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Journal of Clinical Ethics

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https://www.readbyqxmd.com/read/29726942/colorado-s-new-proxy-law-allowing-physicians-to-serve-as-proxies-moving-from-statute-to-guidelines
#1
Jacqueline J Glover, Deb Bennett-Woods, Jean Abbott
In 2016, the Colorado legislature passed an amendment to Colorado's medical proxy law that established a process for the appointment of a physician to act as proxy decision maker of last resort for an unrepresented patient (Colorado HB 16-1101: Medical Decisions For Unrepresented Patients). The legislative process brought together a diverse set of stakeholders, not all of whom supported the legislation. Following passage of the statutory amendment, the Colorado Collaborative for Unrepresented Patients (CCUP), a group of advocates responsible for initiating the legislative process, coordinated a unique effort to engage these stakeholders in the creation of a set of voluntary guidelines to assist facilities and individual careproviders in the implementation of policies and procedures enabled by the statute...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29726671/the-ethics-of-bundled-payments-in-total-joint-replacement-cherry-picking-and-lemon-dropping
#2
Casey Jo Humbyrd
The Centers for Medicare & Medicaid Services has initiated bundled payments for hip and knee total joint replacement in an effort to decrease healthcare costs and increase quality of care. The ethical implications of this program have not been studied. This article considers the ethics of patient selection to improve outcomes; specifically, screening patients by body mass index to determine eligibility for total joint replacement. I argue that this type of screening is not ethically defensible, and that the bundled payment program as structured is likely to lead to unfair restrictions on who receives total joint replacements...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29565799/colorado-s-new-proxy-law-moving-from-statute-to-guidelines
#3
Jacqueline J Glover, Deb Bennett-Woods, Jean Abbott
In 2016, the Colorado legislature passed an amendment to Colorado's medical proxy law that established a process for the appointment of a physician to act as proxy decision maker of last resort for an unrepresented patient (Colorado HB 16-1101: Medical Decisions For Unrepresented Patients). The legislative process brought together a diverse set of stakeholders, not all of whom supported the legislation. Following passage of the statutory amendment, the Colorado Collaborative for Unrepresented Patients (CCUP), a group of advocates responsible for initiating the legislative process, coordinated a unique effort to engage these stakeholders in the creation of a set of voluntary guidelines to assist facilities and individual careproviders in the implementation of policies and procedures enabled by the statute...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29565798/the-ethics-of-bundled-payments-in-total-joint-replacement-cherry-picking-and-lemon-dropping
#4
Casey Jo Humbyrd
The Centers for Medicare and Medicaid Services has initiated bundled payments for hip and knee total joint replacement in an effort to decrease healthcare costs and increase quality of care. The ethical implications of this program have not been studied. This article considers the ethics of patient selection to improve outcomes; specifically, screening patients by body mass index to determine eligibility for total joint replacement. I argue that this type of screening is not ethically defensible, and that the bundled payment program as structured is likely to lead to unfair restrictions on who receives total joint replacements...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29565797/meaningful-use-of-electronic-health-records-for-quality-assessment-and-review-of-clinical-ethics-consultation
#5
Susan Sanelli-Russo, Kelly McBride Folkers, William Sakolsky, Joseph J Fins, Nancy Neveloff Dubler
Evolving practice requires peer review of clinical ethics (CE) consultation for quality assessment and improvement. Many institutions have identified the chart note as the basis for this process, but to our knowledge, electronic health record (EHR) systems are not necessarily designed to easily include CE consultation notes. This article provides a framework for the inclusion of CE consultation notes into the formal EHR, describing a developed system in the Epic EHR that allows for the elaborated electronic notation of the CE chart note...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29565796/the-bedside-capacity-assessment-tool-further-development-of-a-clinical-tool-to-assist-with-a-growing-aging-population-with-increased-healthcare-complexities
#6
Maria Torroella Carney, Brian Emmert, Brian Keefer
BACKGROUND: As the population of the United States ages, chronic diseases increase and treatment options become technologically more complicated. As such, patients' autonomy, or the right of patients to accept or refuse a medical treatment, may become a more pressing and complicated issue. This autonomy rests upon a patient's capacity to make a decision. As more older, cognitively and functionally impaired individuals enter healthcare systems, quality assessments of decision-making capacity must be made...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29565795/an-international-legal-review-of-the-relationship-between-brain-death-and-organ-transplantation
#7
Kiarash Aramesh, Hitoshi Arima, Dale Gardiner, Seema K Shah
The "dead-donor rule" states that, in any case of vital organ donation, the potential donor should be determined to be dead before transplantation occurs. In many countries around the world, neurological criteria can be used to legally determine death (also referred to as brain death). Nevertheless, there is considerable controversy in the bioethics literature over whether brain death is the equivalent of biological death. This international legal review demonstrates that there is considerable variability in how different jurisdictions have evolved to justify the legal status of brain death and its relationship to the dead-donor rule...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29565794/impact-of-cognitive-load-on-family-decision-makers-recall-and-understanding-of-donation-requests-for-the-genotype-tissue-expression-gtex-project
#8
Laura A Siminoff, Maureen Wilson-Genderson, Maghboeba Mosavel, Laura Barker, Jennifer Trgina, Heather M Traino, Howard M Nathan, Richard D Hasz, Gary Walters
Genomic research projects that collect tissues from deceased organ and tissue donors must obtain the authorization of family decision makers under difficult circumstances that may affect the authorization process. Using a quasi-experimental design, the Ethical, Legal, and Social Issues (ELSI) substudy of the Genotype-Tissue Expression (GTEx) project compared the recall and understanding of the donation authorization process of two groups: family members who had authorized donation of tissues to the GTEx project (the comparison group) and family members who had authorized organ and tissue donations in years previous, who subsequently participated in two different mock-authorization processes that mimicked the GTEx authorization process (the intervention groups)...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29565793/-buying-in-and-cashing-out-patients-experience-and-the-refusal-of-life-prolonging-treatment
#9
Nathan Scheiner, Joan Liaschenko
Surgical "buy-in" is an "informal contract between surgeon and patient in which the patient not only consents to the operative procedure but commits to the post-operative surgical care anticipated by the surgeon." Surgeons routinely assume that patients wish to undergo treatment for operative complications so that the overall treatment course is "successful," as in the treatment of a post-operative infection. This article examines occasions when patients buy-in to a treatment course that carries risk of complication, yet refuse treatment when complications arise...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29565792/slowing-down-fast-thinking-to-enhance-understanding
#10
COMMENT
Edmund G Howe
Stress can make the comprehension of complex information more difficult, yet patients and their family members often must receive, process, and make decisions based on new, complex information presented in unfamiliar and stressful clinical environments such the intensive care unit. Family members may be asked to make decisions regarding the donation of organs and genetic tissue soon after the death of a loved one, based on new, complex information, under tight time limits. How can we assist patients and families better process complex information while under stress, and to make better decisions for themselves or for a loved one?...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29257769/the-rise-of-hospitalists-an-opportunity-for-clinical-ethics
#11
Matthew W McCarthy, Diego Real de Asua, Joseph J Fins
Translating ethical theories into clinical practice presents a perennial challenge to educators. While many suggestions have been put forth to bridge the theory-practice gap, none have sufficiently remedied the problem. We believe the ascendance of hospital medicine, as a dominant new force in medical education and patient care, presents a unique opportunity that could redefine the way clinical ethics is taught. The field of hospital medicine in the United States is comprised of more than 50,000 hospitalists-specialists in inpatient medicine-representing the fastest growing subspecialty in the history of medicine, and its members have emerged as a dominant new force around which medical education and patient care pivot...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29257768/moral-distress-ethical-environment-and-the-embedded-ethicist
#12
Donna Massutta
Interest in understanding the experience of moral distress has steadily gained traction in the 30 years since Jameton first described the phenomenon. This curiosity should be of no surprise, since we now have data documenting the incidence across most caregiver roles and healthcare settings, both in the United States and internationally. The data have also amplified healthcare providers' voices who report that the quality of the ethical environment is pivotal to preventing and containing the adverse effects caused by moral distress...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29257767/ongoing-evaluation-of-clinical-ethics-consultations-as-a-form-of-continuous-quality-improvement
#13
Rebecca Volpe
Ongoing evaluation of a clinical ethics consultation service (ECS) allows for continuous quality improvement, a process-based, data-driven approach for improving the quality of a service. Evaluations by stakeholders involved in a consultation can provide real-time feedback about what is working well and what might need to be improved. Although numerous authors have previously presented data from research studies on the effectiveness of clinical ethics consultation, few ECSs routinely send evaluations as an ongoing component of their everyday clinical activities...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29257766/incarcerated-patients-and-equitability-the-ethical-obligation-to-treat-them-differently
#14
Lisa Fuller, Margot M Eves
Prisoners are legally categorized as a vulnerable group for the purposes of medical research, but their vulnerability is not limited to the research context. Prisoner-patients may experience lower standards of care, fewer options for treatment, violations of privacy, and the use of inappropriate surrogates as a result of their status. This case study highlights some of the ways in which a prisoner-patient's vulnerable status impacted the care he received. The article argues the following: (1) Prisoner-patients are entitled to the same quality of care as all other patients, and healthcare providers should be vigilant to ensure that the stigma of incarceration does not influence care decisions...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29257765/make-it-plain-strengthening-the-ethical-foundation-of-first-person-authorization-for-organ-donation
#15
James L Bendict
One response to the chronic shortage of organs for transplant in the United States has been the passage of laws establishing first-person authorization for donation of organs, providing legal grounds for the retrieval of organs and tissues from registered donors, even over the objections of their next of kin. The ethical justification for first-person authorization is that it is a matter of respecting the donor's wishes. The objection of some next of kin may be that the donor would not have wished for his or her loved ones to have their preferences overridden, had they considered that possibility...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29257764/measuring-instrument-for-ethical-sensitivity-in-the-therapeutic-sciences
#16
Alida Naudé, Juan Bornman
There are currently no instruments available to measure ethical sensitivity in the therapeutic sciences. This study therefore aimed to develop and implement a measure of ethical sensitivity that would be applicable to four therapeutic professions, namely audiology, occupational therapy, physiotherapy, and speech-language pathology. The study followed a two-phase, sequential exploratory mixed-methods design. Phase One, the qualitative development phase, employed six stages and focused on developing an instrument based on a systematic review: an analysis of professional ethical codes, focus group discussions, in-depth interviews, a review of public complaints websites, and an expert panel review...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29257763/incapacitated-surrogates-a-new-and-increasing-dilemma-in-hospital-care
#17
Karen L Smith, Patrice Fedel, Jay Heitman
A power of attorney for healthcare (POAHC) form gives designated individuals legal status to make healthcare decisions when patients are unable to convey their decisions to medical staff. Completion of a POAHC form is crucial in the provision of comprehensive healthcare, since it helps to ensure that patients' interests, values, and preferences are represented in decisions about their medical treatment. Because increasing numbers of people suffer from debilitating illness and cognitive deficits, healthcare systems may be called upon to navigate the complexities of patients' care without clear directives from the patients themselves...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29257762/comparativism-and-the-grounds-for-person-centered-care-and-shared-decision-making
#18
Anders Herlitz
This article provides a new argument and a new value-theoretical ground for person-centered care and shared decision making that ascribes to it the role of enabling rational choice in situations involving clinical choice. Rather than referring to good health outcomes and/or ethical grounds such as patient autonomy, it argues that a plausible justification and ground for person-centered care and shared decision making is preservation of rationality in the face of comparative non-determinacy in clinical settings...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29257761/new-ways-to-cut-through-ethical-gordian-knots
#19
COMMENT
Edmund G Howe
Clinicians and ethicists routinely encounter complex ethical dilemmas that seem intractable, which have been described as ethical Gordian knots. How can they best assist patients and surrogate decision makers who are entangled in struggles around the capacity to make life-or-death treatment decisions? In this article I describe unconventional and unorthodox approaches to help slice through these dilemmas.
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28930714/vaccine-exemptions-and-the-church-state-problem
#20
Dena S Davis
All of the 50 states of the United States have laws governing childhood vaccinations; 48 allow for religious exemptions, while 19 also offer exemptions based on some sort of personal philosophy. Recent disease outbreaks have caused these states to reconsider philosophical exemptions. However, we cannot, consistent with the U.S. Constitution, give preference to religion by creating religious exemptions only. The Constitution requires states to put religious and nonreligious claims on equal footing. Given the ubiquity of nonreligious objections to vaccination, I conclude that the best response is to remove all exemptions, as two states have already done...
2017: Journal of Clinical Ethics
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