IF 1.6 4区哲学

Hec Forum Pub Date : 2026-10-15 DOI: 10.1007/s10730-026-09619-3

Fábio R Cabar, Rafaela A da Costa

{"title":"Bioethical Deliberation in Gestational Diabetes Management: Integrating Diego Gracia's Model into Clinical Ethics Consultation and Institutional Policy.","authors":"Fábio R Cabar, Rafaela A da Costa","doi":"10.1007/s10730-026-09619-3","DOIUrl":"https://doi.org/10.1007/s10730-026-09619-3","url":null,"abstract":"Gestational diabetes mellitus (GDM) sits at the intersection of maternal bodily integrity, fetal risk mitigation, and healthcare equity, and rigid guideline enforcement can trigger bedside conflicts and institutional friction. This article examines GDM management through the deliberative model of the Spanish physician and philosopher Diego Gracia, influential in Southern Europe and Latin America but less familiar in North America, which separates moral duties into Level I (Non-Maleficence and Justice) and Level II (Autonomy and Beneficence). We explain why we start from Gracia rather than from Beauchamp and Childress: his model couples a defeasible ordering of duties with an explicit deliberative procedure that institutions can teach and document. We then argue against a misreading of the model in perinatal care that places fetal protection at Level I and maternal decision-making at Level II. Maternal bodily integrity and informed refusal also engage Level I non-maleficence duties, so bedside conflicts are better understood as clashes between two Level I obligations. We extend this reframing by translating Gracia's deliberative steps into a consultation protocol for Healthcare Ethics Committees (HECs), by using international variation in metformin's regulatory standing to show that pharmacological choice involves value judgments, and by treating access to glucose self-monitoring supplies as a matter of distributive justice. A hypothetical, composite vignette illustrates the protocol. The proposals are conceptual and untested; we suggest that structured deliberation may help institutions honor maternal self-determination without abandoning fetal interests.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Who Diagnoses Irreversible Dying? The Irreversible Dying Transition and Medical Responsibility Before Death. 谁诊断不可逆转的死亡？不可逆转的死亡过渡与死亡前的医疗责任。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-10-10 DOI: 10.1007/s10730-026-09618-4

Minoru Matsui

{"title":"Who Diagnoses Irreversible Dying? The Irreversible Dying Transition and Medical Responsibility Before Death.","authors":"Minoru Matsui","doi":"10.1007/s10730-026-09618-4","DOIUrl":"https://doi.org/10.1007/s10730-026-09618-4","url":null,"abstract":"Medicine assigns clear professional responsibility for determining and certifying death, but responsibility for determining when irreversible dying has begun is often less clearly assigned. This paper proposes the irreversible dying transition (IDT) as the point at which no medically reasonable intervention can restore a sustainable life-preserving clinical state. IDT is distinct from prognosis, terminal illness, actively dying, the futility of a particular intervention, and decisions to limit treatment. Its purpose is not to introduce another diagnostic label, but to make explicit a specific medical judgment about reversibility that may otherwise remain implicit. The framework distinguishes a life-preservable clinical state, IDT, the irreversible dying process, and death. It argues that when irreversible dying is reasonably in question, a clearly designated physician should assess whether IDT is established, not established, or indeterminate, while drawing on multidisciplinary information and remaining open to reassessment. Shared decision-making cannot substitute for this assessment because patients and families may choose among medically available options but should not be required to determine which options remain restorative. Long-term care settings in Japan provide one practical illustration of this distinction. When physicians are unavailable or involved mainly at the point of death, nurses, care workers, and families may make consequential decisions about transfer, treatment, and continued facility care without a prior medical determination of reversibility. IDT makes clear where responsibility for this judgment lies. Safeguards are required against premature diagnosis, self-fulfilling prophecy, age and disability bias, nominal compliance, and conflation with treatment withdrawal. The concept therefore clarifies a limited but important responsibility: medicine should explicitly address whether irreversible dying has begun, rather than leaving this responsibility to become apparent only after death.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Complete Ectogenesis, Parental Love, and Human Flourishing: A Confucian Critique. 完整的生殖、父母之爱与人类繁荣：一个儒家批判。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-10-04 DOI: 10.1007/s10730-026-09617-5

Jue Wang, Qin Hu, Ruiping Fan

引用次数: 0

Professional Socialization and Competency-Based Role Development in Clinical Ethics. 临床伦理学的职业社会化与胜任力角色发展。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-09-23 DOI: 10.1007/s10730-026-09614-8

Renee McLeod-Sordjan

{"title":"Professional Socialization and Competency-Based Role Development in Clinical Ethics.","authors":"Renee McLeod-Sordjan","doi":"10.1007/s10730-026-09614-8","DOIUrl":"https://doi.org/10.1007/s10730-026-09614-8","url":null,"abstract":"This essay argues that the professional formation of clinical ethicists should be neither reduced to technical competency nor equated with possession of authoritative moral answers. In conditions of reasonable moral pluralism, the distinct professional identity of the clinical ethicist is better grounded in a disciplined practice: rigorous ethical analysis, transparent reason-giving, role clarity, respect for affected persons, attention to power and exclusion, and a willingness to revise judgments. I define professional moral humility as recognition of the fallibility and situated character of one's normative judgment while retaining the responsibility to make reasoned recommendations when warranted. This posture responds to a central concern about professionalization: credentials can be mistaken for authority to settle contested moral questions. Humility does not require moral skepticism, relativism, or value-neutral facilitation. Rather, it requires consultants to identify the normative premises of their recommendations, distinguish professional and legal constraints from contestable moral judgments, engage credible counterarguments, and remain open to correction. Building on current professional standards and recent empirical data about ethics consultation services and fellowship training, the essay proposes a competency-based approach that links observable consultation skills with longitudinal professional identity formation. Teaching strategies include mentored case participation, structured reflection, interprofessional simulation, and formative standardized encounters. A developmental rubric operationalizes humility, reason-giving, role integrity, justice-sensitive inquiry, reflective practice, and professional leadership. Professionalizing clinical ethics is justified not because ethicists possess the moral truth, but because patients, families, clinicians, and institutions benefit from accountable practitioners trained to reason publicly, listen seriously, and act within defensible professional limits.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Family Veto in Presumed-Consent Organ Donation: Procedural Standing Without Substantive Override. 假定同意器官捐献中的家庭否决权：没有实质推翻的程序地位。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-09-23 DOI: 10.1007/s10730-026-09616-6

Kennedy Chun Yin Kong

{"title":"The Family Veto in Presumed-Consent Organ Donation: Procedural Standing Without Substantive Override.","authors":"Kennedy Chun Yin Kong","doi":"10.1007/s10730-026-09616-6","DOIUrl":"https://doi.org/10.1007/s10730-026-09616-6","url":null,"abstract":"Most jurisdictions that have adopted presumed consent for deceased organ donation have simultaneously retained a family veto: where relatives object, retrieval does not proceed, even where the deceased registered a decision to donate. This article argues that the combination cannot be justified on any of the rationales offered for presumed consent itself. If the policy is defended as producing fewer frustrated wishes than an opt-in default, the veto substitutes a third party's preference for the person's own, and does so most often in the very class of cases the default governs; if it is defended on non-consensual grounds - the wrongfulness of refusal, or the claims of those awaiting transplant - the family's preferences have no standing at all. Disclosure does not dissolve the difficulty: telling registrants that relatives may object supplies no justification for the veto, leaves them no means of securing their decision, and, if complete, removes the ground on which the default was adopted. Three defences of the veto are then examined. The claim that the deceased has no interests to be set back is unavailable to defenders of the present arrangement; the burdens families bear ground support rather than authority; and public trust yields a defeasible institutional reason rather than a conferred power. A procedural-substantive distinction is proposed that preserves the family's evidentiary and supportive role while withdrawing the override.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Patient Participation in Moral Case Deliberation: Evaluating the Dynamics of Shared Reflection in a Mental Healthcare Setting in Türkiye. 患者参与道德案例审议：评估<s:1> rkiye精神卫生保健环境中共同反思的动态。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-09-16 DOI: 10.1007/s10730-026-09613-9

Mustafa Volkan Kavas, Damla Sayar Akaslan, Bert A C Molewijk

{"title":"Patient Participation in Moral Case Deliberation: Evaluating the Dynamics of Shared Reflection in a Mental Healthcare Setting in Türkiye.","authors":"Mustafa Volkan Kavas, Damla Sayar Akaslan, Bert A C Molewijk","doi":"10.1007/s10730-026-09613-9","DOIUrl":"https://doi.org/10.1007/s10730-026-09613-9","url":null,"abstract":"Clinical ethics support services (CESS) have traditionally centered on healthcare professionals (HCPs), leaving the patient participation (PP) as a subject of controversy. This paper evaluates the practical and dialogical dynamics of a patient-participatory moral case deliberation (MCD). We analyze a MCD session conducted in a Turkish psychiatric hospital using the Dilemma Method. The group-comprising the facilitator, the case presenter (a senior psychiatrist), seven mental health professionals including a nurse and a clinical psychologist, and the patient herself-deliberated on a complex moral dilemma: whether to disclose a long-held family secret regarding the patient's biological motherhood to her adult son, balancing potential psychological harms against truth-telling and rights. The patient's active presence shifted the team's focus from clinical-prognostic routines to the core moral question, fostered shared agency, and prompted the attending physician to re-evaluate his professional priorities. Emotional expressions during the session added human dimension, while providing the patient with a reflective distance to process her own narrative within a supportive, non-paternalistic environment. Direct PP in MCD can enhance contextual understanding, dissolve paternalistic barriers, and foster shared ownership of concrete action plans. To avoid symbolic participation or potential harm, CESS providers must ensure preliminary scoping, maintain psychological safety, and guard against patient instrumentalization.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Changing "Hats": Benefits, Challenges, and Best Practice Proposals for Dual-Role Clinical Ethicists. 改变“帽子”：双重角色临床伦理学家的利益、挑战和最佳实践建议。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-09-16 DOI: 10.1007/s10730-026-09615-7

Holland Kaplan, Brenda Barnum, Akilah Burford, Ryan Nelson, Joan Henriksen

{"title":"Changing \"Hats\": Benefits, Challenges, and Best Practice Proposals for Dual-Role Clinical Ethicists.","authors":"Holland Kaplan, Brenda Barnum, Akilah Burford, Ryan Nelson, Joan Henriksen","doi":"10.1007/s10730-026-09615-7","DOIUrl":"https://doi.org/10.1007/s10730-026-09615-7","url":null,"abstract":"Clinical ethics consultation has become increasingly professionalized, yet many ethics consultants continue to maintain active clinical practice as physicians, nurses, or social workers. Despite the prevalence of these dual-role clinical ethicists, the benefits, challenges, and best practices associated with this model remain underexplored. Drawing on the experiences of physician-, nurse-, and social worker-ethicists, we examine how dual-role ethicists approach the intersection of clinical care and ethics consultation. We highlight key strengths of the dual-role model, including enhanced clinical insight, pragmatic ethical analysis, professional credibility, and the ability to translate between clinical and ethical domains. We also explore challenges, including role conflict, boundary ambiguity, conflicts of interest, rollover of professional norms from the clinical role into the ethics role, hierarchical barriers, and concerns regarding accountability and liability. These tensions require dual-role ethicists to continuously negotiate competing professional identities and responsibilities. Lastly, we propose best practices for both individual clinicians and healthcare organizations, emphasizing role clarification, conflict-of-interest management, role-conscious communication skills, and the benefits of multidisciplinary ethics practice, mentorship, protected time, and institutional support.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ketamine-Induced Dissociation as an Ethical Signal, Not a Side Effect: Context as the Determinant of Clinical Duties Under Beneficence and Non-maleficence. 氯胺酮诱导解离作为一个伦理信号，而不是副作用：环境作为临床责任的决定因素在善意和非恶意。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-09-09 DOI: 10.1007/s10730-026-09611-x

Gun Moon, Jack Noto, Zachary Shuler, Bryan Pilkington

{"title":"Ketamine-Induced Dissociation as an Ethical Signal, Not a Side Effect: Context as the Determinant of Clinical Duties Under Beneficence and Non-maleficence.","authors":"Gun Moon, Jack Noto, Zachary Shuler, Bryan Pilkington","doi":"10.1007/s10730-026-09611-x","DOIUrl":"https://doi.org/10.1007/s10730-026-09611-x","url":null,"abstract":"Ketamine has emerged as an important intervention in contemporary psychiatry, yet its acute dissociative effects remain ethically under-theorized. Clinical approaches often frame dissociation as either a liability to minimize or a therapeutic feature to promote, but both views oversimplify a context-dependent phenomenon. We propose that ketamine-induced dissociation is better understood as an ethically salient signal whose significance is shaped by patient vulnerability, dosing, preparatory framing, interpersonal support, and post-session integration. Using a framework grounded in beneficence and non-maleficence, we conceptualize dissociation not as a neutral side effect but as a predictable alteration of subjectivity that may orient patients toward harm or therapeutic possibility. We distinguish two clinically meaningful trajectories: the dysphoric trajectory of dissociative experience, characterized by threat appraisal and foreseeable psychological harm, and the integrative trajectory of dissociative experience, characterized by meaningful or generative appraisal that may permit emotional reappraisal and meaning-making. We advance a dual-trajectory model in which clinical context shapes these outcomes, supporting proportionate safeguards rather than categorical exclusion and informing consent, risk assessment, and intervention design.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ethics Consultation and Mental Health of Women Undergoing IVF-Treatments. 试管受精妇女的伦理咨询与心理健康

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-09-01 Epub Date: 2025-12-29 DOI: 10.1007/s10730-025-09575-4

Jie Chen

引用次数: 0

Telling is Caring: Prioritizing the Best Interests of Dying Children. 诉说即关怀：优先考虑临终儿童的最大利益。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-09-01 Epub Date: 2026-04-04 DOI: 10.1007/s10730-026-09584-x

Stella Mosetti

引用次数: 0

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