Journal of Clinical Ethics最新文献

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Letter to the Editor. 给编辑的信。
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734770
{"title":"Letter to the Editor.","authors":"","doi":"10.1086/734770","DOIUrl":"https://doi.org/10.1086/734770","url":null,"abstract":"","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"205"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121121","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 Moral Distress Model Revisited: Integrating Nurses' Experiences in the United States and United Kingdom. 重新审视道德困境模型:整合美国和英国护士的经验。
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734775
Georgina Morley, Rosemary B Field
{"title":"The Moral Distress Model Revisited: Integrating Nurses' Experiences in the United States and United Kingdom.","authors":"Georgina Morley, Rosemary B Field","doi":"10.1086/734775","DOIUrl":"https://doi.org/10.1086/734775","url":null,"abstract":"<p><p>AbstractScholars have challenged Jameton's original conceptualization of moral distress on the basis that it is too narrow and discounts significant moral experiences. Further inconsistencies about the necessary and sufficient conditions required for moral distress to occur have heightened conceptual ambiguities. The aims of this research were to examine nurses' experiences of moral distress and to utilize these findings to critically examine a previous model of moral distress developed from data gathered in the United Kingdom. This article presents findings from a feminist interpretive phenomenological study in which nurses in the United States were interviewed about their experiences of moral distress. Nurse participants in this study described experiencing strong negative emotions in response to five distinct morally challenging situations. These situations were categorized into the same five moral events as identified in the original study, reinforcing the five subcategories identified from interviews with nurses in the United Kingdom. The most significant change to the moral distress model was centering the interpretive and evaluative component of moral distress. Understanding moral distress as subcategories enables a more precise analysis of moral distress, while retaining the power of the term \"moral distress.\" The revised moral distress model can guide our responses to moral distress and interventions to mitigate its negative effects.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"132-151"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121144","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. TIEC,创伤能力,和道德优先的代理决策者在无效纠纷。
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733392
Autumn Fiester
{"title":"TIEC, Trauma Capacity, and the Moral Priority of Surrogate Decision Makers in Futility Disputes.","authors":"Autumn Fiester","doi":"10.1086/733392","DOIUrl":"10.1086/733392","url":null,"abstract":"<p><p>AbstractIn the past 15 years, trauma-informed care (TIC) has evolved as a new paradigm in healthcare that recognizes the impact of past traumas on patients' and families' healthcare experience while seeking to avoid inducing new trauma during clinical care. A recent paper by Lanphier and Anani extends TIC principles to healthcare ethics consultation (HEC) in what they label \"trauma-informed ethics consultation\" (TIEC), which calls for the \"addition of trauma informed awareness, training, and skill in clinical ethics consultation.\" While Lanphier and Anani claim that TIEC is \"novel, but not radical\" because it builds on the approach to HEC endorsed by the American Society for Bioethics and Humanities, I believe that TIEC has radical implications, particularly regarding ethical obligations to surrogate decision makers (SDMs). Given what I call the SDM's \"trauma capacity,\" I argue that TIEC accords moral priority to SDMs over patients in certain types of end-of-life cases, particularly futility disputes, which is a radical departure from the conventional HEC approach to SDMs.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 1","pages":"40-51"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392152","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. 儿童作为器官捐献者:一个伦理分析模型。
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":"10.1086/733188","url":null,"abstract":"<p><p>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.</p>","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
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":"10.1086/733384","url":null,"abstract":"<p><p>AbstractAutumn Fiester suggests that trauma-informed ethics consultation (TIEC) should focus on surrogate decision makers (SDMs) in preference over patients when (<i>a</i>) the patient is comatose or neurologically devastated, and hence beyond the capacity for suffering or further trauma; (<i>b</i>) the patient is thus incapable of asserting preferences; and (<i>c</i>) the patient's wishes are not known, for example, in the absence of an advance directive. Therefore, (<i>d</i>) 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.</p>","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
Representing the Unrepresented: Providing Medical Care for the Unrepresented Patient. 代表无人代表的人:为无人代表的病人提供医疗服务。
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733394
Vishruth M Nagam, Charles F Sineri, Robert T Pyo
{"title":"Representing the Unrepresented: Providing Medical Care for the Unrepresented Patient.","authors":"Vishruth M Nagam, Charles F Sineri, Robert T Pyo","doi":"10.1086/733394","DOIUrl":"10.1086/733394","url":null,"abstract":"<p><p>AbstractComplex ethical considerations arise when providing medical care for unrepresented patients. Additionally, case reports on navigating ethical challenges when caring for unrepresented patients are sparse. Here we report a clinical case of a patient who has intellectual disability, is unrepresented, and has aortic valve stenosis. We demonstrate a detailed application of capacity assessments, as well as the standards of proxy consent. We also pose a successful implementation of two-physician consent as an effective procedure to help navigate medical care for unrepresented patients. Finally, we discuss the need to streamline the provision of medical care for unrepresented patients. Through this case report, we aim to contribute to the ongoing discussion of how to best provide medical care for unrepresented patients.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 1","pages":"92-96"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392148","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
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. 评论菲斯特的《TIEC、创伤能力和无效争议中替代决策者的道德优先权》,其他人对这一主题的回应,以及她对他们的回应。
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":"10.1086/733186","url":null,"abstract":"<p><p>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.</p>","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
Children as Living Solid Organ Donors: Ethical Discussion and Model Hospital Policy Statement. 儿童作为活体实体器官捐献者:伦理讨论和模范医院政策声明。
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733386
Gyan C Moorthy, Aidan P Crowley, Sandra Amaral
{"title":"Children as Living Solid Organ Donors: Ethical Discussion and Model Hospital Policy Statement.","authors":"Gyan C Moorthy, Aidan P Crowley, Sandra Amaral","doi":"10.1086/733386","DOIUrl":"10.1086/733386","url":null,"abstract":"<p><p>AbstractIn recent years, more attention has been paid to living donation as a means to reduce the suffering of individuals with end-stage kidney or liver disease. Implicated ethical issues include medical risk and risk of coercion, counterbalanced by improved medical outcomes and the benefits of saving a life. Living donation becomes particularly ethically complicated with the prospect of child donation, given the child's developing autonomy and uniquely dependent status. We outline four broad ethical considerations pertinent to living child organ donation: (1) beneficence, (2) respect for the family as a moral unit, (3) respect for the child as a person, and (4) justice. We conclude that it can be ethical for a healthy child to donate a kidney or liver lobe to a close relative who has exhausted other options provided that certain protections are put into place. Ideally, these donations will be rare. Lastly, we construct a model transplant center donation policy.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 1","pages":"23-38"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392060","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 Lanphier and Anani, "Defining and Refining Trauma-Informed Ethics Consultation". 对Lanphier和Anani,“定义和改进创伤知情伦理咨询”的回应。
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733389
Autumn Fiester
{"title":"Response to Lanphier and Anani, \"Defining and Refining Trauma-Informed Ethics Consultation\".","authors":"Autumn Fiester","doi":"10.1086/733389","DOIUrl":"10.1086/733389","url":null,"abstract":"<p><p>AbstractIn their article \"Defining and Refining Trauma-Informed Ethics Consultation,\" Lanphier and Anani respond to my argument about surrogate trauma and prioritization. I show that there is a great deal of overlap between my view and the views of Lanphier and Anani, the architects of TIEC, with potentially some differences. Lanphier and Anani's commentary is structured by three discussion points: (1) the degree to which their articulation of TIEC challenges the HEC status quo, (2) their distinction between HEC \"process\" and \"method,\" and (3) the legitimacy of \"ethically acceptable options.\"</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 1","pages":"58-62"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392150","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
"You Only Know What You Know": Evaluating the Need for a Psychosocial Transplant Database. “你只知道你所知道的”:评估社会心理移植数据库的需求。
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734769
Jordan L Schwartzberg, Storm Portner, Shruti Mutalik, Jacob M Appel
{"title":"\"You Only Know What You Know\": Evaluating the Need for a Psychosocial Transplant Database.","authors":"Jordan L Schwartzberg, Storm Portner, Shruti Mutalik, Jacob M Appel","doi":"10.1086/734769","DOIUrl":"https://doi.org/10.1086/734769","url":null,"abstract":"<p><p>AbstractTransplant psychiatry is a rapidly growing field all across the nation. There are no clear biopsychosocial criteria for transplantation, but similarities among the different leading rating scales do exist. At least at this time, there is no unified electronic medical record (EMR) across all transplant centers, making it possible for information gained at one center to be lost when a patient is transferred or presented to a new center and does not disclose their prior evaluation history. A national database covering a patient's personal history of prior biopsychosocial evaluations would be a helpful unifying tool, helping to ensure that appropriate knowledge is obtained from each candidate. There are some important factors that should be considered before a tool like this can be implemented. These include establishment of the database itself, the presentation of the data, and its impact on equity and justice. We do believe that a database, in the long run, may help bring about fairness in the organ allocation system.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"196-200"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121033","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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