bluuebunny/crossref_metadata_2025_split huggingface dataset:
Managed Competition in Health Care Reform: Just Another American Dream, or the Perfect Solution?
Authors: Reinhardt Uwe E. 
Published: June 2007

Throughout the post-World War II decades, the United States has wrestled in its own unique style with a problem that is shared by all modern societies: how to achieve a reasonably equitable distribution of health care, without losing control of total spending on health care, and without suffocating the delivery system with controls and regulations that inhibit technical progress.Because an equitable distribution of health care inevitably requires at least some government regulation, and because government regulations tend to impose rigidity on any system, it is widely believed in the United States (and elsewhere) that a trade-off actually exists between fairness in the distribution of care and the health system’s ability to innovate. This troublesome trade-off bedevils American policy makers to this day.
Commentary: A New Frontier but the Same Old Problem
Authors: King Gary 
Published: June 2007

As during other eras of American history, both the current debate and attempts to reform the health care system are fraught with vested interests and conflict among policy makers, consumers, the health and medical complex, insurers, and the business community. The process reflects both the strengths and the limitations of our democratic system, and demonstrates the factional battles that must be waged to attain fundamental social change in American society.Although racial justice is not the dominant issue, the parallels between the present congressional deliberations and polemics and the passage of civil rights legislation in the 1960s are inescapable. For one, a major goal is to codify the basic human right of health care for all, regardless of medical or socioeconomic condition—that is, universal health insurance. Second, although a general feeling exists among the public that considerable change is needed in our health care system, elected representatives cannot agree on an appropriate course of action.
Commentary: The Public and the Profession: Meeting at the Right Place
Authors: Murphy Donald J. 
Published: June 2007

Spielman’s taxonomy of collective decision making about medical futility is timely and insightful. Her conclusion, that laws are the best reflection we have of collective values, may be accurate. However, a closer look at the six alternatives for collective decisions is necessary before we rely too heavily on the legislature.The first two alternatives, decisions by professional organizations and by health care facilities, smack of paternalism. Spielman suggests that statements from professional organizations or health care facilities express professional values and lack adequate input from the public. Could it be that some of these statements in fact may be the best reflections of public attitudes?
Federal Regulation of Clinical Practice in Narcotic Addiction Treatment: Purpose, Status, and Alternatives
Authors: Molinari Stephen P. , Cooper James R. , Czechowicz Dorynne J. 
Published: June 2007

The regulation of narcotic medications used in narcotic addiction treatment is unique in medical therapeutics. Physicians who want to use narcotics for this indication must obtain a separate annual registration from the Drug Enforcement Administration(DEA).Annual registration is contingent on compliance with both the DEA's security regulations (inventory, record-keeping, andphysical security) as well as treatment regulations jointly promulgated by the Food and Drug Administration(FDA)and the National Institute on Drug Abuse(NIDA).During the last decade, a number of events have occurred that persuadedNIDAthat it is time to reevaluate the current method by which the Department of Health and Human Services(HHS)regulates methadone treatment. As a result of research during the past twenty years, we have learned about the effective components of methadone treatment. In comparison to other available treatment modalities for opioid addiction, methadone treatment is uniquely effective when administered by well-trained medical staffs.
The Evolution of Workplace Drug Screening: A Medical Review Officer's Perspective
Authors: Broadwell D. Kim 
Published: June 2007

In the United States, screening the urine of employees or job applicants for the presence of drugs has become commonplace. A survey of 794 large- and mediumsized companies, conducted by the American Management Association in January 1994, found that 87 percent of them now test job applicants for drug use. In 1987, a similar survey found that 22 percent screened job applicants. Federally mandated drug testing programs with random testing requirements affect millions of workers in the transportation industry, the nuclear power industry, and the United States civil and military services.As some of these programs pass their fifth anniversary since being instituted, it is important to assess the forces that led to their creation. Whether or not these programs are considered successful depends on what one expects to achieve by such widespread testing.
Prescription Drugs and Nursing Education: Knowledge Gaps and Implications for Role Performance
Authors: Naegle Madeline A. 
Published: June 2007

Nurses in all practice roles and settings need to understand the therapeutic use and potential for abuse of prescription drugs. Nursing roles, which include the administration and prescription of medication, health teaching and the implications of application, and the detection ofdrug-related problems, require that such education be timely and comprehensive. This paper discusses the state of knowledge dissemination about prescription drugs within the general context of nursing education. It highlights educational needs and explores the attitudinal factors and knowledge deficits that influence the nursing practices of prescribing, pain management, nursing assessment, and care of persons with drug problems.Standard educational requirements in all nursing curricula undergird teaching about licit and illicit drugs and medication, as well as their therapeutic use, misuse, and abuse. It has been recognized widely since the early1980s,however, that clinical experiences and didactic content on licit and illicit drugs presented in nursing programs is inadequate.
Truce on the Battlefield: A Proposal for a Different Approach to Medical Informed Consent
Authors: Piper August 
Published: June 2007

What is informed consent in medicine? For more than a generation, this deceptively simple question has vexed the law, discomfited medicine, and generated much inspired, provocative, and even contentious commentary.The question has also spawned several lawsuits. On one side stand patients who claim that, at the time of consent, they were ignorant of a particular risk; who state that, with more or different information, they would have chosen a different treatment; and who argue that, because of an adverse outcome, they now deserve remuneration. On the other side, doctors uneasily watch the lengthening list of suits. Some, troubled by the law's expectations, have reacted by variously describing informed consent as a myth, a fiction, an unattainable goal, or a snare to entrap physicians. They point to the legal commentary condemning informed consent law as ill-defined, diffuse, and fraught with inconsistency, hazy at its best and virtually indecipherable to physicians at its worst: and lacking a fair standard to determine when a patient has sufficient knowledge to give effective consent.
Parents’ Perceptions of Decision Making for Children
Authors: Anderson Betsy , Hall Barbara 
Published: June 2007

Futile treatment. Do not resuscitate (DNR). These terms and the thoughts they evoke may be unfamiliar to families with ill children. Similarly, laws, such as the Americans with Disabilities Act or the Emergency Medical Treatment and Active Labor Act, are probably unfamiliar. Yet these terms and laws, and, more important, their implications, are part of a new world of health care into which more families are thrust—the world of wrenching and complicated decisions.Although the number of these situations is increasing and even predictable, the infrastructure of support services for families dealing with these medical decisions for seriously ill children has not been adequately addressed or developed. Parents know that some children are born with or develop serious illnesses and die. Amid absorbing large amounts of new information and interpreting the parameters and implications of what they are learning about their child's condition, families are forced by circumstances to assess—and to act on—their most critical, and perhaps previously unexamined, values.
The Role of an Ethics Committee in Resolving Conflict in the Neonatal Intensive Care Unit
Authors: Nelson Robert M. , Shapiro Robyn S. 
Published: June 2007

What should be the role of an institutional ethics committee (IEC) in resolving conflict concerning patient care decisions in the neonatal intensive care unit (NICU)? This question takes on added importance in light of recent court decisions which suggest that IEC deliberations may serve as persuasive evidence in court, of proposed state regulations that would establish an IEC as an alternative to judicial review, and of recent Joint Commission on Accreditation of Healthcare Organizations (JCAHO) guidelines that require an institutional policy on limitation or withdrawal of treatment to include a specified mechanism for resolving conflict. Unfortunately, despite these developments, prospective case consultation remains one of the most controversial and poorly understood aspects of IEC functions. Questions and concerns persist about the relation the IEC has and should have to actual decisions in specific cases.We briefly examine the clinical, organizational, and regulatory complexity of the NICU environment and suggest five potential sources of uncertainty, disagreement, and conflict among parent(s) and NICU staff.
Forgoing Medically Provided Nutrition and Hydration in Pediatric Patients
Authors: Nelson Lawrence J. , Rushton Cindy Hylton , Cranford Ronald E. , Nelson Robert M. , Glover Jacqueline J. , Truog Robert D. 
Published: June 2007

Discussion of the ethics of forgoing medically provided nutrition and hydration tends to focus on adults rather than infants and children. Many appellate court decisions address the legal propriety of forgoing medically provided nutritional support of adults, but only a few have ruled on pediatric cases that pose the same issue.The cessation of nutritional support is implemented most commonly for patients in apermanent vegetative state(often referred to aspersistent vegetative state(hereinafter “PVS”)). An estimated 4,000 to 10,000 American children are in the permanent vegetative state, compared to 10,000 to 25,000 adults. Yet the dearth of literature, case reports, and court decisions suggests that physicians and families of pediatric patients stop medically provided nutrition or seek court orders much less frequently.
Legal Protections for the Scientific Misconduct Whistleblower
Authors: Poon Peter 
Published: June 2007

Even with thirty years of academic experience under his belt, nothing could have prepared the medical school department chairman for the unexpected and protracted course of events that would follow his allegations of scientific misconduct against an associate professor in his department. In this actual case of scientific misconduct whistleblowing, the university allowed the accused professor to resign, but the chairman persisted in seeking a full investigation of the matter. Under the direction of the Office of Scientific Integrity (OSI) of the Department of Health and Human Services (DHHS), the institution eventually reopened the investigation, and concluded that the accused professor had fabricated and falsified data, and had plagiarized the unpublished method of other investigators. Thereafter, the professor agreed to a voluntary exclusion from receiving federal funds for a period of three years.Despite the fact that the chairman's allegations proved true, his involvement as a “whistleblower” entailed consequences that censured rather than encouraged his behavior.
The Charleston Policy on Cocaine Use During Pregnancy: A Cautionary Tale
Authors: Jos Philip H. , Marshall Mary Faith , Perlmutter Martin 
Published: June 2007

The conflict between pregnant women freely using cocaine and the well-being of fetuses presents a difficult social problem. Since 1985, at least 200 women, in thirty states, have been criminally prosecuted for using illicit drugs or alcohol during pregnancy. Such policies enjoy considerable public and political support. Nonetheless, treatment programs that include referral to law enforcement officials raise serious ethical and legal issues for hospitals and health care providers. In this paper, we assess the development of one medical university's controversial treatment program for pregnant women addicted to cocaine.In October 1989, the Medical University of South Carolina (MUSC) instituted a new program, called the Interagency Policy on Management of Substance Abuse During Pregnancy (Interagency Policy), designed “to ensure appropriate management of patients abusing illegal drugs during pregnancy.” This program required some pregnant women to seek drug counseling and prenatal care under the threat of criminal sanctions.
Bargaining about Futility
Authors: Spielman Bethany 
Published: June 2007

What I propose in this article is application of existing dispute resolution practices that take place outside the courtroom to the negotiating that takes place between health providers and families when they try to reach agreement about the limits of medical care that arguably is futile. Specifically, I focus on a bargaining paradigm that is associated with divorce proceedings, and suggest how this paradigm is at work in the conflict about futile treatment. At issue are not the well-publicized aspects of high profile cases, but the rather unpublicized bargaining that goes no further than the clinical setting.Physicians and families who disagree about the futility of medical treatments frequently engage in give-and-take exchanges about whether to start disputed treatments, about what period of time might comprise a reasonable trial period if a treatment is to be administered, and about when and how to transfer a patient to another facility if the dispute cannot be resolved.
Stemming the Tide: Assisted Suicide and the Constitution
Authors: Coleman Carl H. , Miller Tracy E. 
Published: June 2007

On November 8, 1994, Oregon became the first state in the nation to legalize assisted suicide. Passage of Proposition 16 was a milestone in the campaign to make assisted suicide a legal option. The culmination of years of effort, the Oregon vote followed on the heels of failed referenda in California and Washington, and other unsuccessful attempts to enact state laws guaranteeing the right to suicide assistance. Indeed, in 1993, four states passed laws strengthening or clarifying their ban against assisted suicide. No doubt, Proposition 16 is likely to renew the effort to legalize assisted suicide at the state level.The battle over assisted suicide is also unfolding in the courts. Litigation challenging Proposition 16 on the grounds that it violates the equal protection clause is ongoing in Oregon. More significantly, three cases, two in federal courts and one in Michigan state court, have been brought to establish assisted suicide as a constitutionally protected right.
Refusing Life-Sustaining Treatment after Catastrophic Injury: Ethical Implications
Authors: Powell Tia , Lowenstein Bruce 
Published: June 2007

In theory, a competent patient may refuse any and all treatments, even those that sustain life. The problem with this theory, confidently and frequently asserted, is that the circumstances of real patients may so confound us with their complexity as to shake our confident assumptions to their core.For instance, it is not the case that one may always and easily know which patients are competent. Indeed, evaluation of decision-making capacity is notoriously difficult. Not only may reasonable and experienced evaluators, say a judge and a psychiatrist, disagree, but also a person's capacity may change from hour to hour and may extend to some decisions yet not to others. And yet it is on this subtle art of capacity evaluation that life and death decisions often turn, especially when patients decline life-sustaining treatment.An evaluation of capacity may consider the impact of serious medical or psychiatric illness, as well as the patient's life circumstances.
Auto-Assignment and Enrollment in Medicaid Managed Care Programs
Authors: Ferber Joel D. 
Published: June 2007

In the face of escalating Medicaid costs and anticipated reductions in federal Medicaid spending, states are increasingly converting from fee-for-service (FFS) to managed health care systems. The interrelated issues of enrollment and auto-assignment are fundamental to the overall success or failure of Medicaid managed care programs. The purpose of this article is to suggest how policy makers, consumer advocates, and providers should address these issues. My major premise is that implementation of managed care will proceed more smoothly if states adopt enrollment strategies that promote voluntary selection of health plans by Medicaid consumers, minimize the likelihood of auto-assignment, and mitigate the negative consequences of mandatory assignment of consumers to managed care organizations (MCOs).States seeking to implement Medicaid managed care must apply for a waiver from the secretary of the Department of Health and Human Services (DHHS). Two different types of waivers are available to implement Medicaid managed care.
Ethnicity and Advance Care Directives
Authors: Murphy Sheila T. , Palmer Joycelynne M. , Azen Stanley , Frank Gelya , Michel Vicki , Blackhall Leslie J. 
Published: June 2007

Advance care directives for health care have been promoted as a way to improve end-of-life decision making. These documents allow a patient to state, in advance of incapacity, the types of medical treatments they would like to receive (a living will), to name a surrogate to make those decisions (a durable power of attorney for health care), or to do both. Although studies have shown that both physicians and patients generally have positive attitudes about the use of these documents, relatively few individuals have actually completed one.What underlies this discrepancy between attitudes and behavior with regard to advance care directives? One obvious explanation is lack of access. Emanuel et al. estimated that approximately 90 percent of the population desire an advance care directive, and they pointed to access as the major barrier. Yet interventions that increase accessibility have typically failed to yield more than a 20 percent completion rate. Thus, it appears that access is not the sole determinant of advance care directive completion.
Physician-Assisted Suicide in Context: Constitutional, Regulatory, and Professional Challenges
Authors: Lo Bernard , Rothenberg Karen H. , Vasko Michael 
Published: June 2007

Last month, afifty-eight-year old man developed bleeding into his cheek and oozing from sites where previously he had had blood samples drawn. This bleeding was caused by disseminated intravascular coagulation, a complication of colon cancer that had spread to his liver and lungs. This complication occurred even though he was on chemotherapy for the cancer. In the hospital, he received transfusions and was administered medicine to stop the bleeding. However, his condition did not improve. He developed more bruises. When he tried to go to the bathroom without assistance, he fell, struck his head, requiring stitches, and developed a black, swollen eye. The patient, a successful businessman, had already overcome another type of cancer—lymphoma—through chemotherapy, twenty-five years ago. In a few days, this dynamic individual who expected to start experimental chemotherapy now saw his quality of life deteriorate steadily.We talked about more chemotherapy, about hospice, and about withholding attempts at resuscitation if his heart should stop.
When Physicians Choose to Participate in the Death of Their Patients: Ethics and Physician-Assisted Suicide
Authors: Thomasma David C. 
Published: June 2007

Physicians have long aided their patients in dying in an effort to ease human suffering. It is only in thenineteenth and twentieth centuries thatthe prolongation of life has taken on new meaning due to the powers now available to physicians, through new drugs and high technology interventions. Whereas earlier physicians and patients could readily acknowledge that nothing further could be done, today that judgment is problematic.Most often, aiding the dying took the form of not doing anything further to prolong life. Morally, this act of restraint was not difficult, because few options could have been considered. However, some physicians, rarely, would help patients die either by hastening death directly or by increasing pain control with the risk of hastening death, the so-called double effect. When directly hastening death, physicians either directly caused the death of the patient through euthansia, or supplied the means to the patient to bring about death with or without encouragement to use these means. The latter is physician-assisted suicide (PAS).
The Role of Hospice Philosophy of Care in Nonhospice Settings
Authors: Conant Loring , Lowney Arlene 
Published: June 2007

Many advances in public health and medical technology have contributed to the improved wellbeing and overall longevity of Americans. Such benefits, however, have been offset by a change in the nature and prolongation of the dying process. Daniel Callahan offers a challenge to caregivers in his observation of violent death by technological attenuation, and he sets an agenda to identify a more appropriate approach to the needs of the dying.Over the past quarter century, hospice has increasingly been used as a resource for care at the end of life. However, according to 1995 estimates by the National Hospice Organization (NHO), hospice care presently accounts for only about 15 percent of the care of terminally ill patients in the United States. We will review issues of access and use of hospice services and examine the various institutional, professional, societal, and cultural barriers to hospice principles of care, and consider various options to promote optimal care at the end of life.
Christian Perspectives on Assisted Suicide and Euthanasia: The Anglican Tradition
Authors: Cohen Cynthia B. 
Published: June 2007

We have always had the ability to commit suicide or request euthanasia in times of serious illness. Yet these acts have been prohibited by the Christian tradition from early times. Some Christians, as they see relatives and friends kept alive too long and in poor condition through the use of current medical powers, however, are beginning to question that tradition. Are assisted suicide and euthanasia compassionate Christian responses to those in pain and suffering who face death? Or are they ways of isolating and abandoning them, of fleeing from Christian compassion, rather than expressing it?The Committee on Medical Ethics of the Episcopal Diocese of Washington recently issued a report addressing assisted suicide and euthanasia. These matters cry out for religious contributions and perspectives, the Committee believes. The group recognizes that religious voices should not determine public policy, but believes they should be heard as we develop a social consensus about assisted suicide and euthanasia.