Journal of Clinical Ethics最新文献_第2页

Nonmaleficence, Professionalism, and the Medical Relationship. 非恶意、专业和医疗关系。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-08-12 DOI: 10.1086/741886

Lynn A Jansen

{"title":"Nonmaleficence, Professionalism, and the Medical Relationship.","authors":"Lynn A Jansen","doi":"10.1086/741886","DOIUrl":"10.1086/741886","url":null,"abstract":"AbstractDoes the principle of nonmaleficence in medicine need updating? And if so, what should such an updating look like? This article engages with these questions by critically discussing the relation-centered view of nonmaleficence presented by Christopher Crenner and Skylar Bird. It contends that an adequate account of the principle must do two things: It must establish the integrity of the principle as one that is distinct from the more general principle of beneficence, and it must show it to have sufficient content to warrant its inclusion as a fundamental principle in clinical medical ethics. The proposal to focus on relational harms in the medical relationship is a good one, but such a proposal must be integrated into a more comprehensive account of the principle of nonmaleficence. This more comprehensive account relates relational harms to medical professionalism and derives the content of the principle of nonmaleficence from the standards of acceptable medical practice. After clarifying this more comprehensive view of medical nonmaleficence, the article concludes by responding to an important autonomy-based objection to it. This response raises large and difficult questions about the nature and point of medical practice in modern societies.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 3","pages":"215-221"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727566","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 Patient Participation in Clinical Ethics Support Deliberation: Perspectives from Parents and Clinicians in a Children's Hospital. 临床伦理支持审议中患者参与的评论：来自儿童医院家长和临床医生的观点。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-08-12 DOI: 10.1086/741881

Mariana Dittborn, Sarah Aylett, Joe Brierley

{"title":"Commentary on Patient Participation in Clinical Ethics Support Deliberation: Perspectives from Parents and Clinicians in a Children's Hospital.","authors":"Mariana Dittborn, Sarah Aylett, Joe Brierley","doi":"10.1086/741881","DOIUrl":"10.1086/741881","url":null,"abstract":"AbstractWhether and how patients should participate in clinical ethics discussions is an important contemporary debate. Murdoch recently reported clinicians' and ethics service members' views from England and the United States on patient participation in ethics consultation. In response to the call for further understanding, we report parents' and clinicians' experiences of active parental and child involvement in ethics case reviews (ECRs), including the then-novel use of videoconference ECRs during the pandemic in a UK tertiary children's hospital. Between January 2018 and May 2023, parents attended 59 of 85 hospital ECRs and provided positive anecdotal feedback. To better understand their perspectives, we interviewed three families (two couples and one single parent) and four clinicians involved in ECRs, conducted via videoconference because of pandemic restrictions, between March and December 2020. All reviews concerned proposals for innovative COVID-19 therapies. Reflexive thematic analysis identified six themes: (1) parental presence at ECRs is essential; (2) preparation is vital; (3) ECRs support complex decision-making; (4) videoconferencing worked well, although choice of format is important; (5) ECRs offer wider benefits; (6) the ECR process was generally smooth but could still be improved. Although this evaluation focused on videoconference ECRs during the pandemic, the findings remain relevant to current debates. Unlike Murdoch, we found that both parents and clinicians highly valued ECR and supported active participation by parents and, where possible, children and young people. However, we agree that clear guidance is needed to support patients' involvement in ethics processes, including preparation and support that promote inclusive, effective reviews.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 3","pages":"283-293"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723087","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

Should Jehovah's Witnesses Be Living Kidney Donors?

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-05-13 DOI: 10.1086/740425

Anna E Blech

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

How Should Researchers Study Consequences of Dobbs on Maternal Morbidity and Mortality? 研究人员应该如何研究多布斯对孕产妇发病率和死亡率的影响？

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-05-13 DOI: 10.1086/740424

Katherine A Ahrens, Marie E Thoma

引用次数: 0

Ethical Responsibility in the Off-Label Use of AI in Medical Imaging. 人工智能在医学成像中超说明书使用的伦理责任。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-05-13 DOI: 10.1086/740421

Heather M Whitney, Marshall H Chin, Maryellen L Giger

{"title":"Ethical Responsibility in the Off-Label Use of AI in Medical Imaging.","authors":"Heather M Whitney, Marshall H Chin, Maryellen L Giger","doi":"10.1086/740421","DOIUrl":"10.1086/740421","url":null,"abstract":"AbstractArtificial intelligence in medical imaging (AI-MI), categorized by the U.S. Food and Drug Administration (FDA) as \"Software as a Medical Device,\" can offer significant benefit to medical care. FDA approval-represented by a \"label\"-indicates that the device has demonstrated safety and efficacy for a specific clinical task and population for which the device is intended. Off-label use of AI-MI outside of the task and/or population can be medically and ethically problematic, yet benefits may be reduced or missed if entirely prohibited. Ethical responsibility frameworks can assist in evaluating and establishing boundaries and opportunities in off-label use of AI-MI. In this work, we review three different models for ethical responsibility and apply them to off-label use of AI-MI. We find that a future-looking collective responsibility framework, involving stakeholders such as industry developers, healthcare organizations, clinicians, and, most importantly, patients and/or their representatives, promotes proactive and practical actions to help ensure safe and ethical use of AI-MI off-label. By adopting this approach, stakeholders can balance innovation with safeguards, advancing patient-centered care while mitigating potential harms associated with off-label AI-MI use. This framework is crucial as AI-MI becomes increasingly integral to clinical decision-making processes.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 2","pages":"130-134"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934400","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

ECMO Used for the Benefit of a Patient's Family: Case Study. 体外氧合用于患者家属的利益：案例研究。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-05-13 DOI: 10.1086/740415

Meghan O Kelly, Piroska Kopar, Douglas Brown

引用次数: 0

"Slow" Trauma to Families with the Demise of Family-Centered Care and Trauma-Informed Care. 随着以家庭为中心的护理和创伤知情护理的消亡，家庭的“缓慢”创伤。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-08-12 DOI: 10.1086/741884

Autumn Fiester

{"title":"\"Slow\" Trauma to Families with the Demise of Family-Centered Care and Trauma-Informed Care.","authors":"Autumn Fiester","doi":"10.1086/741884","DOIUrl":"10.1086/741884","url":null,"abstract":"AbstractIn the article \"Slow Trauma: Reframing Concepts of Moral Injury in Trauma-Informed Ethics Consultation,\" Charles Love argues that family members are at significant risk for \"moral injury and trauma\" through the experience of the hospitalization of their loved ones. But Love adds an important insight about the type of moral injuries experienced by family members, distinguishing between what psychologists refer to as \"fast\" trauma and \"slow\" trauma. Love's detailed exposition of slow trauma is an important refinement of my article \"TIEC, Trauma Capacity, and the Moral Priority of Surrogate Decision Makers in Futility Disputes,\" in which I argue that families involved in disputed futility cases have very high potential for medical traumatic stress. Love's argument is important given both the demise of family-centered care (FCC) and the weakening of family-focused trauma-informed care (TIC). While there has been myopia around family trauma over the past five years, there is a renewed acknowledgment that the harms of healthcare encounters can extend beyond the patient. Love's article is part of an emerging body of work that once again recognizes the trauma capacity of families and is attempting to reverse the regression of FCC and TIC.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 3","pages":"231-234"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724877","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

Understanding a Clinical Ethics Consult: Survey of Parents. 理解临床伦理咨询：对家长的调查。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-08-12 DOI: 10.1086/741894

Vanessa N Madrigal, Kathryn Detwiler, Rebecca R Seltzer, Jennifer Shepard, William Sveen, Talia Bernhard Greenberg, Dörte Thorndike, Xiaobai Li, Renee D Boss, Miriam C Shapiro

{"title":"Understanding a Clinical Ethics Consult: Survey of Parents.","authors":"Vanessa N Madrigal, Kathryn Detwiler, Rebecca R Seltzer, Jennifer Shepard, William Sveen, Talia Bernhard Greenberg, Dörte Thorndike, Xiaobai Li, Renee D Boss, Miriam C Shapiro","doi":"10.1086/741894","DOIUrl":"10.1086/741894","url":null,"abstract":"AbstractObjective: To explore parents' understanding of clinical ethics consults, what might influence their openness to an ethics consult in the future, and what they define as medical ethics.Study design: Electronic survey of parents of children with complex medical conditions. Questions were adapted from a study of adult patients' and family members' experiences of ethical concerns in the healthcare setting. Respondents were also invited to participate in subsequent interviews.Results: We surveyed 218 parents and interviewed 28. Most respondents (63%) were not familiar with ethics consults and did not know how to request one (88%). For those reporting interest in a future ethics consult, knowing more about how ethics consults could help (71%) and a doctor's recommendation (58%) would most influence their interest. Hesitancy in speaking with an ethics consultant most often stemmed from worry that their child/family would not be understood (77%). Parents defined \"medical ethics\" as relating to serious medical conditions (67%), communication with the medical team (61%), and goals of care (57%). Interviews demonstrated generally consistent themes with the survey.Conclusions: Pediatric ethics consultation is not a commonly recognized or utilized resource for families facing medical complexity and ethical challenges. More needs to be understood about how best to meet patient and family needs via ethics consults.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 3","pages":"257-267"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727261","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