Journal of Clinical Ethics最新文献_第3页

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":"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.","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":"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.Methods: 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.Results: 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.Conclusion: 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.","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

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":"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

Incorporating Structural Competency into Clinical Ethics: Piloting New Bioethics Education. 将结构能力纳入临床伦理学：探索新的生命伦理学教育。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734776

Sara Kolmes, Ariana Thompson-Lastad, Kevin Dirksen, Kayla Tabari, Seth M Holmes

{"title":"Incorporating Structural Competency into Clinical Ethics: Piloting New Bioethics Education.","authors":"Sara Kolmes, Ariana Thompson-Lastad, Kevin Dirksen, Kayla Tabari, Seth M Holmes","doi":"10.1086/734776","DOIUrl":"https://doi.org/10.1086/734776","url":null,"abstract":"AbstractThe Liaison Committee on Medical Education recently adopted structural competency, an approach to understanding and responding to social factors in health and healthcare, as a required part of medical training. We have found that structural competency education shows promise for graduate and continuing bioethics education as well. In postgraduate bioethics education, structural competency focuses on the practical skills of identifying where social forces impact specific patients and how clinicians can respond. This can support clinical ethicists in their attempts to help clinicians identify, understand, and respond to ethical dilemmas caused by social forces, for example, the ways in which resource availability may influence a patient's opportunities and health options, and the impact of the built environment on the health hazards people encounter. We describe how one clinical ethics program integrated structural competency into bioethics education for medical residents and other clinicians. This structural competency education pilot received extremely positive feedback from participating clinicians. Ninety-seven percent of those who responded to evaluation surveys identified structural competency as \"valuable\" or \"very valuable\" to their clinical practice. When providing feedback on this education, clinicians described immediately incorporating structural competency strategies in ethically difficult patient care situations. We present a case study shared and developed by clinicians using these strategies to improve patient care. This practical use of structural competency education suggests that there may be benefits to integrating this approach into bioethics education. We suggest next steps for bioethics educators to further examine these educational strategies following our promising pilot.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"158-166"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121118","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: 10.1086/734777

引用次数: 0

Defining and Refining Trauma-Informed Ethics Consultation. 定义和完善创伤知情伦理咨询。

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":"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

The (In)Capacity to Exclude: The Normative Value of Preferences in Surrogate Exclusion. 排除能力：替代排除中偏好的规范价值。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734766

Megan Kitts, Joanna Smolenski

{"title":"The (In)Capacity to Exclude: The Normative Value of Preferences in Surrogate Exclusion.","authors":"Megan Kitts, Joanna Smolenski","doi":"10.1086/734766","DOIUrl":"https://doi.org/10.1086/734766","url":null,"abstract":"AbstractWhen patients are unable to make decisions for themselves, medical teams often turn to surrogate decision makers to help identify what the patient would have wanted. Unless a patient has designated a surrogate, teams must rely on statutory hierarchies that often prioritize legal and biological ties. When cases arise in which patients do not want their legal surrogate to be their medical decision maker, they must take steps to exclude that person. Unfortunately, people often are not aware of this until they are unable to make complex medical decisions for themselves. While much has been said about the capacity to appoint surrogates, comparatively little has been said about excluding surrogates. In current practice, a patient's decision to exclude a surrogate would not be respected when they do not have capacity. It is our view that this blanket inclusion of surrogates can be seriously harmful and potentially violating. Our goals in this article are twofold. First, we aim to carve out the decision to exclude a surrogate as distinct from the decision to appoint one. Second, we argue that respecting an incapacitated patient's exclusion to some degree is morally appropriate. We will conclude by offering suggestions about how to respect the preference to exclude while considering the risks that may come with exclusion.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"112-120"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121141","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". 回应Morreim的“道德咨询的更深层次看”。

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