Clinical Ethics最新文献

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Health policy narratives contributing to health inequities experienced by people with intellectual/developmental disabilities: New evidence from COVID-19 卫生政策叙述助长了智力/发育障碍者所经历的卫生不平等:来自COVID-19的新证据
Clinical Ethics Pub Date : 2023-09-12 DOI: 10.1177/14777509231196704
Sandra Marquis, Renee O'Leary, Nilanga Aki Bandara, Jennifer Baumbusch
{"title":"Health policy narratives contributing to health inequities experienced by people with intellectual/developmental disabilities: New evidence from COVID-19","authors":"Sandra Marquis, Renee O'Leary, Nilanga Aki Bandara, Jennifer Baumbusch","doi":"10.1177/14777509231196704","DOIUrl":"https://doi.org/10.1177/14777509231196704","url":null,"abstract":"This paper discusses three cultural narratives that threaten the health of people with intellectual/developmental disabilities (IDD) and which have become more evident during the COVID-19 pandemic. These meta-narratives are the medical model of health/disability; the population health approach to health inequalities; and policies premised on the assumption of the importance of national economic growth as an incentive for reducing health inequalities. Evidence exists that health research is more likely to become policy if it fits within a medical model and addresses national economic growth. These two criteria are particularly problematic for people who have IDD. The paper also proposes a research model to facilitate the inclusion of IDD related issues in future policy regarding health inequalities.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884203","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
Corrigendum to ‘Ethical challenges in clinical studies with adaptive design in oncology 肿瘤学适应性设计临床研究中的伦理挑战的勘误表
Clinical Ethics Pub Date : 2023-09-11 DOI: 10.1177/14777509231202190
{"title":"Corrigendum to ‘Ethical challenges in clinical studies with adaptive design in oncology","authors":"","doi":"10.1177/14777509231202190","DOIUrl":"https://doi.org/10.1177/14777509231202190","url":null,"abstract":"","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136024461","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
What is 'medical necessity'? 什么是“医疗需要”?
Clinical Ethics Pub Date : 2023-09-01 DOI: 10.1177/14777509231190521
Dominic Jc Wilkinson
{"title":"What is 'medical necessity'?","authors":"Dominic Jc Wilkinson","doi":"10.1177/14777509231190521","DOIUrl":"https://doi.org/10.1177/14777509231190521","url":null,"abstract":"<p><p>Imagine that we are considering whether our healthcare system (or insurer) should fund treatment or procedure X. One factor that may be cited is that of so-called 'medical necessity'. The claim would be that treatment X should be eligible for funding if it is medically necessary, but ineligible if this does not apply. Similarly, (and relevant to the debates in this special issue), if considering whether a particular treatment should be ethically and/or legally permitted, we may wish to distinguish between cases where the treatment is medically necessary, and those were it is not. But what do we mean by this concept? Here I will propose and briefly defend one plausible and practical definition.</p>","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":"18 3","pages":"285-286"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10444616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10356824","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: 2
'Maternal Request' Caesarean Sections and Medical Necessity. "产妇请求"剖腹产和医疗需要。
Clinical Ethics Pub Date : 2023-09-01 DOI: 10.1177/14777509231183365
Rebecca Ch Brown, Andrea Mulligan
{"title":"'Maternal Request' Caesarean Sections and Medical Necessity.","authors":"Rebecca Ch Brown,&nbsp;Andrea Mulligan","doi":"10.1177/14777509231183365","DOIUrl":"https://doi.org/10.1177/14777509231183365","url":null,"abstract":"Currently, many women who are expecting to give birth have no option but to attempt vaginal delivery, since access to elective planned caesarean sections (PCS) in the absence of what is deemed to constitute ‘clinical need’ is variable. In this paper, we argue that PCS should be routinely offered to women who are expecting to give birth, and that the risks and benefits of PCS as compared with planned vaginal delivery should be discussed with them. Currently, discussions of elective PCS arise in the context of what are called ‘Maternal Request Caesarean Sections’ (MRCS) and there is a good deal of support for the position that women who request PCS without clinical indication should be provided with them. Our argument goes further than support for acceding to requests for MRCS: we submit that healthcare practitioners caring for women with uncomplicated pregnancies have a positive duty to inform them of the option of PCS as opposed to assuming vaginal delivery as a default, and to provide (or arrange for the provision of) PCS if that is the woman's preferred manner of delivery.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":"18 3","pages":"312-320"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7614977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10160438","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: 1
Medical need and health need. 医疗需要和健康需要。
Clinical Ethics Pub Date : 2023-09-01 DOI: 10.1177/14777509231173561
Ben Davies
{"title":"Medical need and health need.","authors":"Ben Davies","doi":"10.1177/14777509231173561","DOIUrl":"https://doi.org/10.1177/14777509231173561","url":null,"abstract":"<p><p>I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an overly strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort.</p>","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":"18 3","pages":"287-291"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10444630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10356827","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: 2
Navigating conflict: The role of mediation in healthcare disputes 导航冲突:调解在医疗纠纷中的作用
Clinical Ethics Pub Date : 2023-08-29 DOI: 10.1177/14777509231196699
Jaime Lindsey, M. Doyle, Katarzyna Wazynska-Finck
{"title":"Navigating conflict: The role of mediation in healthcare disputes","authors":"Jaime Lindsey, M. Doyle, Katarzyna Wazynska-Finck","doi":"10.1177/14777509231196699","DOIUrl":"https://doi.org/10.1177/14777509231196699","url":null,"abstract":"Navigating conflict in healthcare settings can be challenging for all parties involved. Here, we analyse disputes about the provision of healthcare to patients, specifically exploring how mediation might be used to resolve disputes where healthcare professionals may disagree with the patient themselves or the patient's family about what healthcare is in the patient's best interests. Despite concerns about compromise over the patient's best interests, there is often room for the parties to come together and think about how the dispute might be resolved in a way that is acceptable to all. It is in this space where mediation might step in. We set out the potential benefits and risks of mediation in this article, and argue that there is a need for clearer, empirically grounded evidence on the use of mediation in healthcare disputes.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43888710","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
Changes in abortion legislation and admissions to paediatric intensive care in Ireland 爱尔兰堕胎立法的变化和儿科重症监护的入院情况
Clinical Ethics Pub Date : 2023-08-21 DOI: 10.1177/14777509231196700
N. Tierney, M. Healy, B. Lyons
{"title":"Changes in abortion legislation and admissions to paediatric intensive care in Ireland","authors":"N. Tierney, M. Healy, B. Lyons","doi":"10.1177/14777509231196700","DOIUrl":"https://doi.org/10.1177/14777509231196700","url":null,"abstract":"The Health (Regulation of Termination of Pregnancy) Act 2018 was commenced on 01/01/2019 in Ireland. The Act provides for legal termination of pregnancy under defined circumstances including for any reason at < 12 weeks gestation; and where two doctors agree there is ‘a condition affecting the foetus that is likely to lead to the death of the foetus either before, or within 28 days of, birth’. As such, abortion for congenital anomaly (CA) can occur at a number of time points, depending on the adjudged severity. Infants born with CAs frequently require significant medical intervention and account for a high proportion of admissions to paediatric intensive care units (PICUs). The purpose of this paper was to evaluate the number of infants with CAs admitted to an Irish PICU in the period before and after the implementation of the Act. All PICU admissions < 1 month of age to a single Irish paediatric hospital between 2012 and 2021 were analysed. CAs were recorded, and the periods before and after the commencement of the Act compared. We found a difference in admissions involving CAs, particularly those related to congenital heart disease involving single ventricle anatomy. It is plausible that this difference was as a result of improved access to abortion services following the implementation of the Act. This article explores the legal conditions related to the abortion of a foetus with a CA in Ireland, and the possible impact of the Independent Review of the Operation of the Health ( Regulation of Termination of Pregnancy) Act 2018.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46747647","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 child's right to bodily integrity and autonomy: A conceptual analysis 儿童身体完整和自主的权利:概念分析
Clinical Ethics Pub Date : 2023-07-25 DOI: 10.1177/14777509231188817
J. Pugh
{"title":"The child's right to bodily integrity and autonomy: A conceptual analysis","authors":"J. Pugh","doi":"10.1177/14777509231188817","DOIUrl":"https://doi.org/10.1177/14777509231188817","url":null,"abstract":"It is widely accepted that children enjoy some form of a right to bodily integrity. However, there is little agreement about the precise nature and scope of this right. This paper offers a conceptual analysis of the child's right to bodily integrity, in order to further elucidate the relationship between the child's right to bodily integrity and considerations of autonomy. Following a discussion of Leif Wenar's work on the structure and justification of rights, I first explain how the adult's right to bodily integrity can be distilled into separate elements that may plausibly be justified by different moral considerations. In particular, I claim that this analysis suggests that whilst the adult's right to bodily integrity is not wholly reducible to bodily autonomy, autonomy nonetheless remains entwined with our understanding of this right in a number of ways. On the basis of this discussion, I go on to outline three important complexities that arise when we consider the child's right to bodily integrity, before particularly focusing on the question of how third parties should determine whether or not to perform a physical interference upon a child who lacks decision-making capacity. Here, I raise some objections to Earp and Mazor's recent attempts to answer this question, before briefly defending an ‘autonomy-based interests’ account of permissible interference, an account that shares in what I take to be the spirit, if not the precise letter, of these earlier views.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43915505","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: 3
The paradox of medical necessity 医疗需要的悖论
Clinical Ethics Pub Date : 2023-07-17 DOI: 10.1177/14777509231188830
S. Godwin, B. Earp
{"title":"The paradox of medical necessity","authors":"S. Godwin, B. Earp","doi":"10.1177/14777509231188830","DOIUrl":"https://doi.org/10.1177/14777509231188830","url":null,"abstract":"The concept of medical necessity is often used to explain or justify certain decisions—for example, which treatments should be allowed under certain conditions—as though it had an obvious, agreed-upon meaning as well as an inherent normative force. In introducing this special issue of Clinical Ethics on medical necessity, we argue that the term, as used in various discourses, generally lacks a definition that is clear, non-circular, conceptually plausible, and fit for purpose. We propose that future work on this concept should address three main questions: what medical necessity is (i.e., what makes something medically necessary, as opposed to something else); what the concept does (what ‘work’ is it doing when invoked in different settings); and what should follow, normatively, from the fact that something is indeed medically necessary (on some plausible conception).","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":"18 1","pages":"281 - 284"},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45776975","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: 2
Fixing bodies and shaping narratives: Epistemic injustice and the responses of medicine and bioethics to intersex human rights demands 修复身体和塑造叙事:认识上的不公正以及医学和生物伦理学对双性人人权要求的反应
Clinical Ethics Pub Date : 2023-06-25 DOI: 10.1177/14777509231180412
Morgan Carpenter
{"title":"Fixing bodies and shaping narratives: Epistemic injustice and the responses of medicine and bioethics to intersex human rights demands","authors":"Morgan Carpenter","doi":"10.1177/14777509231180412","DOIUrl":"https://doi.org/10.1177/14777509231180412","url":null,"abstract":"Children with innate variations of sex characteristics (also termed differences of sex development or intersex traits) are routinely subjected to medical interventions that aim to make their bodies appear or function more typically female or male. Many such interventions lack clear evidence of benefit, they have been challenged for thirty years, and they are now understood to violate children’s rights to bodily autonomy and bodily integrity. In this paper I argue that these persist in part due to epistemic injustices and biomedical authority. Epistemic injustices include limited disclosure of current practices, the systemic marginalisation of community voices and psychosocial professionals, and attempts to discredit or misrepresent testimony. Bioethics has largely failed to change medical practice, and sometimes plays a role in perpetuating epistemic injustices. I find that the development of an intersex movement provides opportunities for epistemic justice and liberation by engaging with other disciplines and promoting oversight of medical decision-making. The paper draws particularly on Australian sources, including internationally influential ethical principles.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47405020","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
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