Shall parent / patient wishes be fulfilled in any case? A series of 32 ethics consultations: from reproductive medicine to neonatology

BACKGROUND

Questions concerning the parent/ patient's autonomy are seen as one of the most important reasons for requesting Ethics Consultations (ECs). Respecting parent/ patient's autonomy also means respecting the patient's wishes. But those wishes may be controversial and sometimes even go beyond legal requirements. The objective of this case series of 32 ECs was to illustrate ethically challenging parent / patients' wishes during the first stages of life and how the principle of patient's autonomy was handled.

METHODS

The case series has a qualitative retrospective approach. A documentary sheet was designed de novo and information was gained from EC minutes and medical charts. The cases originate from the following specialties: reproductive medicine, obstetrics and neonatology as well as two interdisciplinary cases.

RESULTS

Through the structured EC minutes aspects of patient / parents' wishes could be identified explicitly. Overall the patient / parents' wishes were not supported in 61% of the cases. Central reasons for rejection of patient / parent wishes were mainly the protection of the best interest of the unborn / new-born child as well as the rejection of clinical approaches that were regarded as being substandard treatment.

CONCLUSION

The study shows that treatment decisions in reproductive medicine, obstetrics and neonatology raise substantial ethical questions leading to the request for ethics consultation. The systematic case series presented here gives insight into the ethical reflection carried out to support the clinicians in their decision-making and counselling. It shows that clinicians, after using ethics consultation, make deliberate decisions that do not "automatically" fulfil the treatment requests of the patients and parents (to-be).

Cardiac rehabilitation: participating in an exercise program in a quest to survive

Cardiovascular diseases are the major cause of death in the United States. The American Heart Association reports that approximately 500,000 persons die each year from heart attacks. Cardiac rehabilitation programs are based on objectives that would, when adhered to, extend and improve an individual's quality of life after experiencing a cardiac event. The purpose of this qualitative study was to explore and describe strategies that individuals who experienced a cardiac event used to overcome barriers associated with an exercise program. The sample consisted of six subjects (four females and two males) who were enrolled in a cardiac exercise program for 1 year or longer, and who continued to actively participate in at least two cardiac exercise classes per year. This study revealed that individuals who consistently participated in a cardiac exercise program did not use strategies to overcome barriers; rather, in their quest to survive, they used strategies to ensure their participation in the program.

Ovarian steroid manipulation of the antidipsogenic and thermogenic responses of rats to central administration of prostaglandin E1

Intracerebroventricular (icv) injection of prostaglandin E1 (PGE1) increases arterial pressure, suppresses water intake, and elevates core temperature of rats. Treatment of ovariectomized rats with estradiol or progesterone results in an attenuation of the pressor response to PGE1. This work addressed the effects of daily subcutaneous injection of estradiol (1 microgram), progesterone (5 mg), or oil vehicle on the antidipsogenic and thermogenic response to icv PGE1 of ovariectomized rats. The change of core temperature induced by the PGE treatment was significantly correlated with antidipsogenesis for ovariectomized rats receiving daily oil injections. Although neither the suppression of water intake nor the increase of core temperature in response to icv PGE1 was affected significantly by ovarian steroid treatment, the linear relation between the thermogenic and antidisogenic actions of the icv PGE1 was abolished by either estradiol or progesterone administration. Thus, although the pressor, antidipsogenic, and thermogenic effects of icv PGE1 tend to occur in concert, they may be differentially affected by ovarian steroid administration, which suggests that the mechanisms underlying these varied effects of icv PGE1 may be independent.

Ovarian steroid manipulation of the antidipsogenic and thermogenic responses of rats to central administration of prostaglandin E₁

Intracerebroventricular (icv) injection of prostaglandin E1 (PGE1) increases arterial pressure, suppresses water intake, and elevates core temperature of rats. Treatment of ovariectomized rats with estradiol or progesterone results in an attenuation of the pressor response to PGE1. This work addressed the effects of daily subcutaneous injection of estradiol (1 microgram), progesterone (5 mg), or oil vehicle on the antidipsogenic and thermogenic response to icv PGE1 of ovariectomized rats. The change of core temperature induced by the PGE treatment was significantly correlated with antidipsogenesis for ovariectomized rats receiving daily oil injections. Although neither the suppression of water intake nor the increase of core temperature in response to icv PGE1 was affected significantly by ovarian steroid treatment, the linear relation between the thermogenic and antidisogenic actions of the icv PGE1 was abolished by either estradiol or progesterone administration. Thus, although the pressor, antidipsogenic, and thermogenic effects of icv PGE1 tend to occur in concert, they may be differentially affected by ovarian steroid administration, which suggests that the mechanisms underlying these varied effects of icv PGE1 may be independent.