IF 1.3 4区哲学

Hec Forum Pub Date : 2025-07-02 DOI: 10.1007/s10730-025-09554-9

Bryanna Moore, Shalom Schlagman, Laine E DiNoto, David C Kaufman, Nicholas Mercado, Michael J Nabozny, Marjorie Hodges Shaw

{"title":"\"Don't Tell Them Anything\": Should Surrogate Decision-Makers Be Allowed to Withhold Information from Other Family Members or Prevent Them from Visiting with a Patient?","authors":"Bryanna Moore, Shalom Schlagman, Laine E DiNoto, David C Kaufman, Nicholas Mercado, Michael J Nabozny, Marjorie Hodges Shaw","doi":"10.1007/s10730-025-09554-9","DOIUrl":"https://doi.org/10.1007/s10730-025-09554-9","url":null,"abstract":"While patients have the right to control who has access to their health information and designate visitors, it is not always clear whether-when a patient lacks capacity-their surrogate also exercises such rights. States and federal laws are often vague about the limits of surrogate authority. Even where legal or institutional guidance on this issue is clear, requests by surrogates to withhold information or restrict visitation with a patient can be a source of ethical uncertainty and distress on the part of the clinical team. This paper explores the ethical issues raised by such requests. To date, there has been little exploration of this issue in the clinical ethics literature. First, we summarize the scant existing ethical and legal guidance on this issue. Second, we present two potential approaches to navigating requests from surrogates to withhold information or restrict visitation. Third, we discuss the merits and limitations of both approaches, and introduce some additional considerations that further complicate the picture. We argue for a flexible restrictive approach to information-sharing, and a constrained permissive approach to visitation. Finally, we propose several considerations that clinicians and clinical ethicists might think through in these situations to help guide their practice.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545370","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

Moral reasoning during vascular surgeons' case conferences: finding the balance of risk and benefit by exploring the clinical details. 血管外科医生病例会议中的道德推理：通过探讨临床细节找到风险与收益的平衡。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-06-25 DOI: 10.1007/s10730-025-09550-z

Kaja Heidenreich, Marit Karlsson, Anders Bremer, Mia Svantesson

引用次数: 0

MAiD: How Slippery is its Slope? 服务员：它的斜坡有多滑？

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-06-13 DOI: 10.1007/s10730-025-09551-y

Tom Koch

引用次数: 0

An Ethics Consult Documentation Simplification Project: Summation of Participatory Processes, User Perceptions, and Subsequent Use Patterns. 伦理咨询文件简化项目：对参与过程、用户感知和后续使用模式的总结。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-06-01 Epub Date: 2024-10-10 DOI: 10.1007/s10730-024-09537-2

Meaghann S Weaver, Anita J Tarzian, Hannah N Hester, Karinne R Davidson, Rodney P Dismukes, Mary Beth Foglia

{"title":"An Ethics Consult Documentation Simplification Project: Summation of Participatory Processes, User Perceptions, and Subsequent Use Patterns.","authors":"Meaghann S Weaver, Anita J Tarzian, Hannah N Hester, Karinne R Davidson, Rodney P Dismukes, Mary Beth Foglia","doi":"10.1007/s10730-024-09537-2","DOIUrl":"10.1007/s10730-024-09537-2","url":null,"abstract":"Healthcare ethics consultants in the Veterans Health Administration (VHA) document consults in an enterprise-wide web-based database entitled IEWeb, serving as a system of record for healthcare ethics documentation at 1300 VA facilities. The need arose to evolve the database from an ethics process training resource into a more streamlined documentation repository that captures essential consult elements. A VHA National Center for Ethics in Health Care (NCEHC) Improvement Team convened for three tasks: (1) Specify and prioritize IEWeb changes (occurred via six focus groups composed of \"new user\" and \"super user\" cohorts with analysis of existing documentation patterns); (2) Pilot the changes regionally (via regional communication, training, and reviews of pre-post use patterns); and (3) Measure the impact of national change implementation on user perspectives (via pre-and post-change implementation polls). Focus groups identified six implementable priority areas for ethics consult documentation improvement, including the development of a usable consult summary note for ready conversion from IEWeb fields into the electronic health record. Post-IEWeb updates showed an increased number of consults documented, a reduction in \"time to consult documentation closure\" by a mean of 4.5 days, and a clinically-meaningful improvement in the quality of documentation (78% of ethics questions scored \"above-bar\" on the validation tool pre- vs. 89% scored \"above-bar\" post-IEWeb changes, n = 140). According to national survey findings, the number of consultants documenting \"all\" consults in IEWeb increased, satisfaction increased, and perception of documentation difficulty decreased. IEWeb simplification enabled ethics consultants to re-focus their documentation completion efforts by decreasing perception of documentation burden while improving documentation frequency and quality in a clinically-meaningful way.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"249-265"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477395","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

Against Anti-Abortion Violence. 反对反堕胎暴力。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-06-01 Epub Date: 2024-05-14 DOI: 10.1007/s10730-024-09531-8

William Simkulet

引用次数: 0

On What Grounds? A Pilot Study of References Used in Clinical Ethics Consultation and Education. 依据是什么？临床伦理咨询和教育中使用的参考文献的试点研究。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-06-01 Epub Date: 2024-05-31 DOI: 10.1007/s10730-024-09532-7

Kelly Turner, Abram Brummett, Erica Salter

{"title":"On What Grounds? A Pilot Study of References Used in Clinical Ethics Consultation and Education.","authors":"Kelly Turner, Abram Brummett, Erica Salter","doi":"10.1007/s10730-024-09532-7","DOIUrl":"10.1007/s10730-024-09532-7","url":null,"abstract":"In accordance with standards published by the American Society for Bioethics and Humanities (ASBH), ethics consultants are expected to provide recommendations that align with scholarly literature, professional society statements, law, and policy. However, there are no studies to date that characterize the specific references that ethics consultants and educators use to inform their work. To address this gap, a convenience sample of clinical ethics consultants and educators was surveyed online through two major listservs for clinical ethics, the ASBH Clinical Ethics Consultation Affinity Group (CECAG) and the Association of Bioethics Program Directors (ABPD). Ninety-five ethics consultants and/or educators with diverse educational background, credentials, and experience provided responses. In total, 451 references, 315 of which were unique, were reported. These references were broken into 6 categories after analysis: bioethics literature (divided into articles and books), professional society documents (divided into professional society statements and codes of ethics), federal/state/uniform/case law, hospital/health system policies, official religious teachings, and other. We found extensive variation and minimal overlap in the references respondents used for ethics consultation and education, even when referring to the same topics. Future research directions should include conducting more systematic efforts to characterize the references used by ethics consultants across the US; determining whether demographic characteristics of consultants influence the references used; and ascertaining whether the variation in references used reflects genuine disagreements in consultants' and educators' bioethical analysis or recommendations.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"159-177"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141179463","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 Ethics of Human Embryo Editing via CRISPR-Cas9 Technology: A Systematic Review of Ethical Arguments, Reasons, and Concerns. 通过 CRISPR-Cas9 技术进行人类胚胎编辑的伦理问题：对伦理论点、原因和担忧的系统回顾》。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-06-01 Epub Date: 2024-09-20 DOI: 10.1007/s10730-024-09538-1

Lindsay Wiley, Mattison Cheek, Emily LaFar, Xiaolu Ma, Justin Sekowski, Nikki Tanguturi, Ana Iltis

引用次数: 0

Review of Outpatient Pediatric Ethics Consults at an Academic Medical Center. 学术医学中心儿科伦理咨询门诊回顾。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-06-01 Epub Date: 2024-08-22 DOI: 10.1007/s10730-024-09536-3

George E Freigeh, Hannah Fagen, Janice Firn

{"title":"Review of Outpatient Pediatric Ethics Consults at an Academic Medical Center.","authors":"George E Freigeh, Hannah Fagen, Janice Firn","doi":"10.1007/s10730-024-09536-3","DOIUrl":"10.1007/s10730-024-09536-3","url":null,"abstract":"Limited data exist in the specific content of pediatric outpatient ethics consults as compared to inpatient ethics consults. Given the fundamental differences in outpatient and inpatient clinical care, we aimed to describe the distinctive nature of ethics consultation in the ambulatory setting. This is a retrospective review at a large, quaternary academic center of all outpatient ethics consults in a 6-year period. Encounter-level demographic data was recorded, and primary ethical issue and contextual features were identified using qualitative conceptual content analysis. A total of 48 consults were identified representing 44 unique patients. The most common primary ethical issue was beneficence and best interest concern comprising 20 (42%) consults, followed by refusal of recommended treatment comprising 11 (23%) consults and patient preference/assent comprising 5 (10%) consults. The most common contextual features were staff-family communication dispute/conflict comprising 28 (58%) consults, followed by legal involvement comprising 25 (52%) consults and quality of life comprising 19 (40%) consults. The most common consulting specialty was hematology/oncology. Ethical issues encountered in the provision of outpatient pediatric care are distinct and differ from those in inpatient consults. Further research is necessary to identify strategies and educational gaps in outpatient ethics consultation to increase its effectiveness and utilization.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"235-247"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019100","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 Structure of Clinical Ethical Decision-Making: A Hospital System Needs Assessment. 临床伦理决策的结构：医院系统需求评估。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-06-01 Epub Date: 2024-06-08 DOI: 10.1007/s10730-024-09534-5

Leana G Araujo, Martin Shaw, Edwin Hernández

{"title":"The Structure of Clinical Ethical Decision-Making: A Hospital System Needs Assessment.","authors":"Leana G Araujo, Martin Shaw, Edwin Hernández","doi":"10.1007/s10730-024-09534-5","DOIUrl":"10.1007/s10730-024-09534-5","url":null,"abstract":"Bioethical dilemmas can emerge in research and clinical settings, from end-of-life decision-making to experimental therapies. The COVID-19 pandemic raised serious ethical challenges for healthcare organizations, highlighting the need to conduct needs assessments of the bioethics infrastructures of healthcare organizations. Clinical ethics committees (CECs) also create equitable policies, train staff on ethics issues, and play a consultative role in resolving the difficulty of complex individual cases. The main objective of this project was to conduct a needs assessment of the bioethics infrastructure within a comprehensive hospital system. A cross-sectional anonymous online survey, including quantitative and qualitative formatted questions. The survey was sent to five key leaders from the organization's hospitals. Survey questions focused on the composition, structure, function, and effectiveness of their facilities' bioethics infrastructure and ethics-related training and resources. Positive findings included that most facilities have active CECs with multidisciplinary membership; CECs address critical issues and encourage team members to express clinical ethics concerns. Areas of concern included uncertainty about how CECs function and the process for resolving clinical ethics dilemmas. Most reported no formal orientation process for CEC members, and many said there was no ongoing ethics education process. The authors conclude that if CECs are a critical institutional resource where the practice of medicine and mission intersect, having well-functioning ethics committees with trained and oriented members demonstrates an essential commitment to the mission. The survey revealed that more needs to be done to bolster the bioethics infrastructure of this institution.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"203-216"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293815","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

Everyday Clinical Ethics: Essential Skills and Educational Case Scenarios. 日常临床伦理：基本技能和教育案例情景。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-06-01 Epub Date: 2024-07-09 DOI: 10.1007/s10730-024-09533-6

Elaine C Meyer, Giulia Lamiani, Melissa Uveges, Renee McLeod-Sordjan, Christine Mitchell, Robert D Truog, Jonathan M Marron, Kerri O Kennedy, Marilyn Ritholz, Stowe Locke Teti, Aimee B Milliken

{"title":"Everyday Clinical Ethics: Essential Skills and Educational Case Scenarios.","authors":"Elaine C Meyer, Giulia Lamiani, Melissa Uveges, Renee McLeod-Sordjan, Christine Mitchell, Robert D Truog, Jonathan M Marron, Kerri O Kennedy, Marilyn Ritholz, Stowe Locke Teti, Aimee B Milliken","doi":"10.1007/s10730-024-09533-6","DOIUrl":"10.1007/s10730-024-09533-6","url":null,"abstract":"Bioethics conjures images of dramatic healthcare challenges, yet everyday clinical ethics issues unfold regularly. Without sufficient ethical awareness and a relevant working skillset, clinicians can feel ill-equipped to respond to the ethical dimensions of everyday care. Bioethicists were interviewed to identify the essential skills associated with everyday clinical ethics and to identify educational case scenarios to illustrate everyday clinical ethics. Individual, semi-structured interviews were conducted with a convenience sample of bioethicists. Bioethicists were asked: (1) What are the essential skills required for everyday clinical ethics? And (2) What are potential educational case scenarios to illustrate and teach everyday clinical ethics? Participant interviews were analyzed using qualitative content analysis. Twenty-five (25) bioethicists completed interviews (64% female; mean 14.76 years bioethics experience; 80% white). Five categories of general skills and three categories of ethics-specific skills essential for everyday clinical ethics were identified. General skills included: (1) Awareness of Core Values and Self-Reflective Capacity; (2) Perspective-Taking and Empathic Presence; (3) Communication and Relational Skills; (4) Cultural Humility and Respect; and (5) Organizational Understanding and Know-How. Ethics-specific skills included: (1) Ethical Awareness; (2) Ethical Knowledge and Literacy; and (3) Ethical Analysis and Interaction. Collectively, these skills comprise a Toolbox of Everyday Clinical Ethics Skills. Educational case scenarios were identified to promote everyday ethics. Bioethicists identified skills essential to everyday clinical ethics. Educational case scenarios were identified for the purpose of promoting proficiency in this domain. Future research could explore the impact of integrating educational case scenarios on clinicians' ethical competencies.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"179-201"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560039","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

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