Newswise — James Kirkpatrick, MD, who recently joined the University of Pennsylvania School of Medicine as an Assistant Professor of Medicine, is offering his expertise to the media in the often overlooked arena of ethics in cardiovascular medicine.
A few examples of ethical dilemmas in cardiovascular medicine for doctors and for patients:·Cardiac rhythm management device issues - In dying patients, when is it appropriate to turn off devices that continue to keep the heart beating or prevent deadly arrhythmias? What happens to these devices after a patient dies? Is it appropriate to re-use these devices?·Advance directives for cardiac patients - Are there special issues surrounding decisions about technological interventions and life-sustaining procedures in heart failure patients, and what goals should guide these decisions (to prolong life or to make the patient feel better)? ·How ethical issues are different in cardiology than in cancer and the unique ethical issues faced by cardiologists and cardiac patients - The trajectory of illness for patients with cardiac disease is more difficult to predict, making medical treatment decisions more problematic.·Ethnic or racial disparities in heart failure care and outcomes - When it comes to differing treatments along ethnic lines, what is appropriate and just? Why do ethnic minorities suffer disproportionately from cardiac disease?·End of life issues in heart failure - When is it appropriate to utilize high-tech medical interventions for patients?·Use of medical technology in cardiology - Do they work well enough to justify the extra expense?·The need for ethics training in cardiology fellowships - Are cardiologists truly armed with the proper information and perspective to help guide ethical discussions with patients?
Kirkpatrick is a practicing clinician in echocardiography at the Hospital of the University of Pennsylvania and an associate of the Center for Bioethics at Penn. He also completed a clinical ethics fellowship at the University of Chicago, as well as authored a paper on 'golden rule' reasoning in clinical medicine (how a physician should answer when a patients asks him what he would do if he were in the patient's shoes) and another overview article on ethical issues in heart failure.
A few words about"¦ Why ethics in cardiac care may be overlookedKirkpatrick - "These issues have been neglected a bit or not emphasized in technology subspecialties of medicine. Ethics do end up getting practiced in cardiology, but not necessarily looked at, examined, or commented upon, as compared to other fields like geriatrics or oncology. But with heart failure on the rise, and cardiovascular disease being the number one killer, it makes sense this should become a focal point in medicine because of the sheer numbers it is now affecting. Mortality and morbidity is extremely difficult to predict in cardiovascular patients because in the different treatment options we utilize, there can be a dramatic change in outcomes. Since figuring out when cardiac patients are going to die is so unpredictable, these ethical issues should be talked about while the patient is feeling well."
"¦We're not just practicing 'cookbook medicine'Kirkpatrick - "One area that really impacts cardiology is the whole guidelines issue. Are we going to practice 'cookbook medicine' so we'll play it safe, won't get sued, and ensure good outcomes? Sure, there is a set of guidelines to follow when treating cardiac patients, but as a cardiologist, you must also still individualize all the time. You have to be thinking and thoughtful in your approach for each individual patient you see. The 'art of medicine' is still extremely alive in cardiology."
Editor's Notes: For more information on the Cardiac Services at Penn Medicine, visit:http://www.pennhealth.com/cardiac/pcc_ms.htmlFor more information on the Cardiovascular Institute at Penn, visit:http://www.med.upenn.edu/cvi/For more information on the Center for Bioethics at Penn, visit:http://www.bioethics.upenn.edu/James Kirkpatrick, MD -- on-line bio:http://www.uphs.upenn.edu/cardio/faculty/kirkpatrick.html
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