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NET Summaries
National Ethics Teleconferences (NET calls) provide education on selected topics in health care ethics and offer an opportunity for practitioners and others throughout VHA to discuss an important health care ethics issue. Summaries of recent NET calls are listed below. Summaries of earlier calls can be found on the Archives page.
To view a list of NET call summaries organized by ethics domain and topic click here.
Moral Distress: How Can Ethics Consultants Respond? (November 25, 2008) [Word]
Executive Summary and other resources
Special 75th Diamond Edition. NET Calls - Yesterday, Today, and Tomorrow (October 29, 2008) [Word]
Executive Summary and other resources
Ethical Considerations in the use of Home Oxygen for Patients and/or Third Parties Who Smoke (July 30, 2008) [Word]
Executive Summary and other resources
Ethics and the Discharge Process: What to Consider When a Patient Prefers a Plan that the Team Believes is Unsafe (May 28, 2008) [Word]
National Ethics Committee Report: Advance Directives for Mental Health: An Ethical Analysis of State Laws & Implications for VHA Policy (March 26, 2008) [Word]
Disclosure of Adverse Events to Patients: Ethical and Policy Requirements (February 26, 2008) [Word]
Strategies for Increasing Influenza Vaccination Rates in Health Care Workers: Ethical Considerations (January 30, 2008) [Word]
National MRSA (Methicillin-Resistant Staphylococcus Aureus) Initiative: Ethical Considerations in Implementation (October 2007) [Word]
National Ethics Committee Report - Impaired Driving in Older Adults: Ethical Challenges for Health Care Professionals (September 2007) [Word]
State-Authorized Portable Orders: Out of Hospital DNR Orders and Orders for Life-Sustaining Treatment (July 2007) [Word]
National Ethics Committee Report: Ethical Aspects of the Relationship between Clinicians & Surrogate Decision Makers (April 2007) [Word]
Advance Care Planning and Management of Advance Directives (March 2007) [Word]
IntegratedEthics Initiative: Ready to Launch (January 2007) [Word]
Informed Consent Practices: Lessons Learned from Implementing iMedConsent (November 2006) [Word]
Adverse Events and the Management of DNR Orders: Ethical Considerations (September 2006) [Word]
National Ethics Committee Report: The Ethics of Palliative Sedation as a Therapy of Last Resort (July 2006) [Word]
Influenza Pandemic Preparedness Planning: Ethics Concerns (June 2006) [Word]
Patients' Requests to Have Their Health Records Amended (May 2006) [Word]
Ethical Considerations of Cardiac Pacemakers and Implantable Defibrillators for End-of-Life Care (April 2006) [Word]
The Ethical Challenges of Coordinating Mental Health Care Between VHA and DoD (March 2006) [Word]
National Ethics Committee Report: Compensation to Health Care Professionals from the Pharmaceutical Industry (February 2006) [Word]
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NET Summaries Table of Contents - (by ethics domain and topic)
Use the links below to find summaries of National Ethics Teleconferences organized by ethics domain and topic.
To view a list of NET call summaries organized chronologically click here.
Shared Decision Making with Patients
Decision-making capacity
Informed consent process
Surrogate decision making
Advance care planning
Limits to patient choice
Other
1.a Decision-making capacity [ability of the patient to make his/her own health care decisions]
Ethics Center content
Ten Myths About Decision-Making Capacity (NET Summary November 2002) [Word]
Source Patient HIV Testing in Patients Who Lack Decision-Making Capacity (NET Summary October 2002) [Word]
Common Pitfalls in Determining Decision-Making Capacity-Live from the National Ethics Committee Meeting (NET Summary March 2001) [Word]
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1.b Informed consent process [providing information to the patient/surrogate, ensuring that the decision is voluntary, documenting the decision]
Ethics Center content
Informed Consent for HIV Testing: Ethical Issues (NET Summary June 2004) [Word]
Informed Consent Policy Revision (NET Summary January and February 2003) [Word]
Informed Consent Policy Revision: Medical Decision Making in Patients Without Surrogates (NET Summary January 2002) [Word]
Informed Consent for IV Contrast Administration (NET Summary January 2001) [Word]
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1.c Surrogate decision making [selection, role, and responsibilities of the person authorized to make health care decisions for the patient]
Ethics Center content
National Ethics Committee Report: Ethical Aspects of the Relationship between Clinicians & Surrogate Decision Makers (NET Summary April 2007) [Word]
Disclosing Patients' Protected Health Information (NET Summary February 2005) [Word]
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1.d Advance care planning [statements made by a patient with decision-making capacity regarding future health care decisions]
Ethics Center content
National Ethics Committee Report: Advance Directives for Mental Health: An Ethical Analysis of State Laws & Implications for VHA Policy (NET Summary March 26, 2008) [Word]
Advance Care Planning and Management of Advance Directives (NET Summary March 2007) [Word]
Strategies to Make Advance Care Planning More Effective: Best Practices (NET Summary March 2003) [Word]
Ethical Issues in Advance Directives for Behavioral Health Care (NET Summary May 2003) [Word]
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1.e Limits to patient choice [e.g., choice of care setting, choice of provider, a demand for unconventional treatment]
Ethics Center content
Ethical Considerations When Treating Erectile Dysfunction in Patients with Sexually Transmissible Diseases (NET Summary May 2004) [Word]
Should Patients be Able to Refuse Care by House Officers or Trainees? (NET Summary March 2004) [Word]
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1.f Other
Ethics Center content
Ethics and the Discharge Process: What to Consider When a Patient Prefers a Plan that the Team Believes is Unsafe (NET Summary May 28, 2008) [Word]
Strategies for Increasing Influenza Vaccination Rates in Health Care Workers: Ethical Considerations (NET Summary January 30, 2008) [Word]
National MRSA (Methicillin-Resistant Staphylococcus Aureus) Initiative: Ethical Considerations in Implementation (NET Summary October 2007) [Word]
National Ethics Committee Report - Impaired Driving in Older Adults: Ethical Challenges for Health Care Professionals (NET Summary September 2007)
Informed Consent Practices: Lessons Learned from Implementing iMedConsent (NET Summary November 2006) [Word]
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Ethical Practices in End-of-Life Care
Cardiopulmonary resuscitation (CPR)
Life-sustaining treatments
Medical futility
Hastening death
Death and postmortem issues
Other
2.a Cardiopulmonary resuscitation (CPR) [withholding/stopping resuscitation in the event of cardiopulmonary arrest, including DNAR orders]
Ethics Center content
Adverse Events and the Management of DNR Orders: Ethical Considerations (NET Summary September 2006) [Word]
What Does DNR Really Mean? (NET Summary June 2005) [Word] DNR FAQs [PDF]
Do Not Resuscitate Policy Revision: Controversial Topics (NET Summary March 2002) [Word]
Family Presence During Resuscitation (NET Summary August 2001) [Word]
DNR Orders and the Electronic Medical Record (NET Summary December 2000) [Word]
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2.b Life-sustaining treatments [withholding or stopping artificially administered fluid or nutrition, mechanical ventilation, dialysis, surgery, antibiotics, etc.]
Ethics Center content
State-Authorized Portable Orders: Out of Hospital DNR Orders and Orders for Life-Sustaining Treatment (NET Summary July 2007) [Word]
Ethical Considerations of Cardiac Pacemakers and Implantable Defibrillators for End-of-Life Care (NET Summary April 2006) [Word]
Terminal Extubation: Ethics Perspectives (NET Summary March 2005) [Word]
Life Sustaining Treatments and Vegetative State: Implications of the March 2004 Papal Allocution for VHA Health Care (NET Summary October 2004) [Word]
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2.c Medical futility [a physician's judgment that a therapy will be of no benefit to a patient and that it should not be offered or should be withdrawn]
Ethics Center content
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2.d Hastening death [intentionally or unintentionally, e.g., questions related to euthanasia, assisted suicide, or the doctrine of double effect]
Ethics Center content
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2.e Death and postmortem issues [determination of death, organ donation, autopsy, disposition of body or tissue, etc.]
Ethics Center content
Practicing Medical Procedures on the Newly Dead (NET Summary November 2003) [Word]
Ethical Priority of Decedent's vs. Family's Wishes in Organ Donation (NET Summary July 2002) [Word]
Privacy Requirements During the Organ Donation Process (NET Summary January 2001) [Word]
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2.f Other
Ethics Center content
Palliative sedation -
National Ethics Committee Report: The Ethics of Palliative Sedation as a Therapy of Last Resort (NET Summary July 2006) [Word]
Terminal Sedation: An Open Discussion (NET Summary August 2002) [Word]
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Patient Privacy and Confidentiality
Privacy
Confidentiality
Other
3.a Privacy [protecting individuals' interests in maintaining personal space free of unwanted intrusions and in controlling data about themselves]
Ethics Center content
Patients' Requests to Have Their Medical Records Amended (NET Summary May 2006) [Word]
The Ethical Challenges of Coordinating Mental Health Care Between VHA and DoD (NET Summary March 2006) [Word]
Privacy, Safety and Patient Social Security Numbers: Ethics Concerns (NET Summary July 2005) [Word]
National Ethics Committee Report, Online Patient-Clinician Messaging: Fundamentals of Ethical Practice (NET Summary September 2004) [Word]
Privacy Requirements During the Organ Donation Process (NET Summary January 2001) [Word]
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3.b Confidentiality [nondisclosure of information obtained as part of professional-patient relationship]
Ethics Center content
The Ethical Challenges of Coordinating Mental Health Care between VHA and DoD (NET Summary March 2006) [Word]
Shared Medical Appointments: Ethical Concerns (NET Summary October 2005) [Word]
The Ethical Duty to Protect Third Parties from Dangerous Patients (NET Summary April 2005) [Word]
Disclosing Patients' Protected Health Information (NET Summary February 2005) [Word]
Informed Consent for HIV Testing: Ethical Issues (NET Summary June 2004) [Word]
Provider Reporting of Impaired or Potentially Impaired Drivers (NET Summary February 2002) [Word]
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3.c Other
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Professionalism in Patient Care
Conflicts of interest
Truth telling
Difficult patients
Cultural/religious sensitivity
Other
4.a Conflicts of interest [situations that may compromise the clinician's fiduciary duty to patients, including inappropriate business or personal relationships]
Ethics Center content
National Ethics Committee Report: Compensation to Health Care Professionals from the Pharmaceutical Industry (NET Summary February 2006) [Word]
National Ethics Committee Report: Ethical Boundaries in the Patient Clinician Relationship (NET Summary September 2003) [Word]
National Ethics Committee Report: Gifts to Health Care Professionals from the Pharmaceutical Industry (NET Summary January 2004) [Word]
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4.b Truth telling [open and honest communication, including disclosing bad news, adverse events]
Ethics Center content
Disclosure of Adverse Events to Patients: Ethical and Policy Requirements (NET Summary February 26, 2008) [Word]
Clinical Use of Placebo: An Ethics Analysis (NET Summary July 2004) [Word]
National Ethics Committee Report: Disclosing Adverse Events to Patients (NET Summary April 2003) [Word]
Notification of Patients Potentially Exposed to Mad Cow Disease Through Prior Blood Transfusion: Testing the Limits of Full Disclosure (NET Summary April 2001) [Word]
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4.c Difficult patients [clinician interactions with patients who are disruptive or who do not adhere to treatment plans/health care recommendations]
Ethics Center content
Ethical Considerations in the use of Home Oxygen for Patients and/or Third Parties Who Smoke (NET Summary July 30, 2008) [Word] ( Audio not available) Executive Summary and other resources [Word]
Ethics and the Discharge Process: What to Consider When a Patient Prefers a Plan that the Team Believes is Unsafe (NET Summary May 28, 2008) [Word]
Ethical Considerations in Opioid Therapy for Chronic Pain Management (NET Summary November 2005) [Word]
The Ethical Duty to Protect Third Parties from Dangerous Patients (NET Summary April 2005) [Word]
Home Oxygen for Patients Who Smoke: Prescription vs. Proscription (NET Summary October 2001) [Word]
Managing 'Difficult' or 'Non-Compliant' Patients: Ethical Challenges (NET Summary September 2001) [Word]
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4.d Cultural/religious sensitivity [clinician interactions with people of different ethnicity, religion, sexual orientation, gender, age, etc.]
Ethics Center content
Cultures and Persons, Patients and Caregivers: Ethical Obligations and Culturally Competent Care (NET Summary August 2003) [Word]
An Ethical Analysis of Ethnic Disparities in Health Care (NET Summary December 2002) [Word]
Conscience -
The Conscience Clause (NET Summary June 2002) [Word]
Duty to Treat -
Influenza Pandemic Preparedness Planning: Ethics Concerns (NET Summary June 2006) [Word]
Health Care Ethics Issues Raised by SARS (NET Summary June 2003) [Word]
Disaster Medicine: Unique Ethical Challenges (NET Summary April 2002) [Word]
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4.e Other
Ethics Center content
Miscellaneous -
Moral Distress: How Can Ethics Consultants Respond? (November 25, 2008) [Word]
Patients' Requests to Have Their Medical Records Amended (NET Summary May 2006) [Word]
National Ethics Committee Report, Online Patient-Clinician Messaging: Fundamentals of Ethical Practice (NET Summary September 2004) [Word]
Pain/suffering -
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Ethical Practices in Resource Allocation
Systems level (macroallocation)
Individual level (microallocation)
Other
5.a Systems level (macroallocation) [how well the facility demonstrates fairness in allocating resources across programs and services]
Ethics Center content
Influenza Pandemic Preparedness Planning: Ethics Concerns (NET Summary June 2006) [Word]
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5.b Individual level (microallocation) [how well the facility demonstrates fairness in allocating resources to individual patients or staff]
Ethics Center content
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5.c Other
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Ethical Practices in Business and Management
Leadership
Human resources
Business integrity
Other
6.a Leadership [behaviors of leaders in support of an ethical environment and culture]
Ethics Center content
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6.b Human resources [supervisory support for an ethical environment and culture through the high performance management system]
Ethics Center content
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6.c Business integrity [practices that support oversight of business practices, compliance with legal and ethical standards, and promotion of business quality and integrity]
Ethics Center content
Copying, Pasting, and Duplicating in the Electronic Medical Record: An Ethical Analysis (NET Summary February 2004) [Word]
The Relationship Between Ethics and Compliance and Business Integrity (NET Summary July 2001) [Word]
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6.d Other
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Ethical Practices in Government Service
Government ethics rules and laws
Other
7.a Government ethics rules and laws [ethics rules, policies or standards of conduct that apply to federal government employees (e.g., bribery, nepotism, gift and travel rules)]
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7.b Other
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Ethical Practices in the Everyday Workplace
Respect and dignity
Ethical climate
Other
8.a Respect and dignity [e.g., employee privacy, personal safety, respect for diversity]
Ethics Center content
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8.b Ethical climate [e.g., openness of ethics discussion, perceived pressure to engage in unethical conduct]
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8.c Other
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Ethical Practices in Research
Informed consent
Other
9.a Informed consent [providing information to the research subject or surrogate, ensuring that the decision is voluntary, and documenting the decision]
Ethics Center content
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9.b Other
Ethics Center content
Genetics/genomics -
The Ethics of Tissue Banking for Future Genetic Research (NET Summary July 2003) [Word]
Quality Improvement -
Recommendations for the Ethical Conduct of Quality Improvement (NET Summary September 2002) [Word]
Miscellaneous-
Access to VA Databases for Research Purposes (NET Summary February 2001) [Word]
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Executive Summary and other resources
Title: Moral Distress: How Can Ethics Consultants Respond?
Date: November 25, 2008
Domain: Everyday Workplace
Topic: Ethical Climate
Summary of Call:
“Moral distress” has been described as painful feelings that result when a health care provider believes that he or she knows what the right thing to do is, but is prevented from doing the right thing. Internal barriers, such as the lack of power or understanding, and external barriers, such as a lack of time or administrative support, may prevent a provider from doing what he or she believes is the right thing.
Moral distress exacts a heavy toll, imposing psychological burdens on providers and threatening job satisfaction and retention. Moral distress can also affect patient care indirectly by affecting care providers.
This call describes several ethics scenarios that illustrate moral distress; looks at common features and ethical considerations that underlie moral distress; and outlines strategies that ethics consultants can use to address moral distress, including using the CASES approach to ethics consultation.
Take-home Points:
Several common features underlie moral distress: e.g., the decision being considered may involve life and death; questions of capacity may be involved; and there may have been a failure to negotiate and agree on goals of care, resulting in an uncertain or inconsistent care plan.
Several ethical considerations also underlie moral distress: e.g., a provider may feel that his/her values are compromised when asked to provide care that he/she believes is high burden and low benefit, or when the provider is asked to discharge a capable patient to an environment that the patient chooses, but the provider feels is unsafe.
By following the steps in the CASES approach, ethics consultants within VHA may address moral distress by providing: a forum for discussion and consistent practices for all parties involved in a distressing situation, a level playing field for all parties to the situation, and a “moral space” within which to discuss underlying ethical considerations.
By following the steps in the CASES approach, ethics consultants within VHA may address moral distress by providing: a forum for discussion and consistent practices for all parties involved in a distressing situation, a level playing field for all parties to the situation, and a “moral space” within which to discuss underlying ethical considerations.
Faculty:
Kenneth Berkowitz, MD, FCCP*
Barbara Chanko, RN, MBA*
Cynthia Gunnarson, RNC, MSN, Magnet Coordinator, North Chicago VAMC
Maureen Lavin, JD, MA student in Bioethics, University of Pennsylvania
*National Center for Ethics in Health Care
Other Resources:
Link to detailed summary of call: http://vaww.ethics.va.gov/docs/net/NET_Topic_20081125_Moral_Distress_How_can_ethics_consultants_respond.doc
Links to closely related Ethics Center and VHA materials:
“Ethics Consultation: Responding to Ethics Questions in Health Care.” This primer describes the ethics consultation function of IntegratedEthics, including a detailed description of CASES, a step-by-step approach to ethics consultation.http://vaww.ethics.va.gov/docs/integratedethics/Ethics_Consultation_Responding_to_Ethics_Questions_in_Health_Care_20070808.pdf
“Preventive Ethics: Addressing Ethics Quality Gaps on a Systems Level.” This primer describes the preventive ethics function of IntegratedEthics, including a detailed description of ISSUES, a step by step approach to addressing ethics issues on a systems level.http://vaww.ethics.va.gov/docs/integratedethics/Preventive_Ethics_Addressing_Ethics_Quality_Gaps_on_a_Systems_Level_20070808.pdf
“Ethical Leadership: Fostering an Ethical Environment and Culture.” This primer describes the ethical leadership function of IntegratedEthics, including a detailed description of the four “compass” points of ethical leadership.http://vaww.ethics.va.gov/docs/integratedethics/Ethical_Leadership_Fostering_an_Ethical_Environment_and_Culture_20070808.pdf
References
Arras GJ. Doctors, Drugs, and Driving – Tort Liability for Patient-Caused Accidents. NEJM 2008: 521-525. Discusses recent court cases that limit the legal liability and help to clarify ethical responsibility of clinicians. If the physician does everything he or she can to ensure that a patient understands the potential risks of a given course of action, then the patient assumes ethical responsibility for his or her own choice(s).
Jameton A. Dilemmas of moral distress: moral responsibility and nursing practice. AWHONNS Clin Issues Perinat Womens Health Nurs. 1993;4(4):542-51. Nursing Practice: The Ethical Issues. Prentice-Hall Series in the Philosophy of Medicine. NJ: Prentice-Hall, 1984. Introduces the notion of “moral distress” within the nursing literature and distinguishes between moral distress, moral uncertainty and moral dilemmas.
Smith M, Paradis C. Professionals’ Moral Distress: A Neglected Dimension in Ethics Consultation. 2008 Annual Meeting of the American Society of Bioethics and Humanities. Provides examples of de-identified clinical scenarios in which clinicians reported moral distress; discusses common features and ethical considerations that underlie moral distress; and offers general strategies for addressing moral distress.
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Executive Summary and other resources
Title: Special 75th Diamond Edition: N ational Ethics Teleconferences (NET Calls) Yesterday, Today, and Tomorrow
Date: October 29, 2008
This NET call cuts across several ethics domains and topics.
Summary of Call:
This call is the 75th in the National Ethics Teleconference (NET) Call series. The NET Call series has addressed a wide range of ethics concerns over the last 8 years, focusing on such topics as discharge to an environment that the team feels is unsafe; DNR orders; pandemic influenza preparedness; and IntegratedEthics structure and processes.
Using examples of past calls, this 75th call looks back and forward to illustrate the goals and scope of the NET Call series and to illustrate how the series tracks the evolution of ethics thinking within VA. Participation in the NET Call series helps those in the field be ahead of and part of the ethics curve within VA.
Take-home Points:
The main intent of the NET Calls series is to provide practical, useful, and relevant information on ethical issues that arise within VHA, and a forum to discuss them. Individual NET calls are responsive to ethics concerns that arise and are addressed in real time. The calls have not shied away from discussing controversial topics and allow participants to contribute to the evolution of ethics thinking within VHA.
The process of developing each NET call is dynamic and interactive, and involves collaboration with relevant VACO program office staff, outside content experts, and ethics resources from the field.
The NET Call series provides an opportunity for the Ethics Center to educate field staff about newly revised policies or those in revision and to answer questions from the field about implementation.
Faculty:
Ellen Fox, MD*
Kenneth Berkowitz, MD, FCCP*
Barbara Chanko, RN, MBA*
Susan Owen, PhD*
* National Center for Ethics in Health Care
Other Resources:
Link to detailed summary of call: http://vaww.ethics.va.gov/docs/net/NET_Topic_20081029_NET-calls_yesterday_today_tomorrow.doc
Link to closely related Ethics Center and VHA materials:
DNR FAQ, which can be accessed at:http://vaww.ethics.va.gov/docs/net/DNR_FAQs_20050701.pdf
VHA Handbook 1004.1, “Informed Consent for Clinical Treatments and Procedures,” which can be accessed at:http://vaww.ethics.va.gov/docs/policy/VHA_Handbook_1004-1_Informed_Consent_Policy_20030129.pdf
VHA Handbook 1004.2, “Advance Care Planning and the Management of Advance Directives,” which can be accessed at:http://vaww.ethics.va.gov/docs/policy/VHA_Handbook_1004-2_Advance_Care_Planning_20070222.pdf
VHA Handbook 1004.04, “State-Authorized Portable Orders,” which can be accessed at: http://vaww.ethics.va.gov/docs/policy/VHA_Handbook_1004-04_State-Authorized_Portable_Orders_20070615.pdf
VHA Directives 2006-021, “Reducing the Fire Hazard of Smoking When Oxygen Treatment is Expected,” which can be accessed at: http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1407
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Executive Summary and other resources
Title: Ethical Considerations in the Use of Home Oxygen for Patients and/or Third Parties Who Smoke
Faculty:
Kenneth Berkowitz, MD, FCCP
Chief, Ethics Consultation Service
National Center for Ethics in Health Care
Barbara Chanko, RN, MBA
Health Care Ethicist
National Center for Ethics in Health Care
Susan Owen, PhD
Health Care Ethicist
National Center for Ethics in Health Care
Summary of Ethics Topic:
This presentation describes the ethical challenges presented by patients who receive home oxygen therapy and continue to smoke. Practical guidance is offered about how to balance professional obligations to treat, patient’s rights, and safety interests of patients and others. Specific measures stated in the VA directive 2006-021” Reducing the Fire Hazard of Smoking When Oxygen Treatment is Expected” are reviewed.
Concrete recommendations regarding education, smoking cessation, and smoking restrictions are considered.
Take-home Points:
Long term oxygen therapy is the standard of care for treatment of hypoxemic patients with COPD and certain other patients. It improves survival and quality of life.
Risks associated with home oxygen use are small, but real.
Anxiety about risks may prompt caregivers to consider discontinuing treatment, although this is rarely justifiable and may contribute to requests for ethics consultation.
Education of patients, families, care providers, and contractors is essential to maximize smoking cessation, minimize safety risks, and respond in an open and consistent way to patients who continue to smoke.
VHA Directive 2006-021 outlines steps that should be taken to consult about high-risk patients who continue to smoke despite education and warnings.
Other Resources:
Link to detailed summary of call
Link to closely related Ethics Center and VHA materials:
VHA Directive 2006-021, “Reducing the Fire Hazards of Smoking When Oxygen Treatment is Expected,” which can be accessed at: http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1407
2004 report from the VA National Center for Patient Safety, “Selected Root Cause Analyses Topic: Fires and Oxygen Therapy,” which can be accessed in the section “RCA Topic Summaries” at: http://vaww.ncps.med.va.gov/
Annotated Bibliography
Clinical Practice Guidelines on Management of Tobacco Use and Dependencehttp://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf
Edelman DA, Malekyo-Jacobs S, White MK, Lucas CE, Ledgerwood AM. Smoking and home oxygen therapy; a preventable public health hazard. Journal of Burn Care & Research 2007; 29: 119-122.
This study determined the number of patients admitted to the authors burn center from January 2004 through December 2005, also calculating patient demographics, outcomes, total charges, costs and reimbursement to the hospital. The authors found that counseling patients about the dangers of home oxygen use may not be effective, but emphasize that counseling regarding smoking cessation should happen at every physician visit if the patient smokes, regardless of whether the patient is on home oxygen.
Lacasse Y, LaForge J, Maltais F. Got a match? Home oxygen use in current smokers. Thorax 2006; 61:374-375.
In this editorial the authors discuss the controversy related to home oxygen therapy prescribed for smokers.They suggest three things to be considered when prescribing this therapy: first, the risks and benefits must be weighed; second, there must be a clear indication for its prescription; third, re-evaluation should be required when there is an acute exacerbation of COPD.
Link to Ethics Resources on Ethics Center Homepage for materials related to the general health care ethics domain of shared decision making and the health care ethics topic of limits to patient choice. http://vaww.ethics.va.gov/resources/ethicsresources.asp#16
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