Journal of Clinical Ethics最新文献

Introduction: Trauma and Surrogate Decision Makers: An Argument for Moral Priority in Futility Disputes.

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733270

Autumn Fiester

引用次数: 0

Attending to Trauma, Balancing Power, and Prioritizing Stakeholders in Ethics Consultation. 在伦理咨询中关注创伤、平衡权力、优先考虑利益相关者。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733387

Paul J Ford, Georgina Morley, Lauren R Sankary

{"title":"Attending to Trauma, Balancing Power, and Prioritizing Stakeholders in Ethics Consultation.","authors":"Paul J Ford, Georgina Morley, Lauren R Sankary","doi":"10.1086/733387","DOIUrl":"https://doi.org/10.1086/733387","url":null,"abstract":"AbstractClinical ethicists ought to account for stakeholder traumas while finding an acceptable balance between competing obligations and responsibilities. Among these is the ethical responsibility to avoid unnecessary suffering that can occur if the decision-making process is prolonged when accounting for the past and present traumas of patients, healthcare team members, and surrogate decision makers (SDMs). Autumn Fiester makes a radical proposal to prioritize avoidance of SDM retraumatization, suggesting that current ethics consultation best practices fall short of standards in trauma-informed approaches. We respond to Fiester and argue that current best practices in ethics consultation already support creating space to identify stakeholder traumas and integrate them into the decision-making process, which sufficiently fulfills an ethics consultant's responsibility to implement trauma-informed practices. Fiester's proposal of prioritizing SDMs, even when this risks violating a patient's bodily dignity, falls back on a traditional view of prioritizing a power structure of those who are related to a patient by genetics or by law. Ethics consultants should flexibly negotiate all stakeholder perspectives to avoid unnecessary retraumatization and to prioritize stakeholders, depending on the specific ethical issues and context.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 1","pages":"63-68"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Psychiatry's Small-World Problem: Ethical Challenges in Treating Multiple Patients from the Same Family or Household.

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733385

Jacob M Appel

引用次数: 0

Response to Ford, Morley, and Sankary, "Attending to Trauma, Balancing Power, and Prioritizing Stakeholders in Ethics Consultation".

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733390

Autumn Fiester

引用次数: 0

Hindering or Helping: Discussing Patient Participation in Clinical Ethics Support Service Deliberation.

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733393

Katherine Murdoch

{"title":"Hindering or Helping: Discussing Patient Participation in Clinical Ethics Support Service Deliberation.","authors":"Katherine Murdoch","doi":"10.1086/733393","DOIUrl":"https://doi.org/10.1086/733393","url":null,"abstract":"AbstractClinical ethics support services (CESS) are advisory bodies that deal with ethical conflict arising in healthcare. Patient involvement with CESS remains a contentious issue, without uniform practice regarding whether, how, and when patients should be involved. The overall objective of the study was to understand key stakeholders' viewpoints about CESS and urgent decision-making. Patient involvement and clinical ethics emerged as a key area of discussion. Three stakeholder groups were recruited: doctors in England, CESS members in England, and CESS members in the United States. Recruitment occurred via dissemination of the study online and via email. This resulted in a sample size of 13 participants. The focus group transcripts were analyzed using reflexive thematic analysis. The study found that there was uniform acceptance of the importance of patient representation by all stakeholders. However, the ways in which their involvement was facilitated varied. CESS members in the United States routinely involved the family directly by discussion with the clinical ethicist. However, CESS members and doctors in England viewed patient presence in committee meetings as a barrier to open discussion. Instead, CESS in England would seek ways in which involvement could occur, such as a written statement or advocation by the clinical team. The clinical ethicist model, adopted in the United States, appears to support direct patient involvement in the consultation process, in comparison to the clinical ethics committee model adopted in England. However, these results are limited by the small sample size and small number of viewpoints represented.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 1","pages":"9-15"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Children as Organ Donors: A Model of Ethical Analysis.

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733188

Edmund G Howe

{"title":"Children as Organ Donors: A Model of Ethical Analysis.","authors":"Edmund G Howe","doi":"10.1086/733188","DOIUrl":"https://doi.org/10.1086/733188","url":null,"abstract":"AbstractIn this introduction I discuss several ethical issues pertaining to the question other authors raise regarding whether we should permit minors to donate an organ-such as part of their liver or a kidney-to a sibling. I discuss particularly limits of what ethical analysis can accomplish; overriding, disproportionate effects of what might appear to be no more than minor nuances; exceptional expertise \"ethics experts\" can and can't offer; how patients' and family members' feelings may prevail over rational arguments; the importance of recognizing and respecting patients' felt relationships with others; and our global obligations to people worse off. A core feeling considered is a child's feeling of guilt if the child doesn't donate and this sibling dies. A nuance considered is a sibling wanting to donate to an identical twin. I consider some providers' bias that an intervention is death prolonging rather than life prolonging. When providers arrive at an impasse and continue to reasonably differ, switching the question to how an ethical resolution should be reached and by whom is recommended. Practical applications such as this that can be implemented by providers now are offered in regard to each of the ethical issues addressed.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

TIEC, Trauma Capacity, and the Moral Priority of Surrogate Decision Makers in Futility Disputes.

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733392

Autumn Fiester

引用次数: 0

Commentary on Fiester's "TIEC, Trauma Capacity, and the Moral Priority of Surrogate Decision Makers in Futility Disputes," Others' Responses on This Topic, and, Then, Her Responses to Them.

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733186

Edmund G Howe

{"title":"Commentary on Fiester's \"TIEC, Trauma Capacity, and the Moral Priority of Surrogate Decision Makers in Futility Disputes,\" Others' Responses on This Topic, and, Then, Her Responses to Them.","authors":"Edmund G Howe","doi":"10.1086/733186","DOIUrl":"https://doi.org/10.1086/733186","url":null,"abstract":"AbstractIn this issue Autumn Fiester and several other experts explore optimal ethical approaches to surrogate decision-making and trauma-informed ethics consultation (TIEC). Trauma-informed care is currently recommended in many clinical contexts in which the risks of patients being traumatized by their illness and its treatment are present. This care gives priority to patients feeling safe, an asymptotic goal that prescribes no one standard practice for all patients, but one that prescribes individualized treatment tailored to each patient's idiosyncratic needs. Core points Fiester makes are how patients are especially prone to feeling traumatized when others, as is always the case with their providers, have greater power over them and the rarely considered conclusion that although providers have exceptional medical expertise and experience, this does not necessarily provide them with greater ethical expertise than their patients or others. Fiester's most radical contention may be that providers, including ethics consultants, give priority to patients' and surrogate decision makers' feelings. I discuss here these contentions and Fiester's main aim of first creating and then maintaining trust and caring feelings between all parties, no matter how much initially they may disagree. I discuss, too, how legally her suggestions may be implemented immediately.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 1","pages":"88-91"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Representing the Unrepresented: Providing Medical Care for the Unrepresented Patient.

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733394

Vishruth M Nagam, Charles F Sineri, Robert T Pyo

引用次数: 0

A Deeper Look at Ethics Consultation. 深入了解伦理咨询。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733384

Haavi Morreim

{"title":"A Deeper Look at Ethics Consultation.","authors":"Haavi Morreim","doi":"10.1086/733384","DOIUrl":"https://doi.org/10.1086/733384","url":null,"abstract":"AbstractAutumn Fiester suggests that trauma-informed ethics consultation (TIEC) should focus on surrogate decision makers (SDMs) in preference over patients when (a) the patient is comatose or neurologically devastated, and hence beyond the capacity for suffering or further trauma; (b) the patient is thus incapable of asserting preferences; and (c) the patient's wishes are not known, for example, in the absence of an advance directive. Therefore, (d) in these instances the moral obligation to prevent trauma for SDMs overrides obligations to patients. Perhaps Fiester might countenance other instances, but, as presented, Fiester's TIEC placing others' trauma above patients' is thus construed fairly narrowly. This commentary first offers a few brief observations regarding each tenet of Fiester's argument and then offers broader reflections on ethics consultation and on TIEC in particular. As discussed below, when the issue sparking the request for an ethics consultant (EC) is a bona fide question of values rather than, for example, clearing up miscommunication or identifying a need for further information, ECs aim primarily to gather information and then offer their recommendation(s). This mission, I suggest, stands on thinner ice than we may recognize. Moreover, I will argue that if ECs disclose that mission to patients and SDMs with full clarity and truth, genuine TIEC becomes virtually impossible.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 1","pages":"77-83"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0