Hec Forum最新文献_第3页

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

Moral Distress Consultation Services: Insights from Consultants. 道德困境咨询服务：咨询师的见解。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-06-01 Epub Date: 2024-08-03 DOI: 10.1007/s10730-024-09535-4

Vanessa Amos, Phyllis Whitehead, Beth Epstein

{"title":"Moral Distress Consultation Services: Insights from Consultants.","authors":"Vanessa Amos, Phyllis Whitehead, Beth Epstein","doi":"10.1007/s10730-024-09535-4","DOIUrl":"10.1007/s10730-024-09535-4","url":null,"abstract":"Moral distress reflects often recurrent problems within a healthcare environment that impact the quality and safety of patient care. Examples include inadequate staffing, lack of necessary resources, and poor interprofessional teamwork. Recognizing and acting on these issues demonstrates a collaborative and organizational commitment to improve. Moral distress consultation is a health system-wide intervention gaining momentum in the United States. Moral distress consultants assist healthcare providers in identifying and strategizing possible solutions to the patient, team, and systemic barriers behind moral distress. Moral distress consultants offer unique perspectives on the goals, successes, areas for improvement, and sustainability of moral distress consultation. Their ideas can help shape this intervention's continued growth and improvement. This qualitative descriptive study features 10 semi-structured interviews with moral distress consultants at two institutions with longstanding, active moral distress consultation services. Themes from consultant transcripts included consultant training, understanding the purpose of moral distress consultation, interfacing with leadership teams, defining success, and improving visibility and sustainability of the service. These findings describe the beginnings of a framework that organizations can use to either start or strengthen moral distress consultation services, as well as the first steps in developing an evaluation tool to monitor their utility and quality.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"217-233"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890395","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

Should Clinical Ethicists Be Informed About Case Resolutions? 临床伦理学家应该被告知病例解决方案吗？

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-05-14 DOI: 10.1007/s10730-025-09549-6

Marta Fadda

引用次数: 0

Practising and Tolerating Conscientious Objection in Healthcare: A Brief Defence. 在医疗保健实践和容忍良心反对：一个简短的辩护。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-04-28 DOI: 10.1007/s10730-025-09548-7

Helen Watt

引用次数: 0

Responding to Moral Challenges in Clinical Practice: A Qualitative Assessment of Clinical Ethics Support Needs at Three Tanzanian Hospitals. 应对临床实践中的道德挑战：坦桑尼亚三家医院临床伦理支持需求的定性评估。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-04-16 DOI: 10.1007/s10730-025-09547-8

Shija Kevin Kuhumba, Trygve Johannes Lereim Sævareid, Nandera Ernest Mhando, Bert A C Molewijk

{"title":"Responding to Moral Challenges in Clinical Practice: A Qualitative Assessment of Clinical Ethics Support Needs at Three Tanzanian Hospitals.","authors":"Shija Kevin Kuhumba, Trygve Johannes Lereim Sævareid, Nandera Ernest Mhando, Bert A C Molewijk","doi":"10.1007/s10730-025-09547-8","DOIUrl":"https://doi.org/10.1007/s10730-025-09547-8","url":null,"abstract":"Healthcare professionals (HCPs) encounter various moral challenges in clinical practice. In various countries, clinical ethics support (CES) services are developed to support HCPs. One of these CES services is clinical ethics committees (CECs): they address moral challenges faced in healthcare settings and offer support for HCPs. However, in Tanzania, CECs have not yet been implemented. For implementation purposes, greater knowledge about how healthcare professionals navigate and respond to moral challenges, their understanding of CECs, and what they perceive as key needs for implementing CECs in hospitals, are valuable. This study explores HCPs' ways of dealing with their moral challenges at the moment and identifies key needs for establishing CECs in Tanzanian healthcare settings in the near future. The findings show that various implicit ways have been acknowledged as being useful in addressing moral challenges (e.g., regular meetings, family conferences, social welfare units, hospital procedures and guidelines, as well as consulting legal and management units). In addition, HCPs reported that a necessity exists for implementing more formal and systematic modalities to address moral challenges in clinical settings. The research in this paper has served as a preparation for establishing the first CEC in Tanzanian healthcare settings.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045694","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

Vaccine Impact Bonds: An Alternative Way of Allocating the Economic Risks of Mass Vaccination Programs. 疫苗影响债券：大规模疫苗接种计划经济风险的另一种分配方式。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-03-01 Epub Date: 2024-05-24 DOI: 10.1007/s10730-024-09530-9

Pascal René Marcel Kubin

{"title":"Vaccine Impact Bonds: An Alternative Way of Allocating the Economic Risks of Mass Vaccination Programs.","authors":"Pascal René Marcel Kubin","doi":"10.1007/s10730-024-09530-9","DOIUrl":"10.1007/s10730-024-09530-9","url":null,"abstract":"Vaccines can be an appropriate tool for combating pandemics. Accordingly, expectations were high when the first Covid-19 vaccines were administered. However, even though the vaccines have not met these high initial expectations, vaccine manufacturers and their investors were making large profits, while most of the associated economic risks have remained with the taxpaying public. Thus, this paper applies the concept of social impact bonds to mass vaccination programs by conceptualizing vaccine impact bonds (VIBs) as an alternative to the advance purchase agreements (APAs) for Covid-19 vaccines. Rather than rewarding vaccine manufacturers and their investors based on the quantity of doses distributed, VIBs intend to link the real-world vaccine impact to the financial returns of vaccine manufacturers and their investors. This paper indicates that VIBs can theoretically shift the economic risks of mass vaccination programs from the taxpaying public to private investors, thereby aligning commercial and public interests. However, it also identifies several major weaknesses such as the complexity of defining and evaluating the vaccine impact as well as the inherent trade-off between relieving taxpayers (through VIBs) and allowing innovation. As these substantial drawbacks outweigh the theoretical strengths of VIBs, this paper calls for further research in order to identify better alternatives to the Covid-19 vaccine contracts.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"127-142"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141092636","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

Canada's Medical Assistance in Dying System can Enable Healthcare Serial Killing. 加拿大的临终医疗协助系统可以实现医疗保健连环杀人。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-03-01 Epub Date: 2024-08-02 DOI: 10.1007/s10730-024-09528-3

Christopher Lyon

{"title":"Canada's Medical Assistance in Dying System can Enable Healthcare Serial Killing.","authors":"Christopher Lyon","doi":"10.1007/s10730-024-09528-3","DOIUrl":"10.1007/s10730-024-09528-3","url":null,"abstract":"The Canadian approach to assisted dying, Medical Assistance in Dying (MAiD), as of early 2024, is assessed for its ability to protect patients from criminal healthcare serial killing (HSK) to evaluate the strength of its safeguards. MAiD occurs through euthanasia or self-administered assisted suicide (EAS) and is legal or considered in many countries and jurisdictions. Clinicians involved in HSK typically target patients with the same clinical features as MAiD-eligible patients. They may draw on similar rationales, e.g., to end perceived patient suffering and provide pleasure for the clinician. HSK can remain undetected or unconfirmed for considerable periods owing to a lack of staff background checks, poor surveillance and oversight, and a failure by authorities to act on concerns from colleagues, patients, or witnesses. The Canadian MAiD system, effectively euthanasia-based, has similar features with added opportunities for killing afforded by clinicians' exemption from criminal culpability for homicide and assisted suicide offences amid broad patient eligibility criteria. An assessment of the Canadian model offers insights for enhancing safeguards and detecting abuses in there and other jurisdictions with or considering legal EAS. Short of an unlikely recriminalization of EAS, better clinical safeguarding measures, standards, vetting and training of those involved in MAiD, and a radical restructuring of its oversight and delivery can help mitigate the possibility of abuses in a system mandated to accommodate homicidal clinicians.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"65-105"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876263","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

On Seeing Long Shadows: Is Academic Medicine at its Core a Practice of Racial Oppression? 看见长长的阴影：学术医学的核心是种族压迫吗？

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-03-01 Epub Date: 2024-05-10 DOI: 10.1007/s10730-024-09529-2

Thomas S Huddle

{"title":"On Seeing Long Shadows: Is Academic Medicine at its Core a Practice of Racial Oppression?","authors":"Thomas S Huddle","doi":"10.1007/s10730-024-09529-2","DOIUrl":"10.1007/s10730-024-09529-2","url":null,"abstract":"Suggestions that academic medicine is systemically racist are increasingly common in the medical literature. Such suggestions often rely upon expansive notions of systemic racism that are deeply controversial. The author argues for an empirical concept of systemic racism and offers a counter argument to a recent suggestion that academic medicine is systemically racist in its treatment of medical trainees: Anderson et al.'s (Academic Medicine, 98(8S), S28-S36, 2023) \"The Long Shadow: a Historical Perspective on Racism in Medical Education.\" Contra the authors of \"The Long Shadow,\" the author argues that racial performance disparities in medical education cannot be validly attributed to racism without careful empirical confirmation; he further argues that standards of assessment in medical education cannot be properly deemed racist merely because minority trainees are disproportionately disadvantaged by them. Furthermore, the history of medicine and society in the Anglo-European West is not, as argued by the authors of \"The Long Shadow,\" best viewed as one long tale of racial oppression culminating in the present day pervasive racism of academic medicine in the United States. Racism is a deplorable stain on our history and our present but it is not the historical essence of Christianity, European civilization, Western medicine, or contemporary academic medical institutions.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"107-125"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899547","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