Hec Forum最新文献_第6页

Professional Identity Formation in Clinical Ethics: The Role of Fellowship Training. 临床伦理学职业认同的形成：研究员培训的作用。

IF 1.2 4区哲学

Hec Forum Pub Date : 2026-03-25 DOI: 10.1007/s10730-026-09582-z

Ruchika Mishra

{"title":"Professional Identity Formation in Clinical Ethics: The Role of Fellowship Training.","authors":"Ruchika Mishra","doi":"10.1007/s10730-026-09582-z","DOIUrl":"https://doi.org/10.1007/s10730-026-09582-z","url":null,"abstract":"As clinical ethics continues to professionalize, there is growing demand for trained clinical ethicists and expansion of clinical ethics fellowship programs. While existing discussions of professionalization have largely focused on competencies in knowledge, skills, and professional attributes, comparatively little attention has been paid to professional identity formation among clinical ethicists. Professional identity formation - the integration of a profession's values, skills, knowledge, and behaviors into an individual's sense of self - is widely recognized as essential for sustainable and meaningful professional practice in health care. This paper explores the role of clinical ethics fellowship training programs in fostering professional identity formation among trainees. Drawing on established literature in medical education and the author's experience leading a long-standing clinical ethics fellowship within a large health system, the paper highlights three core elements of professional identity formation that should be embedded in clinical ethics fellowship training: experiential learning, reflection, and effective mentoring and professional socialization. Integrating these elements can help trainees internalize the role of the clinical ethicist, promote resilience and well-being, and support long term commitment to the field of clinical ethics.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515808","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

"Don't Tell Them Anything": Should Surrogate Decision-Makers Be Allowed to Withhold Information from Other Family Members or Prevent Them from Visiting with a Patient? “什么都不要告诉他们”：是否应该允许代理决策者向其他家庭成员隐瞒信息或阻止他们探望病人？

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-03-01 Epub Date: 2025-07-02 DOI: 10.1007/s10730-025-09554-9

Bryanna Moore, Shalom Schlagman, Laine E DiNoto, David C Kaufman, Nicholas Mercado, Michael J Nabozny, Marjorie Hodges Shaw

{"title":"\"Don't Tell Them Anything\": Should Surrogate Decision-Makers Be Allowed to Withhold Information from Other Family Members or Prevent Them from Visiting with a Patient?","authors":"Bryanna Moore, Shalom Schlagman, Laine E DiNoto, David C Kaufman, Nicholas Mercado, Michael J Nabozny, Marjorie Hodges Shaw","doi":"10.1007/s10730-025-09554-9","DOIUrl":"10.1007/s10730-025-09554-9","url":null,"abstract":"While patients have the right to control who has access to their health information and designate visitors, it is not always clear whether-when a patient lacks capacity-their surrogate also exercises such rights. States and federal laws are often vague about the limits of surrogate authority. Even where legal or institutional guidance on this issue is clear, requests by surrogates to withhold information or restrict visitation with a patient can be a source of ethical uncertainty and distress on the part of the clinical team. This paper explores the ethical issues raised by such requests. To date, there has been little exploration of this issue in the clinical ethics literature. First, we summarize the scant existing ethical and legal guidance on this issue. Second, we present two potential approaches to navigating requests from surrogates to withhold information or restrict visitation. Third, we discuss the merits and limitations of both approaches, and introduce some additional considerations that further complicate the picture. We argue for a flexible restrictive approach to information-sharing, and a constrained permissive approach to visitation. Finally, we propose several considerations that clinicians and clinical ethicists might think through in these situations to help guide their practice.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"93-106"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545370","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

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 1.6 4区哲学

Hec Forum Pub Date : 2026-03-01 Epub 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":"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":"1-23"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12876543/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Macro-Level Factors Influencing the Adoption and Early Implementation of Clinical Ethics Support Services: A Scoping Review. 影响临床伦理支持服务采用和早期实施的宏观因素：范围综述。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-03-01 Epub Date: 2025-08-28 DOI: 10.1007/s10730-025-09555-8

Gilles Bernard, Michael Fischer

{"title":"Macro-Level Factors Influencing the Adoption and Early Implementation of Clinical Ethics Support Services: A Scoping Review.","authors":"Gilles Bernard, Michael Fischer","doi":"10.1007/s10730-025-09555-8","DOIUrl":"10.1007/s10730-025-09555-8","url":null,"abstract":"Clinical ethics are becoming increasingly important in the twenty-first century. Value-laden cases and moral dilemmas in healthcare have led to the creation of clinical ethics support structures. The last decades have shown their implementation in hospitals around the globe. Recent literature investigates their value, function, and integration. Many conclude that they do valuable work yet remain inadequately integrated, lack institutionalization, and struggle with resource shortages. To gain an understanding of this development and pave the way for future implementation and research, a scoping review was chosen to determine which macro-level factors currently influence the heterogeneous approaches. This review used the scientific research databases Medline and CINAHL in April 2025. It included studies, opinion papers, and book chapters in English and German offering explanations, analysis, discussion, and examples of macro-level clinical ethics support structures' adoption and implementation influences. An inductive qualitative content analysis was conducted to extract the desired information. The resulting categories were formatted into an overview frame. The literature search yielded 400 publications, full-text analysis and snowball search resulted in 47 eligible for analysis. Eight main factors with respective subcategories were identified. These vary in their degree of binding authority, ranging from clearly defined regulations, such as national laws, to more ambiguous influences, such as public opinion and advocacy. Further insights reveal that the effectiveness of these factors cannot yet be determined, and their influence may vary based on the values and political context of the country where a support structure is implemented.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"107-145"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973712","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

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 1.6 4区哲学

Hec Forum Pub Date : 2026-03-01 Epub Date: 2025-04-28 DOI: 10.1007/s10730-025-09548-7

Helen Watt

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 1.6 4区哲学

Hec Forum Pub Date : 2026-03-01 Epub Date: 2025-05-14 DOI: 10.1007/s10730-025-09549-6

Marta Fadda

引用次数: 0

Moral reasoning during vascular surgeons' case conferences: finding the balance of risk and benefit by exploring the clinical details. 血管外科医生病例会议中的道德推理：通过探讨临床细节找到风险与收益的平衡。

IF 1.2 4区哲学

Hec Forum Pub Date : 2026-03-01 Epub Date: 2025-06-25 DOI: 10.1007/s10730-025-09550-z

Kaja Heidenreich, Marit Karlsson, Anders Bremer, Mia Svantesson

引用次数: 0

Liberalism and Lockdowns. 自由主义和封锁。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-03-01 Epub Date: 2025-07-19 DOI: 10.1007/s10730-025-09552-x

D Robert MacDougall

{"title":"Liberalism and Lockdowns.","authors":"D Robert MacDougall","doi":"10.1007/s10730-025-09552-x","DOIUrl":"10.1007/s10730-025-09552-x","url":null,"abstract":"Some authors have argued that liberalism cannot support lockdowns because it cannot engage in collective welfare-type reasoning. Others have thought that liberalism can justify lockdown measures, but that legitimate lockdown measures must be based on pre-legal moral principles that set acceptable limits to the imposition of risk or forbid contributing to collective harm. In this essay, I assess the overall relationship between liberalism and lockdowns. Against the first interpretation of liberalism, I argue in favor of the idea that lockdowns can be justified by liberalism. Liberalism protects the liberty of each and so can presumably protect persons from some kinds of involuntary risks and collective harms. However, liberal governments need principles for determining when the imposition of risks or collective harms is unacceptable. Against the second interpretation of liberalism, I argue that these principles cannot be pre-legal moral duties but instead must be principles that are chosen through legal processes. I explain lockdown policies in terms of existing legal processes that set standards for the imposition of risk and the production of collective harms (negligence theory and cap and trade systems, respectively), but argue that these legal processes settle our moral duties only in the case we assume an authoritative state.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"63-79"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668725","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

Do-Not-Resuscitate Orders After Suicide Attempts: To Uphold or Suspend? 自杀未遂后的不抢救令：维持还是暂停？

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-03-01 Epub Date: 2025-10-04 DOI: 10.1007/s10730-025-09553-w

Noah Berens, Rimma Osipov, Paul Ossman

{"title":"Do-Not-Resuscitate Orders After Suicide Attempts: To Uphold or Suspend?","authors":"Noah Berens, Rimma Osipov, Paul Ossman","doi":"10.1007/s10730-025-09553-w","DOIUrl":"10.1007/s10730-025-09553-w","url":null,"abstract":"When a patient with a pre-existing DNR attempts suicide, physicians must decide between two conflicting options: upholding the patient's DNR and risking a potentially avoidable death or suspending the DNR and risking violating the patient's autonomy. The bioethics literature has proposed a variety of principles to guide decision-making in such cases, but provides little clarity and fails to address all principles cited by physicians when confronted with such cases. Furthermore, little attention has been paid to the ongoing ethical dilemmas medical teams may face when treating a patient with a DNR after a suicide attempt. Using a composite case derived from four clinical cases in which patients with pre-existing DNR attempted suicide and the principles their physicians cited, we develop an ethical framework for the ongoing decision-making required of medical teams treating these patients. We analyze three primary factors, assessing their relevance and utility for decision-making: patient decision-making capacity, physician complicity in suicide, and expected quality of life. We conclude that although physician complicity in suicide and a patient's expected quality of life have intuitive appeal and may influence decision-making in practice, clinicians should set these principles aside and instead focus on assessing a patient's decision-making capacity at the time of their DNR request.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"81-92"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226071","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 Professional Clinical Ethicist: Situated Expertise and the Post-Guild Profession. 专业临床伦理学家：情境专业知识和后公会职业。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-02-12 DOI: 10.1007/s10730-026-09579-8

Margie Hodges Shaw

引用次数: 0