The ethical decisions UK doctors make regarding advanced cancer patients at the end of life - the perceived (in) appropriateness of anticoagulation for venous thromboembolism: A qualitative study [Book Review]
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
Learn more about PhilPapers
BMC Medical Ethics 13 (1):22- (2012)
Background: Cancer patients are at risk of developing blood clots in their veins - venous thromboembolism(VTE) - which often takes the form of a pulmonary embolism or deep vein thrombosis. Therisk increases with advanced disease. Evidence based treatment is low molecular weightheparin (LMWH) by daily subcutaneous injection. The aim of this research is to explore thebarriers for doctors in the UK when diagnosing and treating advanced cancer patients withVTE.MethodQualitative, in-depth interview study with 45 doctors (30 across Yorkshire, England and 15across South Wales). Doctors were from three specialties: oncology, palliative medicine andgeneral practice, with a mixture of senior and junior staff. Framework analysis was used. Results: Doctors opinions as to whether LMWH treatment was ethically appropriate for patients whowere symptomatic from VTE but at end of life existed on a shifting continuum, largelyinfluenced by patient prognosis. A lack of immediate benefit coupled with the discomfort of adaily injection had influenced some doctors not to prescribe LMWH. The point at whichLMWH injections should be stopped in patients at the end of life was ambiguous. Someperceived overcaution in their own and other clinicians treatment of patients. Viewpointswere divergent on whether dying of a PE was considered a "good way to go". Theinterventionalism and ethos of palliative medicine was discussed. Conclusions: Decisions are difficult for doctors to make regarding LMWH treatment for advanced cancerpatients with VTE. Treatment for this patient group is bounded to the doctors own moral andethical frameworks
|Keywords||Venous thromboembolism Heparin Low-molecular-weight Palliative care Qualitative research Ethics Medical|
|Categories||categorize this paper)|
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
|Through your library|
References found in this work BETA
Osamu Muramoto (2011). Socially and Temporally Extended End-of-Life Decision-Making Process for Dementia Patients. Journal of Medical Ethics 37 (6):339-343.
Jan Schildmann, Julia Hoetzel, Anne Baumann, Christof Mueller-Busch & Jochen Vollmann (2011). Limitation of Treatment at the End of Life: An Empirical-Ethical Analysis Regarding the Practices of Physician Members of the German Society for Palliative Medicine. Journal of Medical Ethics 37 (6):327-332.
D. Strech & J. Schildmann (2011). Quality of Ethical Guidelines and Ethical Content in Clinical Guidelines: The Example of End-of-Life Decision-Making. Journal of Medical Ethics 37 (7):390-396.
Citations of this work BETA
No citations found.
Similar books and articles
Helge Skirbekk & Per Nortvedt (2012). Inadequate Treatment for Elderly Patients: Professional Norms and Tight Budgets Could Cause “Ageism” in Hospitals. [REVIEW] Health Care Analysis (2):1-10.
Dominic Wilkinson (2009). The Self-Fulfilling Prophecy in Intensive Care. Theoretical Medicine and Bioethics 30 (6):401-410.
Franklin G. Miller, Robert D. Truog & Dan W. Brock (2010). Moral Fictions and Medical Ethics. Bioethics 24 (9):453-460.
Wendy A. Rogers (2002). Is There a Tension Between Doctors' Duty of Care and Evidence-Based Medicine? Health Care Analysis 10 (3):277-287.
Jerome Lowenstein (2005). The Midnight Meal and Other Essays About Doctors, Patients, and Medicine. University of Michigan Press.
John K. Davis (2004). Conscientious Refusal and a Doctors's Right to Quit. Journal of Medicine and Philosophy 29 (1):75 – 91.
Linus Johnsson, Gert Helgesson, Mats G. Hansson & Stefan Eriksson (2013). Adequate Trust Avails, Mistaken Trust Matters: On the Moral Responsibility of Doctors as Proxies for Patients' Trust in Biobank Research. Bioethics 27 (9):485-492.
David Shaw (2010). An Extra Reason to Roll the Dice: Balancing Harm, Benefit and Autonomy in 'Futile' Cases. Clinical Ethics 5 (217):219.
Raphael Cohen-Almagor (2002). Should Doctors Suggest Euthanasia to Their Patients? Reflections on Dutch Perspectives. Theoretical Medicine and Bioethics 23 (4-5):287-303.
Eugene J. Stein (1980). Doctors and Patients: Partners or Adversaries? [REVIEW] Bioethics Quarterly 2 (2):118-122.
Emma Verástegui (2006). Consenting of the Vulnerable: The Informed Consent Procedure in Advanced Cancer Patients in Mexico. [REVIEW] BMC Medical Ethics 7 (1):1-12.
David Orentlicher (2005). Making Research a Requirement of Treatment: Why We Should Sometimes Let Doctors Pressure Patients to Participate in Research. Hastings Center Report 35 (5):20-28.
Fiona Randall (1996). Palliative Care Ethics: A Good Companion. Oxford University Press.
Barbara Hayes (2010). Trust and Distrust in Cpr Decisions. Journal of Bioethical Inquiry 7 (1):111-122.
Arthur R. Derse (1999). Making Decisions About Life-Sustaining Medical Treatment in Patients with Dementia. Theoretical Medicine and Bioethics 20 (1):55-67.
Added to index2012-09-05
Total downloads3 ( #439,653 of 1,699,479 )
Recent downloads (6 months)1 ( #362,609 of 1,699,479 )
How can I increase my downloads?