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Journal of Clinical Ethics

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https://www.readbyqxmd.com/read/28614080/legal-briefing-unwanted-cesareans-and-obstetric-violence
#1
Thaddeus Mason Pope
A capacitated pregnant woman has a nearly unqualified right to refuse a cesarean section. Her right to say "no" takes precedence over clinicians' preferences and even over clinicians' concerns about fetal health. Leading medical societies, human rights organizations, and appellate courts have all endorsed this principle. Nevertheless, clinicians continue to limit reproductive liberty by forcing and coercing women to have unwanted cesareans. This "Legal Briefing" reviews recent court cases involving this type of obstetric violence...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28614079/do-not-resuscitate-with-no-surrogate-and-no-advance-directive-an-ethics-case-study
#2
Jamie Diamond, Umesh Gidwani, Rosamond Rhodes
Do-not-resuscitate (DNR) orders are typically signed by physicians in conjunction with patients or their surrogate decision makers in order to instruct healthcare providers not to perform cardiopulmonary resuscitation (CPR). Both the medical literature and CPR guidelines fail to address when it is appropriate for physicians to sign DNR orders without any knowledge of a patient's wishes. We explore the ethical issues surrounding instituting a two-physician DNR for a dying patient with multiple comorbidities and no medical record on file, no advance directives, and no surrogate decision maker...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28614078/-development-of-a-clinical-ethics-committee-de-novo-at-a-small-community-hospital-by-addressing-needs-and-potential-barriers
#3
Bonnie H Arzuaga
Hospital ethics committees are common, but not universal, in small hospitals. A needs assessment was completed at a 155-bed community hospital in order to adapt an academic tertiary center model for a clinical ethics committee to fit the needs of the small hospital community. Of 678 questionnaires distributed, 209 were completed. Data suggested that clinical staff frequently experienced ethical dilemmas. Significantly more nonphysicians indicated that they would utilize a consultation service, if available, compared to physicians (p = 0...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28614077/structure-operation-and-experience-of-clinical-ethics-consultation-2007-2013-a-report-from-the-massachusetts-general-hospital-optimum-care-committee
#4
Ellen M Robinson, Wendy Cage, Kimberly Erler, Sharon Brackett, Julia Bandini, Alexandra Cist, M Cornelia Cremens, Eric L Krakauer, Andrew Courtwright
We describe the structure, operation, and experience of the Massachusetts General Hospital ethics committee, formally called the Edwin H. Cassem Optimum Care Committee, from January 2007 through December 2013. Founded in 1974 as one of the nation's first hospital ethics committees, this committee has primarily focused on the optimum use of life-sustaining treatments. We outline specific sociodemographic and clinical characteristics of consult patients during this period, demographic differences between the adult inpatient population and patients for whom the ethics committee was consulted, and salient features of the consults themselves...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28614076/knowing-about-others-on-the-role-of-relational-knowing-in-advance-care-planning
#5
Jamie Lindemann Nelson
Kate Robins-Browne and her colleagues have written a conceptually daring, empirically grounded article that is rich in scholarship and just conceivably might have a salutary effect on the theory and practice of advance care planning. It is, alas, just as easy to believe that its appreciation will be restricted to like-minded theorists. Writing from a posture of great admiration for this article's agenda and achievements, I will consider why non-relationally-based understanding of deciding for others are so enduring, and what might be done about that...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28614075/the-role-of-relational-knowing-in-advance-care-planning
#6
Kate Robins-Browne, Kelsey Hegarty, Marilys Guillmen, Paul Komesaroff, Victoria Palmer
Medical decision making when a patient cannot participate is complicated by the question of whose voice should be heard. The most common answer to this question is that "autonomy" is paramount, and therefore it is the voice of the unwell person that should be given priority. Advance care planning processes and practices seek to capture this sentiment and to allow treatment preferences to be documented and decision makers to be nominated. Despite good intentions, advance care planning is often deficient because it is unable to facilitate a relational approach to decision making in cases when the patient's competence is reduced...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28614074/a-patient-not-alone
#7
Lauren Sydney Flicker
This case analysis examines questions that arise when an ethically appropriate recommendation initially appears to be in conflict with the legally appropriate recommendation. The case involves a dying, incapacitated octogenarian who had friends who were willing to share her values, but not to make decisions on her behalf. These circumstances put the patient in the unique position of being legally considered a "patient alone," but who was ethically like a patient with surrogates-distinctions that are crucial when making end-of-life decisions under the New York Family Health Care Decisions Act...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28614073/how-do-healthcare-providers-feel-about-family-presence-during-cardiopulmonary-resuscitation
#8
Alicia Pérez Blanco
The presence of patients' families during cardiopulmonary resuscitation (CPR) is a controversial topic, due to its repercussions for clinical practice. While family members' presence may help them to overcome their grief, it could be detrimental, as it may case posttraumatic stress disorder (PTSD), and there is the possibility that family members may interfere with the procedure. For these reasons, families' presence during CPR has rejected by some healthcare providers. To research concerns about families' presence among providers dealing with CPR in the Fundación Hospital Alcorcón (Madrid), I performed this study...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28614072/controversies-in-cardiopulmonary-death
#9
Michael G Fara, Breehan Chancellor, Aaron S Lord, Ariane Lewis
We describe two unusual cases of cardiopulmonary death in mechanically ventilated patients in the neurological intensive care unit. After cardiac arrest, both patients were pulseless for a protracted period. Upon extubation, both developed agonal movements (gasping respiration) resembling life. We discuss these cases and the literature on the ethical and medical controversies associated with determining time of cardiopulmonary death. We conclude that there is rarely a single moment when all of a patient's physiological functions stop working at once...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28614071/going-from-what-is-to-what-should-be-to-care-better-for-our-patients-and-families
#10
Edmund G Howe
This piece discusses ways in which clinicians may go beyond their usual practices. These include exploring the limits of old laws, consulting with colleagues and ethics committees earlier and more often, and giving patients' family members new choices they didn't have previously. This could include asking patients and family members whether clinicians should prioritize staying in the single, unconflicted role of serving patients and families, even when this might preclude simultaneously serving another interest, for example, that of a hospital...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28436933/legal-briefing-new-penalties-for-ignoring-advance-directives-and-do-not-resuscitate-orders
#11
Thaddeus Mason Pope
No abstract text is available yet for this article.
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28436932/complexities-in-caregiving-comforts-cultures-countries-conversations-and-contracts
#12
Shenbagam Dewar, Rajan Dewar
As depicted in the case of Mrs. Indira, decision making by patients and surrogates may be complicated by multiple factors, including care, comfort, country, and culture.
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28436931/family-loyalty-as-a-cultural-obstacle-to-good-care-the-case-of-mrs-indira
#13
Shahla Siddiqui
What is the responsibility of the physician when a capacitated patient assigns decision-making authority to a surrogate who does not act in the patient's best interest?
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28436930/a-framework-for-ethical-decision-making-in-the-rehabilitation-of-patients-with-anosognosia
#14
Anna Rita Egbert
Currently, the number of patients diagnosed with impaired self-awareness of their own deficits after brain injury-anosognosia-is increasing. One reason is a growing understanding of this multifaceted phenomenon. Another is the development and accessibility of alternative measurements that allow more detailed diagnoses. Anosognosia can adversely affect successful rehabilitation, as often patients lack confidence in the need for treatment. Planning such treatment can become a complex process full of ethical dilemmas...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28436929/when-not-to-rescue-an-ethical-analysis-of-best-practices-for-cardiopulmonary-resuscitation-and-emergency-cardiac-care
#15
Nancy S Jecker, Arthur R Derse
It is now a default obligation to provide cardiopulmonary resuscitation (CPR), in the absence of knowledge of a patient's or surrogate's wishes to the contrary. We submit that it is time to re-evaluate this position. Attempting CPR should be subject to the same scrutiny demanded of other medical interventions that involve balancing a great benefit against grievous harms.
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28436928/moral-distress-conscious-and-unconscious-feelings
#16
William J Winslade
In analyzing moral distress, perhaps greater attention should be given to the possible implicit sources of feelings of distress, as well as explicit sources.
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28436927/looking-at-the-positive-side-of-moral-distress-why-it-s-a-problem
#17
Elizabeth G Epstein, Ashley R Hurst
Moral distress, is, at its core, an organizational problem. It is experienced on a personal level, but its causes originate within the system itself. In this commentary, we argue that moral distress is not inherently good, that effective interventions must address the external sources of moral distress, and that while there is a place for resilience in the healthcare professions, it cannot be an effective antidote to moral distress.
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28436926/using-moral-distress-for-organizational-improvement
#18
James E Sabin
Moral distress is a major problem for nurses, other clinicians, and the health system itself. But if properly understood and responded to, it is also a promising guide for healthcare improvement. When individuals experience moral distress or burnout, their reports must be seen as crucial data requiring careful attention to the individuals and to the organization. Distress and burnout will often point to important opportunities for system improvements, which may in turn reduce the experience of distress. For this potential virtuous cycle to happen, individuals must be able to articulate their concerns without fear of retribution, and organizational leaders must be able to listen in an undefensive, improvement-oriented manner...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28436925/focus-more-on-causes-and-less-on-symptoms-of-moral-distress
#19
Tessy A Thomas, Laurence B McCullough
In this commentary on Carse and Rushton's call for reorientation of moral distress, we state agreement with the authors that the discourse of moral distress should refocus on the moral components of integrity. We then explain how our philosophical taxonomy of moral distress, mentioned by the authors, appeals to moral integrity. In this process, we clarify our taxonomy's appeal to Aristotle's concept of akrasia. We conclude by offering support of Carse and Rushton's challenge to organizations to strengthen moral integrity by fostering resilience...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28436924/harnessing-the-promise-of-moral-distress-a-call-for-re-orientation
#20
Alisa Carse, Cynda Hylton Rushton
Despite over three decades of research into the sources and costs of what has become an "epidemic" of moral distress among healthcare professionals, spanning many clinical disciplines and roles, there has been little significant progress in effectively addressing moral distress. We believe the persistent sense of frustration, helplessness, and despair still dominating the clinical moral distress narrative signals a need for re-orientation in the way moral distress is understood and worked with. Most fundamentally, moral distress reveals moral investment and energy...
2017: Journal of Clinical Ethics
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