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Journal of Clinical Ethics最新文献

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Guiding Ethical Decisions in Cochlear Implantation for the Hearing Impaired with Comorbid Psychosis. 为合并精神病的听力受损者植入人工耳蜗时的伦理决策指导。
Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/729415
Hannes Prescher, Marie Fefferman, Peter Angelos, Micah Prochaska
{"title":"Guiding Ethical Decisions in Cochlear Implantation for the Hearing Impaired with Comorbid Psychosis.","authors":"Hannes Prescher, Marie Fefferman, Peter Angelos, Micah Prochaska","doi":"10.1086/729415","DOIUrl":"https://doi.org/10.1086/729415","url":null,"abstract":"<p><p>AbstractCochlear implants can restore hearing in people with severe hearing loss and have a significant impact on communication, social integration, self-esteem, and quality of life. However, whether and how much clinical benefit is derived from cochlear implants varies significantly by patient and is influenced by the etiology and extent of hearing loss, medical comorbidities, and preexisting behavioral and psychosocial issues. In patients with underlying psychosis, concerns have been raised that the introduction of auditory stimuli could trigger hallucinations, worsen existing delusions, or exacerbate erratic behavior. This concern has made psychosis a relative contraindication to cochlear implant surgery. This is problematic because there is a lack of data describing this phenomenon and because the psychosocial benefits derived from improvement in auditory function may be a critical intervention for treating psychosis in some patients. The objective of this report is to provide an ethical framework for guiding clinical decision-making on cochlear implant surgery in the hearing impaired with psychosis.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 2","pages":"101-106"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904877","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
Duty to Family: Ethical Considerations in the Resuscitation Bay. 对家人的责任：复苏湾的伦理考虑。
Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/728141
Colin Liphart, Christopher Calciano, Nancy Jacobson, Arthur R Derse, Ashley Pavlic
{"title":"Duty to Family: Ethical Considerations in the Resuscitation Bay.","authors":"Colin Liphart, Christopher Calciano, Nancy Jacobson, Arthur R Derse, Ashley Pavlic","doi":"10.1086/728141","DOIUrl":"10.1086/728141","url":null,"abstract":"<p><p>AbstractTo examine the ethical duty to patients and families in the setting of the resuscitation bay, we address a case with a focus on providing optimal care and communication to family members. We present a case of nonsurvivable traumatic injury in a minor, focusing on how allowing family more time at the bedside impacts the quality of death and what duty exists to maintain an emotionally optimal environment for family grieving and acceptance. Our analysis proposes tenets for patient and family-centric care that, in alignment with trauma-informed care principles, optimize the long-term well-being of the family, namely valuing family desires and sensitivity to location.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 1","pages":"54-58"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906573","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
Home Birth in the United States: An Evidence-Based Ethical Analysis. 美国的家庭分娩：基于证据的伦理分析。
Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/728147
Paige M Anderson, Vivian Altiery De Jesus, Marielle S Gross
{"title":"Home Birth in the United States: An Evidence-Based Ethical Analysis.","authors":"Paige M Anderson, Vivian Altiery De Jesus, Marielle S Gross","doi":"10.1086/728147","DOIUrl":"10.1086/728147","url":null,"abstract":"<p><p>AbstractThe assumption in current U.S. mainstream medicine is that birthing requires hospitalization. In fact, while the American College of Obstetricians and Gynecologists supports the right of every birthing person to make a medically informed decision about their delivery, they do not recommend home birth owing to data indicating greater neonatal morbidity and mortality. In this article, we examine the evidence surrounding home birth in the United States and its current limitations, as well as the ethical considerations around birth setting.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 1","pages":"37-53"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906574","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
Shifting from Equality toward Equity: Addressing Disparities in Research Participation for Clinical Cancer Research. 从平等转向公平：解决临床癌症研究中参与研究的差异。
Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/728144
Elizabeth Warner, Jonathan M Marron, Jeffrey M Peppercorn, Gregory A Abel, Andrew Hantel
{"title":"Shifting from Equality toward Equity: Addressing Disparities in Research Participation for Clinical Cancer Research.","authors":"Elizabeth Warner, Jonathan M Marron, Jeffrey M Peppercorn, Gregory A Abel, Andrew Hantel","doi":"10.1086/728144","DOIUrl":"10.1086/728144","url":null,"abstract":"<p><p>AbstractThere is societal consensus that cancer clinical trial participation is unjust because some sociodemographic groups have been systematically underrepresented. Despite this, neither a definition nor an ethical explication for the justice norm of equity has been clearly articulated in this setting, leading to confusion over its application and goals. Herein we define equity as acknowledging sociodemographic circumstances and apportioning resource and opportunity allocation to eliminate disparities in outcomes, and we explore the issues and tensions this norm generates through practical examples. We assess how equality-based enrollment structures in clinical cancer research have perpetuated historical disparities and what equity-based alternatives are necessary to achieve representativeness and an expansive conception of participatory justice in clinical cancer research. This framework addresses the breadth from normative to applied by defining the justice norm of equity and translating it into practical strategies for addressing participation disparities in clinical cancer research.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 1","pages":"8-22"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10983799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906577","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
Should Providers Ask Family Members What They Want When Establishing Surrogate Decision-Making? 在确立代理决策时，医疗服务提供者是否应该询问家庭成员他们想要什么？
Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/730874
Edmund G Howe
{"title":"Should Providers Ask Family Members What They Want When Establishing Surrogate Decision-Making?","authors":"Edmund G Howe","doi":"10.1086/730874","DOIUrl":"https://doi.org/10.1086/730874","url":null,"abstract":"<p><p>AbstractIn this piece I discuss optimal approaches that providers may take when pursuing surrogate decision-making. A potential critical problem here is some providers' approach differing from that of others. To the extent that this occurs, the results may be arbitrary, and the harm from this may be profound since this may affect, of course, even whether some of these patients will live or die. One factor possibly resulting in these differences is the moral weight providers place on what family members want when these outcomes differ from what they think patients would want. Providers now most commonly place greatest moral weight on following what patients would want to maximally respect their autonomy, but this view may clash with the view of others who see autonomy as more relational and thus based on prior and present social relations with others. Giving family members' wants more moral weight is a radical departure from what providers do now and may increase these differences. I discuss here the rationales for and against these competing choices.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 3","pages":"147-154"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983570","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
Transcultural Psychiatry in Medical Ethics: Assessing Decision-Making Capacity within the Lens of an East African Refugee. 医学伦理学中的跨文化精神病学：从东非难民的角度评估决策能力。
Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/730871
Arlen Gaba, Anna Dorsett, Samantha Ongchuan Martin, Brandon Chen, Sahil Munjal
{"title":"Transcultural Psychiatry in Medical Ethics: Assessing Decision-Making Capacity within the Lens of an East African Refugee.","authors":"Arlen Gaba, Anna Dorsett, Samantha Ongchuan Martin, Brandon Chen, Sahil Munjal","doi":"10.1086/730871","DOIUrl":"10.1086/730871","url":null,"abstract":"<p><p>AbstractA 29-year-old female East African refugee with no formal psychiatric history and a medical history significant for HIV was admitted for failure to thrive and concern for bizarre behavior in the context of abandonment by her husband and separation from her child. After psychiatric evaluation, it was determined that she did not have the capacity to care for herself independently; adult protective services then pursued and was awarded guardianship. While admitted, the patient repeatedly refused medical treatment, had a feeding tube placed for forced nutrition and medications (though she did at one point remove this tube herself), and received two electroconvulsive therapy (ECT) treatments. Soon thereafter, the patient's court-appointed guardian met with the primary medical, psychiatric, and ethics teams to discuss goals of care in the setting of complex social and cultural needs. It was collectively determined that the patient's choices to refuse care (including nutrition, lab work, medications, and ECT) and some repeated behaviors (e.g., denial of divorce, denial of HIV, denial of need for care) could be considered culturally appropriate in the context of the acute stressors leading up to hospitalizations. All teams concluded, therefore, that the patient had the capacity to refuse these interventions and that further forced intervention would pose a greater chance of exacerbating her already-significant trauma history than improving her outcomes. Ultimately, the patient was able to be discharged into the care of her guardian, who would assist her in receiving support from members of her community who share her language and culture.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 3","pages":"190-198"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983571","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
Dual Advocates in Deceased Organ Donation: The Potential for Moral Distress in Organ Procurement Organization Staff. 死者器官捐献中的双重代言人：器官采购组织工作人员道德困扰的可能性》。
Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/728145
Hannah C Boylan, Anna D Goff
{"title":"Dual Advocates in Deceased Organ Donation: The Potential for Moral Distress in Organ Procurement Organization Staff.","authors":"Hannah C Boylan, Anna D Goff","doi":"10.1086/728145","DOIUrl":"10.1086/728145","url":null,"abstract":"<p><p>AbstractOrgan procurement organization (OPO) staff play an essential role in the facilitation of organ donation as they guide family members and loved ones of dying patients through the donation process. Throughout the donation process, OPO staff must assume the role of a dual advocate, considering both the interests of the donor (which often include the wishes of the donor's family) and the interests of potential recipient(s). The benefits of this role are well established; however, minimal literature exists on the ways this role can cause moral distress in OPO staff, who frequently face scenarios in which adhering to the wishes of a donor family may compromise donation potential but failing to honor donor family requests may result in further emotional burden for the family. Given the frequency with which these ethically complex situations exist during donation, OPO staff are at heightened risk for experiencing moral distress and burnout, yet they are seldom acknowledged in the existing moral distress literature. As a result, it is unclear whether the current practices available to mitigate moral distress are beneficial for this population.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 1","pages":"70-75"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906572","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
An Innovation Ethics Framework for Safe and Equitable Contingency Planning. 安全公平应急规划的创新伦理框架。
Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/732208
Alexander Quan, David Alfandre
{"title":"An Innovation Ethics Framework for Safe and Equitable Contingency Planning.","authors":"Alexander Quan, David Alfandre","doi":"10.1086/732208","DOIUrl":"https://doi.org/10.1086/732208","url":null,"abstract":"<p><p>AbstractThe contingency phase is a transition period between usual healthcare delivery and the activation of formalized rationing protocols under crisis standards of care. The contingency phase is defined by two simultaneous goals: avert or forestall critical scarcity of healthcare resources, and provide patient-centered care that is functionally equivalent to usual care when dynamic changes to healthcare operations are necessary to prevent hospital surge overload. Contingency measures modify the allocation of hospital space, staff, and supplies in service of these two goals. Although functionally equivalent care is theoretically possible, hospitals often cannot know a priori which alterations to space, staff, or supplies will lead to downstream effects on patient outcomes, raising ethical questions about how hospitals should institute equitable contingency measures when safety and efficacy data is limited. The current ethics literature has not sufficiently addressed these questions.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 4","pages":"237-248"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630191","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
Should Providers Advocate for Their Patients? 医疗服务提供者是否应该为患者代言？
Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/729224
Edmund G Howe
{"title":"Should Providers Advocate for Their Patients?","authors":"Edmund G Howe","doi":"10.1086/729224","DOIUrl":"https://doi.org/10.1086/729224","url":null,"abstract":"<p><p>AbstractThis piece discusses several ways in which providers may advocate for patients and their families that go beyond what providers usually do to help their patients. A much more expanded view of advocacy is suggested. Real cases illustrating all interventions suggested are presented, and each is paradigmatic of numerous others. Categories of possible options suggested for expanded advocacy include (1) providers enhancing patients' outcomes when standard treatments have failed, (2) providers taking measures outside those they usually take to benefit patients to a greater extent, and (3) providers sacrificing their own needs more than they customarily do to help their patients still further. The suggested interventions are practical and can be implemented immediately. Taken together, the interventions proposed are also aspirational.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 2","pages":"77-84"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904898","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
Palliative Care for Refractory Depressive Symptoms in a Female Veteran Geriatric Patient. 姑息治疗女性退伍老年患者的难治性抑郁症状
Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/730872
Yasser Sammour, Alyssa C Smith, Sydney Waller, Michael Riddle, Yena Choi
{"title":"Palliative Care for Refractory Depressive Symptoms in a Female Veteran Geriatric Patient.","authors":"Yasser Sammour, Alyssa C Smith, Sydney Waller, Michael Riddle, Yena Choi","doi":"10.1086/730872","DOIUrl":"https://doi.org/10.1086/730872","url":null,"abstract":"<p><p>AbstractPsychiatric treatment options, such as electroconvulsive therapy (ECT), can be lifesaving for individuals suffering from severe mental illness. For individuals who are unable to make or communicate their own medical decisions, this decision may fall on a legal guardian, who will make decisions on the patient's behalf. Here we discuss the considerations of end-of-life planning in a patient with severe mental illness under guardianship when treatment modalities, in this case ECT, are no longer effective.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 3","pages":"199-201"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983569","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
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