32 found
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Andrew Courtwright [18]Andrew M. Courtwright [14]
  1.  30
    After the DNR: Surrogates Who Persist in Requesting Cardiopulmonary Resuscitation.Ellen M. Robinson, Wendy Cadge, Angelika A. Zollfrank, M. Cornelia Cremens & Andrew M. Courtwright - 2017 - Hastings Center Report 47 (1):10-19.
    Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...)
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  2.  55
    Stigmatization and public health ethics.Andrew Courtwright - 2011 - Bioethics 27 (2):74-80.
    Encouraged by the success of smoking denormalization strategies as a tobacco-control measure, public health institutions are adopting a similar approach to other health behaviors. For example, a recent controversial ad campaign in New York explicitly aimed to denormalize HIV/AIDS amongst gay men. Authors such as Scott Burris have argued that efforts like this are tantamount to stigmatization and that such stigmatization is unethical because it is dehumanizing. Others have offered a limited endorsement of denormalization/stigmatization campaigns as being justified on consequentialist (...)
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  3.  17
    Normothermic Regional Perfusion, Causes, and the Dead Donor Rule.Andrew M. Courtwright - 2023 - American Journal of Bioethics 23 (2):46-47.
    The interpretation of the dead donor rule (DDR) has been central to recent debates regarding normothermic regional perfusion with controlled donation after circulatory death (NRP-cDCD). Proponents...
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  4.  14
    Who should Decide for the Unrepresented?Andrew Courtwright & Emily Rubin - 2015 - Bioethics 30 (3):173-180.
    Unrepresented patients lack the capacity to make medical decisions for themselves, have no clear documentation of preferences for medical treatment, and have no surrogate decision maker or obvious candidate for that role. There is no consensus about who should serve as the decision maker for these patients, particularly regarding whether to continue or to limit life-sustaining treatment. Several authors have argued that ethics committees should play this role rather than the patient's treating physician, a common current default. We argue that (...)
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  5.  18
    The Evolution of Hospital Ethics Committees in the United States: A Systematic Review.Martha Jurchak & Andrew Courtwright - 2016 - Journal of Clinical Ethics 27 (4):322-340.
    During the 1970s and 1980s, legal precedent, governmental recommendations, and professional society guidelines drove the formation of hospital ethics committees (HECs). The Joint Commission on Accreditation of Health Care Organization’s requirements in the early 1990s solidified the role of HECs as the primary mechanism to address ethical issues in patient care. Because external factors drove the rapid growth of HECs on an institution-byinstitution basis, however, no initial consensus formed around the structure and function of these committees. There are now almost (...)
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  6.  21
    Ethics Consultations at a Major Academic Medical Center: A Retrospective, Longitudinal Analysis.Aimee Milliken, Andrew Courtwright, Pamela Grace, Elizabeth Eagan-Bengston, Monique Visser & Martha Jurchak - 2020 - AJOB Empirical Bioethics 11 (4):275-286.
    Growing evidence suggests that nurses and other clinicians often feel insufficiently equipped to manage ethical issues that arise in their practice (Truog et al. 2015; Woods 2005; Darmon et al. 201...
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  7.  16
    The Role of a Hospital Ethics Consultation Service in Decision-Making for Unrepresented Patients.Andrew M. Courtwright, Joshua Abrams & Ellen M. Robinson - 2017 - Journal of Bioethical Inquiry 14 (2):241-250.
    Despite increased calls for hospital ethics committees to serve as default decision-makers about life-sustaining treatment for unrepresented patients who lack decision-making capacity or a surrogate decision-maker and whose wishes regarding medical care are not known, little is known about how committees currently function in these cases. This was a retrospective cohort study of all ethics committee consultations involving decision-making about LST for unrepresented patients at a large academic hospital from 2007 to 2013. There were 310 ethics committee consultations, twenty-five of (...)
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  8.  13
    Declining to Provide or Continue Requested Life-Sustaining Treatment: Experience With a Hospital Resolving Conflict Policy.Emily B. Rubin, Ellen M. Robinson, M. Cornelia Cremens, Thomas H. McCoy & Andrew M. Courtwright - 2023 - Journal of Bioethical Inquiry 20 (3):457-466.
    In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...)
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  9.  30
    The role of religious beliefs in ethics committee consultations for conflict over life-sustaining treatment.Julia I. Bandini, Andrew Courtwright, Angelika A. Zollfrank, Ellen M. Robinson & Wendy Cadge - 2017 - Journal of Medical Ethics 43 (6):353-358.
    Previous research has suggested that individuals who identify as being more religious request more aggressive medical treatment at end of life. These requests may generate disagreement over life-sustaining treatment (LST). Outside of anecdotal observation, however, the actual role of religion in conflict over LST has been underexplored. Because ethics committees are often consulted to help mediate these conflicts, the ethics consultation experience provides a unique context in which to investigate this question. The purpose of this paper was to examine the (...)
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  10.  23
    Ethics Consultation for Adult Solid Organ Transplantation Candidates and Recipients: A Single Centre Experience.Andrew M. Courtwright, Kim S. Erler, Julia I. Bandini, Mary Zwirner, M. Cornelia Cremens, Thomas H. McCoy, Ellen M. Robinson & Emily Rubin - 2021 - Journal of Bioethical Inquiry 18 (2):291-303.
    Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...)
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  11.  71
    Justice, stigma, and the new epidemiology of health disparities.Andrew M. Courtwright - 2009 - Bioethics 23 (2):90-96.
    Recent research in epidemiology has identified a number of factors beyond access to medical care that contribute to health disparities. Among the so-called socioeconomic determinants of health are income, education, and the distribution of social capital. One factor that has been overlooked in this discussion is the effect that stigmatization can have on health. In this paper, I identify two ways that social stigma can create health disparities: directly by impacting health-care seeking behaviour and indirectly through the internalization of negative (...)
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  12.  42
    Ethics committee consultation due to conflict over life-sustaining treatment: A sociodemographic investigation.Andrew M. Courtwright, Frederic Romain, Ellen M. Robinson & Eric L. Krakauer - 2016 - AJOB Empirical Bioethics 7 (4):220-226.
    Background: The bioethics literature contains speculation but little data about sociodemographic differences between patients for whom ethics committees (EC) are consulted for conflict about life-sustaining treatment (LST) and the broader hospital population that these committees serve. To provide an empirical context for this discussion, we examined differences in five sociodemographic factors between patients for whom an EC was consulted for conflict over LST and the general inpatient population, hypothesizing that nonwhite patients were most likely to be disproportionately represented. Methods: This (...)
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  13.  17
    Experience with a Revised Hospital Policy on Not Offering Cardiopulmonary Resuscitation.Andrew M. Courtwright, Emily Rubin, Kimberly S. Erler, Julia I. Bandini, Mary Zwirner, M. Cornelia Cremens, Thomas H. McCoy & Ellen M. Robinson - 2020 - HEC Forum 34 (1):73-88.
    Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...)
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  14.  19
    Who Is “Too Sick to Benefit”?Andrew Courtwright - 2012 - Hastings Center Report 42 (4):41-47.
    Intensive care units provide focused, aggressive medical intervention to critically ill patients. Physicians responsible for ICU triage must decide which patients are sick enough to require this level of care and which can be managed on the general wards. While some patients are too well for the ICU, intensivists increasingly rely on another category, “too sick to benefit,” when denying ICU admission, even if beds are readily available. Recent studies indicate that between 19 and 37 percent of patients refused ICU (...)
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  15.  16
    An Ethical Framework for the Care of Patients with Prolonged Hospitalization Following Lung Transplantation.Andrew M. Courtwright, Emily Rubin, Ellen M. Robinson, Souheil El-Chemaly, Daniela Lamas, Joshua M. Diamond & Hilary J. Goldberg - 2019 - HEC Forum 31 (1):49-62.
    The lung allocation score system in the United States and several European countries gives more weight to risk of death without transplantation than to survival following transplantation. As a result, centers transplant sicker patients, leading to increased length of initial hospitalization. The care of patients who have accumulated functional deficits or additional organ dysfunction during their prolonged stay can be ethically complex. Disagreement occurs between the transplant team, patients and families, and non-transplant health care professionals over the burdens of ongoing (...)
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  16.  12
    From Unregulated Practice to Credentialed Profession: Implementing Ethics Consultation Competencies.Andrew Courtwright - 2013 - American Journal of Bioethics 13 (2):16-17.
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  17.  16
    Shared Health Governance and the Problem of Stability.Andrew Courtwright - 2011 - American Journal of Bioethics 11 (7):47 - 49.
    The American Journal of Bioethics, Volume 11, Issue 7, Page 47-49, July 2011.
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  18.  22
    Can I trust them to do everything? The role of distrust in ethics committee consultations for conflict over life-sustaining treatment among Afro-Caribbean patients.Frederic Romain & Andrew Courtwright - 2016 - Journal of Medical Ethics 42 (9):582-585.
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  19.  11
    The Moral Relevance of ECMO Bridge Maintenance.Andrew M. Courtwright - 2023 - American Journal of Bioethics 23 (6):52-54.
    Childress et al. (2023) have provided a cogent overview of the ethical considerations involved in withdrawing extracorporeal membrane oxygenation (ECMO) over a capacitated patient’s objection. Alth...
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  20. Benjamin E. Berkman is a faculty.Andrew Courtwright - forthcoming - Hastings Center Report.
     
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  21.  34
    Health disparities and autonomy.Andrew Courtwright - 2008 - Bioethics 22 (8):431-439.
    Disparities in socioeconomic status correlate closely with health, so that the lower a person's social position, the worse his health, an effect that the epidemiologist Michael Marmot has labeled the status syndrome. Marmot has argued that differences in autonomy, understood in terms of control, underlie the status syndrome. He has, therefore, recommended that the American medical profession champion policies that improve patient autonomy. In this paper, I clarify the kind of control Marmot sees as connecting differences in socioeconomic status to (...)
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  22.  11
    Healthcare Provider Limitation of Life-Sustaining Treatment without Patient or Surrogate Consent.Andrew Courtwright & Emily Rubin - 2017 - Journal of Law, Medicine and Ethics 45 (3):442-451.
    In June 2015, the major North American and European critical care societies released new joint guidelines that delineate a process-based approach to resolving intractable conflicts over the appropriateness of providing or continuing LST.2 This article frames the new guidelines within the history, ethical arguments, legal landscape, and empirical evidence regarding limitation of LST without surrogate consent in cases of intractable conflict.
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  23.  60
    Justice, health, and status.Andrew M. Courtwright - 2007 - Theoria 54 (112):1-24.
    Philosophical and political discussions of health inequalities have largely focused on questions of justice. The general strategy employed by philosophers like Norman Daniels is to identify a certain state of affairs—in his case, equality of opportunity—and then argue that health disparities limiting an individual's or group's access to that condition are unjust, demanding intervention. Recent work in epidemiology, however, has highlighted the importance of socioeconomic status in creating health inequalities. I explore the ways in which theories of justice have been (...)
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  24.  12
    Justice, Health, and Status.Andrew M. Courtwright - 2007 - Theoria 54 (112):1-24.
    Philosophical and political discussions of health inequalities have largely focused on questions of justice. The general strategy employed by philosophers like Norman Daniels is to identify a certain state of affairs—in his case, equality of opportunity—and then argue that health disparities limiting an individual's or group's access to that condition are unjust, demanding intervention. Recent work in epidemiology, however, has highlighted the importance of socioeconomic status in creating health inequalities. I explore the ways in which theories of justice have been (...)
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  25.  34
    The social determinants of health: Moving beyond justice.Andrew Courtwright - 2008 - American Journal of Bioethics 8 (10):16 – 17.
    In 2005, the relative risk of death was 30% higher for African Americans than White Americans, with differences in cardiovascular mortality accounting for the largest portion of this disparity (Cen...
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  26.  14
    When Exclusion Criteria Are Appropriate.Andrew M. Courtwright - 2020 - American Journal of Bioethics 20 (7):158-160.
    Volume 20, Issue 7, July 2020, Page 158-160.
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  27.  13
    Clinical Ethics Consultation During the First COVID-19 Pandemic Surge at an Academic Medical Center: A Mixed Methods Analysis.Kimberly S. Erler, Ellen M. Robinson, Julia I. Bandini, Eva V. Regel, Mary Zwirner, Cornelia Cremens, Thomas H. McCoy, Fred Romain & Andrew Courtwright - 2023 - HEC Forum 35 (4):371-388.
    While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to (...)
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  28.  39
    How Should Physicians Manage Neuroprognosis with ECPR?Ian McCurry, Jason Han & Andrew Courtwright - forthcoming - Narrative Inquiry in Bioethics.
    Rapidly advancing technologies in the field of extracorporeal cardiopulmonary resuscitation (ECPR) have presented a new challenge in accurate neuroprognostication following cardiac arrest. Determination of brain state informs the prognostic picture and allows providers to begin effective communication regarding likelihood of meaningful neurological recovery as defined by patients or family members. The evolving role of sedation during ECPR and its impacts on ethical tension in decision-making is reviewed. Work surrounding the advancing field of neuroprognostication after cardiac arrest and hypothermia is summarized (...)
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  29.  10
    How Should Physicians Manage Neuroprognosis with ECPR?Ian J. McCurry, Jason Han & Andrew Courtwright - 2020 - Narrative Inquiry in Bioethics 10 (2):173-182.
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  30.  10
    Listening to, Respecting, and Treating Patients With Psychogenic Nonepileptic Seizures.Joel Salinas & Andrew Courtwright - 2013 - American Journal of Bioethics Neuroscience 4 (3):37-38.
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  31.  6
    Structure, Operation, and Experience of Clinical Ethics Consultation 2007-2013: A Report from the Massachusetts General Hospital Optimum Care Committee. [REVIEW]Andrew M. Courtwright, Eric L. Krakauer, M. Cornelia Cremens, Alexandra Cist, Julia Bandini, Sharon Brackett, Kimberly Erler, Wendy Cadge & Ellen M. Robinson - 2017 - Journal of Clinical Ethics 28 (2):137-152.
    We describe the structure, operation, and experience of the Massachusetts General Hospital ethics committee, formally called the Edwin H. Cassem Optimum Care Committee, from January 2007 through December 2013. Founded in 1974 as one of the nation’s first hospital ethics committees, this committee has primarily focused on the optimum use of life-sustaining treatments. We outline specific sociodemographic and clinical characteristics of consult patients during this period, demographic differences between the adult inpatient population and patients for whom the ethics committee was (...)
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  32.  32
    The Changing Composition of a Hospital Ethics Committee: A Tertiary Care Center’s Experience. [REVIEW]Andrew Courtwright, Sharon Brackett, Alexandra Cist, M. Cornelia Cremens, Eric L. Krakauer & Ellen M. Robinson - 2014 - HEC Forum 26 (1):59-68.
    A growing body of research has demonstrated significant heterogeneity of hospital ethics committee (HEC) size, membership and training requirements, length of appointment, institutional support, clinical and policy roles, and predictors of self identified success. Because these studies have focused on HECs at a single point in time, however, little is known about how the composition of HECs changes over time and what impact these changes have on committee utilization. The current study presents 20 years of data on the evolution of (...)
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