CHEST Guidelines-Response_chest

Response_chest_37
Pdf Summary
The text includes correspondence and commentary published in the journal CHEST, dealing with two primary discussions: methods in pleurodesis in a rabbit model and medical ethics in end-of-life care.<br /><br />In the first discussion, Vincent Acton criticizes a study by Marchi et al. that compares pleurodesis techniques, stating that neither method achieved the complete obliteration of the pleural cavity in rabbits. He suggests that the effectiveness of these methods might lie not in the complete ablation but in their ability to induce changes that reduce pleural permeability. In their response, Marchi et al. clarify that while complete obliteration was not observed in their animal model, the interventions led to significant pleural changes such as local adhesions and collagen deposition, which they argue can reduce pneumothorax recurrence. They stand by their findings, citing the definition of pleurodesis as the fusion of visceral and parietal pleura to prevent lung collapse.<br /><br />The second discussion by Rady, Verheijde, and Yanke centers on ethical interpretations and practices concerning end-of-life care. They argue against Bosslet et al.'s conclusions about the insufficiency of public reasoning in the U.S. over issues of medical futility. They highlight that legal precedents like Vacco v Quill provide substantial reasoning against constitutional rights for medical termination of life. The authors express concerns over how the medical field interprets concepts like autonomy and best interests, warning that ethical reinterpretations could conflict with societal values. They advocate for legislative debate to address these issues, suggesting that differences between medical ethics and societal values may increase conflicts.<br /><br />The content reflects ongoing dialogues within medical and ethical spheres over effective practices and the alignment of medical ethics with cultural values.
Keywords
pleurodesis
medical ethics
end-of-life care
rabbit model
pleural changes
pneumothorax
autonomy
societal values
legal precedents
medical futility