Journal of Clinical Ethics最新文献

筛选
英文 中文
Informed Consent Challenges: A Mixed-Methods Study of Hospital Ethics Consultations. 知情同意的挑战:医院伦理咨询的混合方法研究。
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/736146
Daniel R S Habib, Cristopher Naranjo, Alexander J Langerman
{"title":"Informed Consent Challenges: A Mixed-Methods Study of Hospital Ethics Consultations.","authors":"Daniel R S Habib, Cristopher Naranjo, Alexander J Langerman","doi":"10.1086/736146","DOIUrl":"https://doi.org/10.1086/736146","url":null,"abstract":"<p><p>AbstractIntroduction: Hospital ethics committees guide healthcare workers and patients through complex consent issues. Prior research highlights gaps in consent forms and information delivery, but little is known about real-world ethics consults on consent. This study examines common challenges in consent discussions and compares patient and consult characteristics of consent-related versus other consults.</p><p><strong>Methods: </strong>De-identified ethics consult notes and patient data from Vanderbilt University Medical Center, a quaternary care academic medical center (2014-24), were analyzed. Consults were classified as consent or nonconsent related. Chi-square, Fisher's exact, and Wilcoxon rank-sum tests compared characteristics, while logistic regression assessed associations between consent themes.</p><p><strong>Results: </strong>Among 4,127 ethics consults, 137 (3.3%) were consent related. Compared to nonconsent consults, consent consults involved more adult (96.4% vs. 84.2%, <i>p</i> = .005) and female (58.4% vs. 19.0%, <i>p</i> = .001) patients and were more often low in complexity (36.5% vs. 22.8%, <i>p</i> < .001). Common issues included capacity (65.0%), surrogate decision-making (46.0%), communication barriers (38.0%), treatment timing (29.2%), goals of care (20.4%), patient refusal (19.7%), and sensitivity/invasiveness concerns (13.1%). Capacity concerns increased the odds of surrogate decision-making issues (OR = 2.97, 95% CI: 1.51-6.30). Advance directive completion was linked to older age (<i>p</i> = .031) and goals-of-care discussions (50.0% vs. 17.5%, <i>p</i> = .018).</p><p><strong>Conclusion: </strong>Consent-related consults differ in patient demographics and complexity, with capacity, surrogate decision-making, and communication barriers as key concerns. This study provides actionable insights to improve consent protocols, patient-clinician interactions, and ethical decision-making.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 3","pages":"215-223"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822820","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
Adapting Clinical Ethics Consultations to Address Ethical Issues of Artificial Intelligence. 调整临床伦理咨询以解决人工智能的伦理问题。
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734773
Benjamin X Collins, Shreya Bhatia, Joseph B Fanning
{"title":"Adapting Clinical Ethics Consultations to Address Ethical Issues of Artificial Intelligence.","authors":"Benjamin X Collins, Shreya Bhatia, Joseph B Fanning","doi":"10.1086/734773","DOIUrl":"https://doi.org/10.1086/734773","url":null,"abstract":"<p><p>AbstractAs artificial intelligence (AI) becomes increasingly incorporated into the workflow of clinical practice, it will raise numerous ethical issues and lead to related clinical ethics consultations to address those issues. However, many of the ethical issues associated with AI feature fundamental distinctions from those currently encountered in clinical ethics consultations. Despite potential differences in the types of ethical issues precipitated by AI, little attention has been given to how to approach these issues when they need to be addressed in clinical ethics consultations. In this article, we provide a walkthrough on adapting clinical ethics consultations to look at these issues through an AI lens, which will allow us to recognize essential information and develop targeted questions that guide consultations toward appropriate decisions. We then provide three case studies exploring hypothetical scenarios based on real AI systems and how a clinical ethicist might guide the discussion of ethical issues presented by AI in each scenario. Following the case studies, we further discuss clinical AI in the context of clinical ethics consultations and conclude with a call for more attention to this area of increasing importance.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"167-183"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121106","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
DNAR Order Status Changes During Surgical Procedures: Intent Versus Practice. 手术过程中DNAR顺序状态的改变:意图与实践。
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734768
Lily Johnson, Neil Manago, Michelle Cantillo, Sidney Johnson
{"title":"DNAR Order Status Changes During Surgical Procedures: Intent Versus Practice.","authors":"Lily Johnson, Neil Manago, Michelle Cantillo, Sidney Johnson","doi":"10.1086/734768","DOIUrl":"https://doi.org/10.1086/734768","url":null,"abstract":"<p><p>AbstractIntroduction: The practice of automatic suspension of \"do not attempt resuscitation\" (DNAR) orders has been abandoned in favor of more nuanced discussions. We sought to assess the practical implementation of DNAR orders at our institution during surgery.</p><p><strong>Methods: </strong>This study conducted a retrospective review of DNAR practices, examining the records of 100 random patients with preexisting DNAR orders prior to surgery. The review documented any changes in DNAR status relative to surgery and then assessed whether the changes in DNAR status were carried forward into the electronic health record (EHR) as updated orders.</p><p><strong>Results: </strong>The DNAR status of patients with an existing DNAR order was documented as having been rediscussed in 85 percent of cases prior to surgical procedures or interventions requiring general anesthesia. That noted, there was no update in the EHR to the DNAR orders in 88 percent of these cases, suggesting a potential gap in desired care were an event requiring resuscitation to happen while under anesthesia.</p><p><strong>Conclusion: </strong>Our review indicates that while alterations in the DNAR wishes were often documented relative to anesthesia and surgery, the code status order was not consistently updated, leading to potential gaps in care. The findings underscore the need to standardize processes for updating DNAR status with order sets to ensure that the patient's wishes are accurately reflected during and after anesthesia or surgery.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"184-190"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121110","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
Factors Associated with Successful Intervention to Facilitate Completion of Advance Medical Directives: A Cross-Sectional Study. 成功干预以促进完成预先医疗指示的相关因素:一项横断面研究。
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/736149
Alon Carney, Oksana Friedman, Yulia Treister-Goltzman
{"title":"Factors Associated with Successful Intervention to Facilitate Completion of Advance Medical Directives: A Cross-Sectional Study.","authors":"Alon Carney, Oksana Friedman, Yulia Treister-Goltzman","doi":"10.1086/736149","DOIUrl":"https://doi.org/10.1086/736149","url":null,"abstract":"<p><p>AbstractEven in countries with a defined legal framework for advance directives (AD), the rates of completion are low. The goal of the present study was to assess whether intervention by means of a lecture by a family physician (FP) is effective for the facilitation of completion of AD by patients. A secondary aim was to assess the knowledge and attitudes of adults on AD. The intervention included an interactive lecture on AD by an FP in two villages in southern Israel. The success of the intervention was measured as completion of AD at primary care clinics over a three-month period after the intervention. Sixty-seven patients 17 years of age and older attended the lecture (1.0% vs. 19.0% for the religious and secular villages, respectively, <i>p</i> < .001). Ten participants (14.9%) completed AD within three months after the intervention (<i>p</i> = .002). Patients from both the secular and religious villages expected that their FP (74%) and/or an outpatient nurse (33%) would initiate the discussion on AD and commented that they would like the topic to be more prominent in the media. Intervention by means of an interactive lecture delivered by an FP in the community is an effective way to motivate patients to complete AD.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 3","pages":"286-294"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822819","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patients' Participation in Clinical Ethics: A Vicarious Voice. 患者参与临床伦理:一种替代的声音。
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":"10.1086/733395","url":null,"abstract":"<p><p>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.</p>","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
Simulation-Based Ethics Education: Building Confidence and Competence in Nursing Students. 基于模拟的伦理学教育:建立护生的信心和能力。
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/736150
Rajeev R Dutta, Julia Hunter, Elizabeth Vega-Belluscio
{"title":"Simulation-Based Ethics Education: Building Confidence and Competence in Nursing Students.","authors":"Rajeev R Dutta, Julia Hunter, Elizabeth Vega-Belluscio","doi":"10.1086/736150","DOIUrl":"https://doi.org/10.1086/736150","url":null,"abstract":"<p><p>AbstractBackground: We combined simulation-based learning and ethics education for a unique, educational experience for nursing students. We aimed to assess students' feelings of confidence, efficacy, and moral distress before and after a simulation session focused primarily on handling an ethical dilemma.</p><p><strong>Methods: </strong>A simulation session featuring an ethical dilemma was enacted as an in-class activity for a nursing ethics course. Optional pre- and post-surveys were made available to nursing students (<math><mrow><mi>n</mi><mo>=</mo><mn>13</mn></mrow></math>) to collect both quantitative (five-point Likert) and qualitative data, including a modified version of the Measure of Moral Distress-Healthcare Professionals tool.</p><p><strong>Results: </strong>Students reported significantly increased levels of confidence in handling real-life ethical dilemmas, knowledge of working with a physician in real-life ethical dilemmas, and competence in selecting appropriate actions in ethical dilemmas. Overall moral distress was not found to be significantly increased in participants.</p><p><strong>Conclusions: </strong>Nursing students describe ethics simulation as a valuable, innovative tool for preparing them to handle eventual ethical challenges in their career and anticipating moral distress.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 3","pages":"251-262"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822823","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
Surgeon Perspectives on Palliative Care: Are We the Barrier to Better Care? 外科医生对姑息治疗的看法:我们是更好治疗的障碍吗?
Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/736145
Sean J Donohue, Baddr A Shakhsheer, Peter Phung, Anthony W Kim, Monica Zell, Sean C Wightman
{"title":"Surgeon Perspectives on Palliative Care: Are We the Barrier to Better Care?","authors":"Sean J Donohue, Baddr A Shakhsheer, Peter Phung, Anthony W Kim, Monica Zell, Sean C Wightman","doi":"10.1086/736145","DOIUrl":"https://doi.org/10.1086/736145","url":null,"abstract":"<p><p>AbstractSurgeons face numerous perioperative challenges when caring for patients with life-threatening or chronic diseases. Although palliative care teams are uniquely poised to aid in the supportive approach to such holistic needs, they are underutilized by surgical services. Palliative care has been associated with an average reduction of $3,237 per admission, as well as reduction in emergency department visits, hospital admissions, and hospital length of stay. For patients within the intensive care setting, palliative interventions have shown a 26 percent relative risk reduction in intensive care unit length of stay and overall alignment of patients' and families' goals of care. However, there is a paucity of data surrounding outcomes associated with palliative care in surgery. It remains pervasive in surgical culture that operative intervention and palliation are mutually exclusive and occur sequentially, rather than concurrently. The majority (76.1%) of surgeons have no formal education in palliative care and feel burdened with the unrealistic expectations for patient outcomes after surgical intervention (61.8%). These cultural and knowledge barriers have significant impact on surgical palliative care referrals and team-based care. Preoperative palliative care consultations in surgical patients occur less than 1 percent of the time. Preoperative palliative care may serve to help explore, clarify, and document quality-of-life values and preferences, in hopes of better promoting goal-concordant care. We recommend implementing frailty-score-based risk assessments to refer surgical patients to palliative care consultation preoperatively. Normalizing referral to palliative care can help surgeons embrace its potential benefit in patient care and improve utilization.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 3","pages":"279-285"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822825","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
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
相关产品
×
本文献相关产品
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信