Background: Relatively little is known about neonatologists' roles in helping families navigate the difficult decision to attempt or withhold resuscitation for a neonate delivering at the threshold...

The cost of health care in the United States has important generational considerations whether analyzed at a point in time, or over many years. The budgets of governments contain important information about the funding of public services, including health care, and the intra- and inter-generational implications of both the inherent tradeoffs, and the particular means of funding the services. End-of-life expenditures, while a significant component of the cost of health care, are not the primary consideration in the ethical or moral (...) questions raised. (shrink)

In this essay I ask the reader to consider the “end of life” as a life stage, rather than as a health state. At one end of the life course is childhood and at the other end is elderhood. The basic inter-generational social compact in most societies is that working adults take care of their children and their parents, and count on their children to do the same for them. In developed countries, these obligations are met in part through government (...) programs, with taxpayers funding significant portions of education, health care, and income support. (shrink)

Background This study introduces an empirical approach for studying the role of prudence in physician treatment of end-of-life (EOL) decision making.Methods A mixed-methods analysis of transcripts from 88 simulated patient encounters in a multicenter study on EOL decision making. Physicians in internal medicine, emergency medicine, and critical care medicine were asked to evaluate a decompensating, end-stage cancer patient. Transcripts of the encounters were coded for actor, action, and content to capture the concept of Aristotelian prudence, and then quantitatively and qualitatively (...) analyzed to identify actions associated with preference-concordant treatment.Results Focusing on codes that describe characteristics of physician-patient interaction, the code for physicians restating patient preferences was associated with avoiding intubation. Multiple codes were associated with secondary measures of preference-concordant treatment.Conclusions Prudent actions can be identified empirically, and research focused on the virtue of prudence may provide a new avenue for assessment and training in EOL care. (shrink)