Clinical Ethics最新文献

From a phenomenology of birth towards an ethics of obstetric care 从分娩现象学到产科护理伦理学

Clinical Ethics Pub Date : 2024-06-01 DOI: 10.1177/14777509241233155

Tatjana Noemi Tömmel

{"title":"From a phenomenology of birth towards an ethics of obstetric care","authors":"Tatjana Noemi Tömmel","doi":"10.1177/14777509241233155","DOIUrl":"https://doi.org/10.1177/14777509241233155","url":null,"abstract":"The aim of this paper is to get from a phenomenology of birth towards an ethics of obstetric care: Human rights violations in obstetrics are currently a globally debated phenomenon. Research suggests that maltreatment is widespread and a global phenomenon. However, the prevalence cannot yet be clearly quantified. In view of this problem, it is necessary to take the subjective perspective of those affected seriously. Narrative and phenomenological accounts of birth experiences could help to foster the dialogue between persons giving birth and health professionals. First, I will present narrative accounts of birth experiences recorded by feminist phenomenologists. Second, I will interpret these narrative accounts within a feminist phenomenological framework in order to contribute to a phenomenology of birth, which, in a third step, shall help to develop an ethics of obstetric care. In engaging with the phenomenology of care outlined by feminist care ethicists, I will analyze the elements and conditions of good care, and draw conclusions for an ethic of obstetric and midwifery care. Drawing additionally on the theory of relational autonomy, my paper argues for a relational implementation of self-determination in childbirth. Lastly, I will discuss to what extent the ethical ideal of care has an affinity to the midwifery model of childbirth, and how the current situation of obstetrics prevents a women-centered birth culture.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Psychiatry as a vocation: Moral injury, COVID-19, and the phenomenology of clinical practice. 精神病学是一种职业：道德伤害、COVID-19 和临床实践现象学。

Clinical Ethics Pub Date : 2024-06-01 Epub Date: 2023-11-14 DOI: 10.1177/14777509231208361

Matthew R Broome, Jamila Rodrigues, Rosa Ritunnano, Clara Humpston

{"title":"Psychiatry as a vocation: Moral injury, COVID-19, and the phenomenology of clinical practice.","authors":"Matthew R Broome, Jamila Rodrigues, Rosa Ritunnano, Clara Humpston","doi":"10.1177/14777509231208361","DOIUrl":"10.1177/14777509231208361","url":null,"abstract":"In this article, we focus on a particular kind of emotional impact of the pandemic, namely the phenomenology of the experience of moral injury in healthcare professionals. Drawing on Weber's reflections in his lecture Politics as a Vocation and data from the Experiences of Social Distancing during the COVID-19 Pandemic Survey, we analyse responses from healthcare professionals which show the experiences of burnout, sense of frustration and impotence, and how these affect clinicians' emotional state. We argue that this may relate to the ethical conflicts they experience when they are forced to make clinical decisions where there are no optimal outcomes, and how in turn that impacts on their own emotional state. We then further examine the notion of 'burnout' and the phenomenology of 'moral injury'. Our argument is that these experiences of moral injury across a range of clinicians during the pandemic may be more prevalent and long-standing in psychiatry and mental health than in other areas of healthcare, where ethically difficult decisions and resource constraints are common outside times of crisis. Hence, in these clinical arenas, moral injury and the phenomenology of emotional changes may be independent of the pandemic. The insights gained during the pandemic may provide wider insights into the challenges of developing services and training the workforce to provide appropriate mental health care.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11108749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Phenomenologies of care: Integrating patient and caregiver narratives into clinical care 护理现象学：将患者和护理人员的叙述融入临床护理中

Clinical Ethics Pub Date : 2024-05-05 DOI: 10.1177/14777509241251994

Jenny Krutzinna, Anna Gotlib

引用次数: 0

Loneliness in medicine and relational ethics: A phenomenology of the physician-patient relationship 医学中的孤独感与关系伦理：医患关系现象学

Clinical Ethics Pub Date : 2024-04-09 DOI: 10.1177/14777509241246161

John Han, Benjamin W. Frush, Jay R Malone

{"title":"Loneliness in medicine and relational ethics: A phenomenology of the physician-patient relationship","authors":"John Han, Benjamin W. Frush, Jay R Malone","doi":"10.1177/14777509241246161","DOIUrl":"https://doi.org/10.1177/14777509241246161","url":null,"abstract":"Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140724004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gross negligence manslaughter of intern doctors – scapegoating or justified? 实习医生严重过失杀人--替罪羊还是正当理由？

Clinical Ethics Pub Date : 2024-02-25 DOI: 10.1177/14777509241234778

Wing Hin Kason Lin

引用次数: 0

Breaking down organ donation borders: Revisiting “opt out” residency requirements in the UK 打破器官捐赠的边界：重新审视英国的 "选择退出 "居住要求

Clinical Ethics Pub Date : 2024-02-20 DOI: 10.1177/14777509241231501

J. Parsons

{"title":"Breaking down organ donation borders: Revisiting “opt out” residency requirements in the UK","authors":"J. Parsons","doi":"10.1177/14777509241231501","DOIUrl":"https://doi.org/10.1177/14777509241231501","url":null,"abstract":"All four UK nations have, in recent years, introduced “opt out” organ donation systems. Whilst these systems are largely similar, they operate independently. A key feature of each policy is a residency requirement, stipulating that opt out may only apply where the deceased had been ordinarily resident in that nation for at least 12 months. A resident of Scotland who dies in England, for example, would not fall under opt out. Public awareness is the underlying reasoning for such stipulations. A residency requirement was appropriate when Wales was the only UK nation with an opt out system, but, I suggest, the continued imposition of intra-UK borders on organ donation is unjustified now that all four nations operate the same policy. Further, it has the potential to limit organ donation. There is a need for all four systems to be amended to allow for UK-wide applicability, such that providing the deceased was ordinarily resident in the UK, they can fall under opt out in any of the four nations. I argue that such an amendment is ethically justified – continuing to satisfy the public awareness criterion – and practically straightforward. In doing so, I emphasise that my proposed amendment should extend only to the four UK nations, stopping short of the Crown Dependencies even though they also operate opt out systems for organ donation.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140446783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The need for Hispanic cultural competency in drug abuse treatment training programs: An empirical and ethical evaluation of US universities 在药物滥用治疗培训项目中培养西班牙裔文化能力的必要性：对美国大学的实证和伦理评估

Clinical Ethics Pub Date : 2024-01-09 DOI: 10.1177/14777509231220531

Veronica Fish

{"title":"The need for Hispanic cultural competency in drug abuse treatment training programs: An empirical and ethical evaluation of US universities","authors":"Veronica Fish","doi":"10.1177/14777509231220531","DOIUrl":"https://doi.org/10.1177/14777509231220531","url":null,"abstract":"Ethical clinical practice requires cultural competency. In the United States, Hispanics report stronger attitudinal barriers to drug abuse treatment than any other racial/ethnic group. Hispanics report feeling that drug abuse treatment providers do not understand their unique cultural needs and are unfamiliar with their experiences of discrimination and immigration. Using this case study to explore broader ethical and policy issues, this study investigates the extent to which US universities train counselors to address the culturally specific needs of Hispanic patients and how this is reflected in practice in Los Angeles County. Based on a content analysis of the required courses, syllabi, and course descriptions at 30 universities related to culture/race/racism/ethnicity/diversity at the undergraduate and graduate levels on the addiction therapist track, and thematic analysis of eight in-depth interviews with counselors working in outpatient rehabilitation centers in Los Angeles, I argue that cultural competency education for drug abuse counselors is too surface level and infrequent to adequately prepare students for a career in addiction counseling for Hispanic clients. Significant changes must be made to how cultural diversity is valued and prioritized in the field of psychology to provide better care for Hispanic people with a substance use disorder and fulfill the moral obligation to eliminate this health disparity. Although this study focuses on counselors in Los Angeles, these findings are relevant for professionals and healthcare systems across the United States and beyond who seek to provide equitable and effective care for Hispanic patients.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

No means no: A case study on respecting patient autonomy 不行就是不行关于尊重病人自主权的案例研究

Clinical Ethics Pub Date : 2023-12-19 DOI: 10.1177/14777509231218205

David John Doukas, Nathan Stout

引用次数: 0

Roadblocks to reforming UK guidelines on medically unnecessary penile circumcision: inconsistent safeguarding of bodily integrity 改革英国医学上不必要的阴茎包皮环切术指南的障碍：对身体完整性的保护不一致

Clinical Ethics Pub Date : 2023-12-19 DOI: 10.1177/14777509231216027

Antony Lempert

{"title":"Roadblocks to reforming UK guidelines on medically unnecessary penile circumcision: inconsistent safeguarding of bodily integrity","authors":"Antony Lempert","doi":"10.1177/14777509231216027","DOIUrl":"https://doi.org/10.1177/14777509231216027","url":null,"abstract":"Medically unnecessary penile circumcision (MUPC) performed on a non-consenting child has been the subject of increasing critical attention in recent years. This paper provides a behind-the-scenes narrative of the politics of ethical policymaking in the United Kingdom in this area including a discussion about some potential barriers to reform. After a brief overview of ethical guidance for medically unnecessary surgical procedures on children in general and on their genitalia in particular, the paper takes a closer look at three contemporary documents released by UK medical bodies and highlights the unique ethical and safeguarding contradictions in this area. The outcomes of initiatives aimed at engaging constructively with the medical bodies and encouraging wider debate are then described, along with some of the main obstacles to engagement and counter-arguments employed. MUPC is subsequently discussed in a wider societal context, highlighting why serious safeguarding concerns have been raised about what many people believe to be a harmful, preventable practice hiding ‘in plain sight’. The paper ends by calling for UK MUPC guidance to be made consistent with the body of guidance that UK doctors are expected to follow.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138959936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Shame, health literacy and consent 羞耻感、健康知识和同意

Clinical Ethics Pub Date : 2023-12-12 DOI: 10.1177/14777509231218203

Barry Lyons, Luna Dolezal

引用次数: 0