title: Ethical reasoning about patient eligibility in allogeneic BMT based on psychosocial criteria.
abstract: Chairpersons of the hospital ethics committees (HECs) and BMT clinicians were compared with regard to their willingness to proceed with allogeneic BMT given select psychosocial risk factors. A self-administered questionnaire was sent to 62 HEC chairpersons at hospitals with an accredited BMT program; the response rate was 37%. Items included background information, followed by six case vignettes from a 2006 national survey on which BMT physicians, nurses and social workers agreed not to proceed with allogeneic BMT on the basis of the following risk factors: suicidal ideation; use of addictive, illicit drugs; history of non-compliance; absence of a caregiver; alcoholism; and mild dementia from early onset of Alzheimer's disease. Opinions regarding transplant differed in one case only, in a patient with mild dementia; 27% of HEC chairpersons recommended not proceeding with BMT, which was significantly lower than that of nurses (68%, P<0.001), physicians (63.5%, P<0.001) and social workers (51.9%, P=0.05). Qualitative data show patterns of informal reasoning, linking transplant decisions to patient's responsibility for their psychosocial risk factor(s), as well as to medical benefit and outcome.
authors.affiliation: School of Social Work, Cleveland State University, Cleveland, OH 44115-2214, USA. l.w.foster@csuohio.edu
authors.forename: L W
authors.initials: LW
authors.lastname: Foster
authors.forename: L
authors.initials: L
authors.lastname: McLellan
authors.forename: L
authors.initials: L
authors.lastname: Rybicki
authors.forename: T
authors.initials: T
authors.lastname: Tyler
authors.forename: B J
authors.initials: BJ
authors.lastname: Bolwell
mesh_terms: D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000941:ethics* / Q000523:psychology*; D004608:Eligibility Determination / Q000941:ethics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011584:Psychology / Q000941:ethics*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014184:Transplantation, Homologous