Journal of Clinical Ethics | Page 2

Jeffrey T Berger, Ann B Hamric, Elizabeth Epstein
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.
2019: Journal of Clinical Ethics
Edmund G Howe
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-as they are, as opposed to how they look...
2019: Journal of Clinical Ethics
Gwendolyn P Quinn, Amani Sampson, Lisa Campo-Engelstein, Leena Nahata
No abstract text is available yet for this article.
2019: Journal of Clinical Ethics
Thomas V Cunningham, Andrea Chatburn, Cynthia Coleman, Evan G DeRenzo, Kristin Furfari, John Frye, Avery C Glover, Matthew Kenney, Nico Nortjé, Janet Malek, Mark Repenshek, Flora Sheppard, Joshua S Crites
Scholars and professional organizations in bioethics describe various approaches to "quality assessment" in clinical ethics. Although much of this work represents significant contributions to the literature, it is not clear that there is a robust and shared understanding of what constitutes "quality" in clinical ethics, what activities should be measured when tracking clinical ethics work, and what metrics should be used when measuring those activities. Further, even the most robust quality assessment efforts to date are idiosyncratic, in that they represent evaluation of single activities or domains of clinical ethics activities, or a range of activities at a single hospital or healthcare system...
2019: Journal of Clinical Ethics
Caroline A Buchanan, Johan C Bester, Bethany Bruno, Clare Delany, Kerri O Kennedy, Tracy Koogler, Nneka O Sederstrom, Jessica A Moore, Kathryn L Weise
Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this area...
2019: Journal of Clinical Ethics
Jeffrey S Farroni, Emily Tumilty, Debjani Mukherjee, Susan McCammon, David M Chooljian, Margot M Eves
Debates regarding clinical ethicists' scope of practice are not novel and will continue to evolve. Rapid changes in healthcare delivery, outcomes, and expectations have necessitated flexibility in clinical ethicists' roles whereby hospital-based clinical ethicists are expected to be woven into the institutional fabric in a way that did not exist in more traditional relationships. In this article we discuss three emerging roles: the ethicist embedded in the interdisciplinary team, the ethicist with an expanded educational mandate, and the ethicist as a therapeutic presence in the patient care space...
2019: Journal of Clinical Ethics
Laura Guidry-Grimes, Marika Warren, Hannah I Lipman, Kelly Kent, Kaarkuzhali Babu Krishnamurthy, Arlene M Davis, Thomas May, Marycon Chin Jiro, Jane Jankowski
Our aim in this article is to define the difficulties that clinical ethics services encounter when they are asked to demonstrate the value a clinical ethics service (CES) could and should have for an institution and those it serves. The topic emerged out of numerous related presentations at the Un-Conference hosted by the Cleveland Clinic in August 2018 that identified challenges of articulating the value of clinical ethics work for hospital administrators. After a review these talks, it was apparent that the field of clinical ethics may be at a crisis of sorts due to increased pressure to provide explicit measures to healthcare institutions to concretely demonstrate that CESs make a valuable difference in healthcare delivery...
2019: Journal of Clinical Ethics
Hilary Mabel, Paul J Ford
In an effort to create new synergies to fill gaps in evaluation of value, assessment of quality, and definition of roles in clinical ethics programs we convened a meeting entitled Innovations in Clinical Ethics: A Working Un-Conference (the Un-Conference) in August 2018. The Un-Conference was conceived to be a working event aimed at promoting cross pollination and idea generation for innovative practices in clinical ethics. The event was attended by 95 individuals from 62 institutions, representing a wide diversity of healthcare systems, who believed in the concept and brought their enthusiasm and expertise to share with others...
2019: Journal of Clinical Ethics
Norman Quist
What process ought to guide decision making for pediatric patients? The prevailing view is that decision making should be informed and guided by the best interest of the child. A widely discussed structural model proposed by Buchanan and Brock focuses on parents as surrogate decision makers and examines best interests as guiding and-or intervention principles. Working from two recent articles by Ross on "constrained parental autonomy" in pediatric decision making (which is grounded in the Buchanan and Brock model), I discuss (supportively) features of Ross's effort vis-a-vis the best interest standard...
2019: Journal of Clinical Ethics
Lainie Friedman Ross
In their thoughtful critiques of my article "Better than Best (Interest Standard) in Pediatric Decision Making," my colleagues make clear that there is little consensus on what is (are) the appropriate guidance and intervention principles in pediatric decision making, and disagree about whether one principle can serve both functions. Hester proposes his own unitary principle, the reasonable interest standard, which, like the best interest standard from which it is derived, encourages parents to aim for the great, although Hester tempers it with a pragmatic principle that allows consideration of cultural and family values and practical, financial, social, or psychological circumstances...
2019: Journal of Clinical Ethics
Johan C Bester
While the best interest standard (BIS) enjoys wide endorsement as ethical and decision-making standard in pediatrics, it has been criticized as vague and indeterminate. Alternate decision-making standards have been proposed to replace or augment the BIS, notably the harm principle (HP) and constrained parental autonomy (CPA) model. In this edition of The Journal of Clinical Ethics, Lainie Friedman Ross argues that CPA is a better standard than the BIS or the HP as both guide and limiter in pediatrics. In response, I review the important work done by the BIS in pediatrics, and argue that neither the HP nor the CPA can take over these functions or replace the BIS...
2019: Journal of Clinical Ethics
Erin Paquette
Children's age and developmental capacity leave them incapable of making medical decisions for themselves. Decisions for children are traditionally made under the best interest standard. Ross calls into question whether the best interest standard can function as both a guidance and intervention principle, able to be applied across the spectrum of pediatric decision making. Ross describes constrained parental autonomy as an alternative model, arguing that it affords parents the ability to make decisions within the context of their family while upholding a child's current and future interests...
2019: Journal of Clinical Ethics
Erika K Salter
In this commentary, the author discusses two strengths and two weaknesses of "Better than Best (Interest Standard) in Pediatric Decision-Making," in which Lainie Friedman Ross critiques the best interest standard and proposes her own model of constrained parental autonomy (CPA) as a preferable replacement for both an intervention principle and a guidance principle in pediatric decision making. The CPA's strengths are that it detaches from the language and concept of "best" and that it better respects the family as a distinct and intimate decision-making unit...
2019: Journal of Clinical Ethics
Douglas S Diekema
Thirty years ago, Buchanan and Brock distinguished between guidance principles and interference principles in the setting of surrogate decision making on behalf of children and incompetent adult patients. They suggested that the best interest standard could serve as a guidance principle, but was insufficient as an interference principle. In this issue of The Journal of Clinical Ethics, Ross argues that the best interest standard can serve as neither a guidance or interference principle for decision making on behalf of children, but that her model of constrained parental autonomy can serve as both...
2019: Journal of Clinical Ethics
Mark Christopher Navin, Jason Adam Wasserman
Two core questions in pediatric ethics concern when and how physicians are ethically permitted to intervene in parental treatment decisions (intervention principles), and the goals or values that should direct physicians' and parents' decisions about the care of children (guidance principles). Lainie Friedman Ross argues in this issue of The Journal of Clinical Ethics that constrained parental autonomy (CPA) simultaneously answers both questions: physicians should intervene when parental treatment preferences fail to protect a child's basic needs or primary goods, and both physicians and parents should be guided by a commitment to protect a child's basic needs and primary goods...
2019: Journal of Clinical Ethics
D Micah Hester
Ross's argument against the best interest standard (BIS) makes a clear case for the problems of the BIS, and she also notes challenges with such notions as the harm principle. In light of these critiques, Ross champions her longstanding pediatric moral norm for decision making, constrained parental autonomy (CPA). 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...
2019: Journal of Clinical Ethics
Lainie Friedman Ross
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...
2019: Journal of Clinical Ethics
Edmund G Howe
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...
2019: Journal of Clinical Ethics
Alan R Tait
Informed consent is central to the bioethical principle of respect for persons, a process that involves a discussion between the physician and patient with disclosure of information sufficient to allow the patient to make an informed decision about her or his care. However, despite the importance of informed consent in clinical practice, the process is often ritualized, perfunctory, and performed by individuals with little or no training in the consent process. This article discusses the lack of medical students' and residents' training in informed consent and questions the practice of allowing untrained residents and surrogates to obtain consent from patients...
2019: Journal of Clinical Ethics
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