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Legislating organ donation: problems with this approach. 器官捐献立法:这一方法的问题。
Annals (Royal College of Physicians and Surgeons of Canada) Pub Date : 1997-02-01
F R Sutherland
{"title":"Legislating organ donation: problems with this approach.","authors":"F R Sutherland","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The number of organs available for transplantation in Canada is insufficient to meet the demand, so many patients die waiting for surgery. Improving the supply of donor organs by enacting legislation is controversial. Three approaches to legislation have been suggested: required request, mandated choice, and presumed consent. Required-request legislation demands that physicians ask all families of potential donors for permission to retrieve organs. Mandated choice requires all adults to register whether they wish to be organ donors. Presumed consent allows the removal of organs without permission if no choice was registered. These laws are aimed at coercion of physicians, patients and families retrospectively, but their relative success and ethics are questionable. Facilitating the organ donation process may be a better solution.</p>","PeriodicalId":80483,"journal":{"name":"Annals (Royal College of Physicians and Surgeons of Canada)","volume":"30 1","pages":"33-4"},"PeriodicalIF":0.0,"publicationDate":"1997-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22066031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Knowledge and attitudes of physicians regarding organ donation. 医生对器官捐献的知识和态度。
Annals (Royal College of Physicians and Surgeons of Canada) Pub Date : 1997-02-01
A E Molzahn
{"title":"Knowledge and attitudes of physicians regarding organ donation.","authors":"A E Molzahn","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The objectives of this study were to describe Canadian physicians' knowledge, attitudes, commitment, and professional involvement relating to organ donation, and to identify factors related to personal commitment and professional involvement. A cross-sectional survey design was used. Mailed questionnaires were sent to 2,400 randomly selected physicians practising in Canada. A total of 831 physicians (34.6 per cent) responded. Over 95 per cent of the physicians who responded supported organ donation in principle, but only 63 per cent had signed organ donor cards. Physicians responded correctly on average to 68.3 per cent of the questions testing knowledge. Many respondents incorrectly answered questions on brain-death legislation and religious barriers to organ donation. Many physicians indicated their reluctance to approach relatives of potential organ donors. The predictors of their personal commitment to organ donation included positive attitudes, younger age, and female gender. In relation to professional involvement in organ donation, more knowledge, positive attitudes, younger age, male gender, and higher numbers of hospital beds were important predictors.</p>","PeriodicalId":80483,"journal":{"name":"Annals (Royal College of Physicians and Surgeons of Canada)","volume":"30 1","pages":"29-32"},"PeriodicalIF":0.0,"publicationDate":"1997-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22066029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
National survey on the attitudes of Canadian physicians towards drug-detailing by pharmaceutical representatives. 关于加拿大医生对药品代表详细说明药物的态度的全国性调查。
Annals (Royal College of Physicians and Surgeons of Canada) Pub Date : 1996-12-01
D Strang, M Gagnon, W Molloy, M Bedard, P Darzins, E Etchells, W Davidson
{"title":"National survey on the attitudes of Canadian physicians towards drug-detailing by pharmaceutical representatives.","authors":"D Strang,&nbsp;M Gagnon,&nbsp;W Molloy,&nbsp;M Bedard,&nbsp;P Darzins,&nbsp;E Etchells,&nbsp;W Davidson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Our objective was to study the attitudes of Canadian physicians toward product presentations by pharmaceutical representatives (PRs), the use of inducements by the pharmaceutical industry, and methods to improve the quality of prescribing information provided to physicians.</p><p><strong>Design: </strong>We used a mailed survey.</p><p><strong>Participants: </strong>A random sample of 550 Canadian physicians in all settings was chosen.</p><p><strong>Outcome measures: </strong>The main outcome measure was the proportion of respondents agreeing with a series of statements.</p><p><strong>Results: </strong>The response rate was 262 of 525 deliverable surveys (50 per cent). Respondents had a mean of 4.2 interactions per week with PRs. Of the 262 respondents (5.8 per cent of data were incomplete), 193 (80 per cent) believed that PRs overemphasize their products' effectiveness, 108 (45 per cent) thought PRs do not present fairly the drugs' negative aspects, and 223 (92 per cent) felt that PRs have production promotion as a goal. Most, 175 (70 per cent), believe that drug-detailing affects physicians' prescribing behavior. Most, 210 (86 per cent), considered drug samples acceptable, but fewer agreed that other inducements were acceptable. Of the respondents, 183 (74 per cent) agreed that PRs should be required to use guidelines for standardized, comprehensive drug-detailing, and 165 (65 per cent) agreed that face-to-face drug-detailing by PRs using standardized guidelines would be an effective way to receive information.</p><p><strong>Conclusions: </strong>There is dissatisfaction among Canadian physicians about the quality of information provided by the pharmaceutical industry. Standardized, comprehensive guidelines would be accepted by physicians as one improvement.</p>","PeriodicalId":80483,"journal":{"name":"Annals (Royal College of Physicians and Surgeons of Canada)","volume":"29 8","pages":"474-8"},"PeriodicalIF":0.0,"publicationDate":"1996-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22066685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Refusal of treatment, leading to death: towards optimization of informed consent. 拒绝治疗，导致死亡:优化知情同意。
Annals (Royal College of Physicians and Surgeons of Canada) Pub Date : 1996-12-01
B Trevor-Deutsch, R F Nelson
{"title":"Refusal of treatment, leading to death: towards optimization of informed consent.","authors":"B Trevor-Deutsch,&nbsp;R F Nelson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Few medical decisions create more anguish than ones involving cessation of treatment, resulting in the death of a patient. In this article, the ethical and legal aspects of the withdrawal of treatment are examined with respect to a case of a 67-year-old man who fell and sustained a fracture of his second cervical vertebra, rendering him paralysed and respirator-dependent. He immediately requested the withdrawal of treatment, but his family baulked. Ethics consultation recommended delaying the decision, to give the patient enough time to foster optimal comprehension and synthesis of information related to his condition and the consequences; we refer to this process as \"optimization of informed consent.\" When the patient was informed of the delay and the reasons for it, he was assured (and subsequently repeatedly reassured) of his ultimate right to refuse treatment at a future date. On balance, optimization of informed consent promotes patients' autonomy, even though it involves suspending this autonomy for a time. It is also consistent with physicians' responsibility to promote life and avoid premature death.</p>","PeriodicalId":80483,"journal":{"name":"Annals (Royal College of Physicians and Surgeons of Canada)","volume":"29 8","pages":"487-9"},"PeriodicalIF":0.0,"publicationDate":"1996-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22066686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Do-not-resuscitate practice, guidelines and policies in long-term care in Ontario: results of a survey. 安大略省长期护理的不复苏实践、指导方针和政策:一项调查结果。
Annals (Royal College of Physicians and Surgeons of Canada) Pub Date : 1996-09-01
M Gordon, B E Schwartz
{"title":"Do-not-resuscitate practice, guidelines and policies in long-term care in Ontario: results of a survey.","authors":"M Gordon,&nbsp;B E Schwartz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We used a survey to determine the prevalence of do-not-resuscitate (DNR) guidelines and protocols, and opinions related to cardiopulmonary resuscitation (CPR) in facilities that provide long-term care (LTC) in Ontario. Questionnaires completed by 357 of 474 facilities providing LTC, revealed that most have written DNR policies. Over half inform residents about the policy on admission, and a third later on, with most indicating DNR status on the chart. Over half the institutions can provide CPR, mostly basic cardiac life support. Most institutions rely on emergency ambulance services to treat cardiac arrests. In the absence of a DNR order, almost half will perform CPR, and a quarter have a protocol to deal with this circumstance. Most respondents indicated that staff, families and residents would welcome a protocol to deal with absent DNR orders in cardiac arrests. Most believe that staff, families and residents would welcome DNR as the basic policy, with CPR as the exception. There is a high awareness in facilities that provide LTC of the limits of CPR in the elderly. Without specific legislation, most facilities have policies and protocols, but there are inconsistencies across Ontario.</p>","PeriodicalId":80483,"journal":{"name":"Annals (Royal College of Physicians and Surgeons of Canada)","volume":"29 6","pages":"332-5"},"PeriodicalIF":0.0,"publicationDate":"1996-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22064447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Requiem or renaissance for the law reform commission of Canada? 加拿大法律改革委员会的安魂曲还是文艺复兴?
Annals (Royal College of Physicians and Surgeons of Canada) Pub Date : 1996-04-01
D J Jones
{"title":"Requiem or renaissance for the law reform commission of Canada?","authors":"D J Jones","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>From 1975 to 1992, the protection of life project of the Law Reform Commission of Canada sought to help society answer some of the legal and bioethical riddles posed by the biomedical revolution, particularly as these developments affected the protection of human life, public safety and fundamental values. A focus on the risks, benefits, rights and duties associated with biomedical sciences and technology provided the project both a means of inquiry into pressing health law and bioethics questions, and a methodology of law reform. The inquiry was often applied through a transdisciplinary perspective, to such topics as the redefinition of death, medically assisted procreation, behavioral alteration, human experimentation, organ transplantation, consent, and the criminal law. Amid recent initiatives to resurrect the Commission, the contributions of the protection of life project are likely to be judged by the bioethico-legal decision-making, dispute resolution, legislative or regulatory enactments and court decisions influenced by its corpus of thought.</p>","PeriodicalId":80483,"journal":{"name":"Annals (Royal College of Physicians and Surgeons of Canada)","volume":"29 3","pages":"167-70"},"PeriodicalIF":0.0,"publicationDate":"1996-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22090069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A curriculum for teaching clinical ethics in neonatal-perinatal medicine. 新生儿-围产期医学临床伦理学教学大纲。
Annals (Royal College of Physicians and Surgeons of Canada) Pub Date : 1996-02-01
D J Davis, H Doucet
{"title":"A curriculum for teaching clinical ethics in neonatal-perinatal medicine.","authors":"D J Davis,&nbsp;H Doucet","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Ethical thought plays a role in clinical decision-making, especially in fields such as neonatal-perinatal medicine. There is limited information, however, on the best way to teach ethics to postgraduate medical trainees in this subspeciality. This article describes the development, implementation, and evolution of a structured curriculum in ethics for a program in neonatal-perinatal medicine. The curriculum is facilitated by a specialist in ethics and based on hypothetical case scenarios, which are discussed using a framework that highlights the ethical values promoted or neglected in each decision option. Formal evaluation of the program has been impossible, but informal reviews indicate that there is a high degree of satisfaction.</p>","PeriodicalId":80483,"journal":{"name":"Annals (Royal College of Physicians and Surgeons of Canada)","volume":"29 1","pages":"45-8"},"PeriodicalIF":0.0,"publicationDate":"1996-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22195636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The evolution of the concept of brain death. 脑死亡概念的演变。
Annals (Royal College of Physicians and Surgeons of Canada) Pub Date : 1995-02-01
M T Spoor, F R Sutherland
{"title":"The evolution of the concept of brain death.","authors":"M T Spoor,&nbsp;F R Sutherland","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The definition of death has taken many forms throughout history. Because of advances in critical care and developments in transplantation, a new definition of death has evolved over the past 30 years. The first accounts of brain death were published in 1959, in relative obscurity. They were only considered to be of academic interest. In the mid-1960s, advances in transplantation and the need for viable organs started debate about the use of \"brain-dead\" patients as organ donors. Conceptual advances by the ad hoc committee of the Harvard medical school and the use of angiography and the electroencephalogram both advanced and confused the issue. Acceptance by the medical community remained divided. During the 1970s, brain-stem death was proposed as the true definition of death by pioneers in the United States and Britain. In the 1980s, the clinical diagnosis of brain-stem death was officially accepted and many of the controversies subsided.</p>","PeriodicalId":80483,"journal":{"name":"Annals (Royal College of Physicians and Surgeons of Canada)","volume":"28 1","pages":"30-4"},"PeriodicalIF":0.0,"publicationDate":"1995-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24851449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Presentation to the Special Senate Committee on Euthanasia and Assisted Suicide. 向参议院安乐死和协助自杀特别委员会作报告。
Annals (Royal College of Physicians and Surgeons of Canada) Pub Date : 1994-12-01
G L Crelinsten, P A Singer, N P Kenny
{"title":"Presentation to the Special Senate Committee on Euthanasia and Assisted Suicide.","authors":"G L Crelinsten,&nbsp;P A Singer,&nbsp;N P Kenny","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":80483,"journal":{"name":"Annals (Royal College of Physicians and Surgeons of Canada)","volume":" ","pages":"459-61"},"PeriodicalIF":0.0,"publicationDate":"1994-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24851451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patient autonomy and the physician's ethics. 病人自主和医生道德。
Annals (Royal College of Physicians and Surgeons of Canada) Pub Date : 1994-04-01
E D Pellegrino
{"title":"Patient autonomy and the physician's ethics.","authors":"E D Pellegrino","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the last 25 years, patient autonomy has displaced physician beneficence as a dominant principle in medical ethics. This has enhanced the moral right of patients to refuse unwanted treatment and to participate in clinical decisions. But now, in some cases, patient autonomy is being absolutized. The right to refuse is becoming a right to demand treatment. The result is danger to the moral and professional integrity of physicians. A reassessment of the mutual moral obligations of physicians and patients to respect each other's autonomy is in order.</p>","PeriodicalId":80483,"journal":{"name":"Annals (Royal College of Physicians and Surgeons of Canada)","volume":"27 3","pages":"171-3"},"PeriodicalIF":0.0,"publicationDate":"1994-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24851450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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