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Journal of Clinical Ethics

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https://www.readbyqxmd.com/read/30605442/to-give-or-not-to-give-the-challenge-of-pharmaceutical-coupons
#1
Mihail Zilbermint, Louise Schiavone
Diabetes is epidemic and many people cannot afford insulin, a lifesaving medication, as its price has increased by almost 160 percent in the past five years.1 To help subsidize the cost of insulin, one of the staff members at my hospital would like to give patients copayment coupons provided to her by pharmaceutical companies. I advised my colleague to stop distributing these branded coupons, as they promote particular pharmaceutical companies. This practice is not consistent with the policy on interaction with industry established by the Johns Hopkins Health System...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30605441/discomfort-as-a-catalyst-an-ethical-analysis-of-donation-after-cardiac-death-in-a-patient-with-locked-in-syndrome
#2
Bethany Bruno, Margot Eves
Donation after cardiac death (DCD) traditionally occurs in two patient populations: (1) those who do not meet neurological death criteria but who have suffered severe neurological damage, and (2) those who are fully alert and awake but are dependent on machines. This case highlights the unique dilemma when a patient falls between these two populations-conscious and cognitively intact, but completely paralyzed except for limited eye movement, afflicted by what the medical community refers to as locked-in syndrome...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30605440/justice-and-respect-for-autonomy-jehovah-s-witnesses-and-kidney-transplant
#3
Paul J Cummins, Federico Nicoli
That Jehovah's Witnesses may refuse lifesaving blood transfusions is a morally accepted feature of contemporary medical practice. The principle of respect for autonomy supports this, and there is seldom reason to interfere with this choice because it rarely harms another individual. Advances in surgical technique have made it possible for transplant surgeons to perform bloodless organ transplant, enabling Jehovah's Witnesses to benefit from this treatment. When the transplant organ is a directed donation from a family member or friend, no ethical dilemma arises...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30605439/systematic-review-of-typologies-used-to-characterize-clinical-ethics-consultations
#4
Jennifer E deSante-Bertkau, Michelle L McGowan, Armand H Matheny Antommaria
INTRODUCTION: Classifying the ethical issues in clinical ethics consultations is important to clinical practice and scholarship. We conducted a systematic review to characterize the typologies used to analyze clinical ethics consultations. METHODS: We identified empirical studies of clinical ethics consultation that report types of ethical issues using PubMed. We screened these articles based on their titles and abstracts, and then by a review of their full text...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30605438/technical-considerations-for-implementation-of-tele-ethics-consultation-in-the-intensive-care-unit
#5
Laura S Johnson, David M Brenner, Nneka O Sederstrom
BACKGROUND: Robust ethics consultation services cannot be sustained by all hospitals; consultative service from a high-volume center via teleconferencing is an attractive alternative. This pilot study was conceived to explore the feasibility and understand the practical implications of offering such a service. METHODS: High-definition videoconferencing was used to provide real-time interaction between the rounding clinicians and a remote clinical ethicist. Data collection included: (1) evaluation of the hardware and software required for teleconferencing, and (2) comparison of ethics trigger counts between the remote and on-site ethicist during rounds...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30605437/training-to-increase-rater-reliability-when-assessing-the-quality-of-ethics-consultation-records-with-the-ethics-consultation-quality-assessment-tool-ecqat
#6
Robert Allan Pearlman, David Alfandre, Barbara L Chanko, Mary Beth Foglia, Kenneth A Berkowitz
The Ethics Consultation Quality Assessment Tool (ECQAT) establishes standards by which the quality of ethics consultation records (ECRs) can be assessed. These standards relate to the ethics question, consultation-specific information, ethical analysis, and recommendations and/or conclusions, and result in a score associated with one of four levels of ethics consultation quality. For the ECQAT to be useful in assessing and improving the quality of healthcare ethics consultations, individuals who rate the quality of ECRs need to be able to reliably use the tool...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30605436/proxy-consent-by-a-physician-when-a-patient-s-capacity-is-equivocal-respecting-a-patient-s-autonomy-by-overriding-the-patient-s-ostensible-treatment-preferences
#7
Abraham Graber, Carolyn April, Michael D April
Respect for patients' autonomy has taken a central place in the practice of medicine. Received wisdom holds that respect for autonomy allows overriding a patient's treatment preferences only if the patient has been found to lack capacity. This understanding of respect for autonomy requires a dichotomous approach to assessing capacity, whereby a patient must be found either to have full capacity to make some particular treatment decision or must be found to lack capacity to make that decision. However, clinical reality is more complicated, and, in borderline cases, different physicians may arrive at disparate judgments of capacity...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30605435/familial-discordance-regarding-fertility-preservation-for-a-transgender-teen-an-ethical-case-study
#8
Gwendolyn P Quinn, Amani Sampson, Lisa Campo-Englestein
A 16-year-old adolescent who identifies as transgender wishes to consider fertility preservation prior to the use of gender-affirming hormones. The adolescent's parents are divorced, and one parent supports fertility preservation while the other does not. This case explores the minor's future reproductive autonomy and parental decision making in a field where there is limited evidence of known harms and benefits to the use of fertility preservation in the transgender population and about future potential regret from lack of consideration of fertility preservation during the prime window of opportunity...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30605434/helping-patients-to-achieve-what-they-find-most-meaningful-in-life
#9
Edmund G Howe
Patients' and families' greatest need is often to do what for them is most meaningful. This may be, for example, their religion, their family, or their doing good for others. This piece will explore ways in which care providers may help maximize these ends. Paradigms offered will include Jehovah's Witness patients needing kidney transplants, a transgender adolescent wanting his sperm preserved, care providers' deciding whether to disclose that a deceased organ donor had HIV, and care providers seeking to do good for children profoundly impaired and adults who feel shame for just existing...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30226826/scribes-electronic-health-records-and-the-expectation-of-confidentiality
#10
Paul M Wangenheim
Electronic health record (EHRs) have largely replaced obsolete paper medical charts. This replacement has produced an increased demand on physicians' time and has compromised efficiency. In an attempt to overcome this perceived obstacle to productivity, physicians turned to medical scribes to perform the work required by EHRs. In doing so, they have introduced an uninvited participant in the physician-patient relationship and compromised patients' confidentiality. Scribes may be a successful work around for physicians frustrated by EHRs, but patients' confidentiality should not be sacrificed in the process...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30226825/the-mission-of-safety-net-hospitals-charity-or-equity
#11
Thea James
The traditional mission of safety net hospitals has been charity, providing the best healthcare for all individuals no matter their ability to pay. The focus has been on vulnerable populations that are low-income, uninsured, and other upstream circumstances that manifest downstream as poor health, poor health outcomes, and repeated high-cost interventions that fail to break cycles of perpetual health instability. Safety net hospitals are committed to serving their populations, even if only temporarily, through provision of subsidies and filling gaps that exist in patients' lives...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30226824/-i-would-do-it-all-over-again-cherishing-time-and-the-absence-of-regret-in-continuing-a-pregnancy-after-a-life-limiting-diagnosis
#12
Charlotte Wool, Rana Limbo, Erin M Denny-Koelsch
Parents, after learning of a life-limiting fetal condition (LLFC), experience emotional distress and must consider options that impact the remainder of the pregnancy, their future lives, and family members. For those who continue, little is known about their long-term presence or absence of regret about their choice, the reasons for this feeling, or its impact on their life. The aim of this research was to examine the concept of decision regret in parents who opted to continue a pregnancy affected by an LLFC...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30226823/nursing-ethics-huddles-to-decrease-moral-distress-among-nurses-in-the-intensive-care-unit
#13
Marianne C Chiafery, Patrick Hopkins, Sally A Norton, Margie Hodges Shaw
BACKGROUND: Moral distress (MD) is an emotional and psychological response to morally challenging dilemmas. Moral distress is experienced frequently by nurses in the intensive care unit (ICU) and can result in emotional anguish, work dissatisfaction, poor patient outcomes, and high levels of nurse turnover. Opportunities to discuss ethically challenging situations may lessen MD and its associated sequela. OBJECTIVE: The purpose of this project was to develop, implement, and evaluate the impact of nursing ethics huddles on participants' MD, clinical ethics knowledge, work satisfaction, and patient care among ICU nurses...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30226822/refusal-of-vaccination-a-test-to-balance-societal-and-individual-interests
#14
Kavita Shah Arora, Jane Morris, Allan J Jacobs
While all states in the United States require certain vaccinations for school attendance, all but three allow for religious exemptions to receiving such vaccinations, and 18 allow for exemptions on the basis of other deeply held personal beliefs. The rights of parents to raise children as they see fit may conflict with the duty of the government and society to protect the welfare of children. In the U.S., these conflicts have not been settled in a uniform and consistent manner. We apply a test that provides a concrete and formal rubric to evaluate such conflicts...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30226821/plain-anabaptists-and-healthcare-ethics
#15
James Benedict
Plain Anabaptists are a small but rapidly growing ethnoreligious society with significant concentrations of population in a number of regions in North America. Among the most widely known of the various groups of Plain Anabaptists are the Amish and the Old Order Mennonites. It is the purpose of this article to provide insight into the culture and values of the Plain Anabaptists so that those who may be called upon to address ethical conflict involving Plain Anabaptists can do so with appropriate knowledge and sensitivity...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30226820/posthumous-hiv-disclosure-and-relational-rupture
#16
Laura K Guidry-Grimes, D Micah Hester
In response to Anne L. Dalle Ave and David M. Shaw, we agree with their general argument but emphasize a moral risk of HIV disclosure in deceased donation cases: the risk of relational rupture. Because of the importance that close relationships have to our sense of self and our life plans, this kind of rupture can have long-ranging implications for surviving loved ones. Moreover, the now-deceased individual cannot participate in any relational mending. Our analysis reveals the hefty moral costs that disclosure can bring, which should influence what information is given to would-be donors and how organ procurement coordinators approach these conversations...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30226819/positive-hiv-test-results-from-deceased-organ-donors-should-we-disclose-to-next-of-kin
#17
Anne L Dalle Ave, David M Shaw
In the context of deceased organ donation, donors are routinely tested for HIV, to check for suitability for organ donation. This article examines whether a donor's HIV status should be disclosed to the donor's next of kin. On the one hand, confidentiality requires that sensitive information not be disclosed, and a duty to respect confidentiality may persist after death. On the other hand, breaching confidentiality may benefit third parties at risk of having been infected by the organ donor, as it may permit them to be tested for HIV and seek treatment in case of positive results...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30226818/ethical-challenges-in-acute-evaluation-of-suspected-psychogenic-stroke-mimics
#18
Alexandra J Sequeira, Michael G Fara, Ariane Lewis
Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. The ethical principles of beneficence and nonmaleficence need to be weighed carefully in these situations...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30226817/deathbed-confession-when-a-dying-patient-confesses-to-murder-clinical-ethical-and-legal-implications
#19
Laura Tincknell, Anne O'Callaghan, Joanna Manning, Phillipa Malpas
During an initial palliative care assessment, a dying man discloses that he had killed several people whilst a young man. The junior doctor, to whom he revealed his story, consulted with senior palliative care colleagues. It was agreed that legal advice would be sought on the issue of breaching the man's confidentiality. Two legal opinions conflicted with each other. A decision was made by the clinical team not to inform the police. In this article the junior doctor, the palliative medicine specialist, a medical ethicist, and a lawyer consider the case from their various perspectives...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30226816/how-we-may-become-detached-from-our-patients-and-what-we-can-do-if-this-happens
#20
Edmund G Howe
When clinicians provide clinical care or participate in ethics consultations, they may feel exceptionally painful emotions. When they do, they may distance themselves emotionally from patients and families. This distancing may harm these parties profoundly. It is therefore critical that clinicians avoid this distancing. In this piece, I present an approach that lies outside traditional practice that clinicians may use to try to avoid and even reverse this distancing, if and when they sense that this may be occurring...
2018: Journal of Clinical Ethics
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