Attorney general is to intervene in case of expert witness immunity.
Ontology highlight
ABSTRACT:
SUBMITTER: Dyer C
PROVIDER: S-EPMC1471936 | biostudies-literature | 2006 May
REPOSITORIES: biostudies-literature
Publications
Attorney general is to intervene in case of expert witness immunity.
BMJ (Clinical research ed.) 20060501 7552
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Project description:IntroductionCurrent ethical practice allows for adult patients with decision-making capacity to refuse blood transfusion, even at the cost of high morbidity or mortality. However, for an adult patient who is of the Jehovah's Witness faith, an unwanted blood transfusion confers a psychospiritual cost to the patient and a financial cost to health care entities. The ethical boundaries are increasingly ambiguous with minors who are members of the Jehovah's Witness faith. This simulation experience intends to identify and address knowledge gaps in the care of minors in an emergent setting using a biomedical ethics framework.MethodsThis scenario provides an immersive simulation experience involving a 12-year-old Jehovah's Witness patient requiring emergent laparotomy for splenic hemorrhage. Patient interview (via simulation manikin with instructor voice) and care handoff take place in an operating room setting. The learner ascertains the patient's and family's refusal of blood products. Induction of general anesthesia results in profound patient hypotension secondary to acute blood-loss anemia. Pulseless electrical activity results if packed red blood cells are not administered. Ethical principles require the learner to impose an unwanted lifesaving therapy on a minor patient over the objections of family members. Secondly, the anesthesia provider must advocate for transfusion on these ethical grounds against a well-meaning but ultimately misguided surgeon who opposes transfusion. An included learner evaluation form based on ACGME core competencies facilitates postsimulation debriefing.ResultsParticipants were primarily anesthesia residents and fellows. Anecdotally, the residents said that it "felt good to be an attending" and that the simulation helped them appreciate how important conflict resolution skills are in the OR setting. Additionally, faculty appreciated the ability to assess the development of crucial assertiveness skills, with the option of remediating incorrect behavior during the debriefing.DiscussionThis simulation experience provides experience in the emergent medical management of a pediatric trauma patient while also incorporating specific ethical consent issues unique to pediatric and trauma patient populations. Furthermore, this experience develops professionalism skills and practice in assertive patient advocacy.
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Project description:Individual voluntary climate action could contribute to closing the gap between global emission targets and the instruments in place. However, complex regulatory frameworks make it difficult for individuals to understand which actions align with their goals. Expert advice might provide guidance, but it is not trivial how detailed the advice should be. In a large consequential choice experiment with five informational load conditions, this paper uses the voluntary cancellation of European Union Allowances as an application to narrow down a minimum amount of information required to induce effective actions. We find a clear pattern of advice being processed and followed, even if it includes a demanding level of detail and counters prior convictions. Moreover, a mere assertion is highly effective already. These results are good news for efforts to increase the effectiveness of voluntary climate action.
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