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Journal of Clinical Ethics

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https://www.readbyqxmd.com/read/28436933/legal-briefing-new-penalties-for-ignoring-advance-directives-and-do-not-resuscitate-orders
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/28436923/fourteen-important-concepts-regarding-moral-distress
#11
Edmund G Howe
I suggest that we may want to strive, over time, to change our present professional-cultural view, from one that sees an expression of moral distress as a threat, to a professional-cultural view that welcomes these challenges. Such an effort to better medicine would not only include dissenting clinicians, but patients (and their loved ones) as well.
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28001142/perspective-medical-futility-a-contemporary-review
#12
Ellen Coonan
As medical technology has advanced, the question of medical futility has become a topic of intense debate both within the medical community and within society as a whole. However, a unanimous definition thereof is yet to be decided-some commentators are sceptical as to whether an agreement will ever be reached-and this continues to lead to difficulties, tension, and even legal action when a treating physician disagrees with a patient and/or a patient's family regarding care and treatment options. Although living in a pluralistic society presents one of the major reasons as to why, despite 30 years of intense discussion, no consensus has been made; the issue of medical futility will always be complex as it is, by nature, multifaceted, and numerous elements-including possible risks, evidence of the probability of benefit, the wishes of the patient (and family), professional standards, and cost-interact...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28001141/cases-from-the-cleveland-clinic-foundation-what-s-knowledge-got-to-do-with-it-ethics-epistemology-and-intractable-conflicts-in-the-medical-setting
#13
Bryan Kibbe, Paul J Ford
This article utilizes the case of Ms H. to examine the contrasting ways that surrogate decision makers move from simply hearing information about the patient to actually knowing and understanding the patient's medical condition. The focus of the case is on a family's request to actually see the patient's wounds instead of being told about the wounds, and the role of clinical ethicists in facilitating this request. We argue that clinical ethicists have an important role to play in the work of converting information into knowledge and that this can serve as a valuable way forward in the midst of seemingly intractable conflicts in the medical setting...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28001140/cultivating-administrative-support-for-a-clinical-ethics-consultation-service
#14
Courtney R Bruce, Mary A Majumder, Ashley Stephens, Janet Malek, Amy McGuire
Hospital administrators may lack familiarity with what clinical ethicists do (and do not do), and many clinical ethicists report receiving inadequate financial support for their clinical ethics consultation services (CECSs). Ethics consultation is distinct in that it is not reimbursable by third parties, and its financial benefit to the hospital may not be quantifiable. These peculiarities make it difficult for clinical ethicists to resort to tried-and-true outcome-centered evaluative strategies, like cost reduction or shortened length of stay for patients, to show a "need" for ethics consultation...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28001139/the-evolution-of-american-hospital-ethics-committees-a-systematic-review
#15
Andrew Courtwright, Martha Jurchak
During the 1970s and 1980s, legal precedent, governmental recommendations, and professional society guidelines drove the formation of hospital ethics committees (HECs). The Joint Commission on Accreditation of Health Care Organization's requirements in the early 1990s solidified the role of HECs as the primary mechanism to address ethical issues in patient care. Because external factors drove the rapid growth of HECs on an institution-by-institution basis, however, no initial consensus formed around the structure and function of these committees...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28001138/stakeholders-views-on-barriers-to-research-on-controversial-controlled-substances
#16
Evelyn Rhodes, Michael Andreae, Tyler Bourgiose, Debbie Indyk, Rosamond Rhodes, Henry Sacks
Many diseases and disease symptoms still lack effective treatment. At the same time, certain controversial Schedule I drugs, such as heroin and cannabis, have been reputed to have considerable therapeutic potential for addressing significant medical problems. Yet, there is a paucity of U.S. clinical studies on the therapeutic uses of controlled drugs. For example, people living with HIV/AIDS experience a variety of disease- and medication-related symptoms. Their chronic pain is intense, frequent, and difficult to treat...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28001137/covert-medications-act-of-compassion-or-conspiracy-of-silence
#17
Robert C Macauley
As the population in the United States gets older, more people suffer from dementia, which often causes neuropsychiatric symptoms such as agitation and paranoia. This can lead patients to refuse medications, prompting consideration of covert administration (that is, concealing medication in food or drink). While many condemn this practice as paternalistic, deceptive, and potentially harmful, the end result of assuming the "moral high ground" can be increased suffering for patients and families. This article addresses common criticisms of covert medication and presents a detailed algorithm by which to determine whether the practice is ethically permissible in specific cases...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28001136/covert-administration-of-medication-to-persons-with-dementia-exploring-ethical-dimensions
#18
Jenny M Young, David Unger
The literature, although sparse, reports that covert administration of all types of medications is prevalent in nursing homes. Whether it is ever ethically defensible, however, to administer medications covertly to persons with significant dementia is a complex and contentious question. Some scholars contend that deception is inherently wrong and is never acceptable, while others believe that deception is intrinsic to providing care to persons with dementia. With an aim to begin to reconcile these polarized positions and to objectively study this contentious issue, the authors undertake an ethical analysis of the covert administration of medications by utilizing the principles of respect for autonomy, nonmaleficence, beneficence, and justice...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28001135/a-survey-of-physicians-attitudes-toward-decision-making-authority-for-initiating-and-withdrawing-va-ecmo-results-and-ethical-implications-for-shared-decision-making
#19
Ellen C Meltzer, Natalia S Ivascu, Meredith Stark, Alexander V Orfanos, Cathleen A Acres, Paul J Christos, Thomas Mangione, Joseph J Fins
OBJECTIVE: Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians' attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28001134/new-paradigms-in-medical-ethics
#20
Edmund G Howe
As new technologies develop, new ethical paradigms may be needed. This article considers several examples, such as stopping venoarterial extracorporeal membrane oxygenation (VA-ECMO), treating patients who are in a locked-in-like state who have awareness, purposefully deceiving patients who have dementia, meeting the needs of transgender persons, showing loved ones patients' wounds, and doing research on controlled substances. I suggest that clinicians should identify the practices underlying their value assumptions so they can alter their assumptions when this might improve the care they offer to their patients...
2016: Journal of Clinical Ethics
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