Ethical uncertainty and COVID-19: exploring the lived experiences of senior physicians at a major medical centre
Given the wide-reaching and detrimental impact of COVID-19, its strain on healthcare resources, and the urgent need for—sometimes forced—public health interventions, thorough examination of the ethical issues brought to light by the pandemic is especially warranted. This paper aims to identify some of the complex moral dilemmas faced by senior physicians at a major medical centre in Saudi Arabia, in an effort to gain a better understanding of how they navigated ethical uncertainty during a time of crisis. This qualitative study uses a semistructured interview approach and reports the findings of 16 interviews. ...
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: Muaygil, R., Aldekhyyel, R., AlWatban, L., Almana, L., Almana, R. F., Barry, M. Tags: COVID-19 Original research Source Type: research
Imagination and idealism in the medical sciences of an ageing world
Imagination and idealism are particularly important creative epistemic virtues for the medical sciences if we hope to improve the health of the world’s ageing population. To date, imagination and idealism within the medical sciences have been dominated by a paradigm of disease control, a paradigm which has realised significant, but also limited, success. Disease control proved particularly successful in mitigating the early-life mortality risks from infectious diseases, but it has proved less successful when applied to the chronic diseases of late life (like cancer). The time is ripe for the emergence and prominence ...
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: Farrelly, C. Tags: Original research Source Type: research
Expanding choice at the end of life
We are grateful to the commentators on our article1 for their thoughtful engagement with the ethical and clinical complexity of expanded terminal sedation (ETS) in end-of-life care. We will start by noting some points of common ground, before moving on to the more challenging ways in which TS might be permissibly expanded. First, several commentators pointed out, and we completely concur, that it is important to provide patients with full information about their end-of-life options, including the ‘outcomes, uncertainties and costs of ETS’.2 Where possible, they should be given time to ‘process their feeli...
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: Wilkinson, D., Gilbertson, L., Oakley, J., Savulescu, J. Tags: Commentary Source Type: research
Expanded terminal sedation: too removed from real-world practice
Gilbertson et al present a considered analysis of the abstract problem of ‘sedation’ at the end of life,1 and it is reassuring to see the separation of multiple practises that are often grouped under the heading terminal sedation. In their work, the authors attempt to introduce and justify a new practice in the care of those dying with significant suffering—expanded terminal sedation (ETS). This analysis will not, however, help our colleagues at the bedside. Here, we will focus on the flaws which are most relevant to clinicians: jurisdiction, uncertainty and reversibility. The authors’ focus on a ju...
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: Schofield, G., Baker, I. Tags: Commentary Source Type: research
Implications of extended terminal sedation
Gilbertson, Savulescu, Oakley and Wilkinson propose extending the availability of terminal sedation (TS) to patients with intractable pain and/or suffering who are expected to live more than 2 weeks (hence the designation of extended TS (ETS)) and to patients whose values are known but who do not have decision-making capacity.1 Their plan is worthy of serious consideration: it is, after all, based on the fundamental and well-recognised medical ethical values of patient autonomy and beneficence. But, even when restricted to jurisdictions that allow assisted dying, the ETS proposal raises three important issues. When the aut...
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: Sorum, P. C., Pratt, D. S. Tags: Commentary Source Type: research
Suffering, existential distress and temporality in the provision of terminal sedation
Introduction While there is a great deal to agree with in the essay Expanded Terminal Sedation in End-of-Life Care there is, we think, a need to more fully appreciate the humanistic side of both palliative and end-of-life care.1 Not only does the underlying philosophy of palliative care arguably differ from that which guides curative medicine,2 dying patients are in a uniquely vulnerable position given our cultural disinclination towards open discussions of death and dying. In this brief response, we critically engage Gilbertson et al’s essay and seek to contextualise the perspective they put forward. Suffering Accor...
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: Emmerich, N., Chapman, M. Tags: Commentary Source Type: research
Expanded terminal sedation: dangerous waters
Gilbertson et al should be commended for their insightful exploration of expanded terminal sedation (ETS)1; however, there are a number of concerns that I will address in this response. I will first better characterise the currently accepted and commonplace ‘standard’ TS (STS), and then argue that the advocated forms of ETS draw very close to—and at times clearly constitute a subtype of—euthanasia, as opposed to representing a similar but separate practice. I will then conclude with concerns regarding the inappropriate application of ETS, particularly in the non-voluntary context. Gilbertson et al d...
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: Riisfeldt, T. D. Tags: Commentary Source Type: research
Expanded terminal sedation in end-of-life care
Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term ‘Expanded TS’ (ETS) can be used to describe the use of sedation at the end of life outside one or more of these limits.
In this paper, we explore and defend ETS, focusing on jurisdictions where assisted dying is lawful. We ...
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: Gilbertson, L., Savulescu, J., Oakley, J., Wilkinson, D. Tags: Open access Feature article Source Type: research
Translating Cultural Safety to the UK
Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The ‘Black Lives Matter’ movement has exposed structural racism’s contribution to these health inequities. ‘Cultural Safety’, an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.
This paper explores what it means to be ‘culturally safe’. The ways in which New...
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: Lokugamage, A. U., Rix, E., Fleming, T., Khetan, T., Meredith, A., Hastie, C. R. Tags: Editor's choice Current controversy Source Type: research
Call to action: empowering patients and families to initiate clinical ethics consultations
Clinical ethics consultations exist to support patients, families and clinicians who are facing ethical or moral challenges related to patient care. They provide a forum for open communication, where all stakeholders are encouraged to express their concerns and articulate their viewpoints. Ethics consultations can be requested by patients, caregivers or members of a patient’s clinical or supportive team. Although patients and by extension their families (especially in cases of decisional incapacity) are the common denominators in most ethics consultations, these constituents are the least likely to request them. At m...
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: Blackler, L., Scharf, A. E., Matsoukas, K., Colletti, M., Voigt, L. P. Tags: Clinical ethics Source Type: research
Surgery should be routinely videoed
Video recording is widely available in modern operating rooms. Here, I argue that, if patient consent and suitable technology are in place, video recording of surgery is an ethical duty. I develop this as a duty to protect, arguing for professional and institutional duties, as distinguished for duties of rescue.
A professional duty to protect is described in mental healthcare. Practitioners have to take reasonable steps to prevent serious, foreseeable harm to their clients and others, even if that entails a non-consensual breach of confidentiality. I argue surgeons have a similar duty to patients which means that, provided...
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: Jesudason, E. Tags: Clinical ethics Source Type: research
Clinical law: what do clinicians want to know? The demography of clinical law
Conclusions
Among a broad range of enquiries, recognisable clinical legal phenotypes exist and have for the first time been described and categorised. These are clinical situations which clinicians need to be able to recognise and equipped to deal with. Doing so will likely facilitate timely and better treatment. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: Wheeler, R., Hall, N. Tags: Clinical ethics Source Type: research
Humility
Hume criticised ‘humility’ as a ‘monkish virtue’ and objected to it on the basis that such virtues ‘stupefy the understanding and harden the heart, obscure the fancy and sour the temper.’1 Despite the appeal of Hume’s plea for less restraint and self-denial, other thinkers such as Kant consider epistemic humility to be fundamental, given the limits of our rationality and our struggle to know and do the right thing.2 By epistemic humility, he did not mean weakness or being self-effacing, instead he was referring to an appropriate degree of self-respect that’s tempered by an aw...
Source: Journal of Medical Ethics - March 23, 2023 Category: Medical Ethics Authors: McMillan, J. Tags: Editorial Source Type: research
Endosex
, in contrast to intersex, refers to innate physical sex characteristics judged to fall within the broad range of what is considered normative or typical for ‘binary’ female or male bodies by the medical field, or to persons with such characteristics1 (p. 437). In this short contribution, we explain the origins and increasing use of this little-known term and discuss its practical and ethical relevance to medicine as well as to scholarship from a range of disciplines concerned with individuals’ sexed embodiment. There is growing awareness in many quarters of the term intersex—used within some discou...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Carpenter, M., Dalke, K. B., Earp, B. D. Tags: Words Source Type: research
Verification and trust in healthcare
‘Trust but verify’ is a translation of a Russian proverb made famous by former US President Ronald Reagan. In their paper, Graham et al appear to take an alternate view that might be summarised as trust or verify. The contrast highlights a general question: how do we come to trust in authorities? More specifically, Graham et al claim: (1) that UK Trusted Research Environments (TREs) are misnamed as future custodians for big health data because their promised verification systems actually negate the uncertainty that trust requires; (2) the public is mistaken if it believes such verification enhances trust; (3) t...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Jesudason, E. Tags: Response Source Type: research
