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Journal of Clinical Ethics

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https://www.readbyqxmd.com/read/27658284/legal-briefing-stopping-nonbeneficial-life-sustaining-treatment-without-consent
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
https://www.readbyqxmd.com/read/27333067/-defining-patient-advocacy-for-the-context-of-clinical-ethics-consultation-a-review-of-the-literature-and-recommendations-for-consultants
#12
Tracy Brazg, Taryn Lindhorst, Denise Dudzinski, Benjamin Wilfond
The idea of patient advocacy as a function of clinical ethics consultation (CEC) has been debated in the bioethics literature. In particular, opinion is divided as to whether patient advocacy inherently is in conflict with the other duties of the ethics consultant, especially that of impartial mediator. The debate is complicated, however, because patient advocacy is not uniformly conceptualized. This article examines two literatures that are crucial to understanding patient advocacy in the context of bioethical deliberations: the CEC literature and the literature on advocacy in the social work profession...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27333066/measuring-quality-in-ethics-consultation
#13
Sally E Bliss, Jane Oppenlander, Jacob M Dahlke, Gordon J Meyer, Eva M Williford, Robert C Macauley
For all of the emphasis on quality improvement-as well as the acknowledged overlap between assessment of the quality of healthcare services and clinical ethics-the quality of clinical ethics consultation has received scant attention, especially in terms of empirical measurement. Recognizing this need, the second edition of Core Competencies for Health Care Ethics Consultation1 identified four domains of ethics quality: (1) ethicality, (2) stakeholders' satisfaction, (3) resolution of the presenting conflict/dilemma, and (4) education that translates into knowledge...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27333065/gender-and-race-in-the-timing-of-requests-for-ethics-consultations-a-single-center-study
#14
Bethany Spielman, Christine Gorka, Keith Miller, Carolyn A Pointer, Barbara Hinze
BACKGROUND: Clinical ethics consultants are expected to "reduce disparities, discrimination, and inequities when providing consultations," but few studies about inequities in ethics consultation exist.1 The objectives of this study were (1) to determine if there were racial or gender differences in the timing of requests for ethics consultations related to limiting treatment, and (2) if such differences were found, to identify factors associated with that difference and the role, if any, of ethics consultants in mitigating them...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27333064/medical-boards-and-fitness-to-practice-the-case-of-teleka-patrick-md
#15
Katrina A Bramstedt
BACKGROUND: Medical boards and fitness-to-practice committees aim to ensure that medical students and physicians have "good moral character" and are not impaired in their practice of medicine. METHOD: Presented here is an ethical analysis of stalking behavior by physicians and medical students, with focus on the case of Teleka Patrick, MD (a psychiatry resident practicing medicine while under a restraining order due to her alleged stalking behavior). CONCLUSIONS: While a restraining order is not generally considered a criminal conviction, stalking behavior is clearly unprofessional and a marker of inappropriate character and fitness, yet the reporting obligations for such matters are complex...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27333063/the-medical-ethics-curriculum-in-medical-schools-present-and-future
#16
Alberto Giubilini, Sharyn Milnes, Julian Savulescu
In this review article we describe the current scope, methods, and contents of medical ethics education in medical schools in Western English speaking countries (mainly the United Kingdom, the United States, and Australia). We assess the strengths and weaknesses of current medical ethics curricula, and students' levels of satisfaction with different teaching approaches and their reported difficulties in learning medical ethics concepts and applying them in clinical practice. We identify three main challenges for medical ethics education: counteracting the bad effects of the "hidden curriculum," teaching students how to apply ethical knowledge and critical thinking to real cases in clinical practice, and shaping future doctors' right character through ethics education...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27333062/what-is-everyday-ethics-a-review-and-a-proposal-for-an-integrative-concept
#17
Natalie Zizzo, Emily Bell, Eric Racine
"Everyday ethics" is a term that has been used in the clinical and ethics literature for decades to designate normatively important and pervasive issues in healthcare. In spite of its importance, the term has not been reviewed and analyzed carefully. We undertook a literature review to understand how the term has been employed and defined, finding that it is often contrasted to "dramatic ethics." We identified the core attributes most commonly associated with everyday ethics. We then propose an integrative model of everyday ethics that builds on the contribution of different ethical theories...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27333061/-how-can-clinical-ethics-committees-take-on-organizational-ethics-some-practical-suggestions
#18
James E Sabin
Although leaders in the field of ethics have for many years pointed to the crucial role that organizations play in shaping healthcare ethics, organizational ethics remains a relatively undeveloped area of ethics activity. Clinical ethics committees are an important source of potential expertise, but new skills will be required. Clinical ethics committees seeking to extend their purview to organizational issues will have to respond to three challenges-how to gain sanction and support for addressing controversial and sensitive issues, how to develop an acceptable process, and how to make a difference on the ground...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27333060/untangling-uncertainty-a-study-of-the-discourses-shaping-clinical-ethics-consultation-as-a-professional-practice
#19
Salla Saxén
This qualitative social scientific interview study delves into the ways in which professional vision is constructed in clinical ethics consultation (CEC). The data consist of 11 semi-structured interviews that were conducted with clinical ethics consultants currently working in hospitals in one major urban area in the U.S. The interviews were analyzed with the qualitative research method of critical discourse analysis, with a focus on identifying the cultural structures of knowledge that shape CEC as a professional practice...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27333059/what-do-we-owe-medical-students-and-medical-colleagues-who-are-impaired
#20
Edmund G Howe
Physicians who are impaired, engage in unprofessional behavior, or violate laws may be barred from further practice. Likewise, medical students may be dismissed from medical school for many infractions, large and small. The welfare of patients and the general public must be our first priority, but when we assess physicians and students who have erred, we should seek to respond as caringly and fairly as possible. This piece will explore how we may do this at all stages of the proceedings physicians and students may encounter...
2016: Journal of Clinical Ethics
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