journal
MENU ▼
Read by QxMD icon Read
search

Journal of Clinical Ethics

journal
https://www.readbyqxmd.com/read/28001142/perspective-medical-futility-a-contemporary-review
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
https://www.readbyqxmd.com/read/27658284/legal-briefing-stopping-nonbeneficial-life-sustaining-treatment-without-consent
#10
Thaddeus Mason Pope, Kristin Kemmerling
In the United States, authoritative legal guidance remains sparse on whether or when clinicians may stop life-sustaining treatment without consent. Fortunately, several significant legislative and judicial developments over the past two years offer some clarity. We group these legal developments into the following seven categories: 1. Lawsuits for Damages 2. Amendments to the Texas Advance Directives Act 3. Constitutional Attack on TADA 4. Legislation Prohibiting Clinicians 5. Legislation Authorizing Clinicians 6...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27658283/thinking-about-conscience
#11
B J Crigger
The path to consensus about physicians' exercise of conscience was not linear. It looped back on itself as new insights illuminated earlier deliberations and in turn led to further insights. In particular, coming to agreement about physicians' responsibility in regard to referral charted a route through many course corrections.
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27658282/conscientious-objection-widening-the-temporal-and-organizational-horizons
#12
Armand H Matheny Antommaria
Conscience can influence physicians' interactions with patients in myriad ways and, by extension, can influence the interactions and internal dynamics of a health care team. The AMA's opinion around physicians' exercise of conscience appropriately balance the obligations physicians have to their patients and profession, and the rights of physicians as moral agents to exercise their conscience. While the opinion is an effective starting point, further guidance is necessary to clarify the process by which physicians should identify, manage, and, if necessary, report their conscientious refusals to patients, supervisors, or colleagues...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27658281/action-steps-and-solutions-for-physicians-exercise-of-conscience
#13
Eliza Blanchard, Lynn Stoller
Conscience can influence physicians' interactions with patients in myriad ways and, by extension, can influence the interactions and internal dynamics of a health care team. The AMA's opinion around physicians' exercise of conscience appropriately balance the obligations physicians have to their patients and profession, and the rights of physicians as moral agents to exercise their conscience. While the opinion is an effective starting point, further guidance is necessary to clarify the process by which physicians should identify, manage, and, if necessary, report their conscientious refusals to patients, supervisors, or colleagues...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27658280/who-judges-harm
#14
Nadia N Sawicki
The American Medical Association's (AMA's) "Opinion 1.1.7, Physician Exercise of Conscience" attempts to help physicians strike a reasonable balance between their own conscientious beliefs and their patients' medical interests in an effort to minimize harms to both. However, some ambiguity still remains as to whether the severity of harms experienced by physicians and patients is to be assessed externally (by policy makers or by a professional body like the AMA), or internally by the subjects of those harms...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27658279/professional-ethics-personal-conscience-and-public-expectations
#15
Claudia E Haupt
Examining to what extent physicians are, or ought to be, defined by the profession when giving advice to patients, this commentary seeks to offer a better understanding of the potential conflicts that the American Medical Association's (AMA's) "Opinion 1.1.7, Physician Exercise of Conscience," addresses. This commentary conceptualizes the professions as knowledge communities, and situates the physician-patient relationship within this larger conceptual framework. So doing, it sheds light on how and when specialized knowledge is operationalized in professional advice-giving...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27658278/accommodating-conscientious-objection-in-medicine-private-ideological-convictions-must-not-trump-professional-obligations
#16
Udo Schuklenk
The opinion of the American Medical Association (AMA) Council on Ethical and Judicial Affairs (CEJA) on the accommodation of conscientious objectors among medical doctors aims to balance fairly patients' rights of access to care and accommodating doctors' deeply held personal beliefs. Like similar documents, it fails. Patients will not find it persuasive, and neither should they. The lines drawn aim at a reasonable compromise between positions that are not amenable to compromise. They are also largely arbitrary...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27658277/report-by-the-american-medical-association-s-council-on-ethical-and-judicial-affairs-on-physicians-exercise-of-conscience
#17
B J Crigger, Patrick W McCormick, Stephen L Brotherton, Valarie Blake
As practicing clinicians, physicians are expected to uphold the ethical norms of their profession, including fidelity to patients and respect for patients' self-determination. At the same time, as individuals, physicians are moral agents in their own right and, like their patients, are informed by and committed to diverse cultural, religious, and philosophical traditions and beliefs. In some circumstances, the expectation that physicians will put patients' needs and preferences first may be in tension with the need to sustain the sense of moral integrity and continuity that grounds a physician's personal and professional life...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27658276/towards-a-new-narrative-of-moral-distress-realizing-the-potential-of-resilience
#18
Cynda Hylton Rushton, Alisa Carse
Terri Traudt, Joan Liaschenko, and Cynthia Peden-McAlpine's study contributes to a much-needed reorientation in thinking about and working with the challenges of moral distress. In providing a vital example of nurses able to navigate morally distressing situations in positive and constructive ways, and offering an analysis of the component elements of these nurses' success, the study helps identify promising directions we might take in addressing the epidemic of moral distress. It also invites important questions, concerning the challenges faced by clinicians who do not who work in healthy "moral communities," who lack the ethical competencies, and who don't have the presumptive authority and recognition enjoyed by the seasoned clinicians studied here...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27658275/moral-agency-moral-imagination-and-moral-community-antidotes-to-moral-distress
#19
Terri Traudt, Joan Liaschenko, Cynthia Peden-McAlpine
Moral distress has been covered extensively in the nursing literature and increasingly in the literature of other health professions. Cases that cause nurses' moral distress that are mentioned most frequently are those concerned with prolonging the dying process. Given the standard of aggressive treatment that is typical in intensive care units (ICUs), much of the existing moral distress research focuses on the experiences of critical care nurses. However, moral distress does not automatically occur in all end-of-life circumstances, nor does every critical care nurse suffer its damaging effects...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27658274/harmful-emotional-responses-that-patients-and-physicians-may-have-when-their-values-conflict
#20
Edmund G Howe
One of the most difficult decisions a clinician may face is when, if ever, to decline what a patient wants, based on the clinician's own moral conscience. Regardless of what the clinician decides, the outcome may be deeply emotionally painful for both parties, and the pain may last. I will discuss this pain, how it occurs, and what we can do to try to reduce it before, during, and after a conflict arises. Approaches include explaining how we are like the patient or doctor, that no one is perfect, and that what we do is not who we are...
2016: Journal of Clinical Ethics
journal
journal
30881
1
2
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"