Journal of Clinical Ethics最新文献_第8页

Adapting Clinical Ethics Consultations to Address Ethical Issues of Artificial Intelligence. 调整临床伦理咨询以解决人工智能的伦理问题。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734773

Benjamin X Collins, Shreya Bhatia, Joseph B Fanning

{"title":"Adapting Clinical Ethics Consultations to Address Ethical Issues of Artificial Intelligence.","authors":"Benjamin X Collins, Shreya Bhatia, Joseph B Fanning","doi":"10.1086/734773","DOIUrl":"https://doi.org/10.1086/734773","url":null,"abstract":"AbstractAs artificial intelligence (AI) becomes increasingly incorporated into the workflow of clinical practice, it will raise numerous ethical issues and lead to related clinical ethics consultations to address those issues. However, many of the ethical issues associated with AI feature fundamental distinctions from those currently encountered in clinical ethics consultations. Despite potential differences in the types of ethical issues precipitated by AI, little attention has been given to how to approach these issues when they need to be addressed in clinical ethics consultations. In this article, we provide a walkthrough on adapting clinical ethics consultations to look at these issues through an AI lens, which will allow us to recognize essential information and develop targeted questions that guide consultations toward appropriate decisions. We then provide three case studies exploring hypothetical scenarios based on real AI systems and how a clinical ethicist might guide the discussion of ethical issues presented by AI in each scenario. Following the case studies, we further discuss clinical AI in the context of clinical ethics consultations and conclude with a call for more attention to this area of increasing importance.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"167-183"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121106","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

DNAR Order Status Changes During Surgical Procedures: Intent Versus Practice. 手术过程中DNAR顺序状态的改变：意图与实践。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734768

Lily Johnson, Neil Manago, Michelle Cantillo, Sidney Johnson

{"title":"DNAR Order Status Changes During Surgical Procedures: Intent Versus Practice.","authors":"Lily Johnson, Neil Manago, Michelle Cantillo, Sidney Johnson","doi":"10.1086/734768","DOIUrl":"https://doi.org/10.1086/734768","url":null,"abstract":"AbstractIntroduction: The practice of automatic suspension of \"do not attempt resuscitation\" (DNAR) orders has been abandoned in favor of more nuanced discussions. We sought to assess the practical implementation of DNAR orders at our institution during surgery.Methods: This study conducted a retrospective review of DNAR practices, examining the records of 100 random patients with preexisting DNAR orders prior to surgery. The review documented any changes in DNAR status relative to surgery and then assessed whether the changes in DNAR status were carried forward into the electronic health record (EHR) as updated orders.Results: The DNAR status of patients with an existing DNAR order was documented as having been rediscussed in 85 percent of cases prior to surgical procedures or interventions requiring general anesthesia. That noted, there was no update in the EHR to the DNAR orders in 88 percent of these cases, suggesting a potential gap in desired care were an event requiring resuscitation to happen while under anesthesia.Conclusion: Our review indicates that while alterations in the DNAR wishes were often documented relative to anesthesia and surgery, the code status order was not consistently updated, leading to potential gaps in care. The findings underscore the need to standardize processes for updating DNAR status with order sets to ensure that the patient's wishes are accurately reflected during and after anesthesia or surgery.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"184-190"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121110","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

Factors Associated with Successful Intervention to Facilitate Completion of Advance Medical Directives: A Cross-Sectional Study. 成功干预以促进完成预先医疗指示的相关因素：一项横断面研究。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/736149

Alon Carney, Oksana Friedman, Yulia Treister-Goltzman

{"title":"Factors Associated with Successful Intervention to Facilitate Completion of Advance Medical Directives: A Cross-Sectional Study.","authors":"Alon Carney, Oksana Friedman, Yulia Treister-Goltzman","doi":"10.1086/736149","DOIUrl":"https://doi.org/10.1086/736149","url":null,"abstract":"AbstractEven in countries with a defined legal framework for advance directives (AD), the rates of completion are low. The goal of the present study was to assess whether intervention by means of a lecture by a family physician (FP) is effective for the facilitation of completion of AD by patients. A secondary aim was to assess the knowledge and attitudes of adults on AD. The intervention included an interactive lecture on AD by an FP in two villages in southern Israel. The success of the intervention was measured as completion of AD at primary care clinics over a three-month period after the intervention. Sixty-seven patients 17 years of age and older attended the lecture (1.0% vs. 19.0% for the religious and secular villages, respectively, p < .001). Ten participants (14.9%) completed AD within three months after the intervention (p = .002). Patients from both the secular and religious villages expected that their FP (74%) and/or an outpatient nurse (33%) would initiate the discussion on AD and commented that they would like the topic to be more prominent in the media. Intervention by means of an interactive lecture delivered by an FP in the community is an effective way to motivate patients to complete AD.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 3","pages":"286-294"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822819","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

Children as Living Solid Organ Donors: Ethical Discussion and Model Hospital Policy Statement. 儿童作为活体实体器官捐献者：伦理讨论和模范医院政策声明。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/733386

Gyan C Moorthy, Aidan P Crowley, Sandra Amaral

引用次数: 0

Dialogic Engagement and the Epistemic Norms of Bioethics Mediation. 对话参与和生物伦理调解的认知规范。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/737395

Julia Kolak, Adira Hulkower

{"title":"Dialogic Engagement and the Epistemic Norms of Bioethics Mediation.","authors":"Julia Kolak, Adira Hulkower","doi":"10.1086/737395","DOIUrl":"https://doi.org/10.1086/737395","url":null,"abstract":"AbstractThis article examines Nancy Dubler's pioneering work in bioethics mediation and its enduring impact on the Bioethics Consultation Service for Montefiore Medical Center. In its early formulations, Dubler's application of the techniques and skills of alternate dispute resolution arose directly from her attempt to procedurally grapple with the emotional, psychological, and interpersonal realities uncovered through direct encounters with patients, families, and medical providers in situ. In this article, we argue that the resulting emphasis on dialogic engagement and the firsthand identification of values within the methodology of bioethics mediation fundamentally alters the substance and process of ethics facilitation by changing how we communicate with stakeholders and the way in which we subsequently reason about and derive normative claims. In contrast to committee-based and non-bedside models of case consultation, we maintain that this shift toward an inclusive and deliberative approach to ethics consultation introduces important insights into what it means to be an epistemically responsible interlocuter at the bedside. After examining this question in relation to an adapted case study, we offer the claim that the discursive norms of bioethics mediation-grounded in the concept of speaking with rather than for others-underscore the transformative potential of dialogue, which remains Nancy Dubler's most enduring legacy.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 4","pages":"339-352"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543057","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

Honoring Chosen Family: Revisiting the Doctor-Proxy Relationship. 尊重选择的家庭：重新审视医生-代理关系。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/737391

Patrick D Herron

{"title":"Honoring Chosen Family: Revisiting the Doctor-Proxy Relationship.","authors":"Patrick D Herron","doi":"10.1086/737391","DOIUrl":"10.1086/737391","url":null,"abstract":"AbstractAmong her many scholarly contributions to the field of bioethics, Nancy Neveloff Dubler's exploration of the ethical, legal, and procedural dimensions of surrogate decision-making on behalf of persons who cannot make their own medical decisions has been the most impactful. In their 1999 publication \"The Doctor-Proxy Relationship: An Untapped Resource,\" Dubler and coauthors Linda Farber Post and Jeffrey Blustein examined the decision-making paradigm of patients, their physicians, and trusted family and friends of patients.1 The authors examined the historic dynamics supporting these collaborations and identified themes from focus groups with physicians and patient proxies. Recommendations put forth at the time to support patient proxies are reflected in well-established best practices and standards today. It is notable that there was no distinction made by the authors between those proxies related through kinship and those bonded through intimate relationships and friendships. Despite their appropriately inclusive recognition, many of the state guidelines establishing surrogate hierarchies systematically deprioritize friendships in favor of biological kinship or go so far as to exclude such individuals from being eligible to serve in these roles on behalf of patients, with whom they may have long-standing and well-established relationships defined by choice. Relying solely on traditional nuclear family structures denies the ethical legitimacy of chosen families and persons who may be best suited to make decisions for the patient.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 4","pages":"332-338"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543143","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

A Great Gift … with Great Caveats: Bioethics Mediation versus Bona Fide Mediation. 一份伟大的礼物……但要注意：生物伦理调解与善意调解。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/737397

E H Morreim

引用次数: 0

Surgeon Perspectives on Palliative Care: Are We the Barrier to Better Care? 外科医生对姑息治疗的看法：我们是更好治疗的障碍吗？

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/736145

Sean J Donohue, Baddr A Shakhsheer, Peter Phung, Anthony W Kim, Monica Zell, Sean C Wightman

{"title":"Surgeon Perspectives on Palliative Care: Are We the Barrier to Better Care?","authors":"Sean J Donohue, Baddr A Shakhsheer, Peter Phung, Anthony W Kim, Monica Zell, Sean C Wightman","doi":"10.1086/736145","DOIUrl":"https://doi.org/10.1086/736145","url":null,"abstract":"AbstractSurgeons face numerous perioperative challenges when caring for patients with life-threatening or chronic diseases. Although palliative care teams are uniquely poised to aid in the supportive approach to such holistic needs, they are underutilized by surgical services. Palliative care has been associated with an average reduction of $3,237 per admission, as well as reduction in emergency department visits, hospital admissions, and hospital length of stay. For patients within the intensive care setting, palliative interventions have shown a 26 percent relative risk reduction in intensive care unit length of stay and overall alignment of patients' and families' goals of care. However, there is a paucity of data surrounding outcomes associated with palliative care in surgery. It remains pervasive in surgical culture that operative intervention and palliation are mutually exclusive and occur sequentially, rather than concurrently. The majority (76.1%) of surgeons have no formal education in palliative care and feel burdened with the unrealistic expectations for patient outcomes after surgical intervention (61.8%). These cultural and knowledge barriers have significant impact on surgical palliative care referrals and team-based care. Preoperative palliative care consultations in surgical patients occur less than 1 percent of the time. Preoperative palliative care may serve to help explore, clarify, and document quality-of-life values and preferences, in hopes of better promoting goal-concordant care. We recommend implementing frailty-score-based risk assessments to refer surgical patients to palliative care consultation preoperatively. Normalizing referral to palliative care can help surgeons embrace its potential benefit in patient care and improve utilization.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 3","pages":"279-285"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822825","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

Incorporating Structural Competency into Clinical Ethics: Piloting New Bioethics Education. 将结构能力纳入临床伦理学：探索新的生命伦理学教育。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734776

Sara Kolmes, Ariana Thompson-Lastad, Kevin Dirksen, Kayla Tabari, Seth M Holmes

{"title":"Incorporating Structural Competency into Clinical Ethics: Piloting New Bioethics Education.","authors":"Sara Kolmes, Ariana Thompson-Lastad, Kevin Dirksen, Kayla Tabari, Seth M Holmes","doi":"10.1086/734776","DOIUrl":"https://doi.org/10.1086/734776","url":null,"abstract":"AbstractThe Liaison Committee on Medical Education recently adopted structural competency, an approach to understanding and responding to social factors in health and healthcare, as a required part of medical training. We have found that structural competency education shows promise for graduate and continuing bioethics education as well. In postgraduate bioethics education, structural competency focuses on the practical skills of identifying where social forces impact specific patients and how clinicians can respond. This can support clinical ethicists in their attempts to help clinicians identify, understand, and respond to ethical dilemmas caused by social forces, for example, the ways in which resource availability may influence a patient's opportunities and health options, and the impact of the built environment on the health hazards people encounter. We describe how one clinical ethics program integrated structural competency into bioethics education for medical residents and other clinicians. This structural competency education pilot received extremely positive feedback from participating clinicians. Ninety-seven percent of those who responded to evaluation surveys identified structural competency as \"valuable\" or \"very valuable\" to their clinical practice. When providing feedback on this education, clinicians described immediately incorporating structural competency strategies in ethically difficult patient care situations. We present a case study shared and developed by clinicians using these strategies to improve patient care. This practical use of structural competency education suggests that there may be benefits to integrating this approach into bioethics education. We suggest next steps for bioethics educators to further examine these educational strategies following our promising pilot.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 2","pages":"158-166"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121118","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

Letter to the Editor. 给编辑的信。

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI: 10.1086/734777

引用次数: 0