How Should the 3 R's Be Revised and Why?

The Principles of Humane Experimental Technique established what many know today as the "3 R's"-refinement, reduction, and replacement-when it was published in 1959. Since their formulation, these principles have guided decision-making for many about nonhuman animal subjects' uses in laboratory-based research. Discussion about how to amend or replace the 3 R's is ongoing, driven mainly by philosophical ethics approaches to nonhuman animal rights and by scientific advancement. This article explores merits and drawbacks of possible updates to and interpretations of the 3 R's.

National Standards and State Variation in Physician Orders for Life-Sustaining Treatment Forms.

BACKGROUND: The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm is used across the country to document the treatment preferences of seriously ill or frail patients as medical orders. The National POLST Paradigm Task Force maintains consensus-based standards for POLST programs and uses these to determine whether a state POLST program is developing, endorsed, or mature. OBJECTIVES: To evaluate state program form adherence to national standards. DESIGN: Document review. MEASUREMENTS: Forms from endorsed/mature (n = 21) and developing (n = 23) states were compared with national standards to assess adherence to required and optional form elements. RESULTS: Required elements were present on 84% of endorsed/mature state POLST forms and 73% of the developing state POLST forms. Compliance with required elements in endorsed states ranged from 50% to 100%. Three endorsed/mature states (14%) had forms that met all of the required elements fully and 14 (67%) had forms that met the all of the elements fully or partially. CONCLUSIONS: There is variability in adherence to required and optional standards as well as challenges in interpreting and applying existing standards. Although there may be legal and logistical barriers to the existence of a national POLST form, standardization remains an important goal to support patient-centered care.