Hec Forum最新文献_第4页

Navigating Unilateral DNAR Orders: Findings from a Decade of Ethics Consultation Cases. 导航单边DNAR命令：来自十年道德咨询案例的调查结果。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-07-16 DOI: 10.1007/s10730-026-09600-0

Amanda Hernandez, Adam Marks, Janice Firn

{"title":"Navigating Unilateral DNAR Orders: Findings from a Decade of Ethics Consultation Cases.","authors":"Amanda Hernandez, Adam Marks, Janice Firn","doi":"10.1007/s10730-026-09600-0","DOIUrl":"https://doi.org/10.1007/s10730-026-09600-0","url":null,"abstract":"Unilateral Do Not Attempt Resuscitation (UDNAR) orders remain contentious in the care of seriously ill patients. While some regard UDNAR orders as reducing non-beneficial treatment, others raise concerns around patient autonomy, potential discrimination, and the risk of relational stress between healthcare teams and families. Ethics consultation services (ECS) are often engaged when these decisions are disputed, but data on their role is limited. In this study, we conducted a retrospective analysis of ethics consultations over a 10-year period at a quaternary academic hospital to identify consultations involving UDNAR orders. We identified 58 ethics consultations (55 adult and 3 pediatric) requested in the context of UDNAR orders. There were thirty-seven (63.7%) cases in which the patient and/or surrogate actively disagreed with the proposed code status change, 21 (36.2%) cases in which they assented. We explored contextual features and palliative care involvement using a qualitative conceptual content analysis. We found that Black or African American patients were disproportionately represented among cases of conflict with a proposed UDNAR status change (p = 0.0015). Palliative care was involved in most conflict cases (28, 75.6%) while less frequently in assent cases (8, 38.0%). Our study aims to inform best practices and underscore the ethical intricacies of UDNAR decisions and the need for interdisciplinary collaboration and direct engagement with patients and families.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473474","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

A Commentary on Ethics Case Reflections as an Ethics laboratory in Clinical Practice. 临床实践中作为伦理实验室的伦理案例反思述评

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-06-30 DOI: 10.1007/s10730-026-09598-5

Anna Bennesved, Anders Bremer, Joar Björk

引用次数: 0

From Cyberchondria to Spatial Anxiety: How Much Should I Worry About My Well-Being? 从网络疑病症到空间焦虑：我应该为自己的健康担心多少？

IF 1.2 4区哲学

Hec Forum Pub Date : 2026-06-05 DOI: 10.1007/s10730-026-09595-8

Susi Ferrarello

{"title":"From Cyberchondria to Spatial Anxiety: How Much Should I Worry About My Well-Being?","authors":"Susi Ferrarello","doi":"10.1007/s10730-026-09595-8","DOIUrl":"https://doi.org/10.1007/s10730-026-09595-8","url":null,"abstract":"This article examines the intersection of anxiety, emotional geography, and bioethics, exploring how uncertainty shapes the experience of patients navigating medical and social landscapes. When is the good time to start worrying about one's own well-being? Who is the \"good patient\"? Anxiety, particularly in medical contexts, arises from the epistemic tension between known and unknown realities, challenging patients and clinicians alike to discern which concerns warrant attention. Drawing on phenomenological and bioethical perspectives-including those of Heidegger (1962), Sartre (1996), Ricoeur (1992, 2004), and Tillich (1952), as well as the phenomenology of the body developed by Leder (1990)-alongside contemporary scholarship in emotional geography and medical humanities, this paper investigates different forms of anxiety: digital, existential, and spatial, and their impact on subjective and intersubjective medical experiences. Special attention is given to the \"dys-appearing\" body, the disruption of embodied self-evidence in illness, the courage required to exist in the face of medical uncertainty, and the constitutive role of intersubjective environments in shaping patients' sense of well-being. Ultimately, I argue for a more compassionate, intentional engagement with anxiety that transcends mere symptom management, advocating instead for a holistic approach that accounts for the emotional, spatial, and existential constitution of patients' realities.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164958","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 Considerations of Patient Participation in Moral Case Deliberation: An Explorative Interview Study Among Healthcare Professionals, (Parents of) Patients and Facilitators. 道德案例审议中患者参与的道德考虑：一项对医护人员、患者（家长）和调解人的探索性访谈研究。

IF 1.2 4区哲学

Hec Forum Pub Date : 2026-06-04 DOI: 10.1007/s10730-026-09594-9

Savannah van Kuppenveld, Bert Molewijk, Margreet Stolper, Janine de Snoo-Trimp

{"title":"Moral Considerations of Patient Participation in Moral Case Deliberation: An Explorative Interview Study Among Healthcare Professionals, (Parents of) Patients and Facilitators.","authors":"Savannah van Kuppenveld, Bert Molewijk, Margreet Stolper, Janine de Snoo-Trimp","doi":"10.1007/s10730-026-09594-9","DOIUrl":"https://doi.org/10.1007/s10730-026-09594-9","url":null,"abstract":"Despite increasing initiatives in healthcare, it often remains a challenge to effectuate patient participation. A promising space for patient participation is to be found within Moral Case Deliberation, a dialogical form of Clinical Ethics Support. However, presence of patients in these dialogues is still rare. This paper aims to provide a better understanding of moral considerations of participation of patients (and their relatives) in Moral Case Deliberation, by collecting expectations and experiences from patients, relatives, healthcare professionals and facilitators. The study is an explorative interview study in two clinical settings. Interviewees were recruited through purposeful sampling and among all relevant perspectives (i.e. patient, parent, healthcare professional and facilitator). Twelve interviewees were included; most did not yet have actual experiences with patient participation in Moral Case Deliberation. A variety of moral considerations was found. Three overarching themes were identified: 'equality', 'transparency' and 'vulnerability', connected to nine considerations: 'sharing the moral dilemma, engagement/acknowledgement of the patient and parent perspective', 'mutual understanding', 'complexities', 'risk of harm', 'self-censorship', 'safety' and 'power dynamics'. There seems to be - as of yet - no principled reason to adopt an attitude of categorial rejection nor acceptance of inclusion of patients or family in Moral Case Deliberation. This study provides a starting point for further identification of and reflection on such considerations. We think that a careful assessment of various considerations is something that should be done by those directly involved in the moral issue at hand on a case-by-case basis.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158601","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

Religious Values, Clinical Ethics Consultations, and the Lack of a Secular Bioethical Consensus. 宗教价值观，临床伦理咨询，缺乏世俗的生物伦理共识。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-06-01 Epub Date: 2025-11-12 DOI: 10.1007/s10730-025-09571-8

Kirk Lougheed

{"title":"Religious Values, Clinical Ethics Consultations, and the Lack of a Secular Bioethical Consensus.","authors":"Kirk Lougheed","doi":"10.1007/s10730-025-09571-8","DOIUrl":"10.1007/s10730-025-09571-8","url":null,"abstract":"The extent to which clinical ethics consultations should be neutral with respect to religion is the subject of ongoing debate. One important position says that clinical ethics consultants ought to appeal to the secular bioethical consensus that is available to everyone inasmuch as possible, and that they can do so without the subsequent need to defend an underlying moral theory. This view has been criticized because it is doubtful that such a consensus exists. Abram Brummett argues for a more nuanced approach where clinical ethicists must appeal to the bioethical consensus in clinical settings, but that the consensus and underlying moral principles can be debated in academic contexts (2020). Furthermore, he suggests that the consensus need not avoid making at least some moral, epistemological, and metaphysical commitments, though not to the level of embracing a full-fledged comprehensive worldview. I argue that Brummett's approach fails because it does not successfully avoid the implications of the lack of a secular bioethical consensus. Any defense of such a consensus is only possible at a superficial level where there may be agreement on which moral concepts to use, even though deep disagreement remains about their nature and application. While Brummett's approach is more honest than some secular alternatives because it does not seek to avoid making any judgments about underlying commitments, it is ultimately uninformative in failing to address the fact of pluralism. To conclude, I suggest that even if I am mistaken and there really is a secular bioethical consensus, Brummett's view implies that the consensus can never be legitimately challenged in clinical settings.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"271-285"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497026","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

Case-Based Clinical Ethics Support - A Description and Normative Discussion of Methodological Issues from the Swedish Perspective. 基于病例的临床伦理学支持——从瑞典的角度对方法学问题的描述和规范讨论。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-06-01 Epub Date: 2025-10-12 DOI: 10.1007/s10730-025-09566-5

Pernilla Pergert, Mia Svantesson, Cecilia Bartholdson, Anders Bremer, Margareta Brännström, Catarina Fischer Grönlund, Niklas Juth, Joar Björk

{"title":"Case-Based Clinical Ethics Support - A Description and Normative Discussion of Methodological Issues from the Swedish Perspective.","authors":"Pernilla Pergert, Mia Svantesson, Cecilia Bartholdson, Anders Bremer, Margareta Brännström, Catarina Fischer Grönlund, Niklas Juth, Joar Björk","doi":"10.1007/s10730-025-09566-5","DOIUrl":"10.1007/s10730-025-09566-5","url":null,"abstract":"Clinical Ethics Support (CES) includes various forms of systematic support to deal with ethical challenges in healthcare and case-based CES (C-CES) is used for CES in particular cases. The aim was to describe and normatively discuss organizational and methodological aspects of C-CES used in Swedish healthcare. A mixed-methods approach was used. A descriptive survey was answered regarding eight organizations on hospital, regional and national level, with large variations in the number of conducted C-CES activities. Data were compiled and frequencies calculated. Based on the survey results, normative questions were formulated. Six participants, with expertise of C-CES, participated in a normative group discussion. Field notes and transcribed data were analysed qualitatively. The top ranked goal of C-CES was \"Supporting decision making\". Mainly prospective cases were used and C-CES was carried out as un-planned and pre-planned sessions. The normative results showed the importance of avoiding making C-CES unattractive to clinicians, for instance by keeping the time frame. The professional backgrounds of C-CES leaders varied greatly and arguments were provided for the facilitating role and that C-CES leaders ought not facilitate where they have been clinically engaged. Identified challenges included variations in uptake of C-CES activities that do not mirror the ethical challenges of the context. The unfair uptake of C-CES can be compared with the uptake in Norway where there are legal requirements for CES. In this study patients and families were not reported to request or attend C-CES. Thus, further research and interventions are needed to ensure their representation in Swedish C-CES.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"191-206"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13194189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276160","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

Carrying the Facilitator Responsibility: Experiences of Healthcare Professionals Under Training to Become Facilitators of Ethics Case Reflection Rounds in Paediatric Oncology. 承担引导者的责任：接受培训的医疗保健专业人员成为儿科肿瘤伦理案例反思轮引导者的经验。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-06-01 Epub Date: 2025-11-25 DOI: 10.1007/s10730-025-09572-7

Cecilia Bartholdson, Bert Molewijk, Margreet Stolper, Pernilla Pergert

{"title":"Carrying the Facilitator Responsibility: Experiences of Healthcare Professionals Under Training to Become Facilitators of Ethics Case Reflection Rounds in Paediatric Oncology.","authors":"Cecilia Bartholdson, Bert Molewijk, Margreet Stolper, Pernilla Pergert","doi":"10.1007/s10730-025-09572-7","DOIUrl":"10.1007/s10730-025-09572-7","url":null,"abstract":"In paediatric oncology, ethical dilemmas often arise and includes different perspectives about what is perceived as ethically right care for the child. Ethics Case Reflection (ECR) rounds, a form of Clinical Ethics Support (CES), offer a structured, dialogical approach to facilitate ethical reflection. A Nordic working group on ethics in pediatric oncology offers a training program for healthcare professionals to become facilitators for ECR rounds. The aim of this study was to explore experiences of these facilitator trainees when facilitating ECR rounds in Nordic paediatric oncology. Using classic grounded theory methodology, data were collected through three focus groups with 22 Nordic facilitator trainees and 27 individual interviews with 17 facilitator trainees from Sweden. Carrying the facilitator responsibility is the core category in this study, used to resolve the main concern of delivering a meaningful experience of ethics support and enabling ethically good care for the child. To carry the facilitator responsibility and handle associated challenges, the condition of achieved facilitator confidence and the strategies of allying and undertaking the facilitator role is important. ECR facilitator trainees take their role seriously as they are carrying the facilitator responsibility to deliver a meaningful experience of CES and enable ethically good care for the child. We conclude that this perceived burden of responsibility should be better addressed during future facilitator trainings, emphasising the use of various strategies to decrease this burden and share the responsibility for the ECR together with the ECR participants. Training also needs to strengthen ethical competence to achieve facilitator confidence of the trainees. Further research is needed on what kind of core ethical competencies facilitators of ECR rounds needs.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"287-299"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13194328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606749","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

Aruna Shanbaug and the Evolution of Medico-Legal Ethics in India: A Forensic and Jurisprudential Reappraisal. Aruna Shanbaug与印度医法伦理的演变：法医学和法学的再评价。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-06-01 Epub Date: 2025-11-09 DOI: 10.1007/s10730-025-09568-3

Pragnesh Parmar, Gunvanti Rathod

{"title":"Aruna Shanbaug and the Evolution of Medico-Legal Ethics in India: A Forensic and Jurisprudential Reappraisal.","authors":"Pragnesh Parmar, Gunvanti Rathod","doi":"10.1007/s10730-025-09568-3","DOIUrl":"10.1007/s10730-025-09568-3","url":null,"abstract":"The case of Aruna Shanbaug, a young nurse rendered permanently unconscious following a violent assault in 1973, stands as a defining moment in India's medico-legal and ethical history. Over four decades of institutional care without legal guardianship, reassessment, or advance directive brought to light the systemic gaps in forensic investigation, sexual violence prosecution, and end-of-life jurisprudence. This essay undertakes a critical analysis of the forensic failures surrounding the assault, the narrow legal definitions that denied justice, and the prolonged absence of ethical oversight in Shanbaug's custodial management. It further explores the Supreme Court's 2011 judgment on passive euthanasia, which - though denying the specific plea - laid the groundwork for constitutional recognition of the right to die with dignity. By drawing comparisons with international cases such as Terri Schiavo (USA) and Tony Bland (UK), the essay situates the Indian experience within a global discourse on bioethics, autonomy, and medical futility. It also charts the post-2011 evolution of Indian medico-legal frameworks, including the recognition of advance directives, reforms in sexual violence law, and the institutionalization of ethical review in clinical practice. Through this multidisciplinary reappraisal, the essay argues that the Shanbaug case was both a consequence of systemic inaction and a catalyst for enduring reform in law, medicine, and ethics in India.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"223-245"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483412","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

Bridging the Gap Between Ethical Norms and Clinical Practice: A Quantitative Study of Medical Ethics Implementation in Moroccan Healthcare. 弥合伦理规范和临床实践之间的差距：摩洛哥医疗保健中医学伦理实施的定量研究。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-06-01 Epub Date: 2025-11-12 DOI: 10.1007/s10730-025-09570-9

Kamal El Haidoudi, Hamza Sekkat, Moundib Abdelghani, Abdelhaq Barbach, Abdellah Khallouqi

{"title":"Bridging the Gap Between Ethical Norms and Clinical Practice: A Quantitative Study of Medical Ethics Implementation in Moroccan Healthcare.","authors":"Kamal El Haidoudi, Hamza Sekkat, Moundib Abdelghani, Abdelhaq Barbach, Abdellah Khallouqi","doi":"10.1007/s10730-025-09570-9","DOIUrl":"10.1007/s10730-025-09570-9","url":null,"abstract":"Despite the existence of codified ethical standards in healthcare, their consistent application in clinical decision-making remains underexplored. This study quantitatively evaluates the knowledge, attitudes and practices of Moroccan healthcare professionals regarding medical ethics. Guided by a positivist epistemology and a hypothetico-deductive methodology, a validated questionnaire was administered to 200 practitioners from diverse medical backgrounds. Descriptive statistics revealed that 96% of respondents report disclosing medical errors, yet only 50% had formal exposure to medical ethics, and 51.5% were familiar with the national code of ethics. Correlation analysis indicated weak but positive associations between ethical training and disclosure practices (r ≈ 0.07). Multiple linear regression demonstrated that variables such as knowledge of ethics (β = 0.111) and training (β = 0.022) had modest, non-significant effects on ethical conduct (R² = 1.05%). Attitudinal factors, such as acceptance of placebo use (β = - 0.121, p = 0.094), showed marginal influence, while respect for patient autonomy and additional training did not significantly predict behavior. Sociodemographic variables (age, experience, rank) also lacked predictive power, though the main model constant (β ≈ 1.0, p < 0.001) suggests a generally strong ethical baseline. These findings show the importance of targeted ethics education and institutional reinforcement to strengthen ethical clinical behavior and promote transparency within the Moroccan healthcare system.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"247-270"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497035","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

Responsible Decision Making for AI in Healthcare: Exploring the Role of Ethics Consultants at the Intersection of Ethics and AI. 人工智能在医疗保健中的负责任决策：探索伦理顾问在伦理和人工智能交叉中的作用。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-06-01 Epub Date: 2025-11-09 DOI: 10.1007/s10730-025-09567-4

Michael McCarthy

引用次数: 0