Hec Forum最新文献_第7页

Professional Identity Formation in Clinical Ethics Consultation: A Pedagogical Necessity for Clinical Ethics Training Programs. 临床伦理咨询职业认同的形成：临床伦理培训教学的必要性。

IF 1.2 4区哲学

Hec Forum Pub Date : 2026-02-01 DOI: 10.1007/s10730-026-09577-w

Nicholas R Mercado

{"title":"Professional Identity Formation in Clinical Ethics Consultation: A Pedagogical Necessity for Clinical Ethics Training Programs.","authors":"Nicholas R Mercado","doi":"10.1007/s10730-026-09577-w","DOIUrl":"https://doi.org/10.1007/s10730-026-09577-w","url":null,"abstract":"Clinical ethics consultation is the practice of using ethical principles and theories to engage in complex interventions with stakeholders (patients, families, healthcare providers) to address moral issues. Ethicists must master ethical principles and apply them to complex healthcare dilemmas, employing critical thinking and practical knowledge to address nuances in healthcare. Essential to a clinical ethics consultant's development is the need for professional identity formation. Central this discussion of professional identity formation is what defines a professional and what qualifies a person to serve in that professional capacity. Are these qualifications skills-based, or are there characteristics that a clinical ethicist must have to be in the profession? Must someone have a professional or educational background that begins the professional identity formation process before entering the field of clinical ethics? Furthermore, can someone be taught these qualifications through structured learning activities with the goal of socializing them to a professional community? This essay will explore the reasons why professional identity formation has eluded the clinical ethics consultation field and how educational and training programs in clinical ethics have a duty to help learners develop a professional identity as a clinical ethicist. These programs must not only impart theoretical knowledge and practical skills but also foster the interpersonal abilities essential for ethics consultation. By embedding reflective practices, values clarification, and mentorship opportunities, such programs can guide learners through the complexities of professional identity formation, ensuring they are equipped to navigate the moral and relational challenges of the field.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100969","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

"Who am I to Say?" Why Clinical Ethics Consultants Should be Trained to Give Directive Counsel. “我能说什么呢？”为什么临床伦理咨询师应该接受指导咨询的培训。

IF 1.6 4区哲学

Hec Forum Pub Date : 2026-02-01 DOI: 10.1007/s10730-026-09578-9

Benjamin W Frush, Farr A Curlin

{"title":"\"Who am I to Say?\" Why Clinical Ethics Consultants Should be Trained to Give Directive Counsel.","authors":"Benjamin W Frush, Farr A Curlin","doi":"10.1007/s10730-026-09578-9","DOIUrl":"10.1007/s10730-026-09578-9","url":null,"abstract":"Although clinical ethics consultation once involved the ethicist exercising practical reason to make moral judgments and recommendations, today clinical ethicists largely attempt to keep their “personal” moral judgments on the sidelines (Bell, 2022). Practical reason gives way to reliability, reproducibility, and patient autonomy. As a result, healthcare ethics (HE) consultants operate more as proceduralists negotiating conflicts than as counselors offering substantive recommendations. This pattern mirrors a similar mode of “de-moralization” among medical practitioners, in which clinicians eschew moral evaluation and judgment in favor of facilitating patient access to requested “health care services.” Medicine, like healthcare ethics consultation (HEC), becomes characterized by proceduralism, and clinicians’ moral assessments come to seem irrelevant if not threatening to the twin goals of bureaucratic efficiency and patient autonomy. In this essay, we argue that HE consultants should resist this bent toward procedure over moral substance. A “de-moralized” clinical ethics will neither fulfill its practitioners nor help the patients and clinicians it serves. Against the tide of standardization, bureaucratization, and efficiency-based care driving medical and ethical decision-making, HE consultants, like physicians, should seek to discern the goods/benefits and evils/harms at stake in different contexts and make recommendations toward the former and away from the latter. Those forming the professional identities of HE consultants should encourage them to approach their training as “moral formation” in which they hope to develop the skills and wisdom to offer sound moral counsel to those reckoning with morally complex clinical decisions.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100939","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

Author Index to Volume 37: 2025. 第37卷的作者索引：2025。

IF 1.2 4区哲学

Hec Forum Pub Date : 2025-12-09 DOI: 10.1007/s10730-025-09569-2

引用次数: 0

Introduction, Surrogate Wars: the 'Best Interest Values' Hierarchy & End-of-Life Conflicts with Surrogate Decision-Makers. 引言，替代战争：“最佳利益价值”等级制度和与替代决策者的临终冲突。

IF 1.2 4区哲学

Hec Forum Pub Date : 2025-12-01 Epub Date: 2025-10-15 DOI: 10.1007/s10730-025-09557-6

Autumn Fiester

引用次数: 0

Disability, Quality of Life, and Vitalism in End-of-Life Care. 临终关怀中的残疾、生活质量和活力论。

IF 1.6 4区哲学

Hec Forum Pub Date : 2025-12-01 Epub Date: 2025-10-15 DOI: 10.1007/s10730-025-09561-w

Devan Stahl

引用次数: 0

Competing World Views, Professional Norms, and Conscience. 相互竞争的世界观、职业规范和良知。

IF 1.6 4区哲学

Hec Forum Pub Date : 2025-12-01 Epub Date: 2025-10-15 DOI: 10.1007/s10730-025-09562-9

Ana S Iltis

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 1.6 4区哲学

Hec Forum Pub Date : 2025-12-01 Epub 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":"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":"439-461"},"PeriodicalIF":1.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12701854/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medical Futility Laws Protect Surrogate Decision Makers by Constraining Clinicians and Hospitals. 医疗无效法通过约束临床医生和医院来保护代孕决策者。

IF 1.6 4区哲学

Hec Forum Pub Date : 2025-12-01 Epub Date: 2025-10-15 DOI: 10.1007/s10730-025-09564-7

Thaddeus Mason Pope

{"title":"Medical Futility Laws Protect Surrogate Decision Makers by Constraining Clinicians and Hospitals.","authors":"Thaddeus Mason Pope","doi":"10.1007/s10730-025-09564-7","DOIUrl":"10.1007/s10730-025-09564-7","url":null,"abstract":"Medical futility laws protect surrogate decision makers by constraining clinicians and hospitals. Professor Fiester shows that clinicians and surrogate decision makers often have different value systems. Clinicians espouse the \"Best Interest Values\" (BIV) system, while surrogates often espouse the \"Life-Continuation Values\" (LCV) system. Professor Fiester argues that there is no way to adjudicate between the BIV and LCV value systems. They are incommensurable and irreconcilable. Surrogates are not \"wrong\" about the patient's best interest. They just measure it differently. Consequently, because clinicians have no superior ethical claim to determine the patient's best interest, they should not impose their value-laden notion onto surrogates. I question whether clinicians are as powerful as Professor Fiester suggests. In fact, laws in many U.S. states materially constrain clinicians and hospitals, requiring them to do precisely what the LCV surrogate wants. Therefore, in these jurisdictions, clinicians are already forced to undertake the \"constructive engagement\" that Professor Fiester calls for. In these states, the BIV does not subjugate the LCV. Rather, the LCV likely subjugates the BIV.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"471-477"},"PeriodicalIF":1.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303818","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

Getting To the Bottom of Surrogate Skirmishes: A Response To Fiester's "Surrogate Wars". 探究代理冲突的根源：对菲斯特“代理战争”的回应。

IF 1.6 4区哲学

Hec Forum Pub Date : 2025-12-01 Epub Date: 2025-10-15 DOI: 10.1007/s10730-025-09560-x

Janet Malek

{"title":"Getting To the Bottom of Surrogate Skirmishes: A Response To Fiester's \"Surrogate Wars\".","authors":"Janet Malek","doi":"10.1007/s10730-025-09560-x","DOIUrl":"10.1007/s10730-025-09560-x","url":null,"abstract":"In “Surrogate Wars,” Autumn Fiester hypothesizes that conflicts between health care providers and surrogates about the use of life sustaining treatments (LSTs) often arise from differences in deeply held values about best interests and continuation of life. While Fiester’s view offers much food for thought, this response raises three concerns about its plausibility - and therefore its usefulness in resolving conflicts about LST. First, Fiester’s descriptions of health care providers’ best interests values (BIV) and surrogates’ life-continuation values (LCV) fail to recognize the diverse range of commitments these individuals may have. Second, patients and surrogates who articulate LCVs often do so with the hope of achieving a different underlying goal or motivation. Third, her claims about the “hegemony” of providers’ values over those of others seem to mischaracterize the majority of clinician-surrogate interactions; there are good reasons to believe that health care providers generally seek to respect patients’ and surrogates’ values and only interject their own in extreme cases. A more nuanced version of Fiester’s view might provide insights that could help clinicians and clinical ethics consultants resolve some of the challenging disagreements about provision of LST.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"463-470"},"PeriodicalIF":1.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303771","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

Incompletely Theorized Agreement and Accommodated Disagreement in the Surrogate Wars. 代理战争中不完全理论化的协议与迁就的分歧。

IF 1.6 4区哲学

Hec Forum Pub Date : 2025-12-01 Epub Date: 2025-10-15 DOI: 10.1007/s10730-025-09563-8

Takunda Matose

引用次数: 0