Journal of Clinical Ethics最新文献_第3页

Organizational Virtue Ethics and Moral Distress among Healthcare Workers. 组织道德伦理与医护人员的道德压力。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/730869

Jay Carlson

{"title":"Organizational Virtue Ethics and Moral Distress among Healthcare Workers.","authors":"Jay Carlson","doi":"10.1086/730869","DOIUrl":"https://doi.org/10.1086/730869","url":null,"abstract":"AbstractMoral distress is traditionally defined as situations where one knows the right thing to do but external constraints make it nearly impossible to pursue the right course of action. Many interventions to mitigate moral distress focus on making healthcare workers more resilient or courageous in the face of adverse circumstances. While these \"virtue cultivation\" responses might be valuable traits for individuals, I want to argue that cultivating virtue is at best an incomplete strategy for dealing with moral distress in an organizational setting. The individualistic character of these approaches ignores how an organization's policies may be contributing to many morally distressing situations. I will argue that resources from the virtue tradition can still play a valuable theoretical role in addressing moral distress in healthcare settings if we transpose them to the organizational level. The policies of a hospital or healthcare institution can be seen as virtuous to the degree that they further the organization's goals of medicine. Organizational virtue ethics can then illuminate the issue of moral distress in healthcare organizations. If an organization's policies contribute to its members suffering from moral distress, then that policy may well inhibit the organization from carrying out its mission of providing excellent healthcare. Organizations should respond to moral distress and seek ways to mitigate if not eliminate it.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 3","pages":"169-179"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983568","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

Optimizing Family Presence through Medical Education. 通过医学教育优化家庭陪伴。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/729419

Rona Yu

引用次数: 0

What Factors Contribute to Ethical Problems in Patient Care? A Scoping Review and Case Series of Clinical Ethics Consultations. 哪些因素会导致患者护理中的伦理问题？临床伦理咨询的范围审查和案例系列。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/729414

Jan Schürmann, Stella Reiter-Theil

{"title":"What Factors Contribute to Ethical Problems in Patient Care? A Scoping Review and Case Series of Clinical Ethics Consultations.","authors":"Jan Schürmann, Stella Reiter-Theil","doi":"10.1086/729414","DOIUrl":"10.1086/729414","url":null,"abstract":"AbstractBackground: Healthcare professionals (HCPs) are frequently exposed to ethical problems in patient care that can affect the quality of care. Understanding risk factors for ethical problems may help practitioners to address these problems at an early stage. This study aims to provide an overview of ethical risk factors in patient care. Risk factors known from the literature and those found in clinical ethics consultation (CEC) cases are reviewed.Methods: A scoping review of ethical risk factors in patient care and a CEC case series were conducted, analyzing the documentation (consultation reports, feedback forms, electronic medical records) of 204 CECs from 2012 to 2020 at a somatic and a psychiatric university hospital in Basel, Switzerland.Results: Ninety-nine ethical risk factors were identified in nine articles, related to four risk areas: patient (41), family (12), healthcare team (29), and system (17). Eighty-seven of these risk factors were documented at least once in the CEC case series. The most prevalent risk factors in the consultations studied were patient vulnerability (100%), missing or unclear hospital ethics policy (97.1%), shift work (83.3%), lack of understanding between patient and HCP (73.5%), poor communication (66.2%), disagreement between patient and HCP about care (58.8%), and multiple care teams (53.4%). The prevalence differed significantly by medical specialty.Conclusions: There are highly prevalent ethical risk factors at all levels of clinical care that may be used to prevent ethical problems. Further empirical research is needed to analyze risk ratios and to develop specific risk profiles for different medical specialties.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 2","pages":"119-135"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904929","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

Hidden Fault Lines in the Bedrock: A Critical Examination of Surrogate Decision-Making Standards in Ethics Consultation. 基岩中隐藏的断层线：伦理咨询中代理决策标准的批判性审视》。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/730875

Kelly Turner

{"title":"Hidden Fault Lines in the Bedrock: A Critical Examination of Surrogate Decision-Making Standards in Ethics Consultation.","authors":"Kelly Turner","doi":"10.1086/730875","DOIUrl":"https://doi.org/10.1086/730875","url":null,"abstract":"AbstractClinical ethicists are routinely consulted in cases that involve conflicts and uncertainties related to surrogate decision-making for incapacitated patients. To navigate these cases, we invoke a canonical ethical-legal hierarchy of decision-making standards: the patient's known wishes, substituted judgment, and best interest. Despite the routine application of this hierarchy, however, critical scholarly literature alleges that these standards fail to capture patients' preferences and surrogates' behaviors. Moreover, the extent to which these critiques are incorporated into consultant practices is unclear. In this article I thus explore whether, and how, existing critiques of the hierarchy affect the application of these standards during ethics consults. After discussing four critiques of the hierarchy, I examine how two prominent published ethics consultation methodologies-bioethics mediation and CASES-incorporate these critiques differently. I then argue that while both methodologies explicitly endorse the same hierarchy, the varying degrees to which these four criticisms are incorporated into the prescribed consultation process could produce different applications of the same standard. I demonstrate with a case study how an ethics consultant following either methodology might produce two substantively different recommendations despite using the same substituted judgment standard. I conclude that while this heterogeneity of application should not dismantle the hierarchy's status as field-wide canon, it complicates projects of professional ethics consultation consensus building.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 3","pages":"155-168"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983567","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

Ethical Considerations of Off-Label Prescribing in Disruptive Mood Dysregulation Disorder. 破坏性情绪失调症标示外处方的伦理考虑。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/732212

Harinee Maiyuran, Charles Saylor, Jacob Appel, Timothy R Rice

{"title":"Ethical Considerations of Off-Label Prescribing in Disruptive Mood Dysregulation Disorder.","authors":"Harinee Maiyuran, Charles Saylor, Jacob Appel, Timothy R Rice","doi":"10.1086/732212","DOIUrl":"10.1086/732212","url":null,"abstract":"AbstractDisruptive mood dysregulation disorder (DMDD), a relatively new diagnosis in child and adolescent psychiatry that remains without medications approved for its indication, warrants a renewed consideration of the ethics surrounding the off-label use of medications. In the absence of empirical studies, clinicians must work with the best available information regarding treatment, such as case reports demonstrating the success of off-label interventions. Although subject to ethical limitations and the risk-benefit profile of each medication, increased use of this approach in the treatment of DMDD is warranted. A review of the literature was undertaken to identify studies for inclusion in this article. A case history of a 12-year-old girl with DMDD who was treated with amantadine with good response illustrates these ethical considerations within a clinical context. There are significant benefits of off-label uses of medications in the treatment of DMDD. The promising potential of amantadine as an agent for off-label use for pediatric populations with DMDD illustrates this approach. In the absence of approved medications for DMDD, further attempts to use off-label treatments for this disorder are warranted despite ethical constraints and varying risk-benefit profiles for each medication.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 4","pages":"288-295"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630213","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

Prognosis-Based Definitions for Potentially Inappropriate Treatment: Still Flawed, If Not Futile. 基于预后的潜在不当治疗定义：即使不是徒劳，也仍有缺陷。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/732209

Stephen D Brown, Jonathan M Marron, Joel E Frader, Deirdre F Puccetti, Kerri O Kennedy

{"title":"Prognosis-Based Definitions for Potentially Inappropriate Treatment: Still Flawed, If Not Futile.","authors":"Stephen D Brown, Jonathan M Marron, Joel E Frader, Deirdre F Puccetti, Kerri O Kennedy","doi":"10.1086/732209","DOIUrl":"https://doi.org/10.1086/732209","url":null,"abstract":"AbstractThis analysis of professional organizational policies regarding potentially inappropriate life-sustaining medical treatment (LSMT) focuses on the specific threshold criteria that policies apply for limiting LSMT, as well as when (if ever) override of patient/surrogate preferences may be reasonable. Our article offers a critical analysis of one influential approach, proffered by the Society of Critical Care Medicine, that applies a prognosis-based definition of nonbeneficial/inappropriate treatment to determine that ethical threshold. We observe that this prognosis-based threshold resembles rationing in important ways, though it pertains to settings where resources may not be limited. In doing so, the approach raises concerns similar to those that have been raised about rationing, including the potential for strong institutional or individual practitioner biases and for discrimination against those with severe neurological impairments and/or indefinite technological dependence. We conclude that such concerns are valid and may never be entirely unavoidable. They may, however, be ameliorated with policies that incorporate various conceptions of harm within the calculus of cogent \"competing ethical considerations\" that define potentially inappropriate LSMT.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 4","pages":"224-228"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630216","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

New Ways to Help Patients Worst Off. 帮助最贫困患者的新方法。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/728098

Edmund G Howe

引用次数: 0

Advocacy and Bioethics: Aspiration, Obligation, and Negotiation. 宣传与生命伦理学：愿望、义务和协商。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/729418

Aimee B Milliken

引用次数: 0

Caring for Pregnant Patients by Including Pregnant Participants. 让怀孕参与者参与进来，关爱怀孕患者。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/732214

Jessica L Rizzuto, Abigail S Pyne, Luke A Gatta

{"title":"Caring for Pregnant Patients by Including Pregnant Participants.","authors":"Jessica L Rizzuto, Abigail S Pyne, Luke A Gatta","doi":"10.1086/732214","DOIUrl":"https://doi.org/10.1086/732214","url":null,"abstract":"AbstractPregnant research participants have long been excluded from early-stage clinical trials. This stance has been considered ethically justifiable because it upholds the principle of nonmaleficence by avoiding potential harm, using the fetus(es) as the point of reference. However, there are unintended consequences with this default approach. To illustrate these consequences, this article will review the inclusion and exclusion criteria of the Phase II and Phase III SARS-CoV-2 vaccine trials, demonstrating a downstream delay of vaccine recommendations, which hindered public health efforts. Incorporating ethical principles in addition to nonmaleficence, the authors propose an intentional effort to include pregnant participants in Phase II and Phase III designs. We consider the goals of Phase II and Phase III research of demonstrating safety and efficacy and propose that pregnant participants can potentially support these goals. Rather than reflexive exclusion, the gestational age of the participant or the pharmacology of the trial intervention may be considered as part of inclusion for pregnant participants. Expanding the principles beyond nonmaleficence, pregnancy may become a demographic variable rather than an exclusion criterion.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 4","pages":"284-287"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630194","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

Ethical Concerns Regarding the Timing of Written Consent. 有关书面同意时间的伦理问题。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/732211

Sean C Wightman, Victoria Yin, Jacob S Hershenhouse, Tsehay B Abebe, Li Ding, Scott M Atay, Takashi Harano, Anthony W Kim, John N Pagteilan, Abhineet Uppal, Baddr A Shakhsheer

{"title":"Ethical Concerns Regarding the Timing of Written Consent.","authors":"Sean C Wightman, Victoria Yin, Jacob S Hershenhouse, Tsehay B Abebe, Li Ding, Scott M Atay, Takashi Harano, Anthony W Kim, John N Pagteilan, Abhineet Uppal, Baddr A Shakhsheer","doi":"10.1086/732211","DOIUrl":"https://doi.org/10.1086/732211","url":null,"abstract":"AbstractObjective: Thorough informed consent requires decision-making capacity, adequate information, lack of coercion, and an appropriate environment. Consent obtained in the preoperative area is hurried, limiting the quality of informed consent and the opportunity for patient reflection, characteristics inconsistent with patient-centered practice. The incidence of obtaining consent immediately prior to surgery is unknown.Methods: Consecutive patients undergoing surgery at a single center between 1 June 2021 and 14 June 2021 were identified. Time between consent signature and operating room arrival time was measured. Three surgeons reviewed cases and categorized them as major or not major operations.Results: 78.7 percent (199/253) of patients arriving to the preoperative area the day of surgery signed written consent that day. 99.6 percent (248/249) of anesthesia consents were signed the day of surgery. Spanish as a primary language corelated significantly with consent signing on the day of surgery (p = .04). Race and distance traveled for surgery were not significantly associated with consent signing in the preoperative area. 79.3 percent (157/198) had consent signed within 90 minutes of arrival to the operating room. Among major outpatient cases, 77.8 percent (182/234) had consent signing in the preoperative area.Conclusions: This demonstrates routine consent signing in the hurried preoperative setting, suggesting a potential source for improved informed consent. Additionally, language-based consenting disparities, specifically in Spanish, offer opportunity for improvement. The majority of consents were signed the day of surgery, in the preoperative area, and within 90 minutes prior to operating room start time. This offers an opportunity for improved patient-centered care.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 4","pages":"274-283"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630201","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