Hec Forum最新文献_第2页

Balancing Objectivity and Humanity: Ethical Challenges and Considerations in Surgical Candidacy Decisions. 平衡客观性和人性：外科候选资格决定中的伦理挑战和考虑。

IF 1.2 4区哲学

Hec Forum Pub Date : 2025-08-31 DOI: 10.1007/s10730-025-09565-6

Anthony S Peterson, Bryan Pilkington

{"title":"Balancing Objectivity and Humanity: Ethical Challenges and Considerations in Surgical Candidacy Decisions.","authors":"Anthony S Peterson, Bryan Pilkington","doi":"10.1007/s10730-025-09565-6","DOIUrl":"https://doi.org/10.1007/s10730-025-09565-6","url":null,"abstract":"An essential element of determining surgical candidacy is an accurate understanding of the risks to a given patient. While surgeons remain largely responsible for the selection of their patients, and surgeons' intuition has been shown to be a good indicator of postoperative outcomes, the recent focus in medicine towards minimizing the impact of physician bias has spurred a push towards prioritizing risk assessment tools in candidacy decisions. This has rekindled the debate surrounding what should determine surgical candidacy. Risk assessment tools are proven to be moderately to highly accurate at assessing the risk due to objective and proven risk factors, such as the impact of age or comorbidities. However, they fail to account for the humanity of both the surgeon and the patient and do not measure less easily quantifiable risk factors, such as a surgeon's comfort with a procedure or a patient's health beliefs, when determining risk. In this project, we offer an ethical analysis that highlights these less acknowledged factors. We argue that these factors need to be given greater consideration in risk assessment and surgical candidacy decisions, as they too can affect postoperative risks and outcomes.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973720","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

Macro-Level Factors Influencing the Adoption and Early Implementation of Clinical Ethics Support Services: A Scoping Review. 影响临床伦理支持服务采用和早期实施的宏观因素：范围综述。

IF 1.2 4区哲学

Hec Forum Pub Date : 2025-08-28 DOI: 10.1007/s10730-025-09555-8

Gilles Bernard, Michael Fischer

{"title":"Macro-Level Factors Influencing the Adoption and Early Implementation of Clinical Ethics Support Services: A Scoping Review.","authors":"Gilles Bernard, Michael Fischer","doi":"10.1007/s10730-025-09555-8","DOIUrl":"https://doi.org/10.1007/s10730-025-09555-8","url":null,"abstract":"Clinical ethics are becoming increasingly important in the twenty-first century. Value-laden cases and moral dilemmas in healthcare have led to the creation of clinical ethics support structures. The last decades have shown their implementation in hospitals around the globe. Recent literature investigates their value, function, and integration. Many conclude that they do valuable work yet remain inadequately integrated, lack institutionalization, and struggle with resource shortages. To gain an understanding of this development and pave the way for future implementation and research, a scoping review was chosen to determine which macro-level factors currently influence the heterogeneous approaches. This review used the scientific research databases Medline and CINAHL in April 2025. It included studies, opinion papers, and book chapters in English and German offering explanations, analysis, discussion, and examples of macro-level clinical ethics support structures' adoption and implementation influences. An inductive qualitative content analysis was conducted to extract the desired information. The resulting categories were formatted into an overview frame. The literature search yielded 400 publications, full-text analysis and snowball search resulted in 47 eligible for analysis. Eight main factors with respective subcategories were identified. These vary in their degree of binding authority, ranging from clearly defined regulations, such as national laws, to more ambiguous influences, such as public opinion and advocacy. Further insights reveal that the effectiveness of these factors cannot yet be determined, and their influence may vary based on the values and political context of the country where a support structure is implemented.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973712","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

Evaluating Nurse Conscientious Objection: Application of a Novel Framework. 评估护士良心反对：一个新框架的应用。

IF 1.2 4区哲学

Hec Forum Pub Date : 2025-08-09 DOI: 10.1007/s10730-025-09556-7

Maya Zumstein-Shaha, Lucia D Wocial, Vicki D Lachman, Norah Louise Johnson, Cynda Hylton Rushton, Pamela J Grace

{"title":"Evaluating Nurse Conscientious Objection: Application of a Novel Framework.","authors":"Maya Zumstein-Shaha, Lucia D Wocial, Vicki D Lachman, Norah Louise Johnson, Cynda Hylton Rushton, Pamela J Grace","doi":"10.1007/s10730-025-09556-7","DOIUrl":"https://doi.org/10.1007/s10730-025-09556-7","url":null,"abstract":"Certain moral beliefs and/or values about what is good or harmful can cause nurses and other healthcare professionals to object to participating in some clinical actions. Such objections are also called conscientious objections. Invocation of a conscientious objection (CO) can produce complexities in patient care and health care delivery and must be mindfully evaluated for its soundness. In this manuscript, a recently developed framework, The Ethical Evaluation of a Nurse's Conscientious Objection (EENCO), is applied to expose hidden elements and nuances in a proposed or actual CO by nurses or other healthcare professionals, thereby illuminating strategies that can lessen associated harms. The EENCO is utilized to explore two types of situations where a nurse makes a CO claim. Scenario 1 involves a nurse's reluctance to follow provider medication orders intended to relieve pain and suffering at the end-of-life. In scenario 2, nurses object to a visitation policy during the COVID-19 pandemic. Additionally, we provide a summary of the necessary elements of institutional policy to address claims of CO using the EENCO. Drawing on the EENCO, the two scenarios were analyzed for their ethical implications. This framework contributes to the exposure, scrutiny, and clarification of potentially unappreciated aspects of CO claims. Steps for developing institutional policy are identified. Application of the EENCO guides the analysis of the two scenarios. CO claims are explored more deeply, thereby revealing implications for those involved. Additionally, the EENCO provides guidance for the development of institutional CO policies.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805034","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

Liberalism and Lockdowns. 自由主义和封锁。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-07-19 DOI: 10.1007/s10730-025-09552-x

D Robert MacDougall

引用次数: 0

"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? “什么都不要告诉他们”：是否应该允许代理决策者向其他家庭成员隐瞒信息或阻止他们探望病人？

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

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