Hec Forum最新文献_第6页

COVID-19 and the Authority of Science. COVID-19与科学权威。

IF 1.5 4区哲学

Hec Forum Pub Date : 2023-06-01 DOI: 10.1007/s10730-021-09455-7

Griffin Trotter

{"title":"COVID-19 and the Authority of Science.","authors":"Griffin Trotter","doi":"10.1007/s10730-021-09455-7","DOIUrl":"https://doi.org/10.1007/s10730-021-09455-7","url":null,"abstract":"In an attempt to respond effectively to the COVID-19 pandemic, policy makers and scientific experts who advise them have aspired to present a unified front. Leveraging the authority of science, they have at times portrayed politically favored COVID interventions, such as lockdowns, as strongly grounded in scientific evidence-even to the point of claiming that enacting such interventions is simply a matter of \"following the science.\" Strictly speaking, all such claims are false, since facts alone never yield moral-political conclusions. More importantly, attempts to present a unified front have led to a number of other actions and statements by scientists and policy makers that erode the authority of science. These include actions and statements that: (1) mislead the public about epidemiological matters such as mortality rates, cause of death determinations, and computerized modeling, or fail to correct mainstream media sources that interpret such concepts in misleading ways; (2) incorporate moral-political opinions into ostensible statements of fact; and (3) misrepresent or misuse scientific expertise. The fundamental thesis of the paper is not primarily that such actions and statements have proliferated during the COVID-19 epidemic (though I think they have), but rather that they are unscientific and that presenting them as science undermines the authority of science. In the moral-political realm, the great power of science and the source of its authority derives from its agnosticism about fundamental moral-political claims. Science, for instance, has no built-in presumption that we should respect life, promote freedom, or practice toleration; nor does it tell us which of these values to prioritize when values conflict. Because of this agnosticism, science is recognized across a broad diversity perspectives as morally and politically impartial, and authoritative within its proper sphere. When it is infused with partisan bias, it loses that authority.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"35 2","pages":"111-138"},"PeriodicalIF":1.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-021-09455-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9438610","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: 1

CURA-An Ethics Support Instrument for Nurses in Palliative Care. Feasibility and First Perceived Outcomes. 姑息治疗护士伦理支持工具。可行性和第一感知结果。

IF 1.5 4区哲学

Hec Forum Pub Date : 2023-06-01 DOI: 10.1007/s10730-021-09456-6

Malene Vera van Schaik, H Roeline Pasman, Guy Widdershoven, Bert Molewijk, Suzanne Metselaar

{"title":"CURA-An Ethics Support Instrument for Nurses in Palliative Care. Feasibility and First Perceived Outcomes.","authors":"Malene Vera van Schaik, H Roeline Pasman, Guy Widdershoven, Bert Molewijk, Suzanne Metselaar","doi":"10.1007/s10730-021-09456-6","DOIUrl":"https://doi.org/10.1007/s10730-021-09456-6","url":null,"abstract":"Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with five-point Likert scales were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78-87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"35 2","pages":"139-159"},"PeriodicalIF":1.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10167118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9444710","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: 7

The Ethics Laboratory: A Dialogical Practice for Interdisciplinary Moral Deliberation. 伦理实验室:跨学科道德思考的对话实践。

IF 1.5 4区哲学

Hec Forum Pub Date : 2023-06-01 DOI: 10.1007/s10730-021-09460-w

Jeanette Bresson Ladegaard Knox

{"title":"The Ethics Laboratory: A Dialogical Practice for Interdisciplinary Moral Deliberation.","authors":"Jeanette Bresson Ladegaard Knox","doi":"10.1007/s10730-021-09460-w","DOIUrl":"https://doi.org/10.1007/s10730-021-09460-w","url":null,"abstract":"Recent advancements in therapeutic and diagnostic medicine, along with the creation of large biobanks and methods for monitoring health technologies, have improved the prospects for preventing, treating, and curing illness. These same advancements, however, give rise to a plethora of ethical questions concerning good decision-making and best action. These ethical questions engage policymakers, practitioners, scientists, and researchers from a variety of fields in different ways. Collaborations between professionals in the medical and health sciences and the social sciences and humanities often take an asymmetrical form, as when social scientists use ethnographic approaches to study the moral issues and practices of physicians. The ethics laboratory described in this article is a cross-sectoral and inter-disciplinary forum for collaborative investigation on important moral topics. It offers an experimental way of unpacking implied assumptions, underlying values, and comparable notions from different professional healthcare fields. The aim of this article is to present the ethics laboratory's methodology. The article offers a model and a hermeneutical framework that rests on a dialogical approach to ethical questions. The model and the framework derive from a Danish research project, Personalized Medicine in the Welfare State. This article uses personalized medicine as a point of reference, though it offers an argument for the applicability of the model more broadly.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"35 2","pages":"185-199"},"PeriodicalIF":1.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9435045","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: 2

Addressing Clinical Misconduct: Resigning and Whistleblowing in Clinical Ethics Consultation. 解决临床不端行为:辞职和举报在临床伦理咨询。

IF 1.5 4区哲学

Hec Forum Pub Date : 2023-06-01 DOI: 10.1007/s10730-021-09459-3

Etan Kuperberg, Michael S Dauber

引用次数: 0

Reflective Debriefs as a Response to Moral Distress: Two Case Study Examples. 反思汇报作为对道德困境的回应:两个案例研究例子。

IF 1.5 4区哲学

Hec Forum Pub Date : 2023-03-01 DOI: 10.1007/s10730-021-09441-z

Georgina Morley, Cristie Cole Horsburgh

{"title":"Reflective Debriefs as a Response to Moral Distress: Two Case Study Examples.","authors":"Georgina Morley, Cristie Cole Horsburgh","doi":"10.1007/s10730-021-09441-z","DOIUrl":"https://doi.org/10.1007/s10730-021-09441-z","url":null,"abstract":"Within this paper, we discuss Moral Distress Reflective Debriefs as a promising approach to address and mitigate moral distress experienced by healthcare professionals. We briefly review the empirical and theoretical literature on critical incident stress debriefing and psychological debriefing to highlight the potential benefits of this modality. We then describe the approach that we take to facilitating reflective group discussions in response to morally distressing patient cases (\"Moral Distress Reflective Debriefs\"). We discuss how the debriefing literature and other clinical ethics activities influenced the development of our approach. In particular, we focus on the role of the clinical ethicist as a facilitator with particular emphasis on encouraging perspective-taking and nurturing ethical attunement in a supportive manner. We suggest that this approach reduces the narrowing effects of frustration and anger that are often reported when individuals experience moral-constraint distress. Finally, we provide an example of Moral Distress Reflective Debriefs, elucidating how this supportive process complements ethics consultation and can mitigate the negative effects of moral distress.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"35 1","pages":"1-20"},"PeriodicalIF":1.5,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-021-09441-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10716312","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: 15

Effect of a Moral Distress Consultation Service on Moral Distress, Empowerment, and a Healthy Work Environment. 道德困境咨询服务对道德困境、赋权和健康工作环境的影响。

IF 1.5 4区哲学

Hec Forum Pub Date : 2023-03-01 DOI: 10.1007/s10730-021-09449-5

Elizabeth G Epstein, Ruhee Shah, Mary Faith Marshall

{"title":"Effect of a Moral Distress Consultation Service on Moral Distress, Empowerment, and a Healthy Work Environment.","authors":"Elizabeth G Epstein, Ruhee Shah, Mary Faith Marshall","doi":"10.1007/s10730-021-09449-5","DOIUrl":"https://doi.org/10.1007/s10730-021-09449-5","url":null,"abstract":"Background: Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed.Objective: To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation.Methods: A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff when moral distress was present. The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale.Results: Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment.Conclusions: Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"35 1","pages":"21-35"},"PeriodicalIF":1.5,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-021-09449-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10733461","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: 6

Affirming the Existence and Legitimacy of Secular Bioethical Consensus, and Rejecting Engelhardt's Alternative: A Reply to Nick Colgrove and Kelly Kate Evans. 肯定世俗生命伦理共识的存在和合法性，拒绝恩格尔哈特的替代——对尼克·科尔格罗夫和凯利·凯特·埃文斯的回答。

IF 1.5 4区哲学

Hec Forum Pub Date : 2023-03-01 DOI: 10.1007/s10730-021-09452-w

Abram Brummett

{"title":"Affirming the Existence and Legitimacy of Secular Bioethical Consensus, and Rejecting Engelhardt's Alternative: A Reply to Nick Colgrove and Kelly Kate Evans.","authors":"Abram Brummett","doi":"10.1007/s10730-021-09452-w","DOIUrl":"https://doi.org/10.1007/s10730-021-09452-w","url":null,"abstract":"One of the most significant and persistent debates in secular clinical ethics is the question of ethics expertise, which asks whether ethicists can make justified moral recommendations in active patient cases. A critical point of contention in the ethics expertise debate is whether there is, in fact, a bioethical consensus upon which secular ethicists can ground their recommendations and whether there is, in principle, a way of justifying such a consensus in a morally pluralistic context. In a series of recent articles in this journal, Janet Malek defends a positive view of ethics expertise, claiming that secular ethicists should comport their recommendations with bioethical consensus. In response, Nick Colgrove and Kelly Kate Evans deny the existence of a secular bioethical consensus; question why, even if it did exist, consensus should be considered a reliable way of resolving bioethical questions; and recommend a friendlier approach to clinical ethics based on the thought of H. Tristram Engelhardt Jr. In this article, I respond to Colgrove and Evans on all three points. In part one, I show there is a secular bioethical consensus but note it could be better consolidated and created through a more systematic and inclusive process. In part two, I argue that bioethical consensus is morally justified but note that this justification cannot be plausibly based upon claims that it only invokes moral principles available to or shared by all. In part three, I argue Engelhardt's approach cannot be described as \"friendlier\" to clinical ethics because it is incompatible with many current healthcare laws and policies.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"35 1","pages":"95-109"},"PeriodicalIF":1.5,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-021-09452-w","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10716367","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: 3

The Experience of Moral Distress in an Academic Family Medicine Clinic. 一个学术性家庭医学诊所的道德困境体验。

IF 1.5 4区哲学

Hec Forum Pub Date : 2023-03-01 DOI: 10.1007/s10730-021-09453-9

Dawn Worsham Bourne, Elizabeth Epstein

{"title":"The Experience of Moral Distress in an Academic Family Medicine Clinic.","authors":"Dawn Worsham Bourne, Elizabeth Epstein","doi":"10.1007/s10730-021-09453-9","DOIUrl":"https://doi.org/10.1007/s10730-021-09453-9","url":null,"abstract":"Background and objectives: Primary care providers (PCPs) report decreased job satisfaction and high levels of burnout, yet little is known about their experience of moral distress. The aim of this study was to gain insight into the experiences of PCPs regarding moral distress including causative factors and proposed mitigation strategies.Methods: This qualitative pilot study used semi-structured interviews to identify causes of moral distress in PCPs in an academic family medicine department. Interviews were analyzed using conventional content analysis.Results: Of 35 eligible participants, 12 completed the study (34% participation rate). Most were white, female, and had practiced for less than 10 years. Four PCPs had considered leaving their position due to moral distress. Participants identified five causes of moral distress: policies and procedures that conflict with patient needs, the unpredictable nature of primary care, need to \"bend the rules,\" lack of accountability, and lack of support staff. Six internal conflicts made resolving morally distressing situations difficult: perceived powerlessness, sense of responsibility, socialization to follow orders, emotional toll of the job, competing obligations, and fear of mistakes.Conclusions: These findings matched themes in the current literature and identified an unbending infrastructure. This, coupled with the chaotic nature of primary care, resulted in frequent moral distress. Participants offered solutions to reduce and mitigate moral distress (also similar with current literature) and suggested moral distress and burnout are closely linked.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"35 1","pages":"37-54"},"PeriodicalIF":1.5,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-021-09453-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10723905","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: 2

Psychiatric Hospital Ethics Committee Discussions Over a Span of Nearly Three Decades. 精神病院伦理委员会近三十年的讨论。

IF 1.5 4区哲学

Hec Forum Pub Date : 2023-03-01 DOI: 10.1007/s10730-021-09454-8

Michall Ferencz-Kaddari, Abira Reizer, Meni Koslowsky, Ora Nakash, Shai Konas

{"title":"Psychiatric Hospital Ethics Committee Discussions Over a Span of Nearly Three Decades.","authors":"Michall Ferencz-Kaddari, Abira Reizer, Meni Koslowsky, Ora Nakash, Shai Konas","doi":"10.1007/s10730-021-09454-8","DOIUrl":"https://doi.org/10.1007/s10730-021-09454-8","url":null,"abstract":"Various types of health settings use clinical ethics committees (CEC) to deal with the ethical issues that confront both healthcare providers and their patients. Although these committees are now more common than ever, changes in the content of ethical dilemmas through the years is still a relatively unexplored area of research. The current study examines the major topics brought to the CEC of a psychiatric hospital in Israel and explores whether there were changes in their frequency across nearly three decades. The present paper reports on a thematic analysis of the written verbatim transcripts from 466 ethical topics brought to the CEC between the years 1991 and 2016. The following major topics related to ethical dilemmas were identified: confidentiality (30%), patient autonomy (23%), health records (14%), dual relationship (12%), allocation of resources (11%), inappropriate professional and personal conduct (9%), and multicultural sensitivity (1%). Topics related to confidentiality increased significantly over the years, as did inappropriate professional and personal conduct. In addition, the analysis showed that the content of the ethical cases and the resolutions suggested by the CEC also varied over the years. In conclusion, although most ethical topics have remained relatively stable over time, the discourse around them has evolved, requiring a dynamic assessment and reflection by the mental health practitioners serving as members of a CEC.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"35 1","pages":"55-71"},"PeriodicalIF":1.5,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-021-09454-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10723906","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: 1

Primary Care Ethics is Just Medical Ethics: A Philosophical Argument for the Feasibility of Transitioning Acute Care Ethics to the Primary Care Setting. 初级保健伦理就是医学伦理:急症护理伦理过渡到初级保健环境可行性的哲学论证。

IF 1.5 4区哲学

Hec Forum Pub Date : 2023-03-01 DOI: 10.1007/s10730-021-09451-x

Stephen Perinchery-Herman

引用次数: 0