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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
{"title":"Analysis of 20 Years of Ethics Consultations at a U.S. Children's Hospital.","authors":"Richard James, Ricki S Carroll, Jonathan M Miller","doi":"10.1086/729417","DOIUrl":"https://doi.org/10.1086/729417","url":null,"abstract":"<p><p>AbstractEmpirical studies of pediatric clinical ethics cases are scant in the biomedical and bioethics literature. In this study, more than 100 detailed records of clinical ethics consultations spanning from 2000 to 2020 at a moderately sized U.S. Mid-Atlantic children's hospital were abstracted and analyzed. Findings of the analysis were generally consistent with other studies in pediatric clinical ethics, with additional insight into aspects of moral distress associated with cases, family engagement with consultations, and other characteristics of interest also documented. Over the 20-year time frame, ethics consults were completed on average twice a year, with a detectable upward trend. Consultations were requested across the spectrum of services and units within the hospital, with critical care environments represented most frequently and genetic and neurological conditions being the most common primary diagnoses. Ethical analysis most commonly related to questions around the principles of autonomy and beneficence.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"35 2","pages":"107-118"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904871","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
Front Matter 前页
Journal of Clinical Ethics Pub Date : 2023-09-01 DOI: 10.1086/728208
{"title":"Front Matter","authors":"","doi":"10.1086/728208","DOIUrl":"https://doi.org/10.1086/728208","url":null,"abstract":"Next article FreeFront MatterPDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmailPrint SectionsMoreDetailsFiguresReferencesCited by Volume 34, Number 3Fall 2023 Published on behalf of the MacLean Center for Clinical Medical Ethics Article DOIhttps://doi.org/10.1086/728208 © 2023 The University of Chicago. All rights reserved.PDF download Crossref reports no articles citing this article.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135688633","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
Front Matter 前页
Journal of Clinical Ethics Pub Date : 2023-06-01 DOI: 10.1086/726057
{"title":"Front Matter","authors":"","doi":"10.1086/726057","DOIUrl":"https://doi.org/10.1086/726057","url":null,"abstract":"Next article FreeFront MatterPDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmailPrint SectionsMoreDetailsFiguresReferencesCited by Volume 34, Number 2Summer 2023 Published on behalf of the MacLean Center for Clinical Medical Ethics Article DOIhttps://doi.org/10.1086/726057 Views: 40Total views on this site © 2023 The University of Chicago. All rights reserved.PDF download Crossref reports no articles citing this article.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135626070","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
Front Matter 前页
Journal of Clinical Ethics Pub Date : 2023-03-01 DOI: 10.1086/725078
{"title":"Front Matter","authors":"","doi":"10.1086/725078","DOIUrl":"https://doi.org/10.1086/725078","url":null,"abstract":"Next article FreeFront MatterPDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Volume 34, Number 1Spring 2023 Published on behalf of the MacLean Center for Clinical Medical Ethics Article DOIhttps://doi.org/10.1086/725078 Views: 75Total views on this site © 2023 The University of Chicago. All rights reserved.PDF download Crossref reports no articles citing this article.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135131012","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
Navigating Informed Consent and Patient Safety in Surgery: Lessons for Medical Students and Junior Trainees. 外科手术中的知情同意与患者安全：医学生和初级实习生的课程。
Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/726816
August A Culbert, Alejandro Bribriesco, Michael S O'Connor, Eric Kodish
{"title":"Navigating Informed Consent and Patient Safety in Surgery: Lessons for Medical Students and Junior Trainees.","authors":"August A Culbert,&nbsp;Alejandro Bribriesco,&nbsp;Michael S O'Connor,&nbsp;Eric Kodish","doi":"10.1086/726816","DOIUrl":"10.1086/726816","url":null,"abstract":"<p><p>AbstractIn the operating room, patient safety is of paramount importance. Medical students and junior trainees, despite their primary role as students, may play active roles in assessing patient safety and reporting suspected errors. Active consent is one layer of patient safety that is continuously assessed by several team members. This article examines an instance where patient consent may have been violated. Through the lens of trainee and senior perspectives, we discuss the ethical principles at stake and provide recommendations for medical student and junior trainee involvement in patient care when an error is suspected.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"34 3","pages":"278-281"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215387","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: 1
Patient Autonomy: How a Student's Surgical Experience Highlights the Need for a New Standard Operating Procedure. 患者自主性：学生的手术经验如何凸显对新标准操作程序的需求。
Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/726814
Theresa McAlister Mairson
{"title":"Patient Autonomy: How a Student's Surgical Experience Highlights the Need for a New Standard Operating Procedure.","authors":"Theresa McAlister Mairson","doi":"10.1086/726814","DOIUrl":"10.1086/726814","url":null,"abstract":"<p><p>AbstractThe concerns regarding patient autonomy presented in August A. Culbert et al.'s \"Navigating Informed Consent and Patient Safety in Surgery: Lessons for Medical Students and Junior Trainees\" fall just short of addressing the main issue. Patient autonomy is not something that just one member of a team should consider, and it should not be something that any protocol should have the power to subvert, particularly in an environment as tenuous as the operating room. This article will take the concerns regarding the ethics of removing a patient's hearing aid prior to entering the operating room presented in the aforementioned article and show the necessity for a new standard operating procedure.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"34 3","pages":"285-287"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215388","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: 1
Patients with Invisible Pain: How Might We See This Pain and Help These Patients More? 隐形疼痛患者：我们如何看待这种疼痛并更多地帮助这些患者？
Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/726812
Edmund G Howe
{"title":"Patients with Invisible Pain: How Might We See This Pain and Help These Patients More?","authors":"Edmund G Howe","doi":"10.1086/726812","DOIUrl":"10.1086/726812","url":null,"abstract":"<p><p>AbstractIn this piece I discuss two ways in which providers may become able to treat patients better. The first is for them to encourage all medical parties, including medical students, to always speak up. The second is to take initiatives to learn of pain that patients feel but neither show nor spontaneously report. They may refer to this pain as invisible pain, often bitterly, in that others not seeing their pain judge them wrongly and harshly. Providers, once seeing this pain, are encouraged to then take additional measures to try to alleviate it. Clinical examples provided to illustrate the range of treatments providers may add are post-traumatic stress disorders, problems involving substance use, and hoarding disorders. Similar concerns regarding people who are deaf and hard of hearing are also addressed.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"34 3","pages":"219-224"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215389","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
Default Positions in Clinical Ethics. 临床伦理学中的默认立场。
Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/726809
Parker Crutchfield, Tyler S Gibb, Michael J Redinger
{"title":"Default Positions in Clinical Ethics.","authors":"Parker Crutchfield,&nbsp;Tyler S Gibb,&nbsp;Michael J Redinger","doi":"10.1086/726809","DOIUrl":"10.1086/726809","url":null,"abstract":"<p><p>AbstractDefault positions, predetermined starting points that aid in complex decision-making, are common in clinical medicine. In this article, we identify and critically examine common default positions in clinical ethics practice. Whether default positions ought to be held is an important normative question, but here we are primarily interested in the descriptive, rather than normative, properties of default positions. We argue that default positions in clinical ethics function to protect and promote important values in medicine-respect for persons, utility, and justice. Further, default positions in clinical ethics may also guard against harm. Where default positions exist, there are epistemic burdens to overturn them. The person wishing to reject the default position, rather than the person endorsing it, bears this burden. The person who bears the burden of meeting the epistemic requirements must provide evidence proportional to the degree of harm the default position protects against. Default positions that protect against significant harm impose significant epistemic requirements to overturn. This asymmetry not only makes medical decision-making more economical but also serves to promote and protect certain values. The identification and analysis of common and recognizable default positions can help to identify other default positions and the conditions under which their associated epistemic requirements are met. The article concludes with considerations of potential problems with the use of default positions in clinical ethics.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"34 3","pages":"258-269"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215386","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
Permanent Sterilization in Nulliparous Patients: Is Legislative Anxiety an Indication for Surgery? 未生育患者的永久绝育:立法焦虑是手术的指征吗?
Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/727435
Catherine Hennessey, Camille Johnson, Hillary McLaren, Neha Bhardwaj, Katherine Rivlin, Julie Chor
{"title":"Permanent Sterilization in Nulliparous Patients: Is Legislative Anxiety an Indication for Surgery?","authors":"Catherine Hennessey, Camille Johnson, Hillary McLaren, Neha Bhardwaj, Katherine Rivlin, Julie Chor","doi":"10.1086/727435","DOIUrl":"10.1086/727435","url":null,"abstract":"<p><p>AbstractThe Supreme Court's <i>Dobbs v. Jackson Women's Health Organization</i> decision, first leaked to the public on 2 May 2022 and officially released on 24 June 2022, overturned <i>Roe v. Wade</i> and thereby determined that abortion is no longer a federally protected right under the Constitution. Instead, the decision gives individual states the right to regulate abortion. Since the <i>Dobbs</i> decision first leaked, our institution has received numerous requests for permanent contraception from individuals stating that their motivation to pursue permanent contraception was influenced by the <i>Dobbs</i> decision and concerns about their reproductive autonomy. Discussions with patients seeking permanent contraception since the Supreme Court's leaked decision have led us to ask ourselves, is legislative anxiety an indication for surgery? This article presents a case series consisting of a convenience sample of 17 young, nulliparous individuals who sought out permanent contraception in the six months following the leak of the <i>Dobbs</i> decision. Healthcare professionals often feel discomfort in offering permanent contraception to young and nulliparous individuals. Accordingly, we discuss pertinent legal issues, review relevant ethical considerations, and offer a framework for these discussions intended to empower the consulting healthcare professional to center the bodily autonomy of every patient regardless of age, parity, or indication for permanent contraception.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"34 4","pages":"320-327"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138291974","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
Capacity Assessment in Emergency Surgery. 急诊外科能力评估。
Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/726817
Darren S Bryan, Selwyn O Rogers
{"title":"Capacity Assessment in Emergency Surgery.","authors":"Darren S Bryan, Selwyn O Rogers","doi":"10.1086/726817","DOIUrl":"10.1086/726817","url":null,"abstract":"<p><p>AbstractInformed consent is a necessary component of the ethical practice of surgery. Ideally, consent is performed in a setting conducive to a robust patient-provider conversation, with careful consideration of risks, benefits, and outcomes. For patients with medical or surgical emergencies, navigating the consent process can be complicated and requires both careful and expedited assessment of decision-making capacity. We present a recent case in which a patient in need of emergency care refused intervention, requiring urgent capacity assessment and a modification to usual care.</p>","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"34 3","pages":"270-272"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215385","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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