Hec Forum最新文献_第4页

Specific Trends in Pediatric Ethical Decision-Making: An 18-Year Review of Ethics Consultation Cases in a Pediatric Hospital. 儿科伦理决策的具体趋势：一家儿科医院伦理咨询案例的 18 年回顾。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-03-01 Epub Date: 2024-02-28 DOI: 10.1007/s10730-024-09524-7

Yaa Bosompim, Julie Aultman, John Pope

引用次数: 0

Can We Be Creative with Communication? Assessing Decision-Making Capacity in an Adult with Selective Mutism. 我们能创造性地进行交流吗？评估患有选择性缄默症的成年人的决策能力。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-03-01 Epub Date: 2024-02-05 DOI: 10.1007/s10730-024-09523-8

Nicholas R Mercado

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

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

Mitigating Moral Distress: Pediatric Critical Care Nurses' Recommendations. 减轻精神压力：儿科重症监护护士的建议。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-09-01 Epub Date: 2023-05-04 DOI: 10.1007/s10730-023-09506-1

Sadie Deschenes, Shannon D Scott, Diane Kunyk

{"title":"Mitigating Moral Distress: Pediatric Critical Care Nurses' Recommendations.","authors":"Sadie Deschenes, Shannon D Scott, Diane Kunyk","doi":"10.1007/s10730-023-09506-1","DOIUrl":"10.1007/s10730-023-09506-1","url":null,"abstract":"In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used a qualitative description approach. Participants were recruited using purposive sampling between October 2020 to May 2021 from pediatric critical care units in a western Canadian province. We conducted individual semi-structured interviews via Zoom. A total of 10 registered nurses participated in the study. Four main themes were identified: (1) \"I'm sorry, there's nothing else\": increasing supports for patients and families; (2) \"someone will commit suicide\": improving supports for nurses: (3) \"Everyone needs to be heard\": improving patient care communication; and (4) \"I didn't see it coming\": providing education to mitigate moral distress. Most participants stated they wanted an intervention to improve communication among the healthcare team and noted changes to unit practices that could decrease moral distress. This is the first study that asks nurses what is needed to minimize their moral distress. Although there are multiple strategies in place to help nurses with difficult aspects of their work, additional strategies are needed to help nurses experiencing moral distress. Moving the research focus from identifying moral distress towards developing effective interventions is needed. Identifying what nurses need is critical to develop effective moral distress interventions.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"341-361"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10158695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10314416","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

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