Ethical and clinical dilemmas in patients with head and neck tumors visiting a field hospital in the Philippines.

OBJECTIVE: To describe clinical and ethical dilemmas in patients presenting with head and neck (H&N) tumors to a field hospital in the "subacute" period following a typhoon. METHODS: We retrospectively reviewed charts of H&N patients presenting to an integrated Israeli-Filipino medical facility, which was operated more than 11 days. RESULTS: Of the 1,844 adult patients examined, 85 (5 percent) presented with H&N tumors. Of those, 70 (82 percent) were females, with a mean age of 43 ± 15 years. Thyroid neoplasms were the most common tumors (68, 80 percent). Despite limited resources, we contributed to the workup and treatment of several patients. To better illustrate our dilemmas, we present four key patients, in whom we favored diagnostic/therapeutic interventions in two, and opted to defer any intervention in two. CONCLUSIONS: In a relief mission, despite the lack of clinical and pathological staging and questionable continuity of care, surgical interventions can be considered for therapeutic, palliative, and diagnostic purposes.

"What happens on the van, stays on the van": the (re)structuring of privacy and disclosure scripts on an Appalachian mobile health clinic.

Over the past two decades, mobile health clinics have emerged to address the health needs of underserved populations. Mobile clinics offer curbside care in the primary settings of people's lives: churches, parking lots, grocery stores, and community centers. Drawing on 18 months of ethnographic fieldwork, I explore how physical and symbolic space helps shape the (re)writing of traditional health care scripts of provider-patient confidentiality and medical disclosure in a mobile clinic serving residents of 21 counties in southeastern Ohio. This analysis centered on how clinic staff members blurred the symbolic and physical space of privacy, merged personal and professional discourses, and triaged multiple patient disclosures in the face of social and spatial constraints.

Ethical issues in mobile psychiatric treatment with homebound elderly patients: the Psychogeriatric Assessment and Treatment in City Housing experience.

Unique and challenging ethical difficulties arise during mobile psychiatric treatment of elderly patients. This article outlines and analyzes five of these challenges that have been encountered during nearly 20 years of experience with the Psychogeriatric Assessment and Treatment in City Housing Program in Baltimore, Maryland. The ethical challenges reviewed are: establishing the treatment contract versus the right to refuse treatment, protecting confidentiality versus patient protection, protecting autonomy versus asserting beneficence, treatment termination versus open-ended treatment, and cost versus benefit of care. Ethical challenges with homebound elderly patients are unique because of patient characteristics as well as features of the treatment environment.