Journal of Clinical Ethics最新文献_第2页

Structured Autonomy: Increasing Self-Governance in Modern Medicine. 结构化自治：在现代医学中增加自治。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/736144

Derek Ross Soled

引用次数: 0

Dual-Physician Decision-Making for Unrepresented Patients: Legal and Ethical Obligations for the Second Nontreating Physician. 无代表病人的双重医生决策：第二非治疗医生的法律和道德义务。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734767

Ryan Ward, Holland Kaplan

{"title":"Dual-Physician Decision-Making for Unrepresented Patients: Legal and Ethical Obligations for the Second Nontreating Physician.","authors":"Ryan Ward, Holland Kaplan","doi":"10.1086/734767","DOIUrl":"https://doi.org/10.1086/734767","url":null,"abstract":"AbstractPatients without capacity or a surrogate decision maker are known as unrepresented. These patients are highly vulnerable and frequently encountered in healthcare settings, though there is little consensus regarding how medical decisions should be made on these patients' behalf. Several states now require a second nontreating physician (SNTP) to evaluate nonemergent medical decisions for unrepresented patients. This article examines the legal and ethical challenges faced by SNTPs in the dual-physician authorization process, including biases in SNTP selection, time constraints, power dynamics, and accountability concerns. We propose a checklist to guide SNTPs in the care of unrepresented patients while minimizing biases and conducting rigorous risk-benefit assessments. Institutional strategies to address the challenges faced by SNTPs include systematic SNTP selection processes, protected time for evaluations, peer review panels, training to mitigate implicit bias, and iterative review for quality improvement. By providing an ethical framework for dual-physician authorization and actionable processes for minimizing bias, we seek to promote fair and thoughtful decision-making on behalf of unrepresented patients.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"152-157"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121070","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: 10.1086/734770

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":"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.","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

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":"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.","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":"AbstractAutumn Fiester suggests that trauma-informed ethics consultation (TIEC) should focus on surrogate decision makers (SDMs) in preference over patients when (a) the patient is comatose or neurologically devastated, and hence beyond the capacity for suffering or further trauma; (b) the patient is thus incapable of asserting preferences; and (c) the patient's wishes are not known, for example, in the absence of an advance directive. Therefore, (d) 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.","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

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":"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.","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

When Are Patients Dead? The Cost of Lingering Ambiguity. 病人何时死亡？模棱两可的代价。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/736142

Sheng Xiang Huang, Shuddhadeb Ray, Douglas Brown, Piroska Kopar

引用次数: 0