Hec Forum最新文献_第10页

Experience with a Revised Hospital Policy on Not Offering Cardiopulmonary Resuscitation. 修订医院不提供心肺复苏政策的经验。

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-03-01 Epub Date: 2020-11-02 DOI: 10.1007/s10730-020-09429-1

Andrew M Courtwright, Emily Rubin, Kimberly S Erler, Julia I Bandini, Mary Zwirner, M Cornelia Cremens, Thomas H McCoy, Ellen M Robinson

{"title":"Experience with a Revised Hospital Policy on Not Offering Cardiopulmonary Resuscitation.","authors":"Andrew M Courtwright, Emily Rubin, Kimberly S Erler, Julia I Bandini, Mary Zwirner, M Cornelia Cremens, Thomas H McCoy, Ellen M Robinson","doi":"10.1007/s10730-020-09429-1","DOIUrl":"https://doi.org/10.1007/s10730-020-09429-1","url":null,"abstract":"Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate (DNR) status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation (CPR) despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics consult outcomes were analyzed. In 42 of the 116 cases (36.2%), the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 (97.3%) of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 (79.2%) of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying (p = 0.007). The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants' recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-020-09429-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38556135","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: 1

Ethics Consultation in Surgical Specialties. 外科专业伦理咨询。

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-03-01 Epub Date: 2021-03-05 DOI: 10.1007/s10730-021-09447-7

Nicole A Meredyth, Joseph J Fins, Inmaculada de Melo-Martin

{"title":"Ethics Consultation in Surgical Specialties.","authors":"Nicole A Meredyth, Joseph J Fins, Inmaculada de Melo-Martin","doi":"10.1007/s10730-021-09447-7","DOIUrl":"https://doi.org/10.1007/s10730-021-09447-7","url":null,"abstract":"Multiple studies have been performed to identify the most common ethical dilemmas encountered by ethics consultation services. However, limited data exists comparing the content of ethics consultations requested by specific hospital specialties. It remains unclear whether the scope of ethical dilemmas prompting an ethics consultation differ between specialties and if there are types of ethics consultations that are more or less frequently called based on the specialty initiating the ethics consult. This study retrospectively assessed the incidence and content of ethics consultations called by surgical vs. non-surgical specialties between January 1, 2013 to December 31, 2018 using our RedCap Database and information collected through the EMR via our Clinical and Translational Science Center. 548 total ethics consultations were analyzed (surgical n = 135, non-surgical n = 413). Our results demonstrate that more surgical consults originated from the ICU, as opposed to lower acuity units (45.9% vs. 14.3%, p ≤ 0.001), and surgical patients were more likely to have a DNR in place (37.5% vs. 22.2%, p = 0.002). Surgical specialties were more likely to call about issues relating to withholding/withdrawing life-sustaining treatment (p ≤ 0.001), while non-surgical specialties were more likely to call about issues related to discharge planning (p = 0.001). There appear to be morally relevant differences between consults classified as the \"same\" that are not entirely captured by the usual ethics consultations classification system. In conclusion, this study highlights the unique ethical issues experienced by surgical vs. non-surgical specialties. Ultimately, our data can help ethics consultation services determine how best to educate various hospital specialties to approach ethical issues commonly experienced within their field.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-021-09447-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25441927","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: 1

Functions, Operations and Policy of a Volunteer Ethics Committee: A Quantitative and Qualitative Analysis of Ethics Consultations from 2013 to 2018. 志愿者伦理委员会的职能、运作与政策:2013 - 2018年伦理咨询的定量与定性分析

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-03-01 Epub Date: 2020-09-26 DOI: 10.1007/s10730-020-09426-4

Bryan Kaps, Gary Kopf

{"title":"Functions, Operations and Policy of a Volunteer Ethics Committee: A Quantitative and Qualitative Analysis of Ethics Consultations from 2013 to 2018.","authors":"Bryan Kaps, Gary Kopf","doi":"10.1007/s10730-020-09426-4","DOIUrl":"https://doi.org/10.1007/s10730-020-09426-4","url":null,"abstract":"Few institutions have published reviews concerning the case consultation history of their ethics committees, and policies used by ethics committees to address inappropriate treatment are infrequently reviewed. We sought to characterize the operation of our institution's ethics committee as a representative example of a volunteer ethics committee, and outline its use of a policy to address inappropriate treatment, the Conscientious Practice Policy (CPP). Patients were identified for retrospective review from the ethics consultation database. Patient demographics, medical admission information, and consultation information were obtained from the medical record. Consultation notes were analyzed with directed content analysis. The use of the CPP was documented in each case. Groups of interest were compared via two-sample t-tests. There were 178 consultations between 2013 and 2018. The majority originated from medicine services (N = 145, 82.4%). The most common consultation reasons were end-of-life balances of acute and palliative care (N = 85, 47.2%), best interest standard (N = 82, 46.1%), medical futility (N = 68, 38.2%), and code status and intubation status (N = 67, 37.6%). Average age was 65.5 years and average hospitalization before consultation was 51.4 days. 92 patients (53.3%) had a code status change that occurred after consultation. A policy to address inappropriate treatment (CPP) was used in 42 (23.9%) of the consultations. Bivariate analysis demonstrated a reduction in policy use over time, with use in 32.1% of consultations from 2013 to 2016 and 11.4% of consultations 2017-2018, p = 0.002. End-of-life issues were the most common reason for consultation. Our consultation volume was lower than previously-published reports. A policy used to address inappropriate treatment was frequently used, although use decreased over time.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-020-09426-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38422256","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: 2

The Hidden Curriculum and Integrating Cure- and Care-Based Approaches to Medicine. 隐藏课程与整合医学治疗与护理方法。

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-03-01 DOI: 10.1007/s10730-020-09424-6

Divya Choudhury, Nico Nortjé

引用次数: 3

Field-Testing the Euro-MCD Instrument: Important Outcomes According to Participants Before and After Moral Case Deliberation. 现场测试Euro-MCD工具:道德案例审议前后参与者的重要结果。

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-03-01 DOI: 10.1007/s10730-020-09421-9

J C de Snoo-Trimp, A C Molewijk, M Svantesson, G A M Widdershoven, H C W de Vet

{"title":"Field-Testing the Euro-MCD Instrument: Important Outcomes According to Participants Before and After Moral Case Deliberation.","authors":"J C de Snoo-Trimp, A C Molewijk, M Svantesson, G A M Widdershoven, H C W de Vet","doi":"10.1007/s10730-020-09421-9","DOIUrl":"https://doi.org/10.1007/s10730-020-09421-9","url":null,"abstract":"Ethics support services like Moral Case Deliberation (MCD) intend to support healthcare professionals in ethically difficult situations. To assess outcomes of MCD, the Euro-MCD Instrument has been developed. Field studies to test this instrument are needed and have been conducted, examining important outcomes before MCD participation and experienced outcomes. The current study aimed to (1) describe how participants' perceive the importance of MCD outcomes after MCD; (2) compare these perceptions with those before MCD participation; and (3) test the factor structure of these outcomes. Swedish, Norwegian and Dutch healthcare professionals rated the importance of outcomes in the Euro-MCD Instrument after four and eight MCDs. Ratings were compared with those before MCD participation using paired and independent samples t-tests. The factor structure was tested using exploratory factor analyses. After 4 and 8 MCDs, 443 respectively 247 respondents completed the instrument. More than 69% rated all MCD outcomes as 'quite' or 'very' important, especially outcomes from Enhanced Collaboration, Improved Moral Reflexivity and Improved Moral Attitude. Significant differences for 16 outcomes regarding ratings before and after MCD participation were not considered meaningful. Factor analyses suggested three categories, which seemingly resemble the domains Improved Moral Reflexivity, Enhanced Collaboration and a combination of Improved Moral Attitude and Enhanced Emotional Support. After participation in MCDs, respondents confirmed the importance of outcomes in the Euro-MCD Instrument. The question on perceived importance and the categorization of outcomes need reconsideration. The revised instrument will be presented elsewhere, based on all field studies and theoretical reflections.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-020-09421-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38242854","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: 1

Survey of End-of-Life Care in Intensive Care Units in Ain Shams University Hospitals, Cairo, Egypt. 埃及开罗艾因沙姆斯大学医院重症监护病房临终关怀调查

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-03-01 DOI: 10.1007/s10730-020-09423-7

Sonya M S Azab, Samia A Abdul-Rahman, Ibrahim M Esmat

{"title":"Survey of End-of-Life Care in Intensive Care Units in Ain Shams University Hospitals, Cairo, Egypt.","authors":"Sonya M S Azab, Samia A Abdul-Rahman, Ibrahim M Esmat","doi":"10.1007/s10730-020-09423-7","DOIUrl":"https://doi.org/10.1007/s10730-020-09423-7","url":null,"abstract":"Studies on end-of-life care reveal different practices regarding withholding and/or withdrawing life-sustaining treatments between countries and regions. Available data about physicians' practices regarding end-of-life care in ICUs in Egypt is scarce. This study aimed to investigate physicians' attitudes toward end-of-life care and the reported practice in adult ICUs in Ain Shams University Hospitals, Cairo, Egypt. 100 physicians currently working in several ICU settings in Ain Shams University Hospitals were included. A self-administered questionnaire was used for collection of data. Most of the participants agreed to implementation of \"do not resuscitate\" (DNR) orders and applying pre-written DNR orders (61% and 65% consecutively), while only 13% almost always/often order DNR for terminally-ill patients. 52% of the participants agreed to usefulness of limiting life-sustaining therapy in some cases, but they expressed fear of legal consequences. 47% found withholding life-sustaining treatment is more ethical than its withdrawal. 16% almost always/often withheld further active treatment but continued current ones while only 6% almost always/often withdrew active therapy for terminally-ill patients. The absence of legislation and guidelines for end-of-life care in ICUs at Ain Shams University Hospitals was the main influential factor for the dissociation between participants' attitudes and their practices. Therefore, development of a consensus for end-of-life care in ICUs in Egypt is mandatory. Also, training of physicians in ICUs on effective communication with patients' families and surrogates is important for planning of limitation of life-sustaining treatments.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-020-09423-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38268210","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: 4

Continuous Glucose Monitoring as a Matter of Justice. 持续血糖监测是公正的问题。

IF 1.5 4区哲学

Hec Forum Pub Date : 2021-12-01 DOI: 10.1007/s10730-020-09413-9

Steven R Kraaijeveld

{"title":"Continuous Glucose Monitoring as a Matter of Justice.","authors":"Steven R Kraaijeveld","doi":"10.1007/s10730-020-09413-9","DOIUrl":"https://doi.org/10.1007/s10730-020-09413-9","url":null,"abstract":"Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-020-09413-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37962156","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: 5

Looking Behind the Fear of Becoming a Burden. 从害怕成为负担的背后看问题。

IF 1.5 4区哲学

Hec Forum Pub Date : 2021-12-01 DOI: 10.1007/s10730-020-09420-w

Brandy M Fox

{"title":"Looking Behind the Fear of Becoming a Burden.","authors":"Brandy M Fox","doi":"10.1007/s10730-020-09420-w","DOIUrl":"https://doi.org/10.1007/s10730-020-09420-w","url":null,"abstract":"As they age, many people are afraid that they might become a burden to their families and friends. In fact, fear of being a burden is one of the most frequently cited reasons for individuals who request physician aid in dying. Why is this fear so prevalent, and what are the issues underlying this concern? I argue that perceptions of individual autonomy, dependency, and dignity all contribute to the fear of becoming a burden. However, this fear is misplaced; common conceptions of these values should be re-framed and re-examined. Practices that support a more community-centered type of autonomy can be found in dependency and dignity. This paper offers some practical examples of how to address common end-of-life situations that may cause anxiety to patients who are worried about being a burden. These practices include discussing expectations, both for care and how the relationship among the participants might change, and modeling respectful caregiving behaviors. Most difficult of all, though, includes cultural and societal attitude changes so that people recognize the good in receiving care and get used to the idea that they do not need to do anything to be valuable.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-020-09420-w","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38186361","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: 2

Is Left Ventricular Assist Device Deactivation Ethically Acceptable? A Study on the Euthanasia Debate. 左心室辅助装置停用在伦理上可以接受吗？安乐死辩论研究。

IF 1.3 4区哲学

Hec Forum Pub Date : 2021-12-01 DOI: 10.1007/s10730-020-09408-6

Sara Roggi, Mario Picozzi

引用次数: 0

Making the (Business) Case for Clinical Ethics Support in the UK. 英国临床伦理支持的商业案例

IF 1.5 4区哲学

Hec Forum Pub Date : 2021-12-01 DOI: 10.1007/s10730-020-09416-6

L L Machin, Mark Wilkinson

{"title":"Making the (Business) Case for Clinical Ethics Support in the UK.","authors":"L L Machin, Mark Wilkinson","doi":"10.1007/s10730-020-09416-6","DOIUrl":"https://doi.org/10.1007/s10730-020-09416-6","url":null,"abstract":"This paper provides a series of reflections on making the case to senior leaders for the introduction of clinical ethics support services within a UK hospital Trust at a time when clinical ethics committees are dwindling in the UK. The paper provides key considerations for those building a (business) case for clinical ethics support within hospitals by drawing upon published academic literature, and key reports from governmental and professional bodies. We also include extracts from documents relating to, and annual reports of, existing clinical ethics support within UK hospitals, as well as extracts from our own proposal submitted to the Trust Board. We aim for this paper to support other ethicists and/or health care staff contemplating introducing clinical ethics support into hospitals, to facilitate the process of making the case for clinical ethics support, and to contribute to the key debates in the literature around clinical ethics support. We conclude that there is a real need for investment in clinical ethics in the UK in order to build the evidence base required to support the wider introduction of clinical ethics support into UK hospitals. Furthermore, our perceptions of the purpose of, and perceived needs met through, clinical ethics support needs to shift to one of hospitals investing in their staff. Finally, we raise concerns over the optional nature of clinical ethics support available to practitioners within UK hospitals.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-020-09416-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38178869","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: 7