Clinical Ethics最新文献_第8页

Medical decision-making when the patient is a prisoner 当病人是囚犯时的医疗决策

Clinical Ethics Pub Date : 2022-10-18 DOI: 10.1177/14777509221133660

Erik Larsen, K. Drabiak

{"title":"Medical decision-making when the patient is a prisoner","authors":"Erik Larsen, K. Drabiak","doi":"10.1177/14777509221133660","DOIUrl":"https://doi.org/10.1177/14777509221133660","url":null,"abstract":"Although prisons provide on-site primary care, the corrections system relies on external hospitals to provide a variety of healthcare services. Compared to the general population, incarcerated patients experience higher rates of chronic medical conditions, mental illness, substance abuse, cancer, traumatic brain injury, assault, and communicable disease. Certain specialties of clinicians are likely to encounter patients who are incarcerated, which makes it important for clinicians to understand how medical decision-making may differ when the patient is a prisoner. The corrections system retains custody of inmates and is responsible for their welfare, including facilitating necessary medical care. However, this does not permit corrections personnel or a warden to automatically assume the role of the patient's medical decision-maker. Except for narrow exceptions, prisoners do not lose their rights to medical decision-making. In some instances, corrections staff or the prison warden have improperly asserted authority to act as the patient's medical decision-maker, such as when the patient lacks decision-making capacity. This violates ethical principles of bodily integrity, respect, and fairness. This paper provides an overview of medical decision-making for incarcerated patients, how surrogate decision-maker hierarchies apply to incarcerated patients without decision-making capacity, and special considerations for this subset of patients.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48736772","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

Rational suicide and schizophrenia 理性自杀和精神分裂症

Clinical Ethics Pub Date : 2022-10-17 DOI: 10.1177/14777509221133054

N. Zhand, David G. Attwood

引用次数: 0

Defining the role of facilitated mediation in medical treatment decision-making for critically ill children in the Australian clinical context 确定在澳大利亚临床环境中促进调解在危重儿童医疗决策中的作用

Clinical Ethics Pub Date : 2022-09-25 DOI: 10.1177/14777509221125340

A. Preisz, Neera Bhatia, Patsi Michalson

{"title":"Defining the role of facilitated mediation in medical treatment decision-making for critically ill children in the Australian clinical context","authors":"A. Preisz, Neera Bhatia, Patsi Michalson","doi":"10.1177/14777509221125340","DOIUrl":"https://doi.org/10.1177/14777509221125340","url":null,"abstract":"In this article, we explore alternative conflict resolution strategies to assist families and clinicians in cases of intractable dissent in paediatric health care decision-making. We focus on the ethical and legal landscape using cases from the Australian jurisdiction in New South Wales, while referencing some global sentinel cases. We highlight a range of alternative means of addressing conflict, including clinical ethics support, and contrast and contextualise facilitative or interest-based mediation, concluding that legal intervention via the courts can be protracted and distressing and should be a ‘last resort’. We acknowledge many might view this as the current status quo, but we go further to recommend strategies optimal for all parties to recognise early signs of conflict and prevent its harmful escalation. While more empirical research is needed, we contend that interest-based mediation may be a valuable adjunctive method of conflict resolution. If judiciously distinguished from and utilised with clinical ethical support, it can be an effective tool to address dissent and its negative sequelae in paediatric healthcare decision-making.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43396699","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

Clinical equipoise: Why still the gold standard for randomized clinical trials? 临床平衡：为什么仍然是随机临床试验的金标准？

Clinical Ethics Pub Date : 2022-09-25 DOI: 10.1177/14777509221121107

Charlemagne Asonganyi Folefac, Hugh Desmond

引用次数: 0

Is there a right to a fully vaccinated care team? 是否有权利建立一个完全接种疫苗的护理小组?

Clinical Ethics Pub Date : 2022-09-01 DOI: 10.1177/14777509221077391

Jordan L Schwartzberg, Jeremy Levenson, J. Appel

引用次数: 1

Living bioethics, clinical ethics committees and children's consent to heart surgery. 生命伦理学、临床伦理委员会和儿童同意接受心脏手术。

Clinical Ethics Pub Date : 2022-09-01 Epub Date: 2021-07-30 DOI: 10.1177/14777509211034145

Priscilla Alderson, Deborah Bowman, Joe Brierley, Martin J Elliott, Romana Kazmi, Rosa Mendizabal-Espinosa, Jonathan Montgomery, Katy Sutcliffe, Hugo Wellesley

{"title":"Living bioethics, clinical ethics committees and children's consent to heart surgery.","authors":"Priscilla Alderson, Deborah Bowman, Joe Brierley, Martin J Elliott, Romana Kazmi, Rosa Mendizabal-Espinosa, Jonathan Montgomery, Katy Sutcliffe, Hugo Wellesley","doi":"10.1177/14777509211034145","DOIUrl":"10.1177/14777509211034145","url":null,"abstract":"<p><p>This discussion paper considers how seldom recognised theories influence clinical ethics committees. A companion paper examined four major theories in social science: positivism, interpretivism, critical theory and functionalism, which can encourage legalistic ethics theories or practical living bioethics, which aims for theory-practice congruence. This paper develops the legalistic or living bioethics themes by relating the four theories to clinical ethics committee members' reported aims and practices and approaches towards efficiency, power, intimidation, justice, equality and children's interests and rights. Different approaches to framing ethical questions are also considered. Being aware of the four theories' influence can help when seeking to understand and possibly change clinical ethics committee routines. The paper is not a research report but is informed by a recent study in two London paediatric cardiac units. Forty-five practitioners and related experts were interviewed, including eight members of ethics committees, about the work of informing, preparing and supporting families during the extended process of consent to children's elective heart surgery. The mosaic of multidisciplinary teamwork is reported in a series of papers about each profession, including this one on bioethics and law and clinical ethics committees' influence on clinical practice. The qualitative social research was funded by the British Heart Foundation, in order that more may be known about the perioperative views and needs of all concerned. Questions included how disputes can be avoided, how high ethical standards and respectful cooperation between staff and families can be encouraged, and how minors' consent or refusal may be respected, with the support of clinical ethics committees.</p>","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9361409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40414457","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

A new era for Clinical Ethics 临床伦理学的新时代

Clinical Ethics Pub Date : 2022-08-07 DOI: 10.1177/14777509221113405

Jonathan Lewis

引用次数: 1

Financial incentives and moral distress in Australian audiologists and audiometrists 澳大利亚听力学家和听力测量学家的经济激励和道德困境

Clinical Ethics Pub Date : 2022-08-04 DOI: 10.1177/14777509221117687

Andrea Simpson, Meg Fawcett, Lily McLeod, Jennifer Lin, Selda Tuncer, Bojana Šarkić

{"title":"Financial incentives and moral distress in Australian audiologists and audiometrists","authors":"Andrea Simpson, Meg Fawcett, Lily McLeod, Jennifer Lin, Selda Tuncer, Bojana Šarkić","doi":"10.1177/14777509221117687","DOIUrl":"https://doi.org/10.1177/14777509221117687","url":null,"abstract":"Introduction Financial incentive schemes have been commonly used by the hearing aid industry as a way of encouraging device sales. These schemes can lead to a conflict of interest as the hearing device dispenser is torn between personal reward over the best interests of their client. This conflict of interest has the potential for the dispenser to develop “moral distress”, a negative state of mind when an individual’s ethical values contrast with those of the employing organization. The purpose of this study was to investigate if there was a relationship between financial incentives and moral distress in Australian audiologists and audiometrists. Methods An online survey was distributed to all members of Audiology Australia and the Australian College of Audiology via email. Participants rated their perceived moral distress from 0 to 10 on the Moral Distress Thermometer and answered four questions about financial incentives in their respective workplace. Results A total of 65 participants, 42 females and 23 males, completed the online survey. A quarter of participants rated their moral distress corresponding to levels of uncomfortable or above. A statistically significant association was found between financial incentives, sales target setting, and higher perceived moral distress in participants. Conclusions For our sample, the implementation of financial incentives created ethical challenges for practicing audiologists and audiometrists. Modifications to employee rewards programs as well as a regulation of device sales are recommended.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43851290","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

Unenviable decisions: Is it ethically justifiable to withhold parenteral nutrition from infants with ultra-short bowel syndrome? 不令人羡慕的决定:对患有超短肠综合征的婴儿不给予肠外营养在伦理上是否合理?

Clinical Ethics Pub Date : 2022-08-02 DOI: 10.1177/14777509221117979

Peterson Jlh

{"title":"Unenviable decisions: Is it ethically justifiable to withhold parenteral nutrition from infants with ultra-short bowel syndrome?","authors":"Peterson Jlh","doi":"10.1177/14777509221117979","DOIUrl":"https://doi.org/10.1177/14777509221117979","url":null,"abstract":"Infant A was born at term with an antenatal diagnosis of gastroschisis. His parents were well informed about the condition and understood that he would require surgery. However, at delivery, his bowel was found to be severely compromised. Infant A returned from theatre with only four centimeters of small bowel. This is physiologically devastating and easily qualifies as ultrashort bowel syndrome (USBS). Whilst the prognosis from ultrashort bowel syndrome is greatly improving, the condition continues to carry a significant risk of mortality and morbidity, in part attributable to treatment itself. The cornerstone of management of USBS is provision of intravenous parenteral nutrition (PN). This is not a physiologically normal route of nutrition; it is a medical treatment. Infant A’s parents questioned whether continuation of active treatment was appropriate. If a treatment is not in the patient’s best interests, then it can be argued it is not justified to administer it. Decisions about quality of life are intensely personal. Where there is a significant burden of treatment, even when there is a potential for increased survival, whether the course of treatment is in the child’s best interests must be taken with huge emphasis on the parental perspective and their family values. For well-informed, realistic parents who are welcoming of the full picture of information and implications of their decision, I argue that parents are best placed to make the decision for their child. Long-term PN for USBS may well be a medically encouraged treatment. However, it should not be medically mandated.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46914010","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

Attitudes toward end-of-life decisions other than assisted death amongst doctors in Northern Portugal 葡萄牙北部医生对协助死亡以外的临终决定的态度

Clinical Ethics Pub Date : 2022-08-02 DOI: 10.1177/14777509221117683

J. Ferraz-Gonçalves

{"title":"Attitudes toward end-of-life decisions other than assisted death amongst doctors in Northern Portugal","authors":"J. Ferraz-Gonçalves","doi":"10.1177/14777509221117683","DOIUrl":"https://doi.org/10.1177/14777509221117683","url":null,"abstract":"Doctors often deal with end-of-life issues other than assisted death, such as incompetent patients and treatment withdrawal, including food and fluids. A link to a questionnaire was sent by email three times, at one-week intervals, to the doctors registered in the Northern Section of the Portuguese Medical Association. The questionnaire was returned by 1148 (9%) physicians. This study shows that only a minority of Portuguese doctors were willing to administer drugs in lethal doses to cognitively incompetent patients at the request of a family member or other close person, and even less would do it on their initiative. Most doctors favored the withdrawal of life support measures in advanced and progressive diseases at the patient’s request. Still, much fewer doctors agreed with the suspension of supportive life measures at the request of a family member, another close person, or by their own unilateral decision. However, fewer agreed with that action concerning the rest of the food and fluids. Portuguese doctors favor the administration of drugs for suffering control, even foreseeing they could shorten life. Most doctors in this study respect patients’ autonomy but disagree with measures decided by others that have an impact on patients’ survival. They also agree with the administration of drugs for suffering control, even considering the possibility of shortening life.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43175909","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