Research ethics committees (RECs) are charged with providing an opinion on whether research proposals are ethical. These committees are overseen by a central office that acts for the Department of Health and hence the State. An advisory group has recently reported back to the Department of Health, recommending that it should deal with (excessive) inconsistency in the decisions made by different RECs. This article questions the desirability and feasibility of questing for consistent ethical decisions.
Traditionally clinicians have determined their patients' resuscitation status without consultation. This has been condemned as morally indefensible in cases where notfor resuscitation (NFR) orders are based on quality of life considerations and when the patient's true wishes are not known. Such instances would encompass most resuscitation decisions in elderly patients.Having previously involved patients in CPR decisionmaking, we chose formally to explore the reasons behind the choices made.Although the patients were not upset, and readily decided at the time of initial consultation, on later analysing the decision-making we found poor understanding of the procedure, poor recall of information given and in some cases evidence of harm.This may be attributed to impaired decision-making capacity of elderly hospitalised patients as previously shown, or to the discomfort precipitated by having to contemplate the apparent immediacy of cardiac arrest by these patients.We propose that subscribing to autonomy as a general principle needs to be balanced against particular cases where distress may be caused by, or result in, diminished competence and limited autonomy.
The aim of the study was to identify the functional disabilities and support needs of elderly people who presented but were not admitted to a Dublin Accident & Emergency (A & E) department within a 1 month period. Semi-structured interviews were conducted with 19 per cent (100/532) of the non-admitted elderly within 2 weeks of the A & E visit. Injury related complaints were apparent in 51 per cent of the patients with 3 per cent requiring hospital admission within 2 weeks of the A & E visit. Increased dependency in 1 or more Activities of Daily Living (ADL) occurred in 10 per cent while 28 per cent had increased dependency in 1 or more Instrumental Activities of Daily Living (IADL). Increased family support following discharge was received by 45 per cent of the elderly. The most commonly needed statutory service which was not provided was the home-help service. This study provides baseline data on the non-admitted elderly in one Dublin A & E department and should assist planning of future service.
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