IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-27 DOI: 10.1007/s10730-024-09545-2

Hunter Bissette, Dario Cecchini, Ryan Sterner, Elizabeth Eskander, Veljko Dubljević

引用次数: 0

Surrogate Wars: The "Best Interest Values" Hierarchy & End-of-Life Conflicts with Surrogate Decision-Makers. 代理战争：“最佳利益价值”等级制度和与代理决策者的临终冲突。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-26 DOI: 10.1007/s10730-024-09546-1

Autumn Fiester

{"title":"Surrogate Wars: The \"Best Interest Values\" Hierarchy & End-of-Life Conflicts with Surrogate Decision-Makers.","authors":"Autumn Fiester","doi":"10.1007/s10730-024-09546-1","DOIUrl":"https://doi.org/10.1007/s10730-024-09546-1","url":null,"abstract":"Conflicts involving end-of-life care between healthcare providers (HCPs) and surrogate decision-makers (SDMs) have received sustained attention for more than a quarter of a century, with early studies demonstrating a frequency of HCP-SDM conflict in ICUs ranging from 32-78% of all admissions (Abbott et al. 2001; Breen et al. 2001; Studdert et al. 2003; Azoulay et al. 2009). More recent studies not only acknowledge the persistence of clinical conflict in end-of-life care (Leland et al. 2017), but they have begun to focus on the ways in which these conflicts escalate to verbal or physical violence in the ICU (Slack et al. 2023; Bass et al. 2024; Berger et al. 2024; Sjöberg et al. 2024). I will argue that part of the explanation for the persistence-and even escalation-of ICU disputes is the incommensurable value systems held by many conflicting HCPs and SDMs. I will argue that a common value system among HCPs can be understood as a \"Best Interest Values\" (BIV) hierarchy, which I will argue is irreconcilable with the set of \"Life-Continuation Values\" (LCV) held by a sizable minority of families in the United States. I argue this values-conflict undergirds many ICU disputes. If I am correct that an incommensurable value system underlies many ICU conflicts, then it is not just ineffectual for HCPs to impose their BIV system on LCV families, but also wrong given the American commitment to values pluralism. I conclude that the way to navigate continuous ICU surrogate wars is for BIV-focused healthcare institutions to engage more constructively with LCV stakeholders.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899262","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

Medical Assistance in Dying, Slippery Slopes, and Availability of Care: A Reply to Koch. 死亡中的医疗援助、滑坡和护理的可用性：对科赫的回复。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-09 DOI: 10.1007/s10730-024-09543-4

Don A Merrell

引用次数: 0

Creating Barriers to Healthcare and Advance Care Planning by Requiring Hospitals to Ask Patients About Their Immigration Status. 通过要求医院询问患者的移民身份，为医疗保健和提前护理计划制造障碍。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-07 DOI: 10.1007/s10730-024-09542-5

Cathy L Purvis Lively

{"title":"Creating Barriers to Healthcare and Advance Care Planning by Requiring Hospitals to Ask Patients About Their Immigration Status.","authors":"Cathy L Purvis Lively","doi":"10.1007/s10730-024-09542-5","DOIUrl":"https://doi.org/10.1007/s10730-024-09542-5","url":null,"abstract":"Florida is currently collecting data on the \"costs of uncompensated care for aliens who are not lawfully present in the U.S.\" (Statutes of Florida, 2023). The Florida data collection law, enacted in 2023, is part of aggressive anti-immigrant legislation. Hospitals accepting Medicaid must inquire about patients' immigration status and submit de-identified reports. In August 2024, the Governor of Texas signed an Executive Order comparable to the Florida statute. Although presented as a data-collection measure, the legal requirements have far-reaching consequences. The potential adverse impacts on immigrants' health pose bioethical concerns. Immigration-related inquiries create barriers to healthcare access and advance care planning, exacerbating healthcare disparities and presenting ethical concerns. This article examines the effects on immigrants and the resulting ethical challenges, including respect for persons, beneficence, non-maleficence, and justice. The article proposes recommendations for mitigating these challenges, including community outreach, patient education, policy development, in-service education, and advocacy. While the legal requirements apply specifically to Florida and Texas, the ethical issues have nationwide relevance.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792646","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

Organizational Ethics in Healthcare: A National Survey. 医疗保健领域的组织伦理：全国调查。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-01 Epub Date: 2024-01-17 DOI: 10.1007/s10730-023-09520-3

Kelly Turner, Tim Lahey, Becket Gremmels, Jason Lesandrini, William A Nelson

{"title":"Organizational Ethics in Healthcare: A National Survey.","authors":"Kelly Turner, Tim Lahey, Becket Gremmels, Jason Lesandrini, William A Nelson","doi":"10.1007/s10730-023-09520-3","DOIUrl":"10.1007/s10730-023-09520-3","url":null,"abstract":"Organizational ethics-defined as the alignment of an institution's practices with its mission, vision, and values-is a growing field in health care not well characterized in empirical literature. To capture the scope and context of organizational ethics work in United States healthcare institutions, we conducted a nationwide convenience survey of ethicists regarding the scope of organizational ethics work, common challenges faced, and the organizational context in which this work is done. In this article, we report substantial variability in the structure of organizational ethics programs and the settings in which it is conducted. Notable findings included disagreement about the activities that comprise organizational ethics and a lack of common metrics used to assess organizational ethics activities. A frequently cited barrier to full engagement in these activities was poor institution-wide understanding about the role and function of organizational ethics resources. These data suggest a tension in the trajectory of organizational ethics' professionalization: while some variability is appropriate to the field's relative youth, inadequate attention to definitions of organizational ethics practice and metrics for success can impede discussions about appropriate institutional support, leadership context, and training for practitioners.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"559-570"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139477970","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

Medical-Legal Partnerships and Prevention: Caring for Unrepresented Patients Through Early Identification and Intervention. 医疗-法律合作与预防：通过早期识别和干预照顾无代表病人。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-01 Epub Date: 2023-12-23 DOI: 10.1007/s10730-023-09518-x

Cathy L Purvis Lively

引用次数: 0

What is a High-Quality Moral Case Deliberation?-Facilitators' Perspectives in the Euro-MCD Project. 什么是高质量的道德案例审议？

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-01 Epub Date: 2024-02-05 DOI: 10.1007/s10730-023-09519-w

Lena M Jakobsen, Bert Molewijk, Janine de Snoo-Trimp, Mia Svantesson, Gøril Ursin

{"title":"What is a High-Quality Moral Case Deliberation?-Facilitators' Perspectives in the Euro-MCD Project.","authors":"Lena M Jakobsen, Bert Molewijk, Janine de Snoo-Trimp, Mia Svantesson, Gøril Ursin","doi":"10.1007/s10730-023-09519-w","DOIUrl":"10.1007/s10730-023-09519-w","url":null,"abstract":"The evaluation of the European Moral Case Deliberation Outcomes project (Euro-MCD) has resulted in a revised evaluation instrument, knowledge about the content of MCD (moral case deliberation), and the perspectives of those involved. In this paper, we report on a perspective that has been overlooked, the facilitators'. We aim to describe facilitators' perceptions of high-quality moral case deliberation and their Euro-MCD sessions. The research took place in Norway, Sweden, and the Netherlands using a survey combined with interviews with 41 facilitators. Facilitators' perceived that attaining a high-quality MCD implies fostering a safe and respectful atmosphere, creating a wondering mode, being an attentive authority, developing moral reflective skills, reaching a common understanding, and ensuring organisational prerequisites for the MCD sessions. Our central conclusion is that efforts at three levels are required to attain a high-quality MCD: trained and virtuous facilitator; committed, respectful participants; and organizational space. Furthermore, managers have a responsibility to prepare MCD participants for what it means to take part in MCD.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"541-557"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Non-Psychiatric Treatment Refusal in Patients with Depression: How Should Surrogate Decision-Makers Represent the Patient's Authentic Wishes? 抑郁症患者拒绝非精神治疗：代理决策者应如何代表患者的真实意愿？

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-01 Epub Date: 2024-01-27 DOI: 10.1007/s10730-024-09522-9

Esther Berkowitz, Stephen Trevick

{"title":"Non-Psychiatric Treatment Refusal in Patients with Depression: How Should Surrogate Decision-Makers Represent the Patient's Authentic Wishes?","authors":"Esther Berkowitz, Stephen Trevick","doi":"10.1007/s10730-024-09522-9","DOIUrl":"10.1007/s10730-024-09522-9","url":null,"abstract":"Patients with mental illness, and depression in particular, present clinicians and surrogate decision-makers with complex ethical dilemmas when they refuse life-sustaining non-psychiatric treatment. When treatment rejection is at variance with the beliefs and preferences that could be expected based on their premorbid or \"authentic\" self, their capacity to make these decisions may be called into question. If capacity cannot be demonstrated, medical decisions fall to surrogates who are usually advised to decide based on a substituted judgment standard or, when that is not possible, best interest. We propose that in cases where the patient meets the widely accepted cognitive criteria for capacity but is making decisions that appear inauthentic, the surrogate may best uphold patient autonomy by following a \"restorative representation\" model. We see restorative representation as a subset of substituted judgement in which the decision-maker retains responsibility for deciding as the patient would have, but discerns the decision their \"truest self\" would make, rather than inferring their current wishes, which are directly influenced by illness. Here we present a case in which the patient's treatment refusal and previously undiagnosed depression led to difficulty determining the patient's authentic wishes and placed a distressing burden on the surrogate decision-maker. We use this case to examine how clinicians and ethicists might better advise surrogates who find themselves making these clinically and emotionally challenging decisions.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"591-603"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571794","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

"Follow the Science" in COVID-19 Policy: A Scoping Review. COVID-19 政策中的 "遵循科学"：范围审查。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-01 Epub Date: 2024-03-12 DOI: 10.1007/s10730-024-09521-w

Jacob R Greenmyer

{"title":"\"Follow the Science\" in COVID-19 Policy: A Scoping Review.","authors":"Jacob R Greenmyer","doi":"10.1007/s10730-024-09521-w","DOIUrl":"10.1007/s10730-024-09521-w","url":null,"abstract":"\"Follow the science\" was commonly repeated during debates on COVID-19-related policy. The phrase \"follow the science\" raises questions that are central to our theories of knowledge and the application of scientific knowledge to maximize the wellbeing of our society. The purpose of this study was to (1) perform a scoping review of literature discussing \"follow the science\" and COVID-19, and (2) consider \"follow the science\" in the context of pediatric health. A comprehensive search of 14 databases was performed on May 23, 2023. Articles were included if they used terms such as \"follow the science\", \"follow the scientists\", \"listen to science\" or \"listen to scientists\", and discussed COVID-19. There were 24 articles included in the final review. Existing literature on \"follow the science\" (1) differentiates between scientific knowledge and policy decisions; (2) emphasizes the importance of social sciences in policy making; (3) calls for more transparency in the knowledge synthesis and policy generating process; and (4) finds that scientific advisors see their role as advising on science rather than policy decision making. There was no definitional, epistemological, or philosophical intellectual defense of \"follow the science\" in the peer reviewed literature. Policy requires (1) reliable data and (2) agreement on what to do considering those empirical facts by appealing to values, ethics, morality, and law. A review of school shutdowns is used as an example of the inadequacy of \"follow the science\" as a guiding principle for public policy.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"571-589"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111831","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 Clinical Ethics. 临床伦理学。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-11-29 DOI: 10.1007/s10730-024-09544-3

Matthew Shea

引用次数: 0

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