Bioethics最新文献

Are slow codes uniquely deceptive?

IF 1.7 2区哲学

Bioethics Pub Date : 2025-04-02 DOI: 10.1111/bioe.13415

Michael B Grosso, Paola Nicolas

{"title":"Are slow codes uniquely deceptive?","authors":"Michael B Grosso, Paola Nicolas","doi":"10.1111/bioe.13415","DOIUrl":"https://doi.org/10.1111/bioe.13415","url":null,"abstract":"\"Sham codes\" or \"slow codes\"-defined here as resuscitative efforts undertaken only to the extent necessary to convey the impression that \"everything was done,\" rather than to achieve return of spontaneous circulation (ROSC)-have been almost universally condemned for the past five decades. To facilitate an examination of this practice, we consider how the clinician's obligations and prerogatives differ under four scenarios, all of which involve conflict between the physician who desires to withhold cardiopulmonary resuscitation (CPR) and the family who does not. Under two scenarios, involving quality of life considerations and quantitative futility (\"long shots\"), we argue that slow codes are ethically impermissible. Under two other scenarios, however, we maintain an agnostic view on the moral permissibility of slow codes. We observe that where the case for impermissibility is predicated on considerations of honesty and professional integrity, commonly practiced and commonly defended alternatives to the slow code, such as non-initiation of CPR after bedside assessment, limited trials of CPR, and futile CPR, are typically undertaken for beneficent reasons and, like the slow code, entail non-lying deception. Finally, we offer recommendations for care delivery reform that work \"upstream\" to prevent the conflicts and crises of trust that give rise to intractable conflicts surrounding CPR.","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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: 0

Patient autonomy in the context of digital health.

IF 1.7 2区哲学

Bioethics Pub Date : 2025-04-01 DOI: 10.1111/bioe.13410

Salvador Tarodo Soria

引用次数: 0

Using Electroconvulsive Therapy (ECT) in emergency clinical situations against patient's autonomy: A case study analysis.

IF 1.7 2区哲学

Bioethics Pub Date : 2025-03-24 DOI: 10.1111/bioe.13413

Ekain Payán Ellacuria, Aníbal M Astobiza

{"title":"Using Electroconvulsive Therapy (ECT) in emergency clinical situations against patient's autonomy: A case study analysis.","authors":"Ekain Payán Ellacuria, Aníbal M Astobiza","doi":"10.1111/bioe.13413","DOIUrl":"https://doi.org/10.1111/bioe.13413","url":null,"abstract":"In this paper, we present a comprehensive case study analysis of a specific legal order issued by the Court of First Instance Number 6 of Santiago de Compostela on March 21, 2023. The focal point of the case study is the utilization of Electroconvulsive Therapy (ECT), a specific neurotechnology, in an emergency clinical situation. The objective of this article is to examine the legal and bioethical dimensions surrounding the use of ECT, shedding light on the ethical implications and decision-making processes involved in such cases. The analysis delves into the legal aspects of the case, considering relevant laws and regulations governing the use of ECT. The examination includes an exploration of the court's interpretation of the legal framework within the context of emergency situations, highlighting the specific legal arguments presented in the court judgment. Additionally, the article provides an in-depth bioethical analysis, exploring the ethical principles that come into play when making decisions about ECT in emergency clinical scenarios. The examination considers the delicate balance between respecting patient autonomy and promoting beneficence, while also addressing potential harms and adverse effects associated with ECT. We also consider the moral issues created by the court judgment, specifically those involving patient autonomy and the invasive nature of the process, particularly in cases of mental illness.","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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: 0

Slow codes as ethical disobedience.

IF 1.7 2区哲学

Bioethics Pub Date : 2025-03-20 DOI: 10.1111/bioe.13409

Jason Adam Wasserman

{"title":"Slow codes as ethical disobedience.","authors":"Jason Adam Wasserman","doi":"10.1111/bioe.13409","DOIUrl":"https://doi.org/10.1111/bioe.13409","url":null,"abstract":"KEY: Patients or families sometimes demand interventions that are of no benefit or are even harmful. Even in cases where cardiopulmonary resuscitation is futile or medically inappropriate, instituting a do not attempt resuscitation order requires either consent of the patient or family, or working through a cumbersome and conflictual institutional process to change code status over their objection. Sometimes they contest these decisions in court and sometimes they win. Avoiding such conflicts gave rise to the practice of \"slow codes,\" a situation in which the healthcare team responds to cardiac arrest in a patient in a deliberately slow or perfunctory manner, with the intention of not resuscitating the patient at all. Slow codes have been nearly universally decried as unethical in the literature, at least over the last three decades. After all, a slow code is fundamentally dishonest. But critics tend to avoid the socio-political and clinical realities that motivate the use of slow codes in the first place. In this article, I argue that in the context of judicial and legislative overreach into medical decision-making, the slow code serves a distinctly moral purpose beyond promoting the welfare of the patient: It is an act of disobedience against an unethical system.","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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: 0

Moral enhancement and behavioral trait variance.

IF 1.7 2区哲学

Bioethics Pub Date : 2025-03-18 DOI: 10.1111/bioe.13412

Brandon Long

引用次数: 0

Definitions as boundaries: Bioethics, Palestine and climate catastrophes.

IF 1.7 2区哲学

Bioethics Pub Date : 2025-03-17 DOI: 10.1111/bioe.13411

Dorian Accoe, Clemence Van Ginneken, Michiel De Proost, Seppe Segers

引用次数: 0

Slow codes without regret.