Journal of Clinical Ethics最新文献_第8页

Sequential Organ Failure Assessment Score Grouping Should Not Be the Primary Determinant of Allocation of Ventilators During a Pandemic. 在大流行期间，序贯器官衰竭评估评分分组不应成为分配呼吸机的主要决定因素。

Journal of Clinical Ethics Pub Date : 2021-01-01

Neal P Christiansen

引用次数: 0

The Compromising Interpretive Model as a Harm Reduction Strategy for Families that Have Chosen High School Football. 妥协解释模型作为一个减少伤害的策略，为家庭选择了高中足球。

Journal of Clinical Ethics Pub Date : 2020-01-01

Ruth Tallman

引用次数: 0

Psychiatric Advance Directives as an Ethical Communication Tool: An Analysis of Definitions. 精神科预先指示作为伦理沟通工具:定义分析。

Journal of Clinical Ethics Pub Date : 2020-01-01

Billy Table, Jaime Thomas, Virginia A Brown

{"title":"Psychiatric Advance Directives as an Ethical Communication Tool: An Analysis of Definitions.","authors":"Billy Table, Jaime Thomas, Virginia A Brown","doi":"","DOIUrl":"","url":null,"abstract":"A psychiatric advance directive (PAD) is a communication tool that promotes patients' autonomy and gives capacitated adults who live with serious mental illnesses the ability to record their preferences for care and designate a proxy decision maker before a healthcare crisis. Despite a high degree of interest by patients and previous studies that recommend that clinicians facilitate the completion of PADs, the rate of implementation of PAD remains low. Research indicates that many clinicians lack the necessary experience to facilitate the completion of PADs and to use them, and, as a consequence, do not effectively engage patients about PADs. This study developed practical recommendations for clinicians to improve their ability to communicate and facilitate PADs. We (1) thematically analyzed definitions of PADs published in 118 articles across disciplines, and (2) presented our recommendations for enhanced communication in clinical practice that emphasizes patient-centeredness, usefulness, and clarity, aligned with evidence-based practices that put patients' autonomy and understanding first. While there is no one-size-fits-all script to engage patients in complex conversations, our recommended strategies include an emphasis on patients' autonomy, the adaptation of word choices, the use of metaphor not simile, and checking for patients' understanding as effective methods of clinical communication.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"353-363"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38662951","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

Moral Distress: A Framework for Offering Relief through Debrief. 道德困境:通过汇报提供救济的框架。

Journal of Clinical Ethics Pub Date : 2020-01-01

Shilpa Shashidhara, Shaylona Kirk

引用次数: 0

Living in the Hospital: The Vulnerability of Children with Chronic Critical Illness. 生活在医院:慢性危重症儿童的脆弱性。

Journal of Clinical Ethics Pub Date : 2020-01-01

Alexandra R Ruth, Renee D Boss, Pamela K Donohue, Miriam C Shapiro, Jessica C Raisanen, Carrie M Henderson

{"title":"Living in the Hospital: The Vulnerability of Children with Chronic Critical Illness.","authors":"Alexandra R Ruth, Renee D Boss, Pamela K Donohue, Miriam C Shapiro, Jessica C Raisanen, Carrie M Henderson","doi":"","DOIUrl":"","url":null,"abstract":"The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of family life, and the intensive utilization of resources-combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay. In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to make clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"340-352"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38662950","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

Micro and Macro Ethical Considerations of COVID-19. COVID-19的微观和宏观伦理思考。

Journal of Clinical Ethics Pub Date : 2020-01-01

Amitai Etzioni

引用次数: 0

Beyond Shared Decision Making. 超越共同决策。

Journal of Clinical Ethics Pub Date : 2020-01-01

Edmund G Hower

引用次数: 0

Developing a Triage Protocol for the COVID-19 Pandemic: Allocating Scarce Medical Resources in a Public Health Emergency. 制定COVID-19大流行的分类方案:在突发公共卫生事件中分配稀缺的医疗资源。

Journal of Clinical Ethics Pub Date : 2020-01-01

Benjamin Tolchin, Stephen R Latham, Lori Bruce, Lauren E Ferrante, Katherine Kraschel, Karen Jubanyik, Sarah C Hull, Jennifer L Herbst, Jennifer Kapo, Ernest D Moritz, John Hughes, Mark D Siegel, Mark R Mercurio

{"title":"Developing a Triage Protocol for the COVID-19 Pandemic: Allocating Scarce Medical Resources in a Public Health Emergency.","authors":"Benjamin Tolchin, Stephen R Latham, Lori Bruce, Lauren E Ferrante, Katherine Kraschel, Karen Jubanyik, Sarah C Hull, Jennifer L Herbst, Jennifer Kapo, Ernest D Moritz, John Hughes, Mark D Siegel, Mark R Mercurio","doi":"","DOIUrl":"","url":null,"abstract":"The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the triage protocol, summarize the protocol itself, and discuss the major ethical challenges encountered, along with our answers to these challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments. We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges that they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the COVID-19 pandemic and similar public health emergencies.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"303-317"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38533243","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

The Making of a Clinical Ethicist: A Personal Tribute to Al Jonsen. 临床伦理学家的形成:对阿尔·琼森的个人致敬。

Journal of Clinical Ethics Pub Date : 2020-01-01

Ruchika Mishra

引用次数: 0

Helping Children Hurt Themselves: Why Pediatricians Ought to Support Adolescent Football Players in Their Athletic Goals. 帮助孩子伤害自己:为什么儿科医生应该支持青少年足球运动员的运动目标。

Journal of Clinical Ethics Pub Date : 2020-01-01

Ruth Tallman

{"title":"Helping Children Hurt Themselves: Why Pediatricians Ought to Support Adolescent Football Players in Their Athletic Goals.","authors":"Ruth Tallman","doi":"","DOIUrl":"","url":null,"abstract":"Participation in sports such as football puts youth-athletes at high risk of injury. Helmets cannot protect players from the possibility of traumatic brain injury, and repeated concussive injuries can lead to chronic traumatic encephalopathy later in life. In light of such facts, the morally appropriate role of physicians who treat patient-athletes comes into question. I argue that pediatricians ought to be committed to a high level of shared decision making, whereby their goal, rather than being to provide the medically best advice (which, let's be honest, would be to not play football at all), would be to provide the medically best advice in light of patients' honestly professed plans and goals. If patient-athletes see their doctor as an ally, who wants them on the field as much as they want to be there, they will be more likely to trust their pediatrician to help in the realization of those goals, even if they report an injury. While this approach could feel like a medical betrayal, in that the physician could feel complicit in helping a patient to continue engaging in high-risk behavior, I argue that medical outcomes will be better than if patient-athletes see physicians as an obstruction to their athletic goals.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":" ","pages":"326-330"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38320508","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