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Journal of Clinical Ethics最新文献

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Micro and Macro Ethical Considerations of COVID-19. COVID-19的微观和宏观伦理思考。
Journal of Clinical Ethics Pub Date : 2020-01-01
Amitai Etzioni
{"title":"Micro and Macro Ethical Considerations of COVID-19.","authors":"Amitai Etzioni","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Micro decisions, made by individuals, during a health crisis in which healthcare resources are particularly in short supply, should not be based only on the age of the patients. Ameliorate  care is only appreciated  when the patient has a limited time to live, whatever their age. Macro decisions concern public policy. We must decide now who will pay for the vaccines, who will get them before others, whether minorities should be granted priority, and whether the United States should join a global distribution system.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"318-325"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38533244","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
Beyond Shared Decision Making. 超越共同决策。
Journal of Clinical Ethics Pub Date : 2020-01-01
Edmund G Hower
{"title":"Beyond Shared Decision Making.","authors":"Edmund G Hower","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Shared decision making (SDM) is the state of the art for clinicians' communication with patients and surrogate decision makers. SDM involves give and take, in which all parties interact to maximize the autonomy of patients. In this article I summarize the core steps of SDM and explore ways to use it to benefit patients to the greatest extent. I review three articles included in this issue of The Journal of Clinical Ethics that highlight additional approaches we can use to help patients and parents to see what may be in their own or their child's best interest. I describe how these approaches can be used in most other medical fields. I explore ways to share information with patients that are outside the usual scope of SDM. Finally, I discuss how we might look, together with patients, at what all parties are feeling before we begin the process of SDM.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"293-302"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38320506","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
Developing a Triage Protocol for the COVID-19 Pandemic: Allocating Scarce Medical Resources in a Public Health Emergency. 制定COVID-19大流行的分类方案:在突发公共卫生事件中分配稀缺的医疗资源。
Journal of Clinical Ethics Pub Date : 2020-01-01
Benjamin Tolchin, Stephen R Latham, Lori Bruce, Lauren E Ferrante, Katherine Kraschel, Karen Jubanyik, Sarah C Hull, Jennifer L Herbst, Jennifer Kapo, Ernest D Moritz, John Hughes, Mark D Siegel, Mark R Mercurio
{"title":"Developing a Triage Protocol for the COVID-19 Pandemic: Allocating Scarce Medical Resources in a Public Health Emergency.","authors":"Benjamin Tolchin,&nbsp;Stephen R Latham,&nbsp;Lori Bruce,&nbsp;Lauren E Ferrante,&nbsp;Katherine Kraschel,&nbsp;Karen Jubanyik,&nbsp;Sarah C Hull,&nbsp;Jennifer L Herbst,&nbsp;Jennifer Kapo,&nbsp;Ernest D Moritz,&nbsp;John Hughes,&nbsp;Mark D Siegel,&nbsp;Mark R Mercurio","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the triage protocol, summarize the protocol itself, and discuss the major ethical challenges encountered, along with our answers to these challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments. We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges that they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the COVID-19 pandemic and similar public health emergencies.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"303-317"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38533243","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 Making of a Clinical Ethicist: A Personal Tribute to Al Jonsen. 临床伦理学家的形成:对阿尔·琼森的个人致敬。
Journal of Clinical Ethics Pub Date : 2020-01-01
Ruchika Mishra
{"title":"The Making of a Clinical Ethicist: A Personal Tribute to Al Jonsen.","authors":"Ruchika Mishra","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In this account, the author shares her long-standing personal and professional relationship with her mentor, Albert R. Jonsen, PhD, a prominent figure in the history of bioethics.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"381-382"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38662954","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
Helping Children Hurt Themselves: Why Pediatricians Ought to Support Adolescent Football Players in Their Athletic Goals. 帮助孩子伤害自己:为什么儿科医生应该支持青少年足球运动员的运动目标。
Journal of Clinical Ethics Pub Date : 2020-01-01
Ruth Tallman
{"title":"Helping Children Hurt Themselves: Why Pediatricians Ought to Support Adolescent Football Players in Their Athletic Goals.","authors":"Ruth Tallman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Participation in sports such as football puts youth-athletes at high risk of injury. Helmets cannot protect players from the possibility of traumatic brain injury, and repeated concussive injuries can lead to chronic traumatic encephalopathy later in life. In light of such facts, the morally appropriate role of physicians who treat patient-athletes comes into question. I argue that pediatricians ought to be committed to a high level of shared decision making, whereby their goal, rather than being to provide the medically best advice (which, let's be honest, would be to not play football at all), would be to provide the medically best advice in light of patients' honestly professed plans and goals. If patient-athletes see their doctor as an ally, who wants them on the field as much as they want to be there, they will be more likely to trust their pediatrician to help in the realization of those goals, even if they report an injury. While this approach could feel like a medical betrayal, in that the physician could feel complicit in helping a patient to continue engaging in high-risk behavior, I argue that medical outcomes will be better than if patient-athletes see physicians as an obstruction to their athletic goals.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"326-330"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38320508","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
Do Clinical Ethics Fellowships Prepare Trainees for their First Jobs? A National Survey of Former Clinical Ethics Fellows. 临床伦理学奖学金为学员的第一份工作做好准备了吗?前临床伦理学研究员全国调查。
Journal of Clinical Ethics Pub Date : 2020-01-01
Robert M Guerin, Douglas S Diekema, Sahabat Hizlan, Kathryn L Weise
{"title":"Do Clinical Ethics Fellowships Prepare Trainees for their First Jobs? A National Survey of Former Clinical Ethics Fellows.","authors":"Robert M Guerin,&nbsp;Douglas S Diekema,&nbsp;Sahabat Hizlan,&nbsp;Kathryn L Weise","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Clinical ethics consultants provide a range of services in hospital settings and in teaching environments. Training to achieve the skills needed to meet the expectations of employers comes in various forms, ranging from on-the-job training to formal fellowship training programs. We surveyed graduates of clinical ethics fellowships to evaluate their self-reported preparedness for their first job after fellowship training. The results indicated several areas of need, including greater exposure to program-building skills, quality improvement skills, and approaches to working with members of higher administration. These data will be of use to educators as well as to fellows who advocate for elements of training in preparation for their first position.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"372-380"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38662953","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
Remembering Al Jonsen. 记住阿尔·琼森。
Journal of Clinical Ethics Pub Date : 2020-01-01
Edmund G Howe
{"title":"Remembering Al Jonsen.","authors":"Edmund G Howe","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The author, editor-in-chief of The Journal of Clinical Ethics, recalls the contributions of Albert R. Jonsen, PhD, one of the founding members of the editorial board of the journal.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"383"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38662955","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
Responding to Moral Distress and Ethical Concerns at the Intersection of Medical Illness and Unmet Mental Health Needs. 在医疗疾病和未满足的心理健康需求的交叉点回应道德困扰和伦理问题。
Journal of Clinical Ethics Pub Date : 2017-01-01
Donna D McKlindon, Pamela Nathanson, Chris Feudtner
{"title":"Responding to Moral Distress and Ethical Concerns at the Intersection of Medical Illness and Unmet Mental Health Needs.","authors":"Donna D McKlindon,&nbsp;Pamela Nathanson,&nbsp;Chris Feudtner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Some of the most difficult clinical ethics consultations involve patients who have both medical and mental health needs, as these cases can result in considerable moral distress on the part of the bedside staff. In this article we examine the issues that such consults raise through the illustrative example of a particular case: several years ago our ethics consultation service received a request from a critical care attending physician who was considering a rarely performed psychosurgical intervention to address intractable and life-threatening agitation and aggression in an adolescent patient for whom standard treatments had proven unsuccessful. We consider strategies that may be useful in addressing not only the ethical dilemmas or the clinical problems, but also the emotional, social, and moral distress that arise in delivering care in such complex cases, in which standard routine practices of care have been exhausted. In addition, we explore the processes that led to this situation and suggest ways to promote early recognition and intervention for similar cases in the future.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"222-227"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35530553","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
Re-Evaluating the Ethics of Uterine Transplantation. 子宫移植伦理学的再评价。
Journal of Clinical Ethics Pub Date : 2017-01-01
Danish Zaidi
{"title":"Re-Evaluating the Ethics of Uterine Transplantation.","authors":"Danish Zaidi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In February 2016, the Cleveland Clinic initiated the first attempt at cadaveric uterine transplantation (UTx) in the United States. The transplantation was ultimately unsuccessful, but it opened doors for further research on both live and cadaveric UTx. While initial strides toward successful transplantation have been made, questions persist on the ethics of UTx: whether the uterus is a vital organ, whether we should prioritize live or cadaveric options, and how the procedure should be covered by health insurance. If we agree that the goal of the medical profession is both to treat and improve quality of life, then the question of whether or not infertility is considered a disease becomes inconsequential in the discussion. As such, the medical enterprise should move forward with research in UTx. In doing so, considering the ethical implications of UTx remains essential-and we must remember to pair innovation with regulation.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"212-216"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35371615","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
Universal Health Care: The Cost of Being Human. 全民医疗保健:做人的代价。
Journal of Clinical Ethics Pub Date : 2017-01-01
Roger Strair
{"title":"Universal Health Care: The Cost of Being Human.","authors":"Roger Strair","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In this article I argue that the biological processes that make us human have error rates that distribute illness on a no-fault basis. I propose this as an ethical foundation for universal healthcare.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"247-249"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35530556","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
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