospects owing to the treatment the dermatologist provides. On the other hand, skin-bleaching treatment may be understood as reinforcing the societal racism that advantages lighter skin, possibly making the dermatologist complicit in the continuation of the social ill that generates the patient’s request and the positive impact on the patient’s life chances from the treatment in the first place. Here we lay out the ethical arguments speaking both in favor of and against dermatologic interventions intended to lighten one’s natural complexion with the intention of sparking a dialogue within the field.

Queer in the clinic.

Abstract: Beginning with a rumination on the AIDS-inspired poetry of Thom Gunn, this article by the guest editors introduces the special issue of the Journal of Medical Humanities titled "Queer in the Clinic." After providing an overview of the historical legacy and contemporary dilemmas of LGBTQ persons in biomedical practice, the authors describe the rationale of the issue and the contributions included.