Journal of Clinical Ethics最新文献

Introduction: Trauma and Surrogate Decision Makers: An Argument for Moral Priority in Futility Disputes. 引言：创伤和替代决策者：在无效争议中的道德优先论证。

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

Autumn Fiester

引用次数: 0

How Providers Can Acquire Structural and Intersectional Competencies. 供应商如何获得结构和交叉能力。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734480

Edmund G Howe

{"title":"How Providers Can Acquire Structural and Intersectional Competencies.","authors":"Edmund G Howe","doi":"10.1086/734480","DOIUrl":"https://doi.org/10.1086/734480","url":null,"abstract":"AbstractThis piece describes two patients whose external circumstances caused harm to them. One had poor health insurance and lacked financial resources. The other lacked access to optimal healthcare because he was not a U.S. citizen. These external factors are commonly now referred to as \"structural\" and \"intersectional\" when they are single and multiple, respectively. This piece initially discusses how providers may better come to identify these external sources of harm to patients and then, hopefully, seek to alleviate them. It then discusses how providers, too, may cause external harm. They may make erroneous presuppositions about their patients based on their having certain impairments or symptoms, not know this, and as a result cause these patients iatrogenic harm. Means to avoid this, drawn largely from The Anti-Ableist Manifesto, a recently published, authoritative text on this subject written by Tiffany Yu, are outlined. Finally, the life of a young man, Mats Steen, is presented. His life most profoundly poses the questions of how we make inferences regarding people based only on how they look and what (little) we may know about them and how this may then affect how we can relate with them. Steen's life story is viewable on Netflix.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"105-111"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121114","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

Letter to the Editor. 给编辑的信。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734774

引用次数: 0

Patient Perspectives on the Authority of Advance Directives in Times of Conflict: A Mixed Methods Study. 患者对冲突时期预先指示权威的看法：一项混合方法研究。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734771

Jordan Potter, David S Reis, Jason Lesandrini, Eric Nelson

{"title":"Patient Perspectives on the Authority of Advance Directives in Times of Conflict: A Mixed Methods Study.","authors":"Jordan Potter, David S Reis, Jason Lesandrini, Eric Nelson","doi":"10.1086/734771","DOIUrl":"https://doi.org/10.1086/734771","url":null,"abstract":"AbstractContext: As advance directives (ADs) become more frequently utilized, opportunities increase for conflict between a patient's designated healthcare power of attorney (POA) and the treatment preferences outlined in their living will (LW). Little is known about patient preferences regarding how to resolve these conflicts.Objectives: To assess patient preferences regarding whether their POA or LW should have authority in times of conflict.Methods: In this mixed methods study, we completed a retrospective chart review to analyze patient selections in their AD, including selections in a novel section of the AD called the \"Binding Guidance\" section that gives patients the ability to designate whether their POA or LW should have authority when there is conflict between the two. Additionally, willing patient participants were asked two interview questions about their selections to further elucidate their perspectives.Results: Out of 143 patients, 48.3 percent (n = 69) chose to have their LW followed over their POA and 51.7 percent (n = 74) chose to have their POA followed over their LW. Several statistically significant associations were identified regarding binding guidance selections. Seventy-four (51.75%) of these patients also answered the additional interview questions, with the participants evenly distributed (n = 37 each) in their binding guidance selections.Conclusion: Patients have varying preferences regarding whether their POA or LW should have authority in times of conflict. ADs should reflect this variation in preferences and allow patients the ability to designate whether they prefer their POA or LW to have ultimate authority when in conflict.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"121-131"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121138","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 Safety and Comfort of Home: Can Medical Deportation Alleviate Suffering? 家的安全和舒适：医疗驱逐能减轻痛苦吗？

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734772

Medha Palnati

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":"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

Response to Ford, Morley, and Sankary, "Attending to Trauma, Balancing Power, and Prioritizing Stakeholders in Ethics Consultation". 回应Ford， Morley, and Sankary，“关注创伤，平衡权力，优先考虑道德咨询中的利益相关者”。

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

Autumn Fiester

引用次数: 0

Psychiatry's Small-World Problem: Ethical Challenges in Treating Multiple Patients from the Same Family or Household. 精神病学的小世界问题：治疗来自同一家庭或家庭的多名患者的伦理挑战。

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

Jacob M Appel

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Hindering or Helping: Discussing Patient Participation in Clinical Ethics Support Service Deliberation. 阻碍还是帮助：探讨临床伦理支持服务审议中的患者参与。

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":"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

Dual-Physician Decision-Making for Unrepresented Patients: Legal and Ethical Obligations for the Second Nontreating Physician. 无代表病人的双重医生决策：第二非治疗医生的法律和道德义务。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734767

Ryan Ward, Holland Kaplan

{"title":"Dual-Physician Decision-Making for Unrepresented Patients: Legal and Ethical Obligations for the Second Nontreating Physician.","authors":"Ryan Ward, Holland Kaplan","doi":"10.1086/734767","DOIUrl":"https://doi.org/10.1086/734767","url":null,"abstract":"AbstractPatients without capacity or a surrogate decision maker are known as unrepresented. These patients are highly vulnerable and frequently encountered in healthcare settings, though there is little consensus regarding how medical decisions should be made on these patients' behalf. Several states now require a second nontreating physician (SNTP) to evaluate nonemergent medical decisions for unrepresented patients. This article examines the legal and ethical challenges faced by SNTPs in the dual-physician authorization process, including biases in SNTP selection, time constraints, power dynamics, and accountability concerns. We propose a checklist to guide SNTPs in the care of unrepresented patients while minimizing biases and conducting rigorous risk-benefit assessments. Institutional strategies to address the challenges faced by SNTPs include systematic SNTP selection processes, protected time for evaluations, peer review panels, training to mitigate implicit bias, and iterative review for quality improvement. By providing an ethical framework for dual-physician authorization and actionable processes for minimizing bias, we seek to promote fair and thoughtful decision-making on behalf of unrepresented patients.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"152-157"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121070","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