Author Interviews, COVID -19 Coronavirus / 31.03.2020

MedicalResearch.com Interview with: Professor Carl Coleman, JD Professor of Law Seton Hall Law School MedicalResearch.com: Do health care workers have an ethical and/or legal obligation to provide treatment during an infectious disease outbreak? Are there exceptions such as pregnancy, if the health care worker is her/himself immunocompromised or have young children at home? Response: As a legal matter, health care workers can generally be required to fulfill pre-existing employment or contractual obligations during an infectious disease outbreak. For example, an emergency room nurse who refuses to come to work during a pandemic can be disciplined or fired; a physician who breaches a contractual obligation to provide on-call services during an outbreak can be held liable for damages. In addition to loss of employment and contractual damages, other potential consequences for failing to honor pre-existing commitments during a pandemic could include professional discipline for patient abandonment and, for physicians with on-call responsibilities in hospital emergency departments, civil fines under the federal Emergency Medical Treatment and Active Labor Act. This does not mean that health care workers are obligated to show up for work during a pandemic regardless of the circumstances. For example, under the Americans with Disabilities Act, health care workers who are immunocompromised can ask for a "reasonable accommodation," such as the right to work remotely (if possible) or to take leave. Under the Family and Medical Leave Act, employers with more than 50 employees must give workers up to 12 weeks of unpaid time off to care for a seriously ill immediate family member. In addition, federal labor laws allow employees to refuse to work under "abnormally dangerous conditions," which might apply in situations where an employer fails to provide necessary protective equipment. However, assuming protective equipment is available, it is not clear that an outbreak itself would be considered "abnormally dangerous," particularly in fields like emergency medicine, where exposure to contagious disease is always a foreseeable risk. In most states, health care workers without pre-existing employment or contractual obligations cannot be compelled to treat patients during a pandemic. However, a few states have laws that authorize public health authorities to require health care professionals to work during public health emergencies. I am not aware of any state that has invoked this authority so far. As for ethical obligations, in 2004, the American Medical Association (AMA) declared that "individual physicians have an obligation to provide urgent medical care during disasters," and that "this ethical obligation holds even in the face of greater than usual risks to their own safety, health or life." Some academic ethicists have expressed similar views. Common justifications for this position are that physicians "assumed the risk" of exposure to infectious diseases when they voluntarily committed themselves to the healing professions; that a "social contract" requires physicians to assume risks in exchange for their social status and privileges; and that individuals who are uniquely capable of providing life-saving care have an obligation to do so. However, I am not persuaded that all physicians -- let alone health care workers more generally -- have an ethical obligation to provide treatment when doing so involves significant risk. A willingness to accept risk is not a condition of obtaining a medical license, nor is it part of the oaths that students commonly take at medical school graduation. While I agree that physicians have ethical obligations to contribute to society, there are many ways they can fulfill these obligations without assuming personal health risks. And even assuming that individuals who are in a unique position to provide life-saving care should normally do so, we generally do not expect people to rescue others from danger at significant risk to themselves. (more…)
Author Interviews, JAMA, University of Pennsylvania / 14.04.2019

MedicalResearch.com Interview with: Genevieve P. Kanter, PhD Assistant Professor (Research) of Medicine Medical Ethics and Health Policy University of Pennsylvania Perelman School of Medicine Philadelphia, PA 19104-6021 MedicalResearch.com: What is the background for this study? Response: Physicians frequently have financial relationships with pharmaceutical and medical device firms, but only recently has information on these financial ties been made available to the public. The Open Payments program, created by the Physician Payment Sunshine Act, has made this industry payments information available through a public website since 2014. Because transparent institutions are believed to engender greater public trust, public disclosure of industry payments could increase public trust in the medical profession, which may have been weakened by physicians' relationships with industry. On the other hand, Open Payments may have decreased public trust because of the focus of media reporting on physicians receiving the largest sums of money. We sought to investigate how Open Payments and the public disclosure of industry payments affected public trust in physicians and in the medical profession. We compared changes in trust among patients who lived in states where payments information had, by state statute, previously been made available, to changes in trust among patients who lived in states where this information became newly available through Open Payments. (more…)
Author Interviews, BMJ, Cancer Research, Cost of Health Care, Imperial College / 11.11.2016

MedicalResearch.com Interview with: Peter Wise MD Charing Cross Hospital and Imperial College School of Medicine London, UK MedicalResearch.com: What is the background for this analysis? Response: As a medical ethicist, I wished to know how much patients with advanced – metastatic – cancer knew about the drugs that were being used to treat it. What were their perceptions of likely treatment success and how did that tally with our knowledge of what drugs could actually achieve – and at what cost to the body and to the pocket. Did patients actually have a choice – and how did the drugs get approved for use in the first place? (more…)
Author Interviews, End of Life Care / 18.02.2015

Eva E. Bolt MD Physician researcher Dept. Public and Occupational Health EMGO+ Institute for Health and Care Research (VU University Medical Center) Medical Faculty Amsterdam, The Netherlands MedicalResearch.com Interview with: Eva E. Bolt MD Physician researcher Dept. Public and Occupational Health EMGO+ Institute for Health and Care Research (VU University Medical Center) Medical Faculty Amsterdam, The Netherlands Medical Research: What is the background for this study? What are the main findings? Dr. Bolt: Three-quarter of all Dutch physicians have ever been asked by a patient to perform euthanasia. Each request for euthanasia calls for careful deliberation. Firstly, the physician needs to judge whether euthanasia would be possible within the limits of the law. Above that, a physician needs to decide whether performing euthanasia is in line with his personal believes and values. This study shows that cause of suffering is an important factor in this decision. In the Netherlands, the euthanasia law gives physicians the possibility of performing euthanasia, if they adhere to strict rules. The euthanasia law is not restricted to certain diseases. However, this study shows that the attitude of physicians towards performing euthanasia varies by condition. Most Dutch physicians would consider granting a request for euthanasia in case of cancer (85%) or another severe physical disease (82%). In contrast, only four out of ten physicians would consider granting a request for euthanasia in case of early-stage dementia. One in three would consider it in case of advanced dementia or psychiatric disease, and one in four in case of a person who is tired of living without suffering from a severe disease. (more…)