Journal of Clinical Ethics最新文献_第5页

Should Providers Engage in Religious Discussions, and If They Should, Then with Whom? 医疗服务提供者是否应该参与宗教讨论？

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/732143

Edmund G Howe

{"title":"Should Providers Engage in Religious Discussions, and If They Should, Then with Whom?","authors":"Edmund G Howe","doi":"10.1086/732143","DOIUrl":"https://doi.org/10.1086/732143","url":null,"abstract":"AbstractPatients' spiritual views and, more generally, the meaning they feel in their lives is often, if not always, most important to them, especially when they have serious illness. Yet there are no standard requirements for providers to explore with patients their spiritual needs. Providers' views regarding their both taking initiatives to explore with patients needs and then to discuss with them their religious concerns if they want this vary widely. This piece explores, then, the extent to which providers should take these initiatives and, if they have this interest, whether as providers they should carry on these discussions or refer these patients, always, to clergy persons, as some providers adamantly advocate because they have expertise in this area that providers lack. This piece goes on to discuss whether providers believe they should have these discussions even when their patients' beliefs differ greatly from their own. In exploring this question, examples involving patients with Muslim, Hindu, and Christian beliefs are considered. Beliefs reported by some people from Germany and Israel regarding physician-assisted dying also are reported and compared, illustrating that patients' and people's beliefs cannot be reliably just inferred. Practical approaches, finally, are suggested.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 4","pages":"217-223"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630259","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

How Should We Allocate Divisible Resources? An Overlooked Question. 我们应该如何分配可分割的资源？一个被忽视的问题

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/728143

Noah Berens, Mara Buchbinder

引用次数: 0

Ethics of Pediatric Surgical Innovation: Considerations, Controversies, and Pitfalls. 小儿外科创新的伦理：考虑因素、争议和陷阱。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/730873

Katherine Brooke Snyder, Ryan Austin Stewart, Catherine J Hunter

引用次数: 0

Letting Go of the Status Quo: One Program's Experience Discontinuing Ethics Committees and Creating Alternative Structures for Engagement. 放弃现状：一个项目终止伦理委员会并创建其他参与结构的经验。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/732207

Hilary Mabel, Kate M Gordon, Jessica Ginsberg, Jason Lesandrini, Bryan Kibbe, Lexi C White, David Reis, Barquiesha Madison, Jamila Young, Steven Shields, Jameisha Brown, Jordan Potter

{"title":"Letting Go of the Status Quo: One Program's Experience Discontinuing Ethics Committees and Creating Alternative Structures for Engagement.","authors":"Hilary Mabel, Kate M Gordon, Jessica Ginsberg, Jason Lesandrini, Bryan Kibbe, Lexi C White, David Reis, Barquiesha Madison, Jamila Young, Steven Shields, Jameisha Brown, Jordan Potter","doi":"10.1086/732207","DOIUrl":"https://doi.org/10.1086/732207","url":null,"abstract":"AbstractThe authors describe their Ethics Program's transition from utilizing ethics committees to instead implementing a three-initiative structure consisting of Ethics Grand Rounds, an Ethics Liaison Network, and an Ethics Advisory Group. They first outline the history of ethics committees. Then, they discuss the history of their Ethics Program and the challenges that ethics committees posed. Next, they describe their approach to developing new initiatives for non-ethicist healthcare professionals to engage in ethics work and what these initiatives specifically entail. They then describe how they worked to secure buy-in for dissolving their ethics committees and, based on pre- and post-implementation surveys, how this transition has been received by former ethics committee members. Finally, the authors reflect on what has been gained and lost through these changes and offer insights and recommendations for other ethics programs thinking about discontinuing their own ethics committees in favor of more innovative models.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 4","pages":"260-273"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630214","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

Characteristics and Outcomes of Safe Discharge Planning Bioethics Consultations of a Single Ethics Service at a Large Medical Center. 大型医疗中心单一伦理服务机构的安全出院规划生物伦理咨询的特点和结果。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/732213

Breckin Horton, Adira Hulkower, Sarah Garijo-Garde, Elizabeth Chuang

{"title":"Characteristics and Outcomes of Safe Discharge Planning Bioethics Consultations of a Single Ethics Service at a Large Medical Center.","authors":"Breckin Horton, Adira Hulkower, Sarah Garijo-Garde, Elizabeth Chuang","doi":"10.1086/732213","DOIUrl":"https://doi.org/10.1086/732213","url":null,"abstract":"AbstractBackground: Clinical ethics consults are sometimes requested for patients who lack capacity and do not assent to discharge recommendations, particularly those with neurocognitive or psychiatric disorders desiring home discharge. Balancing the risks and benefits of overriding patient preferences involves considering dignity, values, clinical information, and available resources. Outcomes of such consultations lack characterization in the literature.Methods: We examined clinical ethics consultations from December 2015 to June 2023 at a large, urban academic medical center serving a diverse community with high poverty rates. Time to readmission and proportion readmitted within 30 days were analyzed by discharge disposition.Results: Among 1,163 ethics consults, 167 were for discharge planning. The median age was 65.4. Of these, 56.7 percent were male; 29.9 percent, Black, non-Hispanic; 26.9 percent, Hispanic; and 19.1 percent, White, non-Hispanic. More than 37 percent had a psychiatric diagnosis, with a similar percentage affected by dementia. Discharge to skilled nursing facilities (SNFs), home without nursing care, home with nursing care, subacute rehabilitation facilities, and elopement constituted 33, 26, 26, 2, and 2 percent, respectively. The discharged-to-home group showed the highest average days to readmission (243), while the average for the discharged-to-SNF group was 153. These differences were not statistically significant when controlling for age, gender, and comorbid conditions.Conclusions: Half of the patients consulted for discharge planning were discharged home and were not at higher risk for early readmission. This higher-than-expected percentage may reflect increased attention to patient values when bioethics is involved.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 4","pages":"229-236"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630196","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

When Patients and Providers Feel Helpless: A Commentary on "Palliative Care for Refractory Depressive Symptoms in a Female Veteran Geriatric Patient". 当病人和医护人员感到无助时：女性退伍老年患者难治性抑郁症的姑息治疗 "评论。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/730894

Edmund G Howe

引用次数: 0

When Parents Request Nondisclosure: Rights of Adolescents to Access Their Health Information and Implications of the 21st Century Cures Act Final Rule. 当父母要求保密时：青少年获取其健康信息的权利及 21 世纪治愈法案最终规则的影响》。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/729413

Edward McArdle, Karen L Teelin, Adrienne Borschuk, Amy E Caruso Brown

{"title":"When Parents Request Nondisclosure: Rights of Adolescents to Access Their Health Information and Implications of the 21st Century Cures Act Final Rule.","authors":"Edward McArdle, Karen L Teelin, Adrienne Borschuk, Amy E Caruso Brown","doi":"10.1086/729413","DOIUrl":"10.1086/729413","url":null,"abstract":"AbstractDespite broad ethical consensus supporting developmentally appropriate disclosure of health information to older children and adolescents, cases in which parents and caregivers request nondisclosure continue to pose moral dilemmas for clinicians. State laws vary considerably regarding adolescents' rights to autonomy, privacy, and confidentiality, with many states not specifically addressing adolescents' right to their own healthcare information. The requirements of the 21st Century Cures Act have raised important ethical concerns for pediatricians and adolescent healthcare professionals regarding the protection of adolescent privacy and confidentiality, given requirements that chart notes and results be made readily available to patients via electronic portals. Less addressed have been the implications of the act for adolescents' access to their health information, since many healthcare systems' electronic portals are available to patients beginning at age 12, sometimes requiring that the patients themselves authorize their parents' access to the same information. In this article, we present a challenging case of protracted disagreement about an adolescent's right to honest information regarding his devastating prognosis. We then review the legal framework governing adolescents' rights to their own healthcare information, the limitations of ethics consultation to resolve such disputes, and the potential for the Cures Act's impact on electronic medical record systems to provide one form of resolution. We conclude that although parents in cases like the one presented here have the legal right to consent to medical treatment on their children's behalf, they do not have a corresponding right to direct the withholding of medical information from the patient.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 2","pages":"85-92"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904930","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

Analysis of 20 Years of Ethics Consultations at a U.S. Children's Hospital. 美国儿童医院 20 年伦理咨询分析。

Journal of Clinical Ethics Pub Date : 2024-01-01 DOI: 10.1086/729417

Richard James, Ricki S Carroll, Jonathan M Miller

引用次数: 0

Front Matter 前页

Journal of Clinical Ethics Pub Date : 2023-09-01 DOI: 10.1086/728208

引用次数: 0

Front Matter 前页

Journal of Clinical Ethics Pub Date : 2023-06-01 DOI: 10.1086/726057

引用次数: 0