Journal of Clinical Ethics最新文献_第7页

Representing the Unrepresented: Providing Medical Care for the Unrepresented Patient. 代表无人代表的人：为无人代表的病人提供医疗服务。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733394

Vishruth M Nagam, Charles F Sineri, Robert T Pyo

引用次数: 0

Commentary on Fiester's "TIEC, Trauma Capacity, and the Moral Priority of Surrogate Decision Makers in Futility Disputes," Others' Responses on This Topic, and, Then, Her Responses to Them. 评论菲斯特的《TIEC、创伤能力和无效争议中替代决策者的道德优先权》，其他人对这一主题的回应，以及她对他们的回应。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733186

Edmund G Howe

{"title":"Commentary on Fiester's \"TIEC, Trauma Capacity, and the Moral Priority of Surrogate Decision Makers in Futility Disputes,\" Others' Responses on This Topic, and, Then, Her Responses to Them.","authors":"Edmund G Howe","doi":"10.1086/733186","DOIUrl":"10.1086/733186","url":null,"abstract":"AbstractIn this issue Autumn Fiester and several other experts explore optimal ethical approaches to surrogate decision-making and trauma-informed ethics consultation (TIEC). Trauma-informed care is currently recommended in many clinical contexts in which the risks of patients being traumatized by their illness and its treatment are present. This care gives priority to patients feeling safe, an asymptotic goal that prescribes no one standard practice for all patients, but one that prescribes individualized treatment tailored to each patient's idiosyncratic needs. Core points Fiester makes are how patients are especially prone to feeling traumatized when others, as is always the case with their providers, have greater power over them and the rarely considered conclusion that although providers have exceptional medical expertise and experience, this does not necessarily provide them with greater ethical expertise than their patients or others. Fiester's most radical contention may be that providers, including ethics consultants, give priority to patients' and surrogate decision makers' feelings. I discuss here these contentions and Fiester's main aim of first creating and then maintaining trust and caring feelings between all parties, no matter how much initially they may disagree. I discuss, too, how legally her suggestions may be implemented immediately.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 1","pages":"88-91"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392142","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

Nancy Dubler's Contributions to Clinical Ethics Consultation. Nancy Dubler对临床伦理咨询的贡献。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/737396

Edmund G Howe

引用次数: 0

When Are Patients Dead? The Cost of Lingering Ambiguity. 病人何时死亡？模棱两可的代价。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/736142

Sheng Xiang Huang, Shuddhadeb Ray, Douglas Brown, Piroska Kopar

引用次数: 0

Informed Consent Challenges: A Mixed-Methods Study of Hospital Ethics Consultations. 知情同意的挑战：医院伦理咨询的混合方法研究。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/736146

Daniel R S Habib, Cristopher Naranjo, Alexander J Langerman

{"title":"Informed Consent Challenges: A Mixed-Methods Study of Hospital Ethics Consultations.","authors":"Daniel R S Habib, Cristopher Naranjo, Alexander J Langerman","doi":"10.1086/736146","DOIUrl":"https://doi.org/10.1086/736146","url":null,"abstract":"AbstractIntroduction: Hospital ethics committees guide healthcare workers and patients through complex consent issues. Prior research highlights gaps in consent forms and information delivery, but little is known about real-world ethics consults on consent. This study examines common challenges in consent discussions and compares patient and consult characteristics of consent-related versus other consults.Methods: De-identified ethics consult notes and patient data from Vanderbilt University Medical Center, a quaternary care academic medical center (2014-24), were analyzed. Consults were classified as consent or nonconsent related. Chi-square, Fisher's exact, and Wilcoxon rank-sum tests compared characteristics, while logistic regression assessed associations between consent themes.Results: Among 4,127 ethics consults, 137 (3.3%) were consent related. Compared to nonconsent consults, consent consults involved more adult (96.4% vs. 84.2%, p = .005) and female (58.4% vs. 19.0%, p = .001) patients and were more often low in complexity (36.5% vs. 22.8%, p < .001). Common issues included capacity (65.0%), surrogate decision-making (46.0%), communication barriers (38.0%), treatment timing (29.2%), goals of care (20.4%), patient refusal (19.7%), and sensitivity/invasiveness concerns (13.1%). Capacity concerns increased the odds of surrogate decision-making issues (OR = 2.97, 95% CI: 1.51-6.30). Advance directive completion was linked to older age (p = .031) and goals-of-care discussions (50.0% vs. 17.5%, p = .018).Conclusion: Consent-related consults differ in patient demographics and complexity, with capacity, surrogate decision-making, and communication barriers as key concerns. This study provides actionable insights to improve consent protocols, patient-clinician interactions, and ethical decision-making.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 3","pages":"215-223"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822820","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

Fifty Years of Care and Carcerality. 五十年的小心谨慎。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/737390

Johanna T Crane, Wayne Shelton

{"title":"Fifty Years of Care and Carcerality.","authors":"Johanna T Crane, Wayne Shelton","doi":"10.1086/737390","DOIUrl":"10.1086/737390","url":null,"abstract":"AbstractNancy Dubler founded the Montefiore Bioethics Consultation Service in the late 1970s on the cusp of two epidemics: AIDS and mass incarceration. In New York these two phenomena intersected with devastating consequences. By the late 1980s, the HIV infection rate among incarcerated people in New York State was the highest in the nation. Hospitals across the state built locked units staffed by correctional officers to manage the influx of incarcerated patients dying from AIDS-units that persist to this day. Dubler's earliest scholarship reflects this ethically fraught context. In this article we will first retrace Dubler's work on carceral medicine, in which she advocated for quality, compassionate healthcare for incarcerated patients even as she foregrounded the impossibility of delivering truly equitable care in a carceral setting. We will then show how healthcare providers in prisons, jails, and hospitals continue to struggle with the ethical dilemmas of caring for patients in what Dubler called \"non-health-care spaces.\" In exploring these issues, we draw from our own experiences as ethics consultants and educators working with providers caring for incarcerated patients in New York State. In particular, we focus on how the carceral context may impact medical decision-making and how clinical ethicists (and providers) should respond. Nearly 50 years after Estelle v. Gamble established the right to healthcare in prisons and jails, we observe that providers continue to struggle with many of the ethical challenges Dubler identified decades ago.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 4","pages":"323-331"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543052","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

Reevaluating Benevolent Deception: A Trust-Oriented Approach to Ethical Mediation in Multicultural Healthcare. 重新评估善意欺骗：以信任为导向的多元文化医疗伦理调解方法。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/737398

Ju Zhang

引用次数: 0

Mediation of Medical Distrust due to Racial Injustice: The Legacy of Nancy Dubler. 种族不公正导致的医疗不信任的调解：南希·杜布勒的遗产。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/737394

Paola Nicolas, Laura Specker Sullivan, Elizabeth Chuang

{"title":"Mediation of Medical Distrust due to Racial Injustice: The Legacy of Nancy Dubler.","authors":"Paola Nicolas, Laura Specker Sullivan, Elizabeth Chuang","doi":"10.1086/737394","DOIUrl":"10.1086/737394","url":null,"abstract":"AbstractMedical distrust is often the result of social injustices, discrimination, systemic racism, and the repeated experience of epistemic injustices. Signaling medical trustworthiness in this context requires not only demonstrating competence and caring but grappling with the source of distrust rooted in experience. While we should be wary of framing every unmediatable conflict as an issue of distrust, which may simplify a complex human experience to an identity-based response, we argue that a community-engaged intersectional approach to mediation can address conflicts rooted in distrust and is fundamentally aligned with Nancy Dubler's legacy of addressing power differentials. We present a case where traditional tools of mediation-including addressing informational and emotional gaps-were insufficient at reaching a \"principled resolution.\" In this case, the distance between the family member's and the medical team's understanding of the facts was so profound that it could not be overcome. Far from being irrational or unreasonable, this outcome was a direct response to the perpetual unequal access to epistemic authority experienced by this Black family. Mediators often belong to social groups with more power, and this bias can impact mediation practices, communication norms, and assumptions about conflict. Inclusive mediation models rooted in conflict theory can build on Nancy Dubler's classical work. We argue that bioethicists must engage in risky conversations with local communities to \"collaboratively imagine what a more trustworthy system might look like.\" We describe the inclusive mediation model and how it expands on Nancy Dubler's foundational work and honors her tremendous legacy.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 4","pages":"363-374"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543156","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

Response to Lanphier and Anani, "Defining and Refining Trauma-Informed Ethics Consultation". 对Lanphier和Anani，“定义和改进创伤知情伦理咨询”的回应。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733389

Autumn Fiester

引用次数: 0

"You Only Know What You Know": Evaluating the Need for a Psychosocial Transplant Database. “你只知道你所知道的”：评估社会心理移植数据库的需求。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734769

Jordan L Schwartzberg, Storm Portner, Shruti Mutalik, Jacob M Appel

引用次数: 0