Journal of Clinical Ethics最新文献_第2页

Looking to Our Own and Others' Emotions to Identify Ethical Challenges That We May Resolve Better. 关注我们自己和他人的情绪，以识别我们可能更好地解决的道德挑战。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739012

Edmund G Howe

{"title":"Looking to Our Own and Others' Emotions to Identify Ethical Challenges That We May Resolve Better.","authors":"Edmund G Howe","doi":"10.1086/739012","DOIUrl":"https://doi.org/10.1086/739012","url":null,"abstract":"AbstractIn this piece, I address two topics, both built on articles in this issue. The first involves a new, possibly more effective approach that ethics consultants may use when they want to tell the providers consulting them that they think they should treat a patient differently. These authors call this approach \"curious engagement.\" The second topic I discuss involves what moved the above authors to want to imagine and then propose this new approach, since what moved them may similarly move others to also want to innovate. I suggest that the best way to identify ethical practices needing improvement is to look to painful emotions experienced by oneself or others. I give two clinical examples further illustrating how providers may do this. The first involves the provider evaluating a patient for the interests of a third party, not for this patient's interests. The patient here feels frightened and alone. The second is taken from another article in this issue and involves a patient just waiting to die and experiencing existential angst. Both cases show how our looking to painful emotions may suggest areas in which new and better ethical practices are needed, as well as whether, once proposed, providers will adopt them or not.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208025","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

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

Nancy Neveloff Dubler and Communitarian Ethics at NYC Health + Hospitals. Nancy Neveloff Dubler和纽约健康医院的社区伦理。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/737389

Albina Shkolnik, Leora Botnick, Arthur Cooper, Howard Finger, Steven Hahn, Ivan Hand, Warren Seigel, Rita Sherman, Richard A Siegel, Natasha Suleman, Randi Wasserman

{"title":"Nancy Neveloff Dubler and Communitarian Ethics at NYC Health + Hospitals.","authors":"Albina Shkolnik, Leora Botnick, Arthur Cooper, Howard Finger, Steven Hahn, Ivan Hand, Warren Seigel, Rita Sherman, Richard A Siegel, Natasha Suleman, Randi Wasserman","doi":"10.1086/737389","DOIUrl":"https://doi.org/10.1086/737389","url":null,"abstract":"AbstractNew York City Health + Hospitals (NYC H+H), our nation's largest municipal healthcare system, with 10 acute care hospitals and five long-term care facilities, asserts in its mission statement that healthcare workers should join with communities to promote and protect the total physical, mental, and social well-being of the people. Such is reflective of the communitarian viewpoint, focusing on the importance of the community and advocating for their common good, which is in keeping with the concept of communitarian ethics espoused by Nancy Dubler when she assumed the role of ethics advisor to NYC H+H in 2009. From the onset she implemented key changes, beginning with the creation of a system-wide Bioethics Council, in which all 10 ethics committee chairpersons met regularly with her. During these meetings, groundwork was laid for (1) creation of standardized clinical ethics chart notes, with inclusion of key ethical principles; (2) establishment of a Clinical Ethics Consultation Program for continuous evaluation of performance and education of clinical ethics consultants; (3) development of mechanisms to qualify consultants, including a year-long bioethics certificate course, supervised training, and participation in an annual ethics symposium; (4) formation of clinical ethics algorithms; and (5) publication of journal articles to highlight the work of the Bioethics Council to the broader bioethics community. This article will focus on how Nancy transformed the nation's largest municipal healthcare system from an enterprise lacking an integrated approach to clinical ethics to one with a robust clinical ethics infrastructure and vibrant ethics community.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 4","pages":"315-322"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543164","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

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

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

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