What We Should Learn from the COVID-19 Pandemic.
Authors: Hower EG Abstract The COVID-19 pandemic may have left many of us needing closeness with others more than we have before. Three contexts in which we may especially need this closeness are (1) when we must triage and some but not all will benefit, (2) when families may be separated from loved ones who have COVID-19, and (3) when people for any reason experience shame. In this article I examine sources of present, harmful emotional distancing. I suggest how we might do better in each of these contexts due to what the COVID-19 pandemic can teach us. PMID: 32960804 [PubMed - as supplied by publisher] (Sourc...
Source: Journal of Clinical Ethics - September 23, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

The Top 10 Questions Facing the Field of Clinical Ethics in 2020: Reflections on the Evolving Clinical Ethics UnConference.
Authors: Malek J, Horner C Abstract Evolving Clinical Ethics: A Working UnConference, held 5 through 7 February 2020 in Houston, Texas, brought together 91 participants from a variety of institutions, many of whom are engaged in clinical ethics work. The event followed the success of the first Clinical Ethics UnConference hosted by the Cleveland Clinic Center for Bioethics in 2018, and offered an opportunity for ethicists to share both their challenges and their solutions to clinical ethics issues. In this article we explore the emerging themes of the second UnConference and identify the top 10 questions currently ...
Source: Journal of Clinical Ethics - September 23, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Clarifying and Expanding the Role of Narrative in Ethics Consultation.
Authors: Childress A, Lee SW, Matsler JS, Farroni JS Abstract Understanding a patient's story is integral to providing ethically supportable and practical recommendations that can improve patient care. Important skills include how to elicit an individual's story, how to weave different narrative threads together, and how to assist the care team, patients, and caregivers to resolve difficult decisions or moral dilemmas. Narrative approaches to ethics consultation deepen dialogue and stakeholders' engagement to reveal important values, preferences, and beliefs that may prove critical in resolving care challenges. Rec...
Source: Journal of Clinical Ethics - September 23, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

The Ethics Ambassador Program: A Grassroots Approach.
Authors: Furfari K Abstract The Ethics Ambassador program at the University of Colorado Hospital was born from a desire to encourage earlier ethics consultation, with the goal of providing timely, effective, and patient-centered ethics support. The selected Ethics Ambassadors are individuals from multiple roles across the hospital who receive regular education to serve as an ethics resource for their respective units or specialties. As embedded individuals, they are better able to recognize the unique needs and challenges of their units and provide relevant ethics education to staff and faculty. Outcomes of the fir...
Source: Journal of Clinical Ethics - September 23, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Building an Organizational Ethics Program on a Clinical Ethics Foundation.
Authors: Lahey T, DeRezo EG, Crites J, Fanning J, Huberman BJ, Slosar JP Abstract Organizational ethics programs often are created to address tensions in organizational values that have been identified through repeated clinical ethics consultation requests. Clinical ethicists possess some core competencies that are suitable for the leadership of high-quality organizational ethics programs, but they may need to develop new skills to build these programs, such as familiarity with healthcare delivery science, healthcare financing, and quality improvement methodology. To this end, we suggest that clinical ethicists bui...
Source: Journal of Clinical Ethics - September 23, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Demonstrating Value Through Tracking Ethics Program Activities Beyond Ethics Consultations.
This article describes our ethics program's early efforts to systematically track ethics program activities outside of ethics consultations as a way to demonstrate additional value to the institution that goes beyond ethics consultation. By systematically tracking activities such as internal ethics education sessions, conference presentations, publications, grants, committee/policy work, and other activities, our ethics program has been able to gather substantial quantitative data that highlight our program's numerous activities and outreach, both within and outside the institution, that provide additional value to the ins...
Source: Journal of Clinical Ethics - September 23, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Variation in Clinical Ethics Fellowship Programs: Lessons from the Field.
Authors: Moore B, Horner C Abstract Given the enduring debate over what constitutes quality, and therefore appropriate training, in clinical ethics consultation, it is unsurprising that there is variation in the structure and content of clinical ethics fellowship programs. However, this variation raises questions about the value of fellowship training when the ethicists that emerge from these programs might be quite different. The specifics of fellowship programs are largely internal. As such, the extent of variation and whether such variation is problematic remains unclear. In this article, we summarize lessons le...
Source: Journal of Clinical Ethics - September 23, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Debriefing as a Response to Moral Distress.
Authors: Morley G, Shashidhara S Abstract There are few evidence-based interventions that have been developed that mitigate the negative effects of moral distress. Group debriefing is one approach that some clinical ethicists have adopted as a response. However, there is very little academic literature or empirical research that identifies best practices and approaches to debriefing as a response to moral distress. Our aim at the 2020 UnConference was to share our different approaches to debriefing with other clinical ethicists to identify best practices or guiding principles to enhance our respective approaches an...
Source: Journal of Clinical Ethics - September 23, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Meeting the Challenge of COVID-19: The Response of Two Ethics Consultation Services in New York City.
Authors: Prager KM, Fins JJ Abstract From mid-March through May 2020, New York City was the world's epicenter of the COVID-19 pandemic, and its hospitals faced an unparalleled surge of patients who were critically ill with the virus. In addition to putting an enormous strain on medical resources, the pandemic presented many ethical issues to emotionally and physically stressed clinicians and hospital administrators. Analyses of the challenges faced by the ethics consultation services of the two campuses of New York Presbyterian Hospital, and how they assisted their clinician and administrative colleagues, is the su...
Source: Journal of Clinical Ethics - August 13, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Clinical Ethics Consultations during the COVID-19 Pandemic Surge at a New York City Medical Center.
This report describes the recent experience of the ethics consultants and Columbia University Irving Medical Center during the COVID-19 surge and compares the case load and characteristics to the corresponding period in 2019. By reporting this experience, we hope to supplement the growing body of COVID-19 scientific literature and provide details of the human toll the virus took on our hospitals and communities. We also aim to highlight the role of the clinical ethics consultant as well as areas of policy and law that may need to be addressed in order to be better prepared for a future public health crisis. PMID: 32773...
Source: Journal of Clinical Ethics - August 13, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Phases of a Pandemic Surge: The Experience of an Ethics Service in New York City during COVID-19.
Authors: Huberman BJ, Mukherjee D, Gabbay E, Knowlton SF, Green DST, Pandya N, Meredith N, Walker JM, Shapiro ZE, Hersh JE, Chisholm MF, Waldman SA, MacKenzie CR, de Melo-Martín I, Fins JJ Abstract When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC);...
Source: Journal of Clinical Ethics - August 13, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

The COVID-19 Crisis and Clinical Ethics in New York City.
Authors: Fins JJ, Prager KM Abstract The COVID-19 pandemic that struck New York City in the spring of 2020 was a natural experiment for the clinical ethics services of NewYork-Presbyterian (NYP). Two distinct teams at NYP's flagship academic medical centers-at NYP/Columbia University Medical Center (Columbia) and NYP/Weill Cornell Medical Center (Weill Cornell)-were faced with the same pandemic and operated under the same institutional rules. Each campus used time as an heuristic to analyze our collective response. The Columbia team compares consults during the pandemic with the same period during the year prior. T...
Source: Journal of Clinical Ethics - August 13, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Sweetening the "Sweet Spot" of Dementia.
This article presents the belief of some experts that patients always retain a basic, core underlying awareness. Practical approaches that careproviders and caregivers can take to maximize patients' quality of life are discussed. The possibility that patients and loved ones can find meaning in last months and years of life is emphasized. PMID: 32585653 [PubMed - in process] (Source: Journal of Clinical Ethics)
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Non-Accidental Trauma Associated with Withdrawal of Life-Sustaining Medical Treatment in Severe Pediatric Traumatic Brain Injury.
CONCLUSION: NAT is associated with increased risk for withdrawal of LSMT in pediatric TBI. Age of less than three years is similarly associated with a higher risk for withdrawal of LSMT. Future research in this population is needed to determine what other factors predict withdrawal of LSMT and what resources, such as social workers and/or ethics consults, are utilized. PMID: 32585654 [PubMed - in process] (Source: Journal of Clinical Ethics)
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Abusive Head Trauma and Parental Participation in Pediatric Decision Making.
Authors: Paquette ET, Ross LF Abstract Decision making for children who suffer abusive head trauma invokes multiple ethical considerations. The degree to which parents are permitted to participate in decision making after the injury has occurred is controversial. In particular, in this issue of The Journal of Clinical Ethics, Grigorian and colleagues raise concerns about the potential for conflict of interest in end-of-life decision making if the parents are facing criminal charges that could be escalated if the child dies. There are additional concerns about the parents' capacity to make decisions that are best fo...
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

The Dartmouth Dementia Directive: Experience with a Community-Based Workshop Pilot of a Novel Dementia-Specific Advance Directive.
Authors: Bunnell ME, Baranes SM, McLeish CH, Berry CE, Santulli RB Abstract Dementia is a growing issue at the end of life that presents unique challenges for advance care planning. Advance directives are a useful and important component of end-of-life planning, but standard advance directives have less utility in cases of loss of capacity due to dementia. An advance directive designed to specifically address end-of-life issues in the setting of dementia can provide patients with increased autonomy and caregivers with improved information about the desires of the individual in question. The Dartmouth Dementia Direc...
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Should Positive Claims of Conscience Receive the Same Protection as Negative Claims of Conscience? Clarifying the Asymmetry Debate.
This article outlines arguments against this asymmetry and critiques them for failing to distinguish between positive claims of conscience as positive or negative rights. I suggest the asymmetry debate should be focused on whether positive claims of conscience as positive rights ought to enjoy the same protections as negative claims of conscience. Clarifying the debate in this way helps elucidate some of the best reasons for the asymmetry, which these arguments have not addressed. This article does not take a definitive position on whether the asymmetry is justified, but attempts to bring some focus to the debate by direct...
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Positive or Negative? Consistency and Inconsistency in Claims of Conscience.
Authors: Wilkinson DJ Abstract The debate about positive and negative claims of conscience is, in large part, about ethical consistency. In this commentary I argue that there can be differences between conscientious provision of treatment and conscientious nonprovision of treatment that are ethically relevant. However, in many cases, including those described in this commentary, there is not sufficient ethical reason to treat them differently. This means that asymmetrical conscientious objection policies are potentially unjustified. PMID: 32585658 [PubMed - in process] (Source: Journal of Clinical Ethics)
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Conscientious Objection in Healthcare: Neither a Negative Nor a Positive Right.
Authors: Giubilini A Abstract Conscientious objection in healthcare is often granted by many legislations regulating morally controversial medical procedures, such as abortion or medical assistance in dying. However, there is virtually no protection of positive claims of conscience, that is, of requests by healthcare professionals to provide certain services that they conscientiously believe ought to be provided, but that are ruled out by institutional policies. Positive claims of conscience have received comparatively little attention in academic debates. Some think that negative and positive claims of conscience ...
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Considering Uterus Transplantation for a Same-Sex Couple: A Case Study.
Authors: Testa G, Johannesson L, Wall AE Abstract A woman with congenital absence of a uterus applied for participation in a clinical trial for uterus transplantation. She was married to a woman who had the potential to carry a child without the need for aggressive medical intervention. Thus, the question arose regarding whether the infertile partner should be considered for uterus transplantation. In this article we discuss the ethical issues with uterus transplantation for a member of a same-sex couple, whose partner could carry a pregnancy. We review the medical criteria for uterus transplantation, discuss the a...
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

How Much Volume Should Healthcare Ethics Consult Services Have?
DISCUSSION: The statistical limitations of our study highlight the need to standardize the sharing and reporting of data in clinical ethics. Future work should further standardize methods of HCEC quality assessment using measures similar to those we describe. PMID: 32585661 [PubMed - in process] (Source: Journal of Clinical Ethics)
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Answering the Call for Standardized Reporting of Clinical Ethics Consultation Data.
Authors: Feldman SL, Rias SH, Crites JS, Jankowski J, Ford PJ Abstract Benchmarks against which healthcare ethics consultation (HCEC) services can assess their performance are needed. As first-generation benchmarks continue to be developed, it is the obligation of the field to continually evaluate how these measures reflect the performance of any single HCEC service. This will be possible only with widespread reporting of standardized data points. In their article in this issue of The Journal of Clinical Ethics, Glover and colleagues provide a valuable preliminary approach for assessing appropriate consult volumes ...
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Financial Decision-Making Capacity and Patient-Centered Discharge.
Authors: Mendola A Abstract An ethically sound discharge from the hospital can be impeded by a number of factors, including a lack of payor for a patient's care, a lack of appropriate discharge options, and a lack of authority to sign a patient into a long-term facility. In some cases, the primary barrier involves the patient's lack of financial decision-making capacity. When a patient's income comes primarily from government assistance, financial decision making is connected to both the individual's well-being and to fair allocation of resources. Taking away another person's financial independence is a substantial...
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Ways of Being in Generalist Practice: Using Five "T" Habits of Mind to Guide Ethical Behavior.
Ways of Being in Generalist Practice: Using Five "T" Habits of Mind to Guide Ethical Behavior. J Clin Ethics. 2020;31(2):184-190 Authors: Ventres W, Tunzi M Abstract The practice of generalist medicine differs from the practice of other clinical disciplines. We postulate that the application of ethics in generalist practice similarly differs from its application in other healthcare settings. In contrast to the problem-focused practice of ethics in other medical specialties, the practice of ethics in generalist medicine blends habits of mind with behaviors applied routinely over time-an ethica...
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Compassionate Communication and End-of-Life Care for Critically Ill Patients with SARS-CoV-2 Infection.
This article describes the experiences of clinicians in ICUs in the south of Spain promoted by the Andalusian Society of Intensive Care SAMIUC, in the hope it will serve to improve the conditions in which these patients die, and to help their families who suffer when they cannot say good-bye to their loved ones. In the south of Spain, healthcare professionals use daily videoconferencing to improve communication between clinicians, patients, and their relatives who cannot visit them in the ICU. This close communication allows families to see their loved ones and extends communication between healthcare professionals, patien...
Source: Journal of Clinical Ethics - June 27, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Beyond Determining Decision-Making Capacity.
This article presents criteria and approaches now used to make this assessment and discusses how these approaches are presently applied in five common disorders that can serve as paradigms for approaches in other disorders. I propose that since there are new diagnoses and treatments, reconsidering our current practices is warranted. The possibilities that clinicians can nudge patients to make better choices for themselves and, above all, that clinicians can maintain and maximize positive patient/careprovider relationships during and after these assessments, are emphasized. PMID: 32213687 [PubMed - in process] (Source: ...
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

On Transference in Clinical Ethics Consultation: Recognizing and Working through the Past in Surrogate Decision Making.
Authors: Guerin RM Abstract Clinical ethics consultants often confront the most difficult clinical encounters, typically in the setting of chronically critically ill patients and surrogate decision makers. These encounters require not only analytical skills but interpersonal skills as well. In this article, I focus on an interpersonal skill absent from the American Society for Bioethics and the Humanities Task Force's Core Competencies for Healthcare Ethics Consultation. I introduce the psychoanalytic concept of transference and argue that knowledge and use of transference phenomena are sometimes indispensable for ...
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

A Listening Tour: Pediatric Clinical Ethics Rounds.
Authors: Teti SL Abstract A two-year rounding program was initiated by the clinical ethics consult service (CECS) to improve ethics program integration and utilization at our 323-bed tertiary care pediatric hospital. Two critical variables were identified for improvement. One: identification of cases in which an ethics consult would have benefited clinical care but was not requested. Two: earlier detection of cases for which the medical team and/or family eventually sought ethics consultation but that worsened during the delay. Improvement relied on eliciting dialogue with the CECS by the medical team and/or patien...
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Physician Burnout and Ethics Committees.
This article provides a brief background of key issues in physician burnout, a significant problem in the healthcare industry. The extent and severity of burnout are not well understood; and those seeking help are often stigmatized. A number of different approaches to alleviating burnout have been suggested, but the problem lacks any single or simple solution. We posit that an ethics committee may be well positioned to help address this issue because of its unique position within an institution. An ethics committee serves the entire hospital staff regardless of department. As such it may be able to identify common elements...
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

The Role of Self-Care in Clinical Ethics Consultation: Clinical Ethicists' Risk for Burnout, Potential Harms, and What Ethicists Can Do.
This article reviews the goals and skills of ethics consultation and the role-specific reasons that clinical ethicists may be at risk for burnout, and argues that clinical ethicists may need to engage in self-care practices. Strategies to address burnout are reviewed and opportunities for future research are identified. PMID: 32213691 [PubMed - in process] (Source: Journal of Clinical Ethics)
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Rethinking the Assessment of Decision-Making Capacity and Making Treatment-Related Decisions.
This article will review current methods for assessing capacity, highlight other factors to consider in the decision-making process, and propose an enhanced framework to guide clinicians in making timely and prudent treatment-related decisions for patients with impaired capacity. PMID: 32213692 [PubMed - in process] (Source: Journal of Clinical Ethics)
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Pocketful of Justice: Will Digital Medicine Be Available to the Poor?
Authors: Schwartz J Abstract Digital medicine -- a drug delivered with an ingestion sensor and related data collection system -- has potential clinical value, especially for people whose lives are made more disorganized by poverty-related stress. It would be unjust if poor people were effectively barred from this treatment modality. Yet, unless a concerted effort is made to enable access through provision of smartphones to those who cannot afford them, this injustice will aggravate the digital divide in clinical care. PMID: 32213693 [PubMed - in process] (Source: Journal of Clinical Ethics)
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Roles of the Ethics Consultant: A Response to Vaughan and Colleagues and De Renzo.
Authors: Kornfeld DS, Prager K Abstract We respond to commentaries on our article, "The Clinician as Clinical Ethics Consultant: An Empirical Method of Study," that appeared in the summer 2019 issue of The Journal of Clinical Ethics. PMID: 32213694 [PubMed - in process] (Source: Journal of Clinical Ethics)
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Do You Believe in Magic? Shove, Don't Nudge: Advising Patients at the Bedside.
Authors: Iserson KV Abstract Magical thinking, distortions of reality based on fantasy, are pervasive in society and may influence patients' healthcare decisions. These distortions can "nudge" people to make decisions using System 1 thinking (a heuristic and error-prone decisional pathway that is always "on"), rather than a slower, deliberative, and more labor-intensive process that evaluates evidence (System 2). Physicians have been castigated for subtly nudging their patients toward evidence-based decisions. Yet when patients demonstrate magical thinking in their decision making, physicians ha...
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Curare Aude-Caring for Patients, with Them.
Authors: Hargraves I, Montori VM, Tilburt JC Abstract We reflect on Dr. Iserson's article in this journal, in which he suggests that clinicians must "shove" patients towards appropriate care. While recognizing that overt clinical guidance is part of care, we suggest that its use should be tempered by the guidance's responsiveness to the human and emotional experience of each patient. PMID: 32213696 [PubMed - in process] (Source: Journal of Clinical Ethics)
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

The Paradoxes of Respectful Guidance: A Comment on Kenneth V. Iserson, "Do you Believe in Magic? Shove, Don't Nudge: Advising Patients at the Bedside".
The Paradoxes of Respectful Guidance: A Comment on Kenneth V. Iserson, "Do you Believe in Magic? Shove, Don't Nudge: Advising Patients at the Bedside". J Clin Ethics. 2020;31(1):83-85 Authors: Hausman DM Abstract This commentary argues that the problems identified in Kenneth V. Iserson's Essay, "Do you Believe in Magic? Shove, Don't Nudge: Advising Patients at the Bedside," are perennial difficulties to which there is no single simple solution. In particular, recent work in psychology offers little help to caregivers, who are in the difficult position of guiding the decisions of the...
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

When Push Comes to Shove-How Should Physicians Respond to Magical Thinking?
Authors: Holm S Abstract Should doctors shove their patients to choose in ways that are aligned with the patients' desired goals, when the patients' choices go wrong because of magical beliefs? I argue that doctors should not shove their patients in this way, but push them towards better and more reflective decision making. We can do this by nudging techniques or by more direct advice giving. If patients still choose wrongly, it is their choice, and doctors have fulfilled their professional, ethical duties. PMID: 32213698 [PubMed - in process] (Source: Journal of Clinical Ethics)
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Shove and Nudge: A Commentary on Iserson.
Authors: Grill K Abstract In this comment on Kenneth Iserson's article, "Do You Believe in Magic? Shove, Don't Nudge: Advising Patients at the Bedside," I discuss the definition of and the moral evaluation of nudging. I propose that using persuasive descriptions and intentionally building trust in patients by one's demeanor is a form of nudging. I argue that nudging is not necessarily morally problematic, but that it can be controlling and can limit liberty, despite proponents' claims to the contrary. I agree with Iserson that clinicians should give their patients explicit advice, but add that they should...
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Italy in a Time of Emergency and Scarce Resources: The Need for Embedding Ethical Reflection in Social and Clinical Settings.
Authors: Nicoli F, Gasparetto A Abstract The COVID-19 virus is severely testing the Italian healthcare system, as the requests for intensive treatment are greater than the real capacity of the system to receive patients. Given this emergency situation, it follows that citizens are limited in their freedom of movement in order to limit infection, and that in hospitals a significant number of critical situations must be faced. This brief contribution aims to offer a reflection on the public and clinical role of the bioethicist: a figure able to promote dialogue between the world of medicine and the community, and to ...
Source: Journal of Clinical Ethics - March 29, 2020 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Ethical Issues Posed by Face Transplants.
Authors: Howe EG Abstract A face transplant is as challenging a surgical procedure as any patient can undergo. In this introduction I present the medical aspects of this surgery, the profound ethical issues it raises, and optimal interventions that clinicians can pursue to help these patients and their loved ones. I then discuss how to help other kinds of patients and loved ones who confront similar stresses. I end by presenting a goal that author Sharrona Pearl puts forth after she studied many face transplant patients. The efforts she urges should maximize our capacity to see face transplant patients-and anyone-a...
Source: Journal of Clinical Ethics - December 20, 2019 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Self-Inflicted Moral Distress: Opportunity for a Fuller Exercise of Professionalism.
Authors: Berger JT, Hamric AB, Epstein E Abstract Moral distress is a phenomenon increasingly recognized in healthcare that occurs when a clinician is unable to act in a manner consistent with his or her moral requirements due to external constraints. We contend that some experiences of moral distress are self-inflicted due to one's under-assertion of professional authority, and these are potentially avoidable. In this article we outline causes of self-inflicted moral distress and offer recommendations for mitigation. PMID: 31851622 [PubMed - in process] (Source: Journal of Clinical Ethics)
Source: Journal of Clinical Ethics - December 20, 2019 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

The Ethics of Psychosocial Assessment in Vascularized Composite Allotransplantation: A Call for Transparency of Process to Support the Equitable Selection of Patients.
Authors: Kimberly LL, McQuinn MW, Caplan AL, Levy-Carrick NC Abstract As the field of vascularized composite allotransplantation (VCA) continues to evolve and technological approaches improve, VCA programs must focus on promoting greater consistency in psychosocial assessment across programs to support the equitable selection of patients. Based on a summary of published reports of VCA, we address the ethical considerations raised by the present heterogeneity of approaches to psychosocial assessment, including weighing risks and benefits, informed consent and the role of decisional capacity, and potential or perceiv...
Source: Journal of Clinical Ethics - December 20, 2019 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

An Algorithmic Approach to Patients Who Refuse Care But Lack Medical Decision-Making Capacity.
Authors: Larson SA, Suprapaneni S, Wack K, George M Abstract Situations in which patients lack medical decision-making (MDM) capacity raise ethical challenges, especially when the patients decline care that their surrogate decision makers and/or clinicians agree is indicated. These patients are a vulnerable population and should receive treatment that is the standard of care, in line with their the values of their authentic self, just as any other patient would. But forcing treatment on patients who refuse it, even though they lack capacity, carries medical and psychological risks to the patients and the hospital s...
Source: Journal of Clinical Ethics - December 20, 2019 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

The Role of Informed Consent for Thrombolysis in Acute Ischemic Stroke.
Authors: Comer AR, Damush TM, Torke AM, Williams LS Abstract Although tissue plasminogen activator (tPA) is the only medication approved by the United States Food and Drug Administration (FDA) for acute ischemic stroke, there is no consensus about the need for informed consent for its use. As a result, hospitals throughout the U.S. have varying requirements regarding obtaining informed consent from patients for the use of tPA, ranging from no requirement for informed consent to a requirement for verbal or written informed consent. We conducted a study to (1) determine current beliefs about obtaining patients' infor...
Source: Journal of Clinical Ethics - December 20, 2019 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Family Presence During Cardiopulmonary Resuscitation.
Authors: Lederman Z Abstract Most professional guidelines advocate family presence during resuscitation (FPDR). Many clinicians, however, are still reluctant to implement this recommendation. In this article I present the most comprehensive case for FPDR to date. I review the little that has been written about the ethics of FPDR, as well as the available empirical evidence. More importantly, I present and defend three arguments for FPDR: adherence to professional guidelines, benefit to patients and relatives, and patients' autonomy. I conclude with suggestions for future research. PMID: 31851626 [PubMed - in pr...
Source: Journal of Clinical Ethics - December 20, 2019 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Home Intravenous Antibiotic Treatment for a Patient with Opioid Use Disorder.
Authors: Solomon DA, Price CN, Sadovnikoff N Abstract Intravenous drug abusers may incur bloodstream infections, in particular those involving the heart valves, that often require extended courses of antibiotics, commonly on the order of six weeks. Conventional wisdom has dictated that even when patients are sufficiently well to not need ongoing hospitalization, it is unsafe to complete their antibiotic course in any setting other than in a closely supervised facility, even if this is contrary to their wishes. The assumption has been that such patients would be at risk of using their indwelling intravenous catheter...
Source: Journal of Clinical Ethics - December 20, 2019 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Family-Centered Culture Care: Touched by an Angel.
Authors: Hernandez JA Abstract An Asian Indian Hindu family chose no intervention and hospice care for their newborn with hypoplastic right heart syndrome as an ethical option, and the newborn expired after five days. Professional nursing integrates values-based practice and evidence-based care with cultural humility when providing culturally responsive family-centered culture care. Each person's worldview is unique as influenced by culture, language, and religion, among other factors. The Nursing Team sought to understand this family's collective Indian Hindu worldview and end-of-life beliefs, values, and practice...
Source: Journal of Clinical Ethics - December 20, 2019 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Treating Children Maximally: Practical Applications.
Authors: Howe EG Abstract Lainie Friedman Ross suggests that clinicians increase our efforts to meet children's most basic needs in several ways. These include prioritizing, to a greater extent, children's present and future feelings; placing greater decisional weight on other family members' needs; spotting earlier threats from surrogate decision makers so that we can better prevent these threatened harms; and finding ways to intervene earlier so that we can allow parental surrogate decision makers to remain in this role. I offer some practical ways in which Ross's ideas might be applied. PMID: 31573959 [PubMe...
Source: Journal of Clinical Ethics - October 3, 2019 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Better than Best (Interest Standard) in Pediatric Decision Making.
Authors: Ross LF Abstract Healthcare decision making for children has adopted the best interest of the child standard, a principle originally employed by judges to adjudicate child placement in the case of parental death, divorce, or incompetence. Philosophers and medical ethicists have argued whether the best interest principle is a guidance principle (informing parents on how they should make healthcare decisions for their child), an intervention principle (deciding the limits of parental autonomy in healthcare decision making), or both. Those who defend it as only a guidance principle often cite the harm princip...
Source: Journal of Clinical Ethics - October 3, 2019 Category: Medical Ethics Tags: J Clin Ethics Source Type: research

Offering the "Reasonable Interests Standard" in Response to Ross's Analysis of the Best Interests Standard.
This article argues that while Ross's critique of the traditional accounts of the BIS is correct, her solution still raises some concerns. As such, I offer the "reasonable interests standard" as a way of addressing what I see as weaknesses in both the BIS and CPA. PMID: 31573961 [PubMed - in process] (Source: Journal of Clinical Ethics)
Source: Journal of Clinical Ethics - October 3, 2019 Category: Medical Ethics Tags: J Clin Ethics Source Type: research