Journal of Clinical Ethics最新文献_第3页

Patients as a Limited Resource? Ethical Dilemmas in Pediatric Pulmonary Vein Stenosis. 病人是有限的资源？儿童肺静脉狭窄的伦理困境。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739011

Michaela Asher, Michael O'Byrne, Ryan Callahan, Constantine D Mavroudis

{"title":"Patients as a Limited Resource? Ethical Dilemmas in Pediatric Pulmonary Vein Stenosis.","authors":"Michaela Asher, Michael O'Byrne, Ryan Callahan, Constantine D Mavroudis","doi":"10.1086/739011","DOIUrl":"10.1086/739011","url":null,"abstract":"AbstractThis study explores tensions between rarity, research, and clinical decision-making in surgical diseases through a case study of pediatric pulmonary vein stenosis (PVS), an extremely rare and severe pediatric cardiopulmonary disease. We first examine the history of PVS treatment and illustrate how the field has been characterized by rapid clinical changes that outpace evidence. Through this context, we characterize patients and their ability to contribute to research as a limited resource that future patients depend on. We argue that this establishes future patients as legitimate stakeholders in decisions regarding current-day clinical management. Exploring this tension, we ask, to what extent should just resource utilization and research priorities shape clinical decisions, and can the dual role of patients-both as care recipients and as a limited resource-be ethically balanced? The article interrogates these questions through two proposals: standardizing care across centers, and regionalizing PVS treatment. We argue that regionalization is ethically justifiable, whereas standardization is not. Ultimately, we conclude that while a patient's primary role is as a recipient of care, research and resource considerations can and should still inform clinical management of rare diseases. Importantly, this is ethically possible only under conditions that preserve patient welfare and the accepted standard of care.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 1","pages":"23-33"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208006","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 and Family Perspectives for Trauma-Informed Ethics Consultation: A Pilot Study. 创伤知情伦理咨询的患者和家庭观点：一项试点研究。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739008

Elizabeth Lanphier, Dani Clark, Sachika Singh

引用次数: 0

Ethical Issues with Posted Patient Behavior Signs. 张贴病人行为标志的伦理问题。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-05-13 DOI: 10.1086/740412

Autumn Fiester, Stacy C Smith, Aliza Narva

引用次数: 0

HITECH Meets Dobbs: Federal Mandates, State Laws, and the Complexities of Abortion Data Sharing. HITECH会见多布斯：联邦法令，州法律和堕胎数据共享的复杂性。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-05-13 DOI: 10.1086/740422

Hannah C Reiser, Angad P Singh

引用次数: 0

What Should Be Our Utmost Goals in Teaching Medical Students Ethics. 医学生伦理学教学的终极目标是什么？

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-05-13 DOI: 10.1086/740393

Edmund G Howe

{"title":"What Should Be Our Utmost Goals in Teaching Medical Students Ethics.","authors":"Edmund G Howe","doi":"10.1086/740393","DOIUrl":"10.1086/740393","url":null,"abstract":"AbstractIn introducing this issue, I address several ethical issues related to reproduction, and particularly those that involve recent changes in U.S. state laws. I discuss also how those teaching ethics may best respond when students have values they view as sacred, such as those involving abortion. I urge teachers to strive to help such students feel safe and relate how and why. I describe errors providers and teachers make when teaching ethics that stem from their tendency to unduly and reflexively overly rely on laws, rules, and authorities, one of which involves their overvaluing also the status quo or what is widely known as the \"is\" over the \"ought.\" I emphasize the importance of providers assuming that patients and families have valid reasons underlying what they believe, and thus that providers should seek to discover these reasons and share them explicitly to indicate their understanding or that they still remain in the dark. I suggest that providers consider and take into account both their own moral values and their differing emotional sensitivities, but that, notwithstanding these, they defer most decisions to their patients and families. They, after all, must live with whatever they decide, whereas medical personnel will not.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 2","pages":"91-100"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934466","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

What's Wrong with Nonmaleficence? Updating an Ancient Injunction. 非恶意有什么错？更新一个古老的禁令。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-08-12 DOI: 10.1086/741887

Chris Crenner, Skylar Bird

引用次数: 0

Pediatric Ethics Consultations: Then and Now. 儿科伦理咨询：过去和现在。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-08-12 DOI: 10.1086/741892

Catherine M Groden, Richard Schreiner, Zeynep N I Salih

引用次数: 0

Chemical Coping and the Role of Palliating Existential Suffering: A Case Study. 化学应对与缓解存在性痛苦的作用：个案研究。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739015

Andrew J Baldassarre, Gustavo S Mastroleo, Amitabha Palmer

引用次数: 0

Treatment over Objection Versus Withdrawal of Dialysis in Cases of Severe Mental Illness. 重度精神疾病患者反对治疗与停止透析的比较。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739013

Nicholas S Kowalczyk, Andrea Landi, Liliana Osadchuk

{"title":"Treatment over Objection Versus Withdrawal of Dialysis in Cases of Severe Mental Illness.","authors":"Nicholas S Kowalczyk, Andrea Landi, Liliana Osadchuk","doi":"10.1086/739013","DOIUrl":"10.1086/739013","url":null,"abstract":"AbstractPatients with severe mental illness are more likely to develop kidney disease and its complications compared to patients without severe mental illness. Once patients with mental illness develop end-stage kidney disease, supporting adherence is important but can be difficult in moments of acute psychosis when the patient objects to dialysis, particularly when considering the lack of dialysis-compatible psychiatric hospitals. In this case, a woman with a history of bipolar disease and end-stage kidney disease has a manic episode after discontinuing her antipsychotic medications and refuses dialysis owing to paranoid delusions. We argue that, due to the potential imminent harm to the patient in refusing dialysis when incapacitated due to severe mental illness, it is reasonable to pursue treatment over objection while waiting for return to capacity unless the surrogate decision maker does not believe it would be in line with the patient's values and beliefs. If there is no return to capacity after an agreed trial period and dialysis cannot be safely pursued outside of the hospital, the provider may ethically withdraw dialysis even contrary to the surrogate decision maker when continuing treatment may be limited by resources and overshadowed by harm to the patient. In this article, we will discuss how Rubin and Prager's criteria in deciding to treat over patient objection were used and their limitations in being able to quantifiably weigh each principle, as well as the ethical justifiability of withdrawal of dialysis should the patient continue to be decapacitated and unwilling to cooperate with dialysis.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 1","pages":"38-44"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208021","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

Suicide, Capacity, and End-of-Life Decisions: Ethical Considerations in Withdrawing Care. 自杀，能力和临终决定：撤回护理的伦理考虑。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739016

Tyler J Thompson, Victoria Garcia, Arlen Gaba, Katelyn Li, Sahil Munjal

{"title":"Suicide, Capacity, and End-of-Life Decisions: Ethical Considerations in Withdrawing Care.","authors":"Tyler J Thompson, Victoria Garcia, Arlen Gaba, Katelyn Li, Sahil Munjal","doi":"10.1086/739016","DOIUrl":"10.1086/739016","url":null,"abstract":"AbstractWe present a case of an incarcerated patient who attempted suicide while in police custody for less than 24 hours. He sustained a C1 vertebra fracture resulting in quadriplegia, poor prognosis, and little chance of neurologic recovery. The patient's urine drug screen was positive for multiple substances, indicating likely intoxication at the time of the attempt. While in the intensive care unit he was only able to communicate through eye movements and blinking. He consistently expressed a wish to withdraw life-sustaining care. This case highlights the ethical challenges involved in assessing decision-making capacity after a suicide attempt in an incarcerated individual, the impact of substance use on capacity, the complexities and potential biases in surrogate decision-making, and the emotional and moral burden of end-of-life care decisions on healthcare providers. We used a deliberate approach involving time for information gathering and deliberation, identification of surrogate decision makers, and engagement of multidisciplinary teams to reach a consensus that upheld ethical principles and protected clinicians from moral injury.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 1","pages":"45-51"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208023","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