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How long is long enough, and have we done everything we should?-Ethics of calling codes

Ranola, Primi-Ashley; Merchant, Raina M; Perman, Sarah M; Khan, Abigail M; Gaieski, David; Caplan, Arthur L; Kirkpatrick, James N
'Calling' a code can be an ambiguous undertaking. Despite guidelines and the medical literature outlining when it is acceptable to stop resuscitation, code cessation and deciding what not to do during a code, in practice, is an art form. Familiarity with classic evidence suggesting most codes are unsuccessful may influence decisions about when to terminate resuscitative efforts, in effect enacting self-fulfilling prophesies. Code interventions and duration may be influenced by patient demographics, gender or a concern about the stewardship of scarce resources. Yet, recent evidence links longer code duration with improved outcomes, and advances in resuscitation techniques complicate attempts to standardise both resuscitation length and the application of advanced interventions. In this context of increasing clinical and moral uncertainty, discussions between patients, families and medical providers about resuscitation plans take on an increased degree of importance. For some patients, a 'bespoke' resuscitation plan may be in order.
PMCID:4430436
PMID: 25249374
ISSN: 0306-6800
CID: 1259402

A Potential Solution to the Shortage of Solid Organs for Transplantation

Wall, Stephen P; Plunkett, Carolyn; Caplan, Arthur
PMID: 25961717
ISSN: 1538-3598
CID: 1579122

Ethics of preparticipation cardiovascular screening for athletes

Maron, Barry J; Friedman, Richard A; Caplan, Arthur
Preparticipation screening for unsuspected cardiovascular disease is a controversial topic in the medical and lay communities. Much attention has been directed towards young competitive athletes, particularly the proposed strategy of incorporating 12-lead electrocardiograms into the screening process, even on a national or worldwide basis. However, sudden deaths of young athletes owing to genetic or congenital heart diseases have a low incidence in the general population. Furthermore, young people not engaged in competitive sports can harbour the same conditions that cause sudden death in athletes, which has gone largely unrecognized. Notably, sudden deaths from these diseases are numerically far more common in the much larger population of nonathletes. In this Perspectives article, we propose that an ethical dilemma has emerged, raising the important public-health issue of whether young individuals should be arbitrarily excluded from potentially life-saving clinical screening evaluations because they do not engage in competitive sports programmes.
PMID: 25707388
ISSN: 1759-5002
CID: 1490272

Should patients in need be given access to experimental drugs?

Caplan, Arthur L; Bateman-House, Alison
Patient access to experimental drugs outside of clinical trials is called compassionate use or expanded access. Compassionate use/expanded access presents a powerful ethical dilemma in that it involves competing claims that both have moral weight: specifically, an individual patient's very understandable desire to try to extend his or her life versus the orderly and efficient functioning of a drug development and clinical trial system that benefits much larger numbers of patients. Patient advocates, the FDA, pharmaceutical trade groups, and state and national legislators in the US are all currently weighing in on patient access to experimental drugs, and new guidelines and rules are being introduced. In this editorial, we discuss the impulse to rescue individual patients facing dire diseases and underscore the ethical questions that such rescue efforts raise.
PMID: 26001178
ISSN: 1744-7666
CID: 1591212

The Problem of Publication-Pollution Denialism

Caplan, Arthur L
PMID: 25847132
ISSN: 1942-5546
CID: 1528332

What Happens When An Elementary School Abolishes Homework

Caplan, Arthur L; Igel, Lee H
ORIGINAL:0009561
ISSN: 0015-6914
CID: 1490222

Morality in a time of Ebola

Caplan, Arthur L
PMID: 25703457
ISSN: 0140-6736
CID: 1473362

Organ transplantation in China: concerns remain [Letter]

Trey, Torsten; Sharif, Adnan; Singh, Maria Fiatarone; Khalpey, Zain; Caplan, Arthur L
PMID: 25773087
ISSN: 0140-6736
CID: 1505842

Refugees, humanitarian aid and the right to decline vaccinations

Caplan, A L; Curry, David R
Recent instances of governments and others refusing humanitarian assistance to refugees and IDPs (internally-displaced persons) unless they agreed to polio immunization for their children raise difficult ethical challenges. The authors argue that states have the right and a responsibility to require such vaccinations in instances where the serious vaccine-preventable disease(s) at issue threaten others, including local populations, humanitarian workers, and others in camps or support settings.
PMID: 25135799
ISSN: 0306-6800
CID: 1474282

Doctor Seeking To Perform Head Transplant Is Out Of His Mind

Caplan, Arthur L
ORIGINAL:0009562
ISSN: 0015-6914
CID: 1490232