Clinical Ethics最新文献_第9页

Unconventional harm reduction interventions for Minor-attracted persons 针对未成年人的非常规减少伤害干预措施

Clinical Ethics Pub Date : 2022-08-02 DOI: 10.1177/14777509221117981

J. Appel

引用次数: 1

Non-therapeutic penile circumcision of minors: current controversies in UK law and medical ethics 未成年人非治疗性阴茎包皮环切术:目前在英国法律和医学伦理的争议

Clinical Ethics Pub Date : 2022-07-12 DOI: 10.1177/14777509221104703

Antony Lempert, James Chegwidden, R. Steinfeld, B. Earp

{"title":"Non-therapeutic penile circumcision of minors: current controversies in UK law and medical ethics","authors":"Antony Lempert, James Chegwidden, R. Steinfeld, B. Earp","doi":"10.1177/14777509221104703","DOIUrl":"https://doi.org/10.1177/14777509221104703","url":null,"abstract":"The current legal status and medical ethics of routine or religious penile circumcision of minors is a matter of ongoing controversy in many countries. We focus on the United Kingdom as an illustrative example, giving a detailed analysis of the most recent British Medical Association guidance from 2019. We argue that the guidance paints a confused and conflicting portrait of the law and ethics of the procedure in the UK context, reflecting deeper, unresolved moral and legal tensions surrounding child genital cutting practices more generally. Of particular note is a lack of clarity around how to apply the “best interests” standard—ordinarily associated with time-sensitive proxy decision making regarding therapeutic options for a medically unwell patient—to a parental request for a medically unnecessary surgery to be carried out on the genitalia of a healthy child. Challenges arise in measuring and assigning weights to intended sociocultural or religious/spiritual benefits, and even to health-related prophylactic benefits, and in balancing these against potential physical, functional, and psychosexual risks or harms. Also of concern are apparently inconsistent safeguarding standards being applied to children based on their birth sex categorization or gender of rearing. We identify and discuss recent trends in British and international medical ethics and law, finding gradual movement toward a more unified standard for evaluating the permissibility of surgically modifying healthy children's genitals before they can meaningfully participate in the decision.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41349326","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: 7

Perspectives on early sex assignment and communication with parents in children with disorders of sexual development 性发育障碍儿童早期性别分配及与父母沟通的观点

Clinical Ethics Pub Date : 2022-06-03 DOI: 10.1177/14777509221105457

Husrav Sadri, Sheza Abootty, Aureen D’cunha, Sandeep B. Rai, R. Shenoy

{"title":"Perspectives on early sex assignment and communication with parents in children with disorders of sexual development","authors":"Husrav Sadri, Sheza Abootty, Aureen D’cunha, Sandeep B. Rai, R. Shenoy","doi":"10.1177/14777509221105457","DOIUrl":"https://doi.org/10.1177/14777509221105457","url":null,"abstract":"Disorders of sexual development are a heterogeneous group of disorders in which chromosomal, gonadal or anatomical sex development is atypical. The majority of these children are recognized at birth by ambiguous genitalia. Legal and societal pressures require the physician and parents to assign sex rapidly. Though sex assignment is undebated in several disorders of sexual development, many others need an individualized approach to gender-related concerns. Gender dysphoria is prevalent in disorders of sexual development, and early gender-defining surgeries have potentially lifelong consequences. We use two cases, one of partial androgen insensitivity and another of simple virilizing congenital adrenal hyperplasia to illustrate that in disorders of sexual development, the ethical management principles remain the same at their core despite the vast differences in phenotypes. Sex assignment should maximize functional, psychological and sexual needs. Sex assigned should coincide with gender identity. We propose that we manage such children with the mutual participation of the physician, parents and the child. Though the parents and the physician have the child's best interests when making a decision, the child's developing autonomy should be protected. The communication of the health provider to the parent must be honest if early sex assignment is difficult.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43391613","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

Voluntary assisted death in present-day Japan: A case for dignity 当今日本的自愿协助死亡:尊严的案例

Clinical Ethics Pub Date : 2022-06-03 DOI: 10.1177/14777509221105746

A. Asai, M. Fukuyama

{"title":"Voluntary assisted death in present-day Japan: A case for dignity","authors":"A. Asai, M. Fukuyama","doi":"10.1177/14777509221105746","DOIUrl":"https://doi.org/10.1177/14777509221105746","url":null,"abstract":"No laws or official guidelines govern medical assistance for dying in Japan. However, over the past several years, cases of assisted suicide or voluntary euthanasia, rarely disclosed until recently, have occurred in close succession. Inspired by these events, ethical, legal, and social debates on a patient’s right to die have arisen in Japan, as it has in many other countries. Several surveys of Japanese people’s attitudes towards voluntary assisted dying suggest that a certain number of Japanese prefer active euthanasia. Against this background, it is important to discuss voluntary assisted dying cases in Japan and the Japanese views on them and to consider their implications. We review three recent Japanese voluntary assisted dying cases and discuss the various objections to voluntary assisted dying that have been published in response to these in various media outlets. Our counterarguments include the double suffering of people who are unable to give up their desire to die, individuality of death, variability of culture, problem of being an annoyance to (burden on) others, a slippery slope argument supporting voluntary assisted dying, and unfair claims about responsibility and excessive burden on people who are unable to give up their desire to die. We also point out the psychocultural and social problems in Japanese society that these objections reflect, and argue that voluntary assisted dying can be ethically acceptable under certain conditions. We conclude that Japanese society must change in order to enable those who sincerely wish to die to do so in a better way.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44676029","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

Vulnerability, health information right and the contributions of augmentative and alternative communication for people with aphasia 失语症患者的脆弱性、健康信息权以及辅助和替代沟通的贡献

Clinical Ethics Pub Date : 2022-05-31 DOI: 10.1177/14777509221105397

Ana Inês de Almeida Frade, Luísa d'Espiney, Vanda Marques Pinto

引用次数: 0

The ethics of forced care in dementia: Perspectives of care home staff 痴呆症强制护理的伦理：护理院工作人员的观点

Clinical Ethics Pub Date : 2022-05-09 DOI: 10.1177/14777509221097909

A. Fetherston, J. Hughes, S. Woods

{"title":"The ethics of forced care in dementia: Perspectives of care home staff","authors":"A. Fetherston, J. Hughes, S. Woods","doi":"10.1177/14777509221097909","DOIUrl":"https://doi.org/10.1177/14777509221097909","url":null,"abstract":"Some care home residents with dementia have the capacity, some do not. Staff may need to make decisions about administering care interventions to someone whom they believe lacks the capacity to consent to it, but also resists the intervention. Such intervention can be termed forced care. The literature on forced care (especially reflecting empirical work) is scant. This study aims to investigate how the ethics of forced care is navigated in practice, through ten semi-structured interviews with staff in 1 care home in the North East of England. Participants generally avoided situations where there was overt restraint, taking a flexible approach by either modifying their own behaviour or using covert techniques. The underlying justification given for decisions or actions tended to be that the recipients of care should be valued because of their intrinsic worth as fellow human beings. Participants attempted to put themselves in the position of the resident or think about what a beloved elderly relative would want. The intervention seemed acceptable to staff if the resident was not distressed. When staff were presented with scenario-based questions around capacity they were more successful than when asked direct questions relating to the Mental Capacity Act. Scenario-based training may be helpful to reinforce familiarity and facility with the principles of the Mental Capacity Act.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46478034","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

Engaging the values beneath communication in treatment disputes in the intensive care unit 在重症监护室的治疗纠纷中运用沟通背后的价值观

Clinical Ethics Pub Date : 2022-05-04 DOI: 10.1177/14777509221094486

John Seago

{"title":"Engaging the values beneath communication in treatment disputes in the intensive care unit","authors":"John Seago","doi":"10.1177/14777509221094486","DOIUrl":"https://doi.org/10.1177/14777509221094486","url":null,"abstract":"Disputes over life-sustaining treatment between clinicians and patients or their surrogates are common in the intensive care unit and expected to increase in America because of an aging population, shifts in medical training, and trends in popular opinions on end-of-life decisions. Clinicians struggle to effectively communicate the recommendation that withdrawing life-sustaining treatment is appropriate when the burdens of treatment outweigh the benefits. This view seems foreign and unimaginable to surrogates like family members with deeply held values motivate them to insist “everything be done” as long as the patient can be physiologically kept alive. For over three decades now, clinicians and bioethicists have sought preventative ethical and policy solutions to avoid or resolve these treatment disputes, including efforts to improve the communication between medical professionals and surrogates. Looking at the history of proposed solutions shows that giving providers more and better communication and negotiation tools may be inadequate on its own. However, better communication has the potential to unearth the motivations and deeper values of the disagreeing parties so that differing perspectives can be recognized and common ground can be established. The latest emphasize on communication has the potential to succeed where other historical solutions have failed. If bioethics is going to successfully analyze and remedy these disputes, the values motivating these views, even ones outside the bioethical consensus, must be acknowledged and respected. In short, better communication will not avoid or resolve life-sustaining treatment disputes in the intensive care unit unless the deeper ethical convictions of the disagreeing parties are recognized and engaged.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46715610","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

Physician self-reported use of empathy during clinical practice 医生在临床实践中自我报告共情的使用

Clinical Ethics Pub Date : 2022-05-03 DOI: 10.1177/14777509221096630

Amber R Comer, L. Fettig, S. Bartlett, Lynn D’Cruz, Nina Umythachuk

{"title":"Physician self-reported use of empathy during clinical practice","authors":"Amber R Comer, L. Fettig, S. Bartlett, Lynn D’Cruz, Nina Umythachuk","doi":"10.1177/14777509221096630","DOIUrl":"https://doi.org/10.1177/14777509221096630","url":null,"abstract":"The use of empathy during clinical practice is paramount to delivering quality patient care and is important for understanding patient concerns at both the cognitive and affective levels. This study sought to determine how and when physicians self-report the use of empathy when interacting with their patients. A cross-sectional survey of 76 physicians working in a large urban hospital was conducted in August of 2017. Physicians were asked a series of questions with Likert scale responses as well as asked to respond to open-ended questions. All physicians self-report that they always (69%) or usually (29.3%) use empathic statements when engaging with patients. 93.1% of physicians believe that their colleagues always (20.7%) or usually (69%) use empathic statements when communicating with patients. Nearly one-third of physicians (33%) indicated that using the words “I understand” denotes an empathic statement. Although 36% of physicians reported that they would like to receive more training or assistance about how and when to use empathy during clinical practice. : Despite the self-reported prevalent use of empathic statements, one-third of physicians indicate a desire for more training in what empathy means and when it should be used in a clinical setting. Additionally, nearly one-third of physicians in this study reported using responses that patients may not perceive as being empathic, even when intended to be empathic. This suggests that many physicians feel uncertain about a clinical skill they believe should be used in most, if not all, encounters.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47112316","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

Children, futility and parental disagreement: The importance of ethical reasoning for clinicians in the paediatric intensive care setting 儿童，徒劳和父母的分歧:伦理推理的重要性临床医生在儿科重症监护设置

Clinical Ethics Pub Date : 2022-04-28 DOI: 10.1177/14777509221096628

Chiara Baiocchi, Edmund Horowicz

{"title":"Children, futility and parental disagreement: The importance of ethical reasoning for clinicians in the paediatric intensive care setting","authors":"Chiara Baiocchi, Edmund Horowicz","doi":"10.1177/14777509221096628","DOIUrl":"https://doi.org/10.1177/14777509221096628","url":null,"abstract":"The provision of intensive care enables the lives of neonates, infants and children to be sustained or extended in circumstances previously regarded as impossible. However, as well as benefits, such care may confer burdens that resultingly frame continuation of certain interventions as futile, conferring more harm than or any, benefit. Subsequently, clinicians and families in the paediatric intensive care unit are often faced with decisions to withdraw, withhold or limit intensive care in order to act in the best interests of the child. An integral consideration in respect of these decisions is that futility is a concept that has to be contextualised for all those involved. Recent high-profile legal cases highlight the professional, clinical, legal and social conflicts that can arise when parents and clinicians have different interpretations of futility. In acknowledging the complexity of these conflicts for clinicians, this paper aims to support a better understanding of futility as an integral concept in such difficult and emotive decisions within professional practice. We utilise the concept of futility to frame how these decisions to withdraw or withhold certain invasive life-prolonging interventions are ethically and legally justifiable, even when they disagree or conflict with parental views. To support clinicians in understanding these decisions, we in part use the familiar bioethical framework of Principlism developed by Beauchamp and Childress. We suggest that understanding legal and ethical analysis of futility ultimately will help clinicians in approaching and reflecting on such decision-making.","PeriodicalId":53540,"journal":{"name":"Clinical Ethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45968795","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

Ethics of recommending weight loss in older adults: A case study 推荐老年人减肥的伦理:一个案例研究

Clinical Ethics Pub Date : 2022-04-28 DOI: 10.1177/14777509221096629

C. Mills

引用次数: 0