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Journal of Clinical Ethics

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https://www.readbyqxmd.com/read/30226826/scribes-electronic-health-records-and-the-expectation-of-confidentiality
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
https://www.readbyqxmd.com/read/30130038/the-work-of-asbh-s-clinical-ethics-consultation-affairs-committee-development-processes-behind-our-educational-materials
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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