Journal of Clinical Ethics最新文献_第4页

Slow Trauma: Reframing Concepts of Moral Injury in Trauma-Informed Ethics Consultation. 慢创伤：重建创伤知情伦理咨询中的道德伤害概念。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-08-12 DOI: 10.1086/741885

Charles S Love

{"title":"Slow Trauma: Reframing Concepts of Moral Injury in Trauma-Informed Ethics Consultation.","authors":"Charles S Love","doi":"10.1086/741885","DOIUrl":"10.1086/741885","url":null,"abstract":"AbstractAn emerging area of interest in healthcare ethics consultation (HEC) is the potential for moral injury and trauma to surrogate decision makers (SDMs). Introduced by Anani, Lanphier, and Fiester, trauma-informed ethics consultation (TIEC) recognizes that these encounters frequently involve exigent circumstances and the stressful misalignment between the provider's goals and the expectations of SDMs. Moral injuries sustained in HEC can be intensified by perceived feelings of mistrust, fear, betrayal, and failure. Recognizing signs of emotional, physical, and mental distress resulting from prolonged exposure to anxiety can create opportunities for redirection or referral. This article builds on the contributions of Anani, Lanphier, and Fiester by examining a specific kind of moral injury that is likely to be encountered in HEC and the process by which injuries may develop into post-traumatic stress disorder (PTSD). By narrowing the definition of moral injury and distinguishing between fast and slow trauma, it will be argued that trauma arising in HEC is more closely aligned with slow trauma characterized by a cumulative cognitive burden leading to psychological decompensation and identifiable clinical breakpoints. Different from sudden or violent trauma, associated with PTSD, slow trauma is linked to complications of post-traumatic embitterment disorder (PTED); these have separate pathologies with different causes, clinical presentations, and treatment strategies. The pathophysiological model of slow trauma proposed in this article seeks to elucidate a more nuanced understanding of how moral injury, the effects of unrecognized cumulative stress, and risk factors for emotional and cognitive dysfunction can lead to a richer dialogue in TIEC.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 3","pages":"222-230"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725824","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

Governing Uncertainty: An Ethical Framework for Idiopathic Normal Pressure Hydrocephalus. 控制不确定性：特发性正常压力脑积水的伦理框架。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-08-12 DOI: 10.1086/741889

Kenneth V Iserson

{"title":"Governing Uncertainty: An Ethical Framework for Idiopathic Normal Pressure Hydrocephalus.","authors":"Kenneth V Iserson","doi":"10.1086/741889","DOIUrl":"10.1086/741889","url":null,"abstract":"AbstractIdiopathic normal pressure hydrocephalus presents distinctive ethical challenges, since its treatment requires lifelong device-based therapy in the setting of diagnostic and prognostic uncertainty. Although randomized controlled trials and pooled analyses demonstrate that cerebrospinal fluid shunting can substantially improve gait, and often continence and cognition, outcomes remain variable, and complications requiring revision occur in a significant minority of patients. These realities complicate informed consent, capacity assessment in cognitively vulnerable older adults, and just allocation of neurosurgical resources. Employing principlism, this article argues that clinical uncertainty should not preclude intervention but rather be governed through structured processes. These include a comprehensive consent framework incorporating surrogate decision-making when appropriate, an explicit discussion of shunt nonresponsiveness and revision probabilities, a transparent device selection policy, and guaranteed access to postoperative follow-up and programmable shunt adjustment. This article proposes a practical checklist for neurology and neurosurgery that balances beneficence with nonmaleficence, advances equity for geriatric populations, preserves the possibility of substantial functional recovery, and honors both patient autonomy and responsible resource stewardship.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 3","pages":"235-240"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725297","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

Powerful Perceptions of Genetic Information. 基因信息的强大感知。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-08-12 DOI: 10.1086/741891

Katharine P Callahan, Rebecca Mueller, Molly Hess, John D Lantos

{"title":"Powerful Perceptions of Genetic Information.","authors":"Katharine P Callahan, Rebecca Mueller, Molly Hess, John D Lantos","doi":"10.1086/741891","DOIUrl":"10.1086/741891","url":null,"abstract":"AbstractResearchers who focus on the ethical, legal, and social implications (ELSI) of genetics have tried to anticipate and mitigate the unique risks of genetic testing. To that end, ELSI scholars have focused on the unique predictive power and the subtle ambiguities of genetic test results. Much of this work has assumed that genomic results accurately predict future health problems and has considered the implications of these accurate predictions for the benefits and harms that may result from access to such test results. In this article, we consider a different type of risk-a type of exceptionalism we term \"genetic bias.\" Genetic bias occurs when genomic results have uncertain implications but are perceived as more accurate and accurately predictive than is warranted. Such bias can lead to inappropriate clinical decisions. Specifically, if the genomic results are thought to be more definitive than they really are, they may lead to undue limitations in care. We explore genetic bias through the lens of neonatology, where burgeoning use of genetic testing routinely impacts everyday medical decision-making. Our concerns are supported by preliminary evidence that both neonatologists and parents harbor genetic biases. We examine the implications of this bias and suggest ways that the detrimental effect of such biases could be mitigated.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 3","pages":"241-248"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727153","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

Looking to Our Own and Others' Emotions to Identify Ethical Challenges That We May Resolve Better. 关注我们自己和他人的情绪，以识别我们可能更好地解决的道德挑战。

Journal of Clinical Ethics Pub Date : 2026-01-01 DOI: 10.1086/739012

Edmund G Howe

{"title":"Looking to Our Own and Others' Emotions to Identify Ethical Challenges That We May Resolve Better.","authors":"Edmund G Howe","doi":"10.1086/739012","DOIUrl":"10.1086/739012","url":null,"abstract":"AbstractIn this piece, I address two topics, both built on articles in this issue. The first involves a new, possibly more effective approach that ethics consultants may use when they want to tell the providers consulting them that they think they should treat a patient differently. These authors call this approach \"curious engagement.\" The second topic I discuss involves what moved the above authors to want to imagine and then propose this new approach, since what moved them may similarly move others to also want to innovate. I suggest that the best way to identify ethical practices needing improvement is to look to painful emotions experienced by oneself or others. I give two clinical examples further illustrating how providers may do this. The first involves the provider evaluating a patient for the interests of a third party, not for this patient's interests. The patient here feels frightened and alone. The second is taken from another article in this issue and involves a patient just waiting to die and experiencing existential angst. Both cases show how our looking to painful emotions may suggest areas in which new and better ethical practices are needed, as well as whether, once proposed, providers will adopt them or not.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208025","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

A "Primer" for Parents Involved in Ethics Consults Involving Their Children. 为涉及子女的伦理咨询的父母准备的“入门”。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-08-12 DOI: 10.1086/741883

Edmund G Howe

{"title":"A \"Primer\" for Parents Involved in Ethics Consults Involving Their Children.","authors":"Edmund G Howe","doi":"10.1086/741883","DOIUrl":"10.1086/741883","url":null,"abstract":"AbstractIn this issue of The Journal of Clinical Ethics (JCE), two studies identify a so-called critical \"disconnect\" in the discourse between parents and ethics consultants seeking an optimal outcome regarding children. Parents, these authors report, lack specific ethics-informed resources geared to their understanding as lay people that would enable them to advocate effectively for what they think and feel is best for their children and thus what they also want most. These authors call for new materials to be written, especially for these parents. These might be best conceptualized as \"primers\" for these parents. This piece, then, is not like the usual initial article that expands on one or two articles also in the issue. Rather, it is written for parents but includes recommendations for ethics consultants and other providers related to the many disparate discussions intended for parents. These include the limits of ethics and ethical expertise, the disability paradox, mutual pretense, selected ethical problems that arise at children's different ages, suicide, sick children's siblings, and parents' own grief. This primer, written in response to the above studies' call, is an initial effort that hopefully will be followed by others and may serve as a model for these future endeavors.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 3","pages":"197-206"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724880","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

Organizational Ethics in Practice: Examples from a Large Pediatric Healthcare System. 实践中的组织伦理：来自大型儿科医疗保健系统的例子。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-08-12 DOI: 10.1086/741890

Denise Dudzinski, Aaron Wightman, Jennifer Kett, Jonna Clark, Douglas Diekema, Holly Vo, Benjamin Wilfond, Arika Patneaude, Emily R Berkman

引用次数: 0

What to Do When Incapacitated Patients Resist Treatment: Ethical Considerations in Weighing Beneficence Versus Patient Autonomy. 当丧失行为能力的病人抗拒治疗时该怎么办：权衡善行与病人自主的伦理考虑。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-08-12 DOI: 10.1086/741888

Rachel LeMalefant, Clare Einberger, Kendra J Cooper, Suzanne B Murray, Alvaro J La Rosa

{"title":"What to Do When Incapacitated Patients Resist Treatment: Ethical Considerations in Weighing Beneficence Versus Patient Autonomy.","authors":"Rachel LeMalefant, Clare Einberger, Kendra J Cooper, Suzanne B Murray, Alvaro J La Rosa","doi":"10.1086/741888","DOIUrl":"10.1086/741888","url":null,"abstract":"AbstractThis case series presents three instances where care teams grappled with how to reconcile the two ethical principles of beneficence and patient autonomy when incapacitated patients actively resisted life-sustaining treatment. Readers are invited to consider how differences in patient demographics, psychiatric comorbidities, urgency and duration of recommended medical interventions, and clinical contexts impacted clinical decision-making and outcomes in each case. Physicians should consider the risks and benefits of proposed interventions, including the risks of the means necessary to force interventions in nonassenting patients, and include these factors in consent discussions with patients' legal next of kin. Physicians should also reflect on how their own potential biases may impact what treatments they offer and when, and they should seek consultation with hospital ethics committees when members of the care team have differing views on how best to proceed with patient care. Momentary capacity assessments should not be universally applied in evolving clinical scenarios when risks versus benefits of proposed interventions rapidly shift, nor should lack of availability of next of kin prevent emergent lifesaving treatment or interventions that could restore a patient's capacity and ability to have more nuanced discussions about the long-term care trajectory.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"37 3","pages":"249-256"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726925","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

Documentation and Data About Dobbs as a Source of Harm. 关于多布斯作为危害来源的文件和数据。

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-05-13 DOI: 10.1086/740420

Alexandra Woodcock, Ashish Premkumar

引用次数: 0

How Should Physicians Interpret Legislatures' Lists of Exceptions to Abortion Restrictions? 医生应该如何解释立法机构关于堕胎限制的例外清单？

Journal of Clinical Ethics Pub Date : 2026-01-01 Epub Date: 2026-05-13 DOI: 10.1086/740416

Carly Dahl, Cara Heuser

引用次数: 0

Introduction: Trauma and Surrogate Decision Makers: An Argument for Moral Priority in Futility Disputes. 引言：创伤和替代决策者：在无效争议中的道德优先论证。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733270

Autumn Fiester

引用次数: 0