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Hastings Center Report

Kirstin Borgerson
The volume of clinical research is increasing exponentially-far beyond our ability to process and absorb the results. Given this situation, it may be beneficial to consider reducing the flow at its source. In what follows, I will motivate and critically evaluate the following proposal: researchers should conduct fewer clinical trials. More specifically, I consider whether researchers should be permitted to conduct only clinical research of very high quality and, in turn, whether research ethics committees (RECs) should prohibit all other, lower-quality research, even when it might appear to meet some minimal ethical standard...
October 6, 2016: Hastings Center Report
Marsha D Fowler
Modern American nursing arose during the Civil War and subsequently adopted the Nightingale educational model in the 1870s. By 1889, the journal Trained Nurse and Hospital Review had been established. It published a six-part series on ethics in nursing. With the establishment of the American Nurses Association in 1893, the articles of incorporation gave the organization its first charge: "to establish and maintain a code of ethics." While the rich and enduring tradition of nursing's ethics has been concerned about individual patients and their relational nexus, nursing ethics has from the beginning been a social ethics, intimately concerned both for the shape of society and for social change...
September 2016: Hastings Center Report
Christine Grady
Nursing and bioethics have a lot in common because they share concerns about life and death, illness and health, the rights of individuals and communities, ethical patient care, health care delivery, and public health. Nurses and bioethicists contribute to ethical practice, ethics scholarship, and health policy-making in a variety of ways. Some nurses have bioethics education or experience, some bioethicists study or collaborate closely with nurses, and some of us proudly identify as both bioethicists and as nurses...
September 2016: Hastings Center Report
Diana J Mason
The Hill Burton Act, which was signed into law in 1946 and ended in 1997, was one of the most significant forces that shaped the health care system we have today. Providing grants and loans for the construction and expansion of hospitals across the country, it required beneficiary hospitals to give some amount of uncompensated care to the poor and uninsured in return. The act not only led to our health care system's current emphasis on the acute-care hospital as the primary site of health care delivery, but it also had a profound effect on nursing, fully involving the profession in an acute-care world...
September 2016: Hastings Center Report
Sarah E Shannon
An important role for all health care professionals is to be an advocate for their patients, and there is no question that many patients need advocacy to reach their health care goals. The role of advocate takes many forms, but one is to speak up when one is concerned for the safety or well-being of a patient. A nurse is often the member of a health care team most likely to notice changes that might signal problems or poor responses to treatment. The duty of the nurse is to speak up in a timely and urgent manner when the nurse believes-or fears-that the patient's safety may be at risk...
September 2016: Hastings Center Report
Mary Naylor, Nancy Berlinger
Numerous studies have revealed that health care transitions for chronically ill older adults are frequently poorly managed, often with devastating human and economic consequences. And poorly managed transitions and their consequences also occur among younger, relatively healthy individuals who have adequate resources and are prepared to advocate on their own behalf. Despite the rich base of research confirming that evidence-based transitional care enhances patients' experiences, improves health and quality of life, and reduces costs, organizational, regulatory, financial, and cultural barriers have, until recently, prevented widespread adoption of these proven approaches...
September 2016: Hastings Center Report
Lisa Wolf, Connie M Ulrich, Christine Grady
Excellent patient care within the emergency department requires interdisciplinary training, teamwork, and communication to manage the chaos of the environment. Specifically, invasive procedures required to manage airway, breathing, and circulation via intubation, chest compressions, and establishing intravenous access can provide a direct benefit to save lives but also have the potential to harm both patients and health care clinicians alike; emergency health care clinicians can be exposed to significant amounts of blood and body fluids as well as other threats of physical and psychological harm...
September 2016: Hastings Center Report
Clareen Wiencek, Ramón Lavandero, Nancy Berlinger
Health care work is interprofessional work. Nurses and physicians, members of the professions whose close collaboration is foundational to health care delivery, continue to be educated separately in most academic institutions. Their work also is organized in ways that challenge interprofessional collaboration. Understanding workplace realities faced by nurses and physicians, separately and jointly, is a starting place for exploring how to support ethically sound interprofessional work. In this essay, we look most closely at the work of nurses and physicians who care for seriously ill hospitalized patients, a patient population closely associated with ethical challenges...
September 2016: Hastings Center Report
Cynda Hylton Rushton
Undisputedly, the United States' health care system is in the midst of unprecedented complexity and transformation. In 2014 alone there were well over thirty-five million admissions to hospitals in the nation, indicating that there was an extraordinary number of very sick and frail people requiring highly skilled clinicians to manage and coordinate their complex care across multiple care settings. Medical advances give us the ability to send patients home more efficiently than ever before and simultaneously create ethical questions about the balance of benefits and burdens associated with these advances...
September 2016: Hastings Center Report
Ann B Hamric, Lucia D Wocial
Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective ethics resources are requisite for quality care for another reason...
September 2016: Hastings Center Report
Connie M Ulrich
Few bioethicists are educated with a view into nursing. Thus, much of the conceptual and empirical research on ethical issues in nursing practice has been conducted by nurse ethicists themselves and, to a lesser degree, by individuals with a strong interest in nursing ethics. Although this work has internally shaped nursing practice, education, and policy, the broader field of bioethics has seldom examined and acknowledged the everyday ethical concerns of practicing nurses and their important contributions to bioethics discourse...
September 2016: Hastings Center Report
Joan Liaschenko, Elizabeth Peter
It may be the case that the most challenging moral problem of the twenty-first century will be the relationship between the individual moral agent and the practices and institutions in which the moral agent is embedded. In this paper, we continue the efforts that one of us, Joan Liaschenko, first called for in 1993, that of using feminist ethics as a lens for viewing the relationship between individual nurses as moral agents and the highly complex institutions in which they do the work of nursing. Feminist ethics, with its emphasis on the inextricable relationship between ethics and politics, provides a useful lens to understand the work of nurses in context...
September 2016: Hastings Center Report
Pam Grace, Aimee Milliken
Because health care professions exist to provide a good for society, ethical questions are inherently part of them. Such professions and their members can be assessed based on how effective they are in developing knowledge and enacting practices that further the health and well-being of individuals and society. The complexity of contemporary health care environments makes it important to prepare clinicians who can anticipate, recognize, and address problems that arise in practice or that prevent a profession from fulfilling its service goals and obligations...
September 2016: Hastings Center Report
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September 2016: Hastings Center Report
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No abstract text is available yet for this article.
September 2016: Hastings Center Report
Karen J Maschke
Over the past year media outlets and scientific and bioethics journals have reported about several medical and scientific innovations touted as having the potential to fundamentally change not only how diseases and disorders are diagnosed and treated but even how to alter the genomes of future generations. The purported "miracle" blood-testing technology of Theranos and the potential use of the genome editing technology CRISPR-Cas9 to modify human and nonhuman organisms reflect dramatic advances in scientific understanding about the biological mechanisms of humans and other living organisms...
September 2016: Hastings Center Report
Ilina Singh
Eighteen months ago, I left a permanent professorship in a generously interdisciplinary department of sociology and took an impermanent, lower-paying job at a university where I had to apply to something called the "Committee on Distinction" to retain the title of "Professor." Some people say, "That's what happens when Oxford calls." But it wasn't just that. It was the opportunity to engage in a groundbreaking experiment: to embed and integrate ethics within the Oxford Department of Psychiatry and Neuroscience...
September 2016: Hastings Center Report
(no author information available yet)
No abstract text is available yet for this article.
September 2016: Hastings Center Report
Jonathan Ives
In "A Conceptual Model for the Translation of Bioethics Research and Scholarship," Debra Mathews et al. aim to "begin an important discussion" about how to measure success in bioethics, and in doing so they set out a typology of bioethics research and scholarship with the arguably correct assumption that we cannot evaluate success in bioethics without first understanding what its goals are. I think the authors are correct in their claim that, in the current academic climate, having work in bioethics deemed a success is likely to hinge, in some way, on its being translated into practice and having impact...
September 2016: Hastings Center Report
Mildred Z Solomon
What is bioethics to do when it strives to assess the quality of its research and scholarship and when it needs to justify its work to prospective funders, especially a funder like the National Institutes of Health that privileges empirical discovery? In "A Conceptual Model for the Translation of Bioethics Research and Scholarship," Debra Mathews and colleagues take an important first step at advancing an answer. The authors describe what they call a translational process, whereby bioethics "outputs" are translated into changes of three types: in thinking, practice, and policy...
September 2016: Hastings Center Report
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