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Journal of Clinical Ethics

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https://www.readbyqxmd.com/read/28930714/vaccine-exemptions-and-the-church-state-problem
#1
Dena S Davis
All of the 50 states of the United States have laws governing childhood vaccinations; 48 allow for religious exemptions, while 19 also offer exemptions based on some sort of personal philosophy. Recent disease outbreaks have caused these states to reconsider philosophical exemptions. However, we cannot, consistent with the U.S. Constitution, give preference to religion by creating religious exemptions only. The Constitution requires states to put religious and nonreligious claims on equal footing. Given the ubiquity of nonreligious objections to vaccination, I conclude that the best response is to remove all exemptions, as two states have already done...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28930713/universal-health-care-the-cost-of-being-human
#2
Roger Strair
In this article I argue that the biological processes that make us human have error rates that distribute illness on a no-fault basis. I propose this as an ethical foundation for universal healthcare.
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28930712/the-ethics-of-research-in-lower-income-countries-double-standards-are-not-the-problem
#3
David S Wendler
Discussion of the ethics of clinical trials in lower income countries has been dominated by concern over double standards. Most prominently, clinical trials of interventions that are less effective than the worldwide best treatment methods typically are not permitted in higher income countries. Commentators conclude that permitting such trials in lower income countries involves an ethical double standard. Despite significant attention to this concern, and its influence over prominent guidelines for research in lower income countries, there has been little analysis of what constitutes an ethical double standard in clinical research...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28930711/the-angry-amish-grandfather-cultural-competence-and-empathy-a-case-commentary
#4
James L Benedict
Crosscultural encounters are common in the delivery of healthcare, and cultural differences may contribute to misunderstandings and ethical conflict. Encounters between members of the Amish ethno-religious group and modern, science-based healthcare providers hold a high potential for misunderstanding and conflict because the Amish stridently maintain a countercultural outlook and they approach such encounters with suspicion and anxiety. This commentary on the case presented by Amy E. Caruso Brown, MD,1 involving a grandfather's resistance to treating a child with leukemia commends this physician for successfully managing the case and deriving important insights from reflection upon it...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28930710/at-the-intersection-of-faith-culture-and-family-dynamics-a-complex-case-of-refusal-of-treatment-for-childhood-cancer
#5
Amy E Caruso Brown
Refusing treatment for potentially curable childhood cancers engenders much discussion and debate. I present a case in which the competent parents of a young Amish child with acute myeloid leukemia deferred authority for decision making to the child's maternal grandfather, who was vocal in his opposition to treatment. I analyze three related concerns that distinguish this case from other accounts of refused treatment. First, I place deference to grandparents as decision makers in the context of surrogate decision making more generally...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28930709/responding-to-moral-distress-and-ethical-concerns-at-the-intersection-of-medical-illness-and-unmet-mental-health-needs
#6
Donna D McKlindon, Pamela Nathanson, Chris Feudtner
Some of the most difficult clinical ethics consultations involve patients who have both medical and mental health needs, as these cases can result in considerable moral distress on the part of the bedside staff. In this article we examine the issues that such consults raise through the illustrative example of a particular case: several years ago our ethics consultation service received a request from a critical care attending physician who was considering a rarely performed psychosurgical intervention to address intractable and life-threatening agitation and aggression in an adolescent patient for whom standard treatments had proven unsuccessful...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28930708/may-medical-centers-give-nonresident-patients-priority-in-scheduling-outpatient-follow-up-appointments
#7
Armand H Matheny Antommaria
Many academic medical centers are seeking to attract patients from outside their historical catchment areas for economic and programmatic reasons, and patients are traveling for treatment that is unavailable, of poorer quality, or more expensive at home. Treatment of these patients raises a number of ethical issues including whether they may be given priority in scheduling outpatient follow-up appointments in order to reduce the period of time they are away from home. Granting them priority is potentially unjust because medical treatment is generally allocated based on medical need and resource utilization, and then on a first-come, first-served basis...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28930707/re-evaluating-the-ethics-of-uterine-transplantation
#8
Danish Zaidi
In February 2016, the Cleveland Clinic initiated the first attempt at cadaveric uterine transplantation (UTx) in the United States. The transplantation was ultimately unsuccessful, but it opened doors for further research on both live and cadaveric UTx. While initial strides toward successful transplantation have been made, questions persist on the ethics of UTx: whether the uterus is a vital organ, whether we should prioritize live or cadaveric options, and how the procedure should be covered by health insurance...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28930706/giving-voice-to-the-voiceless-the-colorado-response-to-unrepresented-patients
#9
Deb Bennett-Woods, Jean Abbott, Jacqueline J Glover
Medical decision making on behalf of unrepresented patients is one of the most challenging ethical issues faced in clinical practice. The legal environment surrounding these patients is equally complex. This article describes the efforts of a small coalition of interested healthcare professionals to address the issue in Colorado. A brief history of the effort is presented, along with discussion of the legal, ethical, practical, and political dimensions that arose in Colorado's effort to address decision making for unrepresented patients through an extension of the existing Colorado Medical Treatment Decision Act (CRS 15-18)...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28930705/how-we-become-who-we-are-ashley-carla-and-the-rest-of-us
#10
Jamie Lindemann Nelson
Lisa Freitag and Joan Liaschenko's thoughtful and important article goes directly to the under-examined heart of Ashley's case, namely to what sustains her in a habitable and intelligible identity. Though quite sympathetic with their conclusion and line of argument, I try to trouble their proceedings a bit, largely by wondering how having a specific such identity, out of several that may be in-principle available, matters to someone with Ashley's cognitive scope. I do this not simply to be contrary, but because their article also seems to me to raise issues in the ethics of bioethics-in particular, what I call the dilemma of ethical endeavor: How ought one publicly pursue deeply important and complex issues, the very raising of which may offend interlocutors who indeed have grounds for resentment...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28930704/holding-ashley-x-bestowing-identity-through-caregiving-in-profound-intellectual-disability
#11
Lisa Freitag, Joan Liaschenko
The controversy over the so-called Ashley Treatment (AT), a series of medical procedures that inhibited both growth and sexual development in the body of a profoundly intellectually impaired girl, usually centers either on Ashley's rights, including a right to an intact, unaltered body, or on Ashley's parents' rights to make decisions for her. The claim made by her parents, that the procedure would improve their ability to care for her, is often dismissed as inappropriate or, at best, irrelevant. We argue, however, that caregiving is a central issue in the controversy, as Ashley's need for caregiving is a defining characteristic of her life...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28930703/nine-lessons-from-ashley-and-her-parents
#12
Edmund G Howe
Parents' love for their child, even a child who has severe impairments, may give them much joy and quality in their life. This is also the case for caregivers of adults with severe cognitive impairments, such as end-stage dementia. How can clinicians work with these parents and caregivers and help them?
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28614080/legal-briefing-unwanted-cesareans-and-obstetric-violence
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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