Faculty Bibliography

Implantable cardioverter defibrillators are life-saving devices for many patients with cardiac disease. Recipients of these devices, nevertheless, often suffer from progressive comorbid and cardiac conditions. Therefore, physicians should anticipate situations in which the defibrillator is no longer desired by the patient or no longer medically appropriate. Near the end of life, many of these patients may decline cardiopulmonary resuscitation. The comanagement of do-not-resuscitate orders and implanted defibrillators can be confusing to patients and physicians alike since the former proscribe the use of electrical cardioversion while the latter provide this precise treatment. Although the use of implanted defibrillators has important ethical implications, few studies have examined these issues, and guidelines have not yet been developed to assist physicians in caring for patients who have received defibrillators. This paper discusses bioethical considerations in disabling implantable cardioverter defibrillators.

It is not uncommon for oncologists and other clinicians to encounter families who wish that grave medical information be withheld from their loved ones. Despite families' typically benevolent motives in making these requests, often, nondisclosure is not in the patients' best interests. Furthermore, nondisclosure may challenge physicians' professional obligations to their patients. However, there are particular situations in which nondisclosure is ethically appropriate, if not ethically obligatory. This article discusses potential benefits and harms associated with therapeutic nondisclosure in adult patients and offers strategies to effect more appropriate disclosure when therapeutic nondisclosure is contemplated.

A multitarget visual cancellation test was administered to patients with Alzheimer's disease (AD) and age-matched healthy controls (HC). Attentional loads--physical similarity (number of features shared by target and distractors; 3 levels) and density (number of items per page; 3 levels)--were varied systematically. As physical similarity increased, both groups slowed their search, but whereas the HC group maintained accuracy, the AD group increased commission errors and tended to miss more targets. Increased density yielded slower search and more target omissions in the AD group. Commission errors are additional indicators of higher order attentional deficits, especially in early disease. The findings suggest that patients with AD may rely increasingly on physical features of stimuli during a search, leading to inefficient bottom-up processing strategies.

Do-not-resuscitate (DNR) orders are commonly found in treatment plans for patients near the end of life. Orders for partial resuscitation (eg, "do not intubate") have evolved from DNR orders. Although the ethics of DNR orders have been widely examined in the medical literature, little has been written about the ethics of partial resuscitation. This article explores the ethical implications of partial DNR orders and identifies the need to develop care plans addressing life-threatening conditions for patients with DNR orders.