CHEST Guidelines-Response_chest

Response_chest_5 (1)

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This document contains a correspondence between two groups of doctors discussing the ethical considerations of using silibinin for treating Amanita mushroom poisoning. The initial letter, written by Michael E. Mullins, MD, and colleagues, expresses surprise at the perceived ethical quandary over using silibinin, highlighted in a CHEST journal article by Gores et al. The authors argue that withholding silibinin, which is the most supported treatment according to both canine and human studies, would be more ethically questionable. They emphasize that silibinin is a well-established treatment in Europe and is available in the U.S. under compassionate use protocols despite not having FDA approval due to market limitations.<br /><br />In their response, Gores and Schmidt elaborate on the ethical dilemma they faced. They assert that while they chose to offer silibinin to a patient experiencing hepatic failure from Amanita poisoning, they found it challenging to balance the risks and benefits due to the reliance on animal studies and uncontrolled case reports. They acknowledge that many might not see an ethical issue, but they were cautious about the tendency of physicians to take action, possibly influenced by psychological or medicolegal factors, when in some instances, inaction might be the safer route. They emphasize their concern that the desire for silibinin, regardless of the thin supporting evidence, demonstrates the complexity of the decision.<br /><br />This discussion highlights the ethical challenges in balancing patient treatment options, especially with interventions that have variable levels of scientific backing and regulatory approval.

Keywords

silibinin

Amanita poisoning

ethical considerations

hepatic failure

compassionate use

FDA approval

treatment options

medical ethics

physician decision-making

CHEST journal