Journal of Clinical Ethics最新文献_第8页

When Guideline-Concordant Standardized Care Results in Healthcare Disparities. 当指南一致性标准化护理导致医疗保健差异时。

Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/726815

Micah Prochaska, David Meltzer, Peter Angelos

引用次数: 0

Reducing Moral Distress by Teaching Healthcare Providers the Concepts of Values Pluralism and Values Imposition. 通过教导医疗保健提供者价值观多元化和价值观强加的概念来减少道德困扰。

Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/727437

Autumn Fiester

{"title":"Reducing Moral Distress by Teaching Healthcare Providers the Concepts of Values Pluralism and Values Imposition.","authors":"Autumn Fiester","doi":"10.1086/727437","DOIUrl":"10.1086/727437","url":null,"abstract":"AbstractThere is a clear need for interventions that reduce moral distress among healthcare providers (HCPs), given the high prevalence of moral distress and the far-ranging negative consequences it has for them. Healthcare ethics consultants are frequently called upon to manage moral distress, especially among nursing staff. Recently, researchers have both broadened the definition of moral distress and demarcated subcategories of the phenomenon with the intent of creating more targeted and effective interventions. One of the most frequently occurring subcategories of moral distress in this new taxonomy has been labeled \"moral-constraint distress,\" though scholars have argued that not all constraints on HCPs' moral agency are inappropriate given the often-competing healthcare values of patients, families, and clinical staff. To attempt to reduce the instances of moral distress in cases in which the constraints on HCPs' moral agency are justified, we propose an intervention that focuses on shifting the HCPs' \"frame of reference\" on moral-constraint distress, teaching HCPs how to distinguish unjustified and justified constraints on their moral agency. The anchors of this blueprint for reducing moral-constraint distress are the philosophical concepts of \"values pluralism\" and \"values imposition.\" The rationale for this intervention is that, in situations where the constraint on moral agency is justified but the experience of moral distress could nevertheless be severe, the emphasis needs to be on helping the HCP to \"think differently\" rather than \"act differently.\"","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"34 4","pages":"296-306"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138291975","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 Should Providers Defer versus Impose Their Views? 什么时候提供者应该推迟还是强加他们的观点?

Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/727439

Edmund G Howe

引用次数: 0

Practical Ethics: A Medical Student's Ethical Case in Surgery Clerkship. 实践伦理学：医学生在外科文书工作中的伦理学案例。

Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/726810

Christine B Kwak

引用次数: 0

Professional Guidelines for the Care of Extremely Premature Neonates: Clinical Reasoning versus Ethical Theory. 极早产新生儿护理专业指南：临床推理与伦理理论。

Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/726813

H Alexander Chen, Matthew J Drago

{"title":"Professional Guidelines for the Care of Extremely Premature Neonates: Clinical Reasoning versus Ethical Theory.","authors":"H Alexander Chen, Matthew J Drago","doi":"10.1086/726813","DOIUrl":"10.1086/726813","url":null,"abstract":"AbstractProfessional statements guide neonatal resuscitation thresholds at the border of viability. A 2015 systematic review of international guidelines by Guillen et al. found considerable variability between statements' clinical recommendations for infants at 23-24 weeks gestational age (GA). The authors concluded that differences in the type of data included were one potential source for differing resuscitation thresholds within this \"ethical gray zone.\" How statements present ethical considerations that support their recommendations, and how this may account for variability, has not been as rigorously explored. We performed a mixed-methods exploratory analysis of 25 current international guidelines for neonatal resuscitation at 22+0-25+0 weeks GA. Qualitative analysis using a modified grounded theory yielded 34 distinct codes, eight categories, and four overarching themes. Three themes, consequentialism, principlism, and rights-based, consisted of concepts central to these ethical frameworks. The fourth theme, clinical reasoning, described counseling practices, medical management, outcomes data, and prognostic uncertainty, without any ethical context. The theme of clinical reasoning appeared in 22 of 25 guidelines. Ten guidelines lacked any ethical theme. Guidelines with an identified ethical theme were more likely to recommend comfort care than guidelines without an identified ethical theme, and recommended it at a higher average GA (22.7 weeks vs. 22.0 weeks, p = 0.03). Thus, how ethical concepts are incorporated into guidelines potentially impacts resuscitation thresholds. We argue that inclusion of explicit discussion of ethical considerations surrounding resuscitation in the \"gray zone\" would clarify values that inform recommendations and facilitate discussions about how neonatology ought to approach periviability as outcomes continue to evolve.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"34 3","pages":"233-244"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215391","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

Against an Inflexible, Prioritized List for Default Surrogate Selection. 针对默认代理选择的不灵活的优先级列表。

Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/727434

Dylan Manson

{"title":"Against an Inflexible, Prioritized List for Default Surrogate Selection.","authors":"Dylan Manson","doi":"10.1086/727434","DOIUrl":"10.1086/727434","url":null,"abstract":"AbstractSurrogate selection can be extremely consequential for patients. Most surrogates are selected by default, so we should care about whether legal provisions for default surrogate selections are ethically justified. Most U.S. states use an inflexible, prioritized list of relationships, that is, a hierarchical list where eligible classes of higher-ranked individuals must be selected before lower-ranked individuals. I argue that while some inflexible, prioritized lists may roughly reflect the order that many patients would select, there is a significant minority that inflexible lists systematically disempower. This is morally unacceptable given the availability of less morally problematic alternatives. One alternative is a flexible, prioritized list, which provides conditions for lower-ranked individuals to be selected ahead of higher-ranked ones. I argue that since all the U.S. states that currently have an inflexible, prioritized list systematically disempower a significant proportion of their residents, they have good reason to adopt a flexible, prioritized list instead. Furthermore, the Universal Law Commission currently recommends that states adopt an inflexible, prioritized list, so they have good reason to change their recommendation.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"34 4","pages":"307-319"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138291971","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

Nursing Ethics Liaison Program: A Pilot Study. 护理伦理联络计划:一项试点研究。

Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/727436

Marianne Chiafery, Karen Keady

引用次数: 0

Ethics Education in U.S. Allopathic Medical Schools: A National Survey of Medical School Deans and Ethics Course Directors. 美国对抗疗法医学院的伦理教育:对医学院院长和伦理课程主任的全国调查。

Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/727433

Nicholas R Jarvis, Ellen C Meltzer, Jon C Tilburt, Lyndsay A Kandi, Yu-Hui H Chang, Elisabeth S Lim, Timothy J Ingall, Michael A Howard, Chad M Teven

{"title":"Ethics Education in U.S. Allopathic Medical Schools: A National Survey of Medical School Deans and Ethics Course Directors.","authors":"Nicholas R Jarvis, Ellen C Meltzer, Jon C Tilburt, Lyndsay A Kandi, Yu-Hui H Chang, Elisabeth S Lim, Timothy J Ingall, Michael A Howard, Chad M Teven","doi":"10.1086/727433","DOIUrl":"10.1086/727433","url":null,"abstract":"AbstractPurpose: to characterize ethics course content, structure, resources, pedagogic methods, and opinions among academic administrators and course directors at U.S. medical schools.Method: An online questionnaire addressed to academic deans and ethics course directors identified by medical school websites was emailed to 157 Association of American Medical Colleges member medical schools in two successive waves in early 2022. Descriptive statistics were utilized to summarize responses.Results: Representatives from 61 (39%) schools responded. Thirty-two (52%) respondents were course directors; 26 (43%) were deans of academic affairs, medical education, or curriculum; and 3 with other roles also completed the survey (5%). All 61 schools reported some form of formal ethics education during the first year of medical school, with most (n = 54, 89%) reporting a formal mandatory introductory course during preclinical education. Schools primarily utilized lecture and small-group teaching methods. Knowledge-based examinations, attendance, and participation were most commonly used for assessment. A large majority regarded ethics as equally or more important than other foundational courses, but fewer (n = 37, 60%) provided faculty training for teaching ethics.Conclusions: Despite a response rate of 39 percent, the authors conclude that medical schools include ethics in their curricula in small-group and lecture formats with heterogeneity regarding content taught. Preclinical curricular redesigns must innovate and implement best practices for ensuring sound delivery of ethics content in future curricula. Additional large-scale research is necessary to determine said best practices.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"34 4","pages":"328-341"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138291972","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

Using Patient Quotations in Chart Notes: A Clinical Ethics Perspective. 在图表注释中使用病人语录:临床伦理学的视角。

Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/727438

Olivia Schuman, Haven Gabrielle Romero

引用次数: 0

Supporting and Contextualizing Pediatric ECMO Decision-Making Using a Person-Centered Framework. 使用以人为本的框架支持和情境化儿科ECMO决策。

Journal of Clinical Ethics Pub Date : 2023-01-01 DOI: 10.1086/726811

Julie M Aultman, Patricia L Raimer, Daniel H Grossoehme, Ryan A Nofziger, Adiaratou Ba, Sarah Friebert

{"title":"Supporting and Contextualizing Pediatric ECMO Decision-Making Using a Person-Centered Framework.","authors":"Julie M Aultman, Patricia L Raimer, Daniel H Grossoehme, Ryan A Nofziger, Adiaratou Ba, Sarah Friebert","doi":"10.1086/726811","DOIUrl":"10.1086/726811","url":null,"abstract":"AbstractThere is a critical need to establish a space to engage in careful deliberation amid exciting, important, necessary, and groundbreaking technological and clinical advances in pediatric medicine. Extracorporeal membrane oxygenation (ECMO) is one such technology that began in pediatric settings nearly 50 years ago. And while not void of medical and ethical examination, both the symbolic progression of medicine that ECMO embodies and its multidimensional challenges to patient care require more than an intellectual exercise. What we illustrate, then, is a person-centered framework that incorporates the philosophy and practice of palliative care and care-based ethical approaches. This person-centered framework is valuable for identifying and understanding challenges central to ECMO, guides collaborative decision-making, and recognizes the value of relationships within and between patients, families, healthcare teams, and others who impact and are impacted by ECMO. Specifically, this person-centered approach enables caregivers to provide compassionate and effective support in critical, and often urgent, situations where conflicts may emerge among healthcare team members, families, and other decision makers. By reflecting on three cases based on actual situations, we apply our person-centered framework and identify those aspects that were utilized in and informed this project. We aim to fill a current gap in the pediatric ECMO literature by presenting a person-centered framework that promotes caregiving relationships among hospitalized critically ill children, families, and the healthcare team and is supported through the philosophy and practice of palliative care and clinical ethics.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"34 3","pages":"245-257"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215392","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