E. Howe

This article reviews careproviders’ most difficult emotional challenges during disasters and provides approaches for responding optimally to them. It describes key approaches that careproviders may pursue to best help patients and others during a catastrophe. It raises unanswered questions regarding when, if ever, careproviders should provide active euthanasia to patients who are incompetent, and when, if ever, careproviders should give their own food and water to patients or others who may otherwise soon die without them.

This article discusses a case in this issue of The Journal of Clinical Ethics by McCrary and colleagues, “Elective Delivery Before 39 Weeks’ Gestation Reconciling Maternal, Fetal, and Family Circumstances,” in which parents asked the medical team to deliver their fetus “early.” The author discusses (1) the importance that parents have to a child when they are able to love the child, and how important it is for decision makers to consider this; (2) exceptional approaches that may enable parents to “change their minds”; and (3) substantive and procedural innovations that may help to prevent clinicians’ views from playing too big a role and/or being arbitrary. The author concludes by describing how he felt when reading the case and uses this to illustrate how clinicians may benefit by assessing their feelings.

The author describes an alternative approach that careproviders may want to consider when caring for patients who request interventions that careproviders see as futile. This approach is based, in part, on findings of recent neuroimaging research. The author also provides several examples of seemingly justifiable “paternalistic omissions,” taken from articles in this issue of The Journal of Clinical Ethics (JCE). The author suggests that while careproviders should always give patients and their loved ones all potentially relevant information regarding “futile” decisions, careproviders may wish to consider, paradoxically, not giving advice in these situations, when the advice is based mostly or wholly on their own moral views, based on this same, ethical rationale.

Attention to the ethical concerns of healthcare aides can provide important information about patients’ needs to careproviders, improve the ethical environment of an institution, and benefit aides who suffer from bearing ethical concerns alone. All persons benefit from sharing their ethical concerns with others. Among other benefits, ethics consultation offers careproviders, caregivers, healthcare aides, patients, and patients’ loved ones an opportunity to have their concerns heard.John Fletcher tried to follow every ethics consultation with a debriefing for all participants, including patients and family members, to increase the possibility for continued healing after the conclusion of the consultation, and there are good reasons to follow this practice.

In the documentary Boston Med, patients, their family members, and their careproviders agree to be filmed in real medical situations. Why would they do this? The possible answers to this question may help us to make sense of the paradoxical results of a recent study, in which patients with terminal illness ranked their careproviders highly for communication, even though the patients had failed to learn that they had a fatal illness. Based on this analysis, I offer careproviders a practical approach they can use to improve communication with patients, particularly to help patients to feel less alone. This same approach can also be applied in bioethics consultation.

In this issue of The Journal of Clinical Ethics, Emily Bell and Eric Racine are guest editors of a special section focusing on the use of deep brain stimulation (DBS) to treat Parkinson’s disease. In “Deep Brain Stimulation, Ethics, and Society,” Bell and Racine report that DBS already has been used to treat more than 50,000 patients. The ethical issues raised in this special section are important not only in regard to Parkinson’s disease and DBS, but in many areas of medicine.The articles discuss sound, state-of-the-art ethical approaches. This introduction to the issue presents approaches that are adjunctive and intended to increase careproviders’ options, that should increase careproviders’ ability to individualize the care that they provide to their patients.

In this special issue of The Journal of Clinical Ethics, different views on both the ethical desirability of women delivering in hospitals or at home with midwives are discussed. What careproviders, including midwives, should recommend to mothers in regard to the place of giving birth is considered. Emotional concerns likely to be of importance to mothers, fathers, midwives, and doctors are also presented. Finally, possible optimal approaches at the levels of both policy and the bedside are suggested.