Uses and Abuses of Prescription Drug Information in Pharmacy Benefits Management Programs

Article Abstract:

A 1998 incident illustrates the ethical problems in providing access to medical records without the patient's consent. This often happens in pharmacy benefits management programs. These programs are used to improve the quality of medical care, warn doctors of adverse drug reactions, and remind patients to refill their medications. Two Washington, DC pharmacies sent their customers' prescription records to a database marketing firm. The firm in turn mailed letters to some customers promoting a certain drug. Public outrage caused both pharmacies to cancel the program.

Medical records, Access control, Prescription drug plans

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When is CPR futile?

Article Abstract:

Safeguards may be necessary to ensure that physicians consistently apply the medical futility concept and to cultivate greater regard for patient values. The medical futility rationale can justify 'do-not-attempt-resuscitation' (DNAR) orders for patients in whom such interventions are futile. One study revealed significant problems associated with DNAR orders that were based on the medical futility concept. Quantitative futility is difficult to define and is used inconsistently. Physicians' values may affect their judgments of qualitative futility which introduces arbitrariness, inconsistency, and unfairness to the decision-making process. Safeguards, including improved physician education about medical futility and DNAR orders and the development of a specific definition of futility, may help remedy these problems. Mediation procedures must be established for cases in which physicians and patients disagree about medical futility orders. Physicians must justify unilateral DNAR orders in writing and such orders should be subjected to review.

Care and treatment, Editorial, Standards, Usage, Physicians, Medical professions, Hospital patients, CPR (First aid), Cardiopulmonary resuscitation

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Does it make clinical sense to equate terminally ill patients who require life-sustaining interventions with those who do not?

Article Abstract:

The decision of two US appeals courts in cases of physician-assisted suicide may have unintended consequences. The courts stated that refusing life-sustaining treatment was equivalent to committing suicide and ruled that patients not on life support should have the same right to die as those who refuse such treatment. However, refusing life-sustaining treatment does not necessarily lead to death and cannot therefore be considered suicide. And equating discontinuation of life support with suicide will cause many doctors who oppose physician-assisted suicide to refuse all requests for discontinuing life support.

Cases, Terminal care, Assisted suicide, Right to refuse treatment, Treatment refusal

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