Hec Forum最新文献_第8页

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

From Prohibition to Permission: The Winding Road of Medical Assistance in Dying in Canada. 从禁止到允许:加拿大死亡医疗援助的曲折之路。

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-12-01 DOI: 10.1007/s10730-022-09488-6

Jocelyn Downie

引用次数: 5

The Implementation of Assisted Dying in Quebec and Interdisciplinary Support Groups: What Role for Ethics? 协助死亡在魁北克和跨学科支持小组的实施:伦理的作用是什么?

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-12-01 Epub Date: 2022-09-08 DOI: 10.1007/s10730-022-09484-w

Marie-Eve Bouthillier, Catherine Perron, Delphine Roigt, Jean-Simon Fortin, Michelle Pimont

{"title":"The Implementation of Assisted Dying in Quebec and Interdisciplinary Support Groups: What Role for Ethics?","authors":"Marie-Eve Bouthillier, Catherine Perron, Delphine Roigt, Jean-Simon Fortin, Michelle Pimont","doi":"10.1007/s10730-022-09484-w","DOIUrl":"https://doi.org/10.1007/s10730-022-09484-w","url":null,"abstract":"The purpose of this text is to tell the story of the implementation of the Act Respecting End-of-Life Care, referred to hereafter as Law 2 (Gouvernement du Québec, 2014) with an emphasis on the ambiguous role of ethics in the Interdisciplinary Support Groups (ISGs), created by Quebec's Ministère de la santé et des services sociaux (MSSS). As established, ISGs provide \"clinical, administrative and ethical support to health care professionals responding to a request for Medical aid in dying (MAiD)\" (Gouvernement du Québec, 2015). It is suggested that their composition includes the participation of a person with an expertise in ethics. These ISGs represent an important innovation for stakeholders involved in MAiD. To date, no scientific research has specifically addressed ISGs and little research has been conducted in other jurisdictions on the roles, operations and practices of MAiD support structures, especially the implication of ethics. Several ISGs have certainly developed promising practices that could benefit all stakeholders in the wider field of ethics and end of life. We will explore the development of ISGs in Quebec as a support structure for MAiD by highlighting the role that ethics has played (and should play) in these morally and humanly challenging situations.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"355-369"},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33449280","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: 4

Implementation of Medical Assistance in Dying as Organizational Ethics Challenge: A Method of Engagement for Building Trust, Keeping Peace and Transforming Practice. 作为组织伦理挑战的临终医疗援助的实施:一种建立信任、维护和平和转变实践的参与方法。

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-12-01 Epub Date: 2022-08-24 DOI: 10.1007/s10730-022-09485-9

Andrea Frolic, Paul Miller

{"title":"Implementation of Medical Assistance in Dying as Organizational Ethics Challenge: A Method of Engagement for Building Trust, Keeping Peace and Transforming Practice.","authors":"Andrea Frolic, Paul Miller","doi":"10.1007/s10730-022-09485-9","DOIUrl":"https://doi.org/10.1007/s10730-022-09485-9","url":null,"abstract":"This paper focuses on the ethics of how to approach the introduction of MAiD as an organizational ethics challenge, a focus that diverges from the traditional focus in healthcare ethics on the ethics of why MAiD is right or wrong. It describes a method co-designed and implemented by ethics and medical leadership at a tertiary hospital to develop a values-based, grassroots response to the decriminalization of assisted dying in Canada. This organizational ethics engagement method embodied core tenants that drew inspiration from a variety of sources, including poetic ones. These tenants are: make the problem bigger; focus on values; cultivate open moral spaces; and trust emergence. The paper describes how these tenants were put into practice in order to create a rigorous and sustainable MAiD program that delivers high-quality care to patients and families while honoring the moral diversity of the hospital workforce. One of the goals in sharing this method is to provide a roadmap for healthcare organizations in Canada and other jurisdictions around the world that are facing the challenge of responding to patient requests for MAiD following the decriminalization of this care option.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"371-390"},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40651646","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: 5

Introducing Medical Assistance in Dying in Canada: Lessons on Pragmatic Ethics and the Implementation of a Morally Contested Practice. 在加拿大介绍临终医疗援助:关于实用伦理学的教训和实施道德上有争议的做法。

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-12-01 Epub Date: 2022-09-02 DOI: 10.1007/s10730-022-09495-7

Andrea Frolic, Allyson Oliphant

{"title":"Introducing Medical Assistance in Dying in Canada: Lessons on Pragmatic Ethics and the Implementation of a Morally Contested Practice.","authors":"Andrea Frolic, Allyson Oliphant","doi":"10.1007/s10730-022-09495-7","DOIUrl":"https://doi.org/10.1007/s10730-022-09495-7","url":null,"abstract":"Medical Assistance in Dying (MAiD) in Canada has had a tumultuous social and legal history. In the 6 years since assisted dying was decriminalized by the Canadian Parliament in June 2016, the introduction of this practice into the Canadian healthcare system has been fraught with ethical challenges, practical hurdles and grass-roots innovation. In 2021, MAiD accounted for approximately 3.3% of all Canadian deaths annually, and more patients are seeking MAiD year over year as this option becomes more widely know. Unfortunately, some patients who want MAiD are unable to access it in a timely manner because of a lack of willing MAiD providers. This introduction describes statistics about the uptake of MAiD in Canada and the challenges presented by Canadians' rapid acceptance of this end of life care option. In this special edition of HEC Forum about the implementation of MAiD in Canada, authors depict a range of ethical challenges and strategies to address issues related to MAiD access and quality, organizational engagement, clinician recruitment and retention, and support for a morally diverse workforce. In each article, the authors reflect on the question: What are the practical ethics involved in introducing assisted dying into a new healthcare context, and how can ethicists and ethics resources collaborate with stakeholders to ensure the integration of ethical considerations as this practice continues to evolve?","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"307-319"},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9437383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40345058","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: 4

Getting Beyond Pros and Cons: Results of a Stakeholder Needs Assessment on Physician Assisted Dying in the Hospital Setting. 超越利弊:利益相关者对医院环境中医生协助死亡的需求评估结果。

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-12-01 Epub Date: 2022-08-23 DOI: 10.1007/s10730-022-09492-w

Andrea Frolic, Leslie Murray, Marilyn Swinton, Paul Miller

{"title":"Getting Beyond Pros and Cons: Results of a Stakeholder Needs Assessment on Physician Assisted Dying in the Hospital Setting.","authors":"Andrea Frolic, Leslie Murray, Marilyn Swinton, Paul Miller","doi":"10.1007/s10730-022-09492-w","DOIUrl":"https://doi.org/10.1007/s10730-022-09492-w","url":null,"abstract":"This study assessed the attitudes and needs of physicians and health professional staff at a tertiary care hospital in Canada regarding the introduction of physician assisted dying (PAD) during 2015-16. This research aimed to develop an understanding of the wishes, concerns and hopes of stakeholders related to handling requests for PAD; to determine what supports/structures/resources health care professionals (HCP) require in order to ensure high quality and compassionate care for patients requesting PAD, and a supportive environment for all healthcare providers across the moral spectrum. This study constituted a mixed methods design with a qualitative descriptive approach for the study's qualitative component. A total of 303 HCPs working in a tertiary care hospital completed an online survey and 64 HCPs working in hospital units with high mortality rates participated in 8 focus group discussions. Both focus group and survey data coalesced around several themes to support the implementation of PAD following the decriminalization of this practice: the importance of high quality care; honoring moral diversity; supporting values (such as autonomy, privacy, beneficence); and developing resources, including collaboration with palliative care, education, policies and a specialized team. This study provided the foundational evidence to support the development of the PAD program described in other papers in this collection, and can be a model for gathering evidence from stakeholders to inform the implementation of PAD in any healthcare organization.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"391-408"},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9671973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40413451","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: 5

MAiD to Last: Creating a Care Ecology for Sustainable Medical Assistance in Dying Services. 女仆到最后:创建一个可持续的临终医疗援助服务的护理生态。

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-12-01 Epub Date: 2022-09-12 DOI: 10.1007/s10730-022-09487-7

Andrea Frolic, Paul Miller, Will Harper, Allyson Oliphant

{"title":"MAiD to Last: Creating a Care Ecology for Sustainable Medical Assistance in Dying Services.","authors":"Andrea Frolic, Paul Miller, Will Harper, Allyson Oliphant","doi":"10.1007/s10730-022-09487-7","DOIUrl":"https://doi.org/10.1007/s10730-022-09487-7","url":null,"abstract":"This paper depicts a case study of an organizational strategy for the promotion of ethical practice when introducing a new, high-risk, ethically-charged medical practice like Medical Assistance in Dying (MAiD). We describe the development of an interprofessional program that enables the delivery of high-quality, whole-person MAiD care that is values-based and sustainable. A \"care ecology\" strategy recognizes the interconnected web of relationships and structures necessary to support a quality experience of MAiD for patients, families, and clinicians. This program exemplifies a care ecology approach that addresses common barriers to entry to MAiD practice, and also meets the needs of a variety of stakeholders through the creation of patient and family resources, team supports, standards of practice, professional development opportunities, organizational infrastructure, and community partnerships. We also describe how a thriving care ecology evolves to remain resilient, and to enable integration as the needs of the organization, team and program change over time. The design and development of this program may be adapted to other jurisdictions and organizations where MAiD is introduced, or where new patient populations become eligible for MAiD. This care ecology model may also be applicable to the creation of sustainable programs that provide other morally controversial or novel clinical services.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"409-428"},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9465134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33463064","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: 5

Author Index to Volume 34: 2022. 第34卷的作者索引:2022。

IF 1.5 4区哲学

Hec Forum Pub Date : 2022-12-01 DOI: 10.1007/s10730-022-09497-5

引用次数: 0