National Center for Ethics in Health Care
Index of Publications Listed by Health Care Ethics Domain
The National Center for Ethics in Health Care produces a variety of material addressing different aspects of health care ethics. The material is released in the form of national policy, National Ethics Committee Reports, National Ethics Teleconferences, periodic center publications, and papers addressing specific issues such as pandemic influenza preparedness. The publications on this page are listed by health care ethics domain.
You also can search NCEHC-produced materials listed by subject or keyword.
Note: The information contained in NCEHC publications is current as of the date of publication. However, health care ethics is a dynamic field in which best practices and thinking are constantly evolving. Therefore, some information in our publications may become outdated or may be superseded. We note these instances when they occur, and we encourage users to consult additional authorities on these topics, including current VA policy and regulation.
Use the links below to find resources that explore ethical issues in the following domains:
- Shared decision making with patients
- Ethical practices in end-of-life care
- Ethical practices at the beginning of life
- Patient privacy and confidentiality
- Professionalism in patient care
- Ethical practices in resource allocation
- Ethical practices in business and management
- Ethical practices in research
- Ethical practice in the everyday workplace
- Ethical practices in government service
Ethical Practices in Business and Management
Business integrity - practices that support oversight of business practices, compliance with legal and ethical standards, and promotion of business quality and integrity
NCEHC content
Copying, Pasting, and Duplicating in the Electronic Medical Record: An Ethical Analysis (NET Summary February 2004)
The Relationship Between Ethics and Compliance and Business Integrity (NET Summary July 2001)
Legal Briefs: Integrating Documentation, Compliance, and Ethics (news@vhaethics Spring 2002)
Integrating Ethics with Compliance (Council of Ethical Organizations. Compliance Case Study Library, 1999:60-76. Oak J.)
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Ethical Practices in End-of-Life Care
Cardiopulmonary resuscitation (CPR)
Life-sustaining treatments
Medical futility
Hastening death
Death and postmortem issues
Other
Overview
NCEHC content
IntegratedEthics Online Learning Module: Ethical Practices in End-of-Life Care
Weighed in the Balance: Ethical Decisions at the End of Life ( news@vhaethics Spring 2001)
Non-VA content
End of Life Issues (University of Washington School of Medicine)
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Cardiopulmonary resuscitation (CPR) - withholding/stopping resuscitation in the event of cardiopulmonary arrest, including DNAR orders
NCEHC content
Do Not Resuscitate Policy Revision: Controversial Topics (NET Summary March 2002)
Policy Perspectives: Should Residents be Allowed to Enter DNR Orders? ( news@vhaethics Summer/Fall 2002)
Family Presence During Resuscitation (NET Summary August 2001)
Ethics Rounds: Wristbands for DNR? ( news@vhaethics Fall 2000)
DNR Orders and the Electronic Medical Record (NET Summary December 2000)
Non-VA content
#023 - DNR Orders in the Hospital Setting - Part I (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
#024 - DNR Orders in the Hospital Setting - Part II (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
Do Not Resuscitate Orders (University of Washington School of Medicine)
Do Not Resuscitate Orders During Anesthesia and Urgent Procedures (University of Washington School of Medicine)
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Life-sustaining treatments - withholding or stopping artificially administered fluid or nutrition, mechanical ventilation, dialysis, surgery, antibiotics, etc.
NCEHC content
Ethical Considerations of Cardiac Pacemakers and Implantable Defibrillators for End-of-Life Care (NET Summary April 2006)
Terminal Extubation: Ethics Perspectives (NET Summary March 2005)
Legal Briefs: Must Food and Fluids Always be Provided? ( news@vhaethics Fall 2000)
VHA Handbook 1004.04 State-Authorized Portable Orders
Non-VA content
#111 - Cardiac Pacemakers at End of Life (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
#112 - Implantable cardioverter Defibrillator (ICD) at End of Life (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
#133 - Non-Oral Hydration in Palliative Care (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
Termination of Treatment (University of Washington School of Medicine)
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Medical futility - a physician's judgment that a therapy will be of no benefit to a patient and that it should not be offered or should be withdrawn
Non-VA content
Futility (University of Washington School of Medicine)
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Hastening death - intentionally or unintentionally, e.g., questions related to euthanasia, assisted suicide, or the doctrine of double effect
Non-VA content
#008 - Morphine & Hastened Death (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
#156 - Evaluating Requests for Hastened Death (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
Euthanasia and Assisted Suicide (CMAJ Bioethics for Clinicians)
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Death and postmortem issues - determination of death, organ donation, autopsy, disposition of body or tissue, etc.
NCEHC content
Practicing Medical Procedures on the Newly Dead (NET Summary November 2003)
Ethical Priority of Decedent's vs. Family's Wishes in Organ Donation (NET Summary July 2002)
Privacy Requirements During the Organ Donation Process (NET Summary January 2001)
Non-VA content
#004 - Death Pronouncement (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
#079 - Discussing organ donation with families (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
#115 - Declaring Brain Death (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
Family Disagreement over Organ Donation (AMA Virtual Mentor)
Brain Death (CMAJ Bioethics for Clinicians)
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NCEHC content
Ethics Rounds: Appropriate Palliative Care? ( news@vhaethics Spring 2001)
- Palliative sedation
National Ethics Committee Report: The Ethics of Palliative Sedation as a Therapy of Last Resort (NET Summary July 2006)
Terminal Sedation: An Open Discussion (NET Summary August 2002)
Non-VA content
#106 - Controlled Sedation for Refractory Suffering - Part I (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
#152 - The Military History as a Vehicle for Exploring End of Life Care with Veterans (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
Quality End of Life Care CMAJ Bioethics for Clinicians
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Government ethics rules and laws - ethics rules, policies or standards of conduct that apply to federal government employees (e.g., bribery, nepotism, gift and travel rules)
Legal Briefs: Health Care Ethics vs. Government Ethics ( news@vhaethics Winter 2001)
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Ethical Practices in Research
Informed consent - providing information to the research subject or surrogate, ensuring that the decision is voluntary, and documenting the decision
NCEHC content
Best Practices: Informed Consent for Research ( news@vhaethics Winter 2002)
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NCEHC content
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Genetics/genomics
The Ethics of Tissue Banking for Future Genetic Research (NET Summary July 2003)
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Quality Improvement
Recommendations for the Ethical Conduct of Quality Improvement (NEC Report May 2002)
Recommendations for the Ethical Conduct of Quality Improvement (NET Summary September 2002)
Ethics Rounds: A Case of Quality Improvement ( news@vhaethics Winter 2002)
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Miscellaneous
Ethical Considerations in the Report of a Work Group on Post Traumatic Stress Disorder (PTSD) and Vulnerable Populations in Research (NET Summary February 2009)
Access to VA Databases for Research Purposes (NET Summary February 2001)
Legal Briefs: The HIPAA Privacy Rule and its Impact on Research ( news@vhaethics Winter 2002)
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Ethical Practices in Resource Allocation
Systems level (macroallocation)
Overview
IntegratedEthics Online Learning Module, Ethical Practices in Resource Allocation
Systems level (macroallocation) - how well the facility demonstrates fairness in allocating resources across programs and services
NCEHC content
Meeting the Challenge of Pandemic Influenza: Ethical Guidance for Leaders and Health Care Professionals in the Veterans Health Administration (VHA) (July 2010)
VA Fact Sheet for Health Care Staff: Meeting the Ethical Challenges of a Severe Pandemic Influenza
Ethical Considerations for Resource Allocation in Health Care (NET Summary May 27, 2009 and June 30, 2009)
Influenza Pandemic Preparedness Planning: Ethics Concerns (NET Summary June 2006)
Tough Decisions: Preparing VA for the Ethical Challenges of Pandemic Influenza
Policy Perspectives: The Administrator's Dilemma ( news@vhaethics Fall 2003)
Foglia MB, Pearlman RA, Bottrell MM, Altemose JA, Fox E. Priority Setting and the Ethics of Resource Allocation within VA Healthcare Facilities: Results of a Survey. Organizational Ethics. 2008 Fall-Winter;4(2):83-96. (based on research conducted as part of the IESS).
Non-VA content
The Five People You Meet in a Pandemic - and What They Need from You Today (The Hastings Center)
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Ethical Practices in the Everyday Workplace
Respect and dignity - e.g., employee privacy, personal safety, respect for diversity
Non-VA content
Problem Peers (AMA Virtual Mentor)
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Patient Privacy and Confidentiality
Overview
IntegratedEthics Online Learning Module: Patient Privacy and Confidentiality
Privacy - protecting individuals' interests in maintaining personal space free of unwanted intrusions and in controlling data about themselves
NCEHC content
Patients' Requests to Have Their Medical Records Amended (NET Summary May 2006)
The Ethical Challenges of Coordinating Mental Health Care Between VHA and DoD (NET Summary March 2006)
Privacy, Safety and Patient Social Security Numbers: Ethics Concerns (NET Summary July 2005)
National Ethics Committee Report, Online Patient-Clinician Messaging: Fundamentals of Ethical Practice (NET Summary September 2004)
Ethics Rounds: Wristbands for DNR? ( news@vhaethics Fall 2000)
Privacy Requirements During the Organ Donation Process (NET Summary January 2001)
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Confidentiality - nondisclosure of information obtained as part of professional-patient relationship
NCEHC content
The Ethical Challenges of Coordinating Mental Health Care Between VHA and DoD (NET Summary March 2006)
Shared Medical Appointments: Ethical Concerns (NET Summary October 2005)
The Ethical Duty to Protect Third Parties from Dangerous Patients (NET Summary April 2005)
Provider Reporting of Impaired or Potentially Impaired Drivers (NET Summary February 2002)
Non-VA content
Confidentiality (University of Washington School of Medicine)
Confidentiality (CMAJ Bioethics for Clinicians)
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Professionalism in Patient Care
Conflicts of interest
Truth telling
Challenging clinical relationships
Cultural/religious sensitivity
Other
Overview
IntegratedEthics Online Learning Module, Professionalism in Patient Care
Non-VA content
Professionalism (University of Washington School of Medicine)
Physician-Patient Relationship (University of Washington School of Medicine)
Conflicts of interest - situations that may compromise the clinician's fiduciary duty to patients, including inappropriate business or personal relationships
NCEHC content
VHA Handbook 1004.07 Financial Relationships Between VHA Health Care Professionals and Industry
VHA Handbook 1004.07: Financial Relationships Between VHA Health Care Professionals and the Pharmaceutical Industry (NET Summary November 24, 2009)
National Ethics Committee Report: Compensation to Health Care Professionals from the Pharmaceutical Industry (NET Summary February 2006)
National Ethics Committee Report: Ethical Boundaries in the Patient Clinician Relationship (NET Summary September 2003)
National Ethics Committee Report: Gifts to Health Care Professionals from the Pharmaceutical Industry (NET Summary January 2004)
Ethics Rounds: Sale of House to a Patient? (news@vhaethics Winter 2001)
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Truth telling - open and honest communication, including disclosing bad news, adverse events
NCEHC content
Critical Thinking About Institutional Disclosure of Adverse Events to Patients (National Call August 2012)
Clinical and Institutional Disclosure of Adverse Events to Patients (National Call May 2012)
Disclosure of Adverse Events to Patients: Ethical and Policy Requirements (NET Summary February 2008)
Clinical Use of Placebo: An Ethics Analysis (NET Summary July 2004)
National Ethics Committee Report: Disclosing Adverse Events to Patients (NET Summary April 2003)
Notification of Patients Potentially Exposed to Mad Cow Disease Through Prior Blood Transfusion: Testing the Limits of Full Disclosure (NET Summary April 2001)
VHA Handbook 1004.08 Disclosure of Adverse Events to Patients
Non-VA content
#006 - Delivering Bad News, Part I (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
#011 - Delivering Bad News, Part II (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
#021 - Hope and Truth Telling (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
Medical Error Disclosure (AMA Virtual Mentor)
Breaking Bad News (University of Washington School of Medicine)
Truth Telling and Withholding Information (University of Washington School of Medicine)
Mistakes (University of Washington School of Medicine)
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Challenging clinical relationship - clinician interactions with patients who are disruptive or who do not adhere to treatment plans/health care recommendations
NCEHC content
Ethical Considerations That Arise When a Home Care Patient on Long Term Oxygen Therapy Continues to Smoke (March 2010)
Ethical Considerations in the use of Home Oxygen for Patients and/or Third Parties Who Smoke (NET Summary July 30, 2008)
Ethics and the Discharge Process: What to Consider When a Patient Prefers a Plan that the Team Believes is Unsafe (NET Summary May 28, 2008)
Ethical Considerations in Opioid Therapy for Chronic Pain Management (NET Summary November 2005)
The Ethical Duty to Protect Third Parties from Dangerous Patients (NET Summary April 2005)
Ethics Rounds: Patient Refusal of Care by a Trainee ( news@vhaethics Summer/Fall 2002)
Home Oxygen for Patients Who Smoke: Prescription vs. Proscription (NET Summary October 2001)
Managing 'Difficult' or 'Non-Compliant' Patients: Ethical Challenges (NET Summary September 2001)
Non-VA content
Who is Being Difficult? Addressing the Determinants of Difficult Patient-Physician Relationships (AMA Virtual Mentor)
When a Nonadherent Patient Needs Your Care (AMA Virtual Mentor)
Stigmatized Patients' Right to Equal Treatment (AMA Virtual Mentor)
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Cultural/religious sensitivity - clinician interactions with people of different ethnicity, religion, sexual orientation, gender, age, etc.
NCEHC content
Cultures and Persons, Patients and Caregivers: Ethical Obligations and Culturally Competent Care (NET Summary August 2003)
An Ethical Analysis of Ethnic Disparities in Health Care (NET Summary December 2002)
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Conscience
The Conscience Clause (NET Summary June 2002)
- Duty to Treat
Influenza Pandemic Preparedness Planning: Ethics Concerns (NET Summary June 2006)
Best Practices: A Duty to Treat (news@vhaethics Fall 2003)
Health Care Ethics Issues Raised by SARS (NET Summary June 2003)
Ethics Rounds: Taking Risks to Protect Patients ( news@vhaethics Fall 2003)
Disaster Medicine: Unique Ethical Challenges (NET Summary April 2002)
Non-VA content
Accomodating Bigotry (JAMA 2014; 311(2):139-140)
#120 - Physicians and Prayer Requests (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
Spirituality and Medicine (University of Washington School of Medicine)
Ethics and Multiculturalism (AMA Virtual Mentor)
Physician Values (AMA Virtual Mentor)
Professional Demands and Religious Observance (AMA Virtual Mentor)
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NCEHC content
The Place of Codes of Ethics in Ethics Consultation (NET Summary May 26, 2010)
Best Practices: Teaching Ethics and Professionalism (news@vhaethics Summer/Fall 2002)
- Miscellaneous
Core Competencies for Health Care Ethics Consultation (NET Summary March 24, 2010)
The Interplay Between Patient Advocacy and Health Care Ethics (NET Summary March 25, 2009)
Moral Distress: How Can Ethics Consultants Respond? (NET Summary November 25, 2008)
Patients' Requests to Have Their Medical Records Amended (NET Summary May 2006)
Online Patient-Clinician Messaging: Fundamentals of Ethical Practice (NEC Report July 2004)
National Ethics Committee Report, Online Patient-Clinician Messaging: Fundamentals of Ethical Practice (NET Summary September 2004)
- Pain/suffering
Non-VA content
Self-Regulation (AMA Virtual Mentor)
Impaired Physicians (AMA Virtual Mentor)
Peer Reporting (AMA Virtual Mentor)
"Competent and Irrascible" (AMA Virtual Mentor)
Protection for Conscientious Objection (AMA Virtual Mentor)
Obligation to Provide Services (AMA Virtual Mentor)
Student Issues (University of Washington School of Medicine)
Interdisciplinary Team Issues (University of Washington School of Medicine)
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Shared Decision Making with Patients
Decision-making capacity
Informed consent process
Surrogate decision making
Advance care planning
Limits to patient choice
Other
Overview
IntegratedEthics Online Learning Module: Shared Decision Making with Patients
Decision-making capacity - ability of the patient to make his/her own health care decisions
NCEHC content
Ten Myths About Decision-Making Capacity (NET Summary November 2002)
Common Pitfalls in Determining Decision-Making Capacity-Live from the National Ethics Committee Meeting (NET Summary March 2001)
Non-VA content
#055 - Decision Making Capacity (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
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Informed consent process - providing information to the patient/surrogate, ensuring that the decision is voluntary, documenting the decision
NCEHC content
Requirement to Provide Written Materials for HIV Testing Waived (Ethics Rx May 2016)
Signature Informed Consent Workflows: "Gurney Consent" (EthicsRx July 2015)
The Basics of Informed Consent: History, Ethics and Law (NET Summary September 2010)
Informed Consent for Methicillin-Resistant Staphylococcus Aureus (MRSA) Testing (Ethics Rx February 2009)
When Must Clinicians Obtain a Separate Consent for Use of Blood Products in the Post-Operative Period? (Ethics Rx August 2006)
Ethics Rounds: Substituted Judgment or Best Interests? ( news@vhaethics Summer 2003)
Informed Consent Policy Revision: Medical Decision Making in Patients Without Surrogates (NET Summary January 2002)
Informed Consent for IV Contrast Administration (NET Summary January 2001)
VHA Directive 1005: Informed Consent for Long-Term Opioid Therapy for Pain
Non-VA content
#056 - What to do when a patient refuses treatment (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
Informed Consent (University of Washington School of Medicine)
Informed Consent in the Operating Room (University of Washington School of Medicine)
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Surrogate decision making - selection, role, and responsibilities of the person authorized to make health care decisions for the patient
NCEHC content
Ethical Aspects of the Relationship Between Clinicians & Surrogate Decision Makers (NEC Report April 2007)
National Ethics Committee Report: Ethical Aspects of the Relationship between Clinicians & Surrogate Decision Makers (NET Summary April 2007)
Choosing Among Surrogates of the Same Priority (Ethics Rx April 2005)
Disclosing Patients' Protected Health Information to Surrogates (NEC Report February 2005) *Note: With the passage of the Caregivers and Veterans Omnibus Health Services Act of 2010, VA health care providers are now authorized to disclose 7332-protected information to surrogate decision makers for the purposes of informed consent for patients who lack decision making capacity but who have not specifically authorized that disclosure.
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Advance care planning - statements made by a patient with decision-making capacity regarding future health care decisions
NCEHC content
Documenting Veterans’ Mental Health Treatment Preferences in Advance Directives (July 2016, updated from 2009)
Advance Directives for Mental Health: An Ethical Analysis of State Laws & Implications for VHA Policy (NEC Report February 2008)
Must All Patients Be Asked About Mental Health Advance Directives? (Ethics Rx February 2005)
VHA Handbook 1004.02 Advance Care Planning and Management of Advance Directives
VA Form 10-0137 VA Advance Directive - Durable Power of Attorney for Health Care and Living Will
VA 10-0137A Your Rights Regarding Advance Directives
VA 10-0137B What You Should Know About Advance Directives
Advance care planning worksheets updated August 2011: Mental Health Treatment Preferences and Who to Contact
Non-VA content
#012 - Myths about Advance Directives (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
Advance Care Planning (University of Washington School of Medicine)
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Limits to patient choice - e.g., choice of care setting, choice of provider, a demand for unconventional treatment
NCEHC content
Ethical Considerations When Treating Erectile Dysfunction in Patients with Sexually Transmissible Diseases (NET Summary May 2004)
Should Patients be Able to Refuse Care by House Officers or Trainees? (NET Summary March 2004)
Ethics Rounds: Patient Refusal of Care by a Trainee ( news@vhaethics Summer/Fall 2002)
Non-VA content
Dealing with Demands for Inappropriate Treatment (CMAJ Bioethics for Clinicians)
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NCEHC content
Ethics and the Discharge Process: What to Consider When a Patient Prefers a Plan that the Team Believes is Unsafe (NET Summary May 28, 2008)
Strategies for Increasing Influenza Vaccination Rates in Health Care Workers: Ethical Considerations (NET Summary January 30, 2008)
National MRSA (Methicillin-Resistant Staphylococcus Aureus) Initiative: Ethical Considerations in Implementation (NET Summary October 2007)
National Ethics Committee Report - Impaired Driving in Older Adults: Ethical Challenges for Health Care Professionals (NET Summary September 2007)
Informed Consent Practices: Lessons Learned from Implementing iMedConsent (NET Summary November 2006)
Non-VA content
#052 - Quality of Life (Fast Facts and Concepts. End of Life/Palliative Education Research Center (EPERC), Medical College of Wisconsin)
