Hec Forum最新文献_第3页

Credentialing Character: A Virtue Ethics Approach to Professionalizing Healthcare Ethics Consultation Services. 认证品格：医疗保健伦理咨询服务专业化的道德伦理方法》。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-09-01 Epub Date: 2023-02-15 DOI: 10.1007/s10730-023-09505-2

Andrea Thornton

{"title":"Credentialing Character: A Virtue Ethics Approach to Professionalizing Healthcare Ethics Consultation Services.","authors":"Andrea Thornton","doi":"10.1007/s10730-023-09505-2","DOIUrl":"10.1007/s10730-023-09505-2","url":null,"abstract":"In the process of professionalization, the American Society for Bioethics and Humanities (ASBH) has emphasized process and knowledge as core competencies for clinical ethics consultants; however, the credentialing program launched in 2018 fails to address both pillars. The inadequacy of this program recalls earlier critiques of the professionalization effort made by Giles R. Scofield and H. Tristram Engelhardt, Jr.. Both argue that ethics consultation is not a profession and the effort to professionalize is motivated by self-interest. One argument they offer against professionalization is that ethics consultants lack normative expertise. Although the question of expertise cannot be resolved completely, the accusation of self-interest can be addressed. Underlying these critiques is a concern for hubris, which can be addressed in certification and the vetting of candidates.Drawing on the virtue ethics literature of Alasdair MacIntyre and Edmund D. Pellegrino, I argue that medicine is a moral community in which ethics consultants are moral agents with a duty to foster the virtue of humility (or what Pellegrino and Thomasma call self-effacement). The implications of this argument include a requirement for self-reflection in one's role as a moral agent and reflection on one's progress toward developing or deepening virtuous engagement with the moral community of medicine. I recommend that professionalization of clinical ethics consultants include a self-reflective narrative component in the initial certification and ongoing renewal of certification where clinical ethics consultants address the emotional dimensions of their work as well as their own moral development. Adopting a teleological view of ethics consultation and incorporating narratives that work toward that purpose will mitigate the self-interest and hubris of the professionalization project.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"317-339"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9268066","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

East-West Dialogues on the Ethics of Sex Robots. 关于性爱机器人伦理的东西方对话。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-09-01 Epub Date: 2023-06-02 DOI: 10.1007/s10730-023-09507-0

Benedict S B Chan

引用次数: 0

Evaluation of Interventions to Address Moral Distress: A Multi-method Approach. 评估解决道德压力的干预措施：采用多种方法。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-09-01 Epub Date: 2023-07-10 DOI: 10.1007/s10730-023-09508-z

Lucia D Wocial, Genina Miller, Kianna Montz, Michelle LaPradd, James E Slaven

{"title":"Evaluation of Interventions to Address Moral Distress: A Multi-method Approach.","authors":"Lucia D Wocial, Genina Miller, Kianna Montz, Michelle LaPradd, James E Slaven","doi":"10.1007/s10730-023-09508-z","DOIUrl":"10.1007/s10730-023-09508-z","url":null,"abstract":"Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs' perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants' moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work environment. We used quantitative instruments and explored participants' perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"373-401"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10335998","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

It's Worth What You Can Sell It for: A Survey of Employment and Compensation Models for Clinical Ethicists. 能卖多少钱就值多少钱：临床伦理学家就业和薪酬模式调查》。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-09-01 Epub Date: 2023-08-05 DOI: 10.1007/s10730-023-09509-y

Jason Adam Wasserman, Abram Brummett, Mark Christopher Navin

{"title":"It's Worth What You Can Sell It for: A Survey of Employment and Compensation Models for Clinical Ethicists.","authors":"Jason Adam Wasserman, Abram Brummett, Mark Christopher Navin","doi":"10.1007/s10730-023-09509-y","DOIUrl":"10.1007/s10730-023-09509-y","url":null,"abstract":"This article reports results of a survey about employment and compensation models for clinical ethics consultants working in the United States and discusses the relevance of these results for the professionalization of clinical ethics. This project uses self-reported data from healthcare ethics consultants to estimate compensation across different employment models. The average full-time annualized salary of respondents with a clinical doctorate is $188,310.08 (SD=$88,556.67), $146,134.85 (SD=$55,485.63) for those with a non-clinical doctorate, and $113,625.00 (SD=$35,872.96) for those with a masters as their highest degree. Pay differences across degree level and type were statistically significant (F = 3.43; p < .05). In a multivariate model, there is an average increase of $2,707.84 for every additional year of experience, controlling for having a clinical doctorate (ß=0.454; p < .01). Our results also show high variability in the backgrounds and experiences of healthcare ethics consultants and a wide variety of employment models. The significant variation in employment and compensation models is likely to pose a challenge for the professionalization of healthcare ethics consultation.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"405-420"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10394016","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

The SIA Can't Just Go with the FLO. SIA 不能只是 "FLO"。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-09-01 Epub Date: 2023-07-13 DOI: 10.1007/s10730-023-09510-5

Joe Slater

{"title":"The SIA Can't Just Go with the FLO.","authors":"Joe Slater","doi":"10.1007/s10730-023-09510-5","DOIUrl":"10.1007/s10730-023-09510-5","url":null,"abstract":"Hendricks (2018) has defended an argument that abortion is (usually) immoral, which he calls the impairment argument. This argument purports to apply regardless of the moral status of the fetus. It has recently been bolstered by several amendments from Blackshaw and Hendricks (2021a; 2021b). In this paper, three problems are presented for their Strengthened Impairment Argument (SIA). In the first, it is observed that even with the new modifications the argument, contrary to their insistence, does seem to depend on Marquis' argument. In order for it not to do so, they would need to provide some other plausible reason why impairing a fetus is wrong that persists in cases of abortion. Because of the restrictions regarding what reasons can be used, they are not entitled to stipulate that some plausible reason can be found. In the second section, the use of an over-ridingness caveat - the most recent modification - is scrutinised. This is shown to either beg the question about the permissibility of abortion by assuming that opposing reasons are insufficient in most cases, or require an entirely separate argument to establish that such reasons are insufficient. Thirdly, I observe that the principle utilised in the latest version of the argument fails to account for undercutting reason, which suggest that the principle, in its current form, is false.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"423-439"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9775128","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

Understanding Rare Disease Experiences Through the Concept of Morally Problematic Situations. 通过 "有道德问题的情况 "这一概念来理解罕见疾病的经历。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-09-01 Epub Date: 2023-07-29 DOI: 10.1007/s10730-023-09511-4

Ariane Quintal, Élissa Hotte, Caroline Hébert, Isabelle Carreau, Annie-Danielle Grenier, Yves Berthiaume, Eric Racine

{"title":"Understanding Rare Disease Experiences Through the Concept of Morally Problematic Situations.","authors":"Ariane Quintal, Élissa Hotte, Caroline Hébert, Isabelle Carreau, Annie-Danielle Grenier, Yves Berthiaume, Eric Racine","doi":"10.1007/s10730-023-09511-4","DOIUrl":"10.1007/s10730-023-09511-4","url":null,"abstract":"Rare diseases, defined as having a prevalence inferior to 1/2000, are poorly understood scientifically and medically. Appropriate diagnoses and treatments are scarce, adding to the burden of living with chronic medical conditions. The moral significance of rare disease experiences is often overlooked in qualitative studies conducted with adults living with rare diseases. The concept of morally problematic situations arising from pragmatist ethics shows promise in understanding these experiences. The objectives of this study were to (1) acquire an in-depth understanding of morally problematic situations experienced by adults living with rare diseases in the province of Québec and (2) to develop an integrative model of the concept of morally problematic situations. To this end, an online survey targeting this population was developed through a participatory action research project. Respondents provided 90 long testimonies on the most important morally problematic situations they faced, often in healthcare settings. An integrative model was developed based on various qualitative analyses of these testimonies and relevant literature. The integrative model showcases that morally problematic situations have causes (i.e., contextual and relational factors, personal factors, jeopardized valuations), have affective repercussions (i.e., emotions and feelings, internal tensions), prompt action (i.e., through empowerment strategies leading to the evolution of situations), and elicit outcomes (i.e., factual consequences, residual emotions and feelings, positive or negative resolutions). In sum, this study advances understanding of the moral experiences of adults living with rare diseases while proposing a comprehensive conceptual tool to guide future empirical bioethics research on moral experiences.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"441-478"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10247800","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

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 : 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":"https://doi.org/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":""},"PeriodicalIF":1.3,"publicationDate":"2024-08-22","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

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 : 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":"https://doi.org/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":""},"PeriodicalIF":1.3,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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 : 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":"https://doi.org/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":""},"PeriodicalIF":1.3,"publicationDate":"2024-07-09","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

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 1.5 4区哲学

Hec Forum Pub 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":"https://doi.org/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":""},"PeriodicalIF":1.5,"publicationDate":"2024-06-08","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