Journal of Clinical Ethics最新文献_第2页

Children as Living Solid Organ Donors: Ethical Discussion and Model Hospital Policy Statement.

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733386

Gyan C Moorthy, Aidan P Crowley, Sandra Amaral

引用次数: 0

Response to Lanphier and Anani, "Defining and Refining Trauma-Informed Ethics Consultation".

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733389

Autumn Fiester

引用次数: 0

Patients' Participation in Clinical Ethics: A Vicarious Voice.

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733395

Kristina Orfali

{"title":"Patients' Participation in Clinical Ethics: A Vicarious Voice.","authors":"Kristina Orfali","doi":"10.1086/733395","DOIUrl":"https://doi.org/10.1086/733395","url":null,"abstract":"AbstractDespite the prevailing norm of patient autonomy, a patient's direct participation in clinical ethics remains quite infrequent given that most often the patient is incapacitated. Often, clinical ethics consultants deal with someone representing the patient-either family members or a legal surrogate (DPA) who has decision-making authority. This stands in sharp contrast to most European countries, where an incapacitated patient typically falls under medical jurisdiction. Despite recent legal trends in Europe recognizing the role of advance directives and the possibility of a surrogate representing the patient (such as a \"trusted person\"), these persons are only \"consulted\" by the healthcare team; most often, they have no decision-making authority. This article explores these contrasting cultural differences regarding who (a legally recognized surrogate in the United States vs. mostly the physician in Europe) has the legitimacy to speak on behalf of the incapacitated patient who can no longer voice his/her preferences. Surrogates (often families) are in the United States given a voice for their incapacitated loved one because they are often those bearing the burden of any decisions; in many European countries, however, society (the state) at large will bear much of such cost. By looking into the broader contrasting framework of autonomy-focused bioethics, such as in the United States, versus public health ethics, which entails commitment to the common good before the individual, much of the differences of patients' role in clinical ethics and even the format of clinical ethics support services here and abroad can be better understood.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 1","pages":"16-22"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392146","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

Defining and Refining Trauma-Informed Ethics Consultation.

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733391

Elizabeth Lanphier, Uchenna E Anani

{"title":"Defining and Refining Trauma-Informed Ethics Consultation.","authors":"Elizabeth Lanphier, Uchenna E Anani","doi":"10.1086/733391","DOIUrl":"https://doi.org/10.1086/733391","url":null,"abstract":"AbstractThis article responds to Autumn Fiester's \"TIEC, Trauma Capacity, and the Moral Priority of Surrogate Decision Makers in Futility Disputes,\" in which Fiester argues for a vision of trauma-informed ethics consultation that systematically prioritizes the preferences of surrogate decision makers in cases of disagreement between surrogates and clinical teams over continued life-sustaining therapies for severely neurologically impaired patients. We identify three issues arising from Fiester's article that allow us to clarify our account of trauma-informed ethics consultation on which she builds and that illustrate the need for further research on trauma-informed ethics consultation in both theory and practice. The first issue responds to her charge that ours was an overly \"modest\" proposal. The second issue is to suggest closer attention to distinctions between ethics consultation process, methods, and content that we argue would enhance Fiester's account. The third is to better evaluate the appropriate role of \"ethically acceptable options\" in trauma-informed ethics consultation. In conclusion, we raise several global points regarding the further development of trauma-informed ethics consultation and conceptualizations of trauma-informed care relevant to it.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 1","pages":"52-57"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392143","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 Morreim, "A Deeper Look at Ethics Consultation".

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733388

Autumn Fiester

引用次数: 0

Beyond the Hospital Walls: The Role of the Ethicist in Community Healthcare Settings. 超越医院围墙：伦理学家在社区医疗机构中的作用。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/730876

Bryanna Moore

{"title":"Beyond the Hospital Walls: The Role of the Ethicist in Community Healthcare Settings.","authors":"Bryanna Moore","doi":"10.1086/730876","DOIUrl":"https://doi.org/10.1086/730876","url":null,"abstract":"AbstractCommunity-based \"free\" clinics can be a key site of primary and preventive care, especially for underserved members of the community. Ethical issues arise in community clinics. Despite this-and the fact that ethics consultation is a well-established practice within hospitals-ethics support is rarely integrated within community clinics, and the clinical ethicist's role in community care settings remains unexplored. In this article I explore what community-engaged practice might look like for the clinical ethicist. I share my experience of being invited into a local community clinic where a team of volunteers, in partnership with a local church, provide care to persons experiencing housing and food security in our county. First, I outline some of the key ethical issues we encounter in our clinic, including how to promote the agency of community members, develop shared standards for clinic volunteers, and balance different values and priorities within the partnership. Second, I explore how the ethicist's knowledge and skills translate into this setting. I argue that, given the range of ethical issues that arise in community clinics and the need for ongoing dialogue, education, and critical reflection within such partnerships, there is a role for the clinical ethicist in this space. I discuss how clinical ethicists might begin to develop community-based partnerships and practices.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 3","pages":"208-216"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983565","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

Patient Consent for Medical Student Pelvic Exams under Anesthesia: An Exploratory Retrospective Chart Review. 医学生在麻醉状态下进行骨盆检查时的患者同意书：探索性回顾病历。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/729416

Jessica A Jushchyshyn, Lakeisha Mulugeta-Gordon, Cara Curley, Florencia Greer Polite, Jon F Merz

{"title":"Patient Consent for Medical Student Pelvic Exams under Anesthesia: An Exploratory Retrospective Chart Review.","authors":"Jessica A Jushchyshyn, Lakeisha Mulugeta-Gordon, Cara Curley, Florencia Greer Polite, Jon F Merz","doi":"10.1086/729416","DOIUrl":"https://doi.org/10.1086/729416","url":null,"abstract":"AbstractObjective: We performed this study to examine patients' choices to permit or refuse medical student pelvic examinations under anesthesia (EUAs) during planned gynecologic procedures.Design: We conducted an exploratory retrospective chart review of electronic consent forms at a single academic medical center using contingency tables, logistic regression, and nonparametric tests to explore relationships between patient and physician characteristics and consent.Results: We identified and downloaded electronic consent forms for a census of 4,000 patients undergoing gynecologic surgery from September 2020 through calendar year 2022. Forms were linked to anonymized medical record information. Of the 4,000 patients, 142 (3.6%) were removed from analysis because consent forms were incomplete. Of 3,858 patients, 308 (8.0%) were asked for EUA consent more than once, 46 of whom were not consistent. Overall, 3,308 (85.7%) patients consented every time asked, and 550 (14.2%) refused or limited EUA consent at least once. Nine patients limited their consent to female students, and two patients refused medical student participation at all. We performed exploratory multiple logistic regression analyses exploring differences in rates of consent across patient and physician demographic groups.Conclusions: We find that some patients are more likely than others to refuse a pelvic EUA, magnifying the dignitary harm from a nonconsensual invasion of intimate bodily integrity and perpetuating historic wrongs visited upon vulnerable people of color and religious minorities. Patients' rights to respect and control over their bodies require that physicians take seriously the ethical obligation to inform their patients and ask them for permission.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 2","pages":"93-100"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904883","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 Unbefriended Patient, Their Professional Guardians, and Clinical Liaison Psychiatry: The Challenging Ethics of Changing Goals of Care. 未结为好友的病人、其专业监护人和临床联络精神病学：改变护理目标的伦理挑战》。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/732210

Arlen Gaba, Benjamin D Smart, Sahil Munjal

{"title":"The Unbefriended Patient, Their Professional Guardians, and Clinical Liaison Psychiatry: The Challenging Ethics of Changing Goals of Care.","authors":"Arlen Gaba, Benjamin D Smart, Sahil Munjal","doi":"10.1086/732210","DOIUrl":"10.1086/732210","url":null,"abstract":"AbstractUnbefriended patients are those with decisional impairments who lack family or friends to serve as healthcare surrogates. When such patients cannot make decisions, the court typically appoints a professional guardian to make choices aligned with the patient's values and preferences. However, this case report illustrates ethical challenges that can arise when professional guardians disregard the patient's authentic wishes. In this case study, the 38-year-old unbefriended African American male patient expressed fears about traumatic resuscitation efforts and ultimately desired de-escalation of care, which the guardian was hesitant to honor despite confirmed decision-making capacity. The guardian quickly reversed a new do-not-resuscitate order when the patient later changed his mind. Decisions about aggressive interventions like a colostomy were significantly delayed while awaiting final judgments involving the guardian's supervisors and the judicial system. The case highlights pitfalls with guardians defaulting to treatment escalation without sufficiently engaging with ethical standards or eliciting the patient's narrative identity, leading to inconsistent surrogate decisions. We propose that more robust reforms are needed, including enhanced training of guardians in ethical decision-making, and we present other means to facilitate best practices in proxy decision-making.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 4","pages":"249-259"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630263","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

U.S. Healthcare Provider Views and Practices Regarding Planned Birth Setting. 美国医疗服务提供者对计划内分娩的看法和做法。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/728142

Natalie R Shovlin-Bankole, Jessica L Bienstock, Ha Vi Nguyen, Marielle S Gross

{"title":"U.S. Healthcare Provider Views and Practices Regarding Planned Birth Setting.","authors":"Natalie R Shovlin-Bankole, Jessica L Bienstock, Ha Vi Nguyen, Marielle S Gross","doi":"10.1086/728142","DOIUrl":"10.1086/728142","url":null,"abstract":"AbstractBackground: Little is known about U.S. healthcare provider views and practices regarding evidence, counseling, and shared decision-making about in-hospital versus out-of-hospital birth settings.Methods: We conducted 19 in-depth, semistructured, qualitative interviews of eight obstetricians, eight midwives, and three pediatricians from across the United States. Interviews explored healthcare providers' interpretation of the current evidence and their personal and professional experiences with childbirth within the existing medical, ethical, and legal context in the United States.Results: Themes emerged concerning risks and benefits, decision-making, and patient-provider power dynamics. Collectively, the narratives illuminated fundamental ideological tensions between in- and out-of-hospital providers arising from divergent assignment of value to described risks and benefits. The majority of physicians focused on U.S.-specific data demonstrating increased neonatal morbidity and mortality associated with delayed access to hospital-based interventions, thereby justifying hospital birth as the standard of care. By contrast, midwives emphasized data demonstrating fewer interventions and superior maternal and neonatal outcomes in high-income European countries, where out-of-hospital birth is more common for low-risk birthing people. A key gap in counseling was revealed, as no interviewees offered anticipatory counseling regarding birth setting options. Providers directly and indirectly illustrated the propensity for asymmetric power relations between birth providers and pregnant people, especially in hospital settings.Conclusions: The narratives highlight the common goal of optimizing maternal and neonatal outcomes despite tensions arising from divergent prioritization of specific maternal and neonatal risks. Our findings suggest opportunities to foster collaboration and optimize outcomes via mutual respect and improved integration of care.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 1","pages":"23-36"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906578","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

When Can Physicians Fire Patients with Opioid Use Disorder for Nonmedical Use of Prescription Medications? 医生何时可以解雇非医疗使用处方药的阿片类药物使用障碍患者？

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/728146

Levi Durham

引用次数: 0