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Journal of Clinical Ethics

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https://www.readbyqxmd.com/read/30130038/the-work-of-asbh-s-clinical-ethics-consultation-affairs-committee-development-processes-behind-our-educational-materials
#1
Courtenay R Bruce, Jane Jankowski, Barbara L Chanko, Anne Cordes, Barrie J Huberman, Liza-Marie Johnson, Deborah L Kasman, Aviva Katz, Ellen M Robinson, Katherine Wasson, George E Hardart
The authors of this article are previous or current members of the Clinical Ethics Consultation Affairs (CECA) Committee, a standing committee of the American Society for Bioethics and Humanities (ASBH). The committee is composed of seasoned healthcare ethics consultants (HCECs), and it is charged with developing and disseminating education materials for HCECs and ethics committees. The purpose of this article is to describe the educational research and development processes behind our teaching materials, which culminated in a case studies book called A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care (hereafter, the Study Guide)...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30129744/medically-complex-children-in-foster-care-do-research-protections-make-this-vulnerable-population-more-vulnerable
#2
Rebecca R Seltzer, Megan Kasimatis Singleton, Erin P Williams, Renee D Boss
Children in foster care are considered a “vulnerable population” in clinical care and research, with good reason. These children face multiple medical, psychological, and social risks that obligate the child welfare and healthcare systems to protect them from further harms. An unintended consequence of the “vulnerable population” designation for children in foster care is that it may impose barriers on tracking and studying their health that creates gaps in knowledge that are key to their receipt of medical care and good outcomes...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30129740/medical-decision-making-for-medically-complex-children-in-foster-care-who-knows-the-child%C3%A2-s-best-interests
#3
Rebecca R Seltzer, Rachel A B Dodge, Renee D Boss
Aproximately one in 10 children in foster care are medically complex and require intensive medical supervision, frequent hospitalization, and difficult medical decision making. Some of these children are in foster care because their parents cannot care for their medical needs; other parents are responsible for their child’s medical needs due to abuse or neglect. In either case, there can be uncertainty about the role that a child’s biological parents should play in making serious medical decisions. Here we highlight some of the ethical challenges inherent in making these decisions for children in foster care, as seen through the lenses of a child welfare provider, an inpatient care physician, and a primary care pediatrician...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30129737/medical-futility-in-concept-culture-and-practice
#4
Grattan T Brown
This article elucidates the premises and limited meaning of medical futility in order to formulate an ethically meaningful definition of the term, that is, a medical intervention’s inability to deliver the benefit for which it is designed. It uses this definition to show the two ways an intervention could become medically futile, to recommend an even more limited usage of medical futility, and to explain why an intervention need not be futile in order to be withdrawn over patient-based objections. If an intervention retains some benefit, then patients or surrogates might legitimately consider that benefit in their case and request the intervention...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/30129735/ttapp-together-take-a-pause-and-ponder-a-critical-thinking-tool-for-exploring-the-public-private-lives-of-patients
#5
Leslie Kuhnel
The broad use of social networking and user-generated content has increased the online footprint of many individuals. A generation of healthcare professionals have grown up with online search activities as part of their everyday lives. Sites like Facebook, Twitter, and Instagram have given the public new ways to share intimate details about their public and private lives and the lives of their friends and families. As a result, careproviders have the ability to find out more about their patients with just the tap of a key or the click of a mouse...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29916834/letter-can-islamic-jurisprudence-justify-procurement-of-transplantable-vital-organs-in-brain-death
#6
COMMENT
Mohamed Y Rady
In their article, "An International Legal Review of the Relationship between Brain Death and Organ Transplantation," in The Journal of Clinical Ethics 29, no. 1, Aramesh, Arima, Gardiner, and Shah reported on diverse international legislative approaches for justifying procurement of transplantable vital organs in brain death. They stated, "In Islamic traditions in particular, the notion of unstable life is a way to justify organ donation from brain-dead patients that we believe has not been fully described previously in the literature...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29916833/the-development-and-rationale-for-ceca-s-case-based-study-guide
#7
George J Agich
This article discusses the approach of the Clinical Ethics Consultation Advisory Committee (CECA) in developing A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care. This article addresses the processes used by the CECA, its use of pivot questions intended to encourage critical reflection, and the target audience of this work. It first considers the salience of case studies in general education and their relevance for training ethics consultants. Second, it discusses the enfolding approach used in presenting the case material designed to engage the trainee in the details of the case while stimulating critical reflection...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29916832/the-work-of-asbh-s-clinical-ethics-consultation-affairs-committee-development-processes-behind-our-educational-materials
#8
Coutenay R Bruce, Jane Jankowski, Barbara L Chanko, Anne Cordes, Barrie J Humberman, Liza-Marie Johnson, Deborah L Kasman, Aviva Katz, Ellen M Robinson, Katherine Wasson, George E Hardart
The authors of this article are previous or current members of the Clinical Ethics Consultation Affairs (CECA) Committee, a standing committee of the American Society for Bioethics and Humanities (ASBH). The committee is composed of seasoned healthcare ethics consultants (HCECs), and it is charged with developing and disseminating education materials for HCECs and ethics committees. The purpose of this article is to describe the educational research and development processes behind our teaching materials, which culminated in a case studies book called A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care (hereafter, the Study Guide)...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29916831/medically-complex-children-in-foster-care-do-research-protections-make-this-vulnerable-population-more-vulnerable
#9
Rebecca R Seltzer, Megan Kasimatis Singleton, Erin P Williams, Renee D Boss
Children in foster care are considered a "vulnerable population" in clinical care and research, with good reason. These children face multiple medical, psychological, and social risks that obligate the child welfare and healthcare systems to protect them from further harms. An unintended consequence of the "vulnerable population" designation for children in foster care is that it may impose barriers on tracking and studying their health that creates gaps in knowledge that are key to their receipt of medical care and good outcomes...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29916830/medical-decision-making-for-medically-complex-children-in-foster-care-who-knows-the-child-s-best-interests
#10
Rebecca R Seltzer, Rachel A B Dodge, Renee D Boss
Approximately one in 10 children in foster care are medically complex and require intensive medical supervision, frequent hospitalization, and difficult medical decision making. Some of these children are in foster care because their parents cannot care for their medical needs; other parents are responsible for their child's medical needs due to abuse or neglect. In either case, there can be uncertainty about the role that a child's biological parents should play in making serious medical decisions. Here we highlight some of the ethical challenges inherent in making these decisions for children in foster care, as seen through the lenses of a child welfare provider, an inpatient care physician, and a primary care pediatrician...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29916829/action-guide-for-addressing-ethical-challenges-of-resource-allocation-within-community-based-healthcare-organizations
#11
Krista L Harrison, Holly A Taylor, Maria W Merritt
This article proposes an action guide to making decisions regarding the ethical allocation of resources that affect access to healthcare services offered by community-based healthcare organizations. Using the filter of empirical data from a study of decision making in two community-based healthcare organizations, we identify potentially relevant conceptual guidance from a review of frameworks and action guides in the public health, health policy, and organizational ethics literature. We describe the development of this action guide...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29916828/medical-futility-in-concept-culture-and-practice
#12
Grattan T Brown
This article elucidates the premises and limited meaning of medical futility in order to formulate an ethically meaningful definition of the term, that is, a medical intervention's inability to deliver the benefit for which it is designed. It uses this definition to show the two ways an intervention could become medically futile, to recommend an even more limited usage of medical futility, and to explain why an intervention need not be futile in order to be withdrawn over patient-based objections. If an intervention retains some benefit, then patients or surrogates might legitimately consider that benefit in their case and request the intervention...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29916827/ttapp-together-take-a-pause-and-ponder-a-critical-thinking-tool-for-exploring-the-public-private-lives-of-patients
#13
Leslie Kuhnel
The broad use of social networking and user-generated content has increased the online footprint of many individuals. A generation of healthcare professionals have grown up with online search activities as part of their everyday lives. Sites like Facebook, Twitter, and Instagram have given the public new ways to share intimate details about their public and private lives and the lives of their friends and families. As a result, careproviders have the ability to find out more about their patients with just the tap of a key or the click of a mouse...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29916826/response-to-psychiatric-diagnoses-and-informed-consent
#14
COMMENT
David Brendel
A patient's rights to informed consent and self-determination in psychiatric treatment are well enshrined, but the same rights have not yet been meaningfully extended to patients with regard to psychiatric diagnosis. Andrew Clark's essay entitled "Psychiatric Diagnoses and Informed Consent" in The Journal of Clinical Ethics empowers both psychiatrists and patients to rethink who "owns" the process of clinical assessment and of bestowing diagnostic labels that may have far-reaching consequences...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29916825/psychiatric-diagnoses-and-informed-consent
#15
Andrew Clark
Although informed consent for treatment has become a cornerstone principle of psychiatric care, the process of diagnosis has remained largely in the hands of the physician alone. While the conferring of a psychiatric diagnosis has historically not been considered a form of medical intervention, the potential impact of a diagnosis for any particular patient may be substantial. This article explores the challenges involved in balancing respect for patients with the physician's duty of truth-telling and clinical accuracy...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29916824/edge-of-the-field-ethics-consulting-what-are-we-missing
#16
COMMENT
Edmund G Howe
Ethics consultants' grasp of ethical principles is ever improving. Yet, what still remains and will remain lacking is their ability to access factors that lie outside their conscious awareness and thus still effect suboptimal outcomes. This article will explore several ways in which these poor outcomes may occur. This discussion will include clinicians' implicit biases, well-intentioned but nonetheless intrusive violations of patients' privacy, and clinicians' unwittingly connoting to patients and families that clinicians regard their moral values and conclusions as superior...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29726942/colorado-s-new-proxy-law-allowing-physicians-to-serve-as-proxies-moving-from-statute-to-guidelines
#17
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
#18
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
#19
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
#20
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
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