Journal of Clinical Ethics最新文献

A Primer on Epistemic Injustice and Patients with Non-English Language Preference. 认知不公与非英语语言偏好患者初探。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739005

Samantha A Chipman, Karen M Meagher, Ryan Marshall Felder, Amelia Barwise

{"title":"A Primer on Epistemic Injustice and Patients with Non-English Language Preference.","authors":"Samantha A Chipman, Karen M Meagher, Ryan Marshall Felder, Amelia Barwise","doi":"10.1086/739005","DOIUrl":"https://doi.org/10.1086/739005","url":null,"abstract":"AbstractEpistemic injustice is a concept capturing the way people are treated as knowers. In healthcare, epistemic injustice involves evaluation of a series of underlying knowledge-based conditions at the core of patient interactions. This article describes a case study demonstrating different forms of epistemic injustice as it manifests for Hispanic and Spanish-speaking people in healthcare settings characterized by English language dominance. The analysis provided here differentiates epistemic injustice in terms of hermeneutical injustice, testimonial injustice (including testimonial smothering), epistemic oppression, and epistemic colonialism. This discussion is tailored to provide a resource for bioethicists and clinical teams at the bedside and to advance an increased voice for patients and families in U.S. healthcare. While potential avenues for pursuing and assuring epistemic justice in healthcare systems are beyond the scope of this examination, we focus on using epistemic injustice to name oppression and opportunities for resistance in the current healthcare environment. An overview of how patients can be treated unfairly as knowers is also situated within a broader national discourse about other forms of injustice and is imperative to redress U.S. health disparities.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 1","pages":"63-74"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207988","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

The Gray Zone Between Quality Improvement and Human Subject Research. 质量改进与人体实验研究之间的灰色地带。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739010

Baddr Shakhsheer, Michael O'Connor, Bita Makarachi, Peter Angelos

引用次数: 0

When Pigs Fly into Medicine: Navigating Ethical Challenges Posed by Animal-Derived Medical Products. 当猪飞进医学：导航动物源性医疗产品带来的伦理挑战。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739014

Chelsey Patten, Gianna Morales

{"title":"When Pigs Fly into Medicine: Navigating Ethical Challenges Posed by Animal-Derived Medical Products.","authors":"Chelsey Patten, Gianna Morales","doi":"10.1086/739014","DOIUrl":"10.1086/739014","url":null,"abstract":"AbstractThis article explores the ethical, religious, and process complexities surrounding the use of animal-derived products in medicine, using the case of a 19-year-old Muslim patient with homozygous familial hypercholesterolemia, receiving lifesaving LDL apheresis with porcine-derived heparin. Despite the critical role of LDL apheresis to manage her high cholesterol levels over the past year, the charge nurse has recently raised concerns owing to the porcine origin of the anticoagulant used in her treatment, recognizing that this may conflict with her religious beliefs. This case raises critical questions about the disclosure of ethically sensitive information during the consent process. Should providers disclose the origin of such products, even when they are essential and no alternatives exist? Balancing respect for patient autonomy with concerns about moral distress and potential treatment refusal highlights the challenges in culturally informed care. The article examines the broader implications of these dilemmas, emphasizing the necessity of cultural humility in healthcare. While Islamic bioethics and other faith traditions may permit the use of prohibited substances in lifesaving situations, interpretations vary widely. Providers must engage patients in open, respectful dialogues to understand their individual values, avoiding harmful generalizations.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 1","pages":"83-89"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208037","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

Informed Consent and Fetal Directive Counseling in the Setting of High-Risk Pregnancy. 高危妊娠的知情同意和胎儿指导咨询。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739007

Nina Feinberg, Paul Burcher

引用次数: 0

Curious Engagement: Navigating False Predicates in Ethics Consultation. 好奇的参与：在伦理咨询中导航错误谓词。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739009

Anna D Goff, Joseph J Fins

引用次数: 0

Patient and Family Perspectives for Trauma-Informed Ethics Consultation: A Pilot Study. 创伤知情伦理咨询的患者和家庭观点：一项试点研究。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739008

Elizabeth Lanphier, Dani Clark, Sachika Singh

引用次数: 0

Patients as a Limited Resource? Ethical Dilemmas in Pediatric Pulmonary Vein Stenosis. 病人是有限的资源？儿童肺静脉狭窄的伦理困境。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739011

Michaela Asher, Michael O'Byrne, Ryan Callahan, Constantine D Mavroudis

{"title":"Patients as a Limited Resource? Ethical Dilemmas in Pediatric Pulmonary Vein Stenosis.","authors":"Michaela Asher, Michael O'Byrne, Ryan Callahan, Constantine D Mavroudis","doi":"10.1086/739011","DOIUrl":"10.1086/739011","url":null,"abstract":"AbstractThis study explores tensions between rarity, research, and clinical decision-making in surgical diseases through a case study of pediatric pulmonary vein stenosis (PVS), an extremely rare and severe pediatric cardiopulmonary disease. We first examine the history of PVS treatment and illustrate how the field has been characterized by rapid clinical changes that outpace evidence. Through this context, we characterize patients and their ability to contribute to research as a limited resource that future patients depend on. We argue that this establishes future patients as legitimate stakeholders in decisions regarding current-day clinical management. Exploring this tension, we ask, to what extent should just resource utilization and research priorities shape clinical decisions, and can the dual role of patients-both as care recipients and as a limited resource-be ethically balanced? The article interrogates these questions through two proposals: standardizing care across centers, and regionalizing PVS treatment. We argue that regionalization is ethically justifiable, whereas standardization is not. Ultimately, we conclude that while a patient's primary role is as a recipient of care, research and resource considerations can and should still inform clinical management of rare diseases. Importantly, this is ethically possible only under conditions that preserve patient welfare and the accepted standard of care.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 1","pages":"23-33"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208006","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

Chemical Coping and the Role of Palliating Existential Suffering: A Case Study. 化学应对与缓解存在性痛苦的作用：个案研究。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739015

Andrew J Baldassarre, Gustavo S Mastroleo, Amitabha Palmer

引用次数: 0

Treatment over Objection Versus Withdrawal of Dialysis in Cases of Severe Mental Illness. 重度精神疾病患者反对治疗与停止透析的比较。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739013

Nicholas S Kowalczyk, Andrea Landi, Liliana Osadchuk

{"title":"Treatment over Objection Versus Withdrawal of Dialysis in Cases of Severe Mental Illness.","authors":"Nicholas S Kowalczyk, Andrea Landi, Liliana Osadchuk","doi":"10.1086/739013","DOIUrl":"10.1086/739013","url":null,"abstract":"AbstractPatients with severe mental illness are more likely to develop kidney disease and its complications compared to patients without severe mental illness. Once patients with mental illness develop end-stage kidney disease, supporting adherence is important but can be difficult in moments of acute psychosis when the patient objects to dialysis, particularly when considering the lack of dialysis-compatible psychiatric hospitals. In this case, a woman with a history of bipolar disease and end-stage kidney disease has a manic episode after discontinuing her antipsychotic medications and refuses dialysis owing to paranoid delusions. We argue that, due to the potential imminent harm to the patient in refusing dialysis when incapacitated due to severe mental illness, it is reasonable to pursue treatment over objection while waiting for return to capacity unless the surrogate decision maker does not believe it would be in line with the patient's values and beliefs. If there is no return to capacity after an agreed trial period and dialysis cannot be safely pursued outside of the hospital, the provider may ethically withdraw dialysis even contrary to the surrogate decision maker when continuing treatment may be limited by resources and overshadowed by harm to the patient. In this article, we will discuss how Rubin and Prager's criteria in deciding to treat over patient objection were used and their limitations in being able to quantifiably weigh each principle, as well as the ethical justifiability of withdrawal of dialysis should the patient continue to be decapacitated and unwilling to cooperate with dialysis.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 1","pages":"38-44"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208021","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

Suicide, Capacity, and End-of-Life Decisions: Ethical Considerations in Withdrawing Care. 自杀，能力和临终决定：撤回护理的伦理考虑。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739016

Tyler J Thompson, Victoria Garcia, Arlen Gaba, Katelyn Li, Sahil Munjal

{"title":"Suicide, Capacity, and End-of-Life Decisions: Ethical Considerations in Withdrawing Care.","authors":"Tyler J Thompson, Victoria Garcia, Arlen Gaba, Katelyn Li, Sahil Munjal","doi":"10.1086/739016","DOIUrl":"10.1086/739016","url":null,"abstract":"AbstractWe present a case of an incarcerated patient who attempted suicide while in police custody for less than 24 hours. He sustained a C1 vertebra fracture resulting in quadriplegia, poor prognosis, and little chance of neurologic recovery. The patient's urine drug screen was positive for multiple substances, indicating likely intoxication at the time of the attempt. While in the intensive care unit he was only able to communicate through eye movements and blinking. He consistently expressed a wish to withdraw life-sustaining care. This case highlights the ethical challenges involved in assessing decision-making capacity after a suicide attempt in an incarcerated individual, the impact of substance use on capacity, the complexities and potential biases in surrogate decision-making, and the emotional and moral burden of end-of-life care decisions on healthcare providers. We used a deliberate approach involving time for information gathering and deliberation, identification of surrogate decision makers, and engagement of multidisciplinary teams to reach a consensus that upheld ethical principles and protected clinicians from moral injury.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 1","pages":"45-51"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208023","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