The decision to donate an organ is often the decision to save a loved one’s life. Frequently recognized as an ultimate act of altruism, a person’s choice to donate is embedded in their right to make decisions about their own body and well-being, free of coercion. To ensure donors are truly acting out of altruism, transplant professionals will not allow someone to donate if there are concerns of duress or inability to consent. Although the evaluation of potential donors is well-intentioned and necessary, stigma and assumptions about young adults can sometimes lead to their being denied the opportunity to donate based on age rather than evidence, thus infringing upon their bodily autonomy. This case examines the narrative of a young man trying to save his sister through kidney donation, and the ramifications of denying him the opportunity to do so, and how the transplant community can re-envision their role in protecting young adult donors.
{"title":"Moral Inequity in Organ Donation: An Examination of Age-Based Denial","authors":"Tayyah S. Diwan, Lindsay R. Beaman","doi":"10.1353/nib.0.a933010","DOIUrl":"https://doi.org/10.1353/nib.0.a933010","url":null,"abstract":"The decision to donate an organ is often the decision to save a loved one’s life. Frequently recognized as an ultimate act of altruism, a person’s choice to donate is embedded in their right to make decisions about their own body and well-being, free of coercion. To ensure donors are truly acting out of altruism, transplant professionals will not allow someone to donate if there are concerns of duress or inability to consent. Although the evaluation of potential donors is well-intentioned and necessary, stigma and assumptions about young adults can sometimes lead to their being denied the opportunity to donate based on age rather than evidence, thus infringing upon their bodily autonomy. This case examines the narrative of a young man trying to save his sister through kidney donation, and the ramifications of denying him the opportunity to do so, and how the transplant community can re-envision their role in protecting young adult donors.","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher S. Calciano, Colin R. Liphart, Annie B. Friedrich, Christina D. Diaz
A 10 year-old child requires an esophagogastroduodenoscopy (EGD). One of the child’s parents is requesting an unsedated esophagogastroduodenoscopy, citing their experiences in a different country and concerns about anesthetic medications. The child is assenting to the procedure. The patient previously had multiple sedated EGDs without complications. Concerns are raised by the anesthesia, GI, and operating room teams about the ethics and child safety of performing an unsedated EGD, given this is not the typical standard of care at the performing hospital. In this paper we analyze prior literature and ethical principles, and explore whether unsedated EGD with appropriate monitoring is an ethically acceptable alternative to sedated EGD in this instance.
{"title":"Ethical Considerations of Unsedated Esophagogastroduodenoscopy in Pediatric Patients","authors":"Christopher S. Calciano, Colin R. Liphart, Annie B. Friedrich, Christina D. Diaz","doi":"10.1353/nib.0.a934010","DOIUrl":"https://doi.org/10.1353/nib.0.a934010","url":null,"abstract":"A 10 year-old child requires an esophagogastroduodenoscopy (EGD). One of the child’s parents is requesting an unsedated esophagogastroduodenoscopy, citing their experiences in a different country and concerns about anesthetic medications. The child is assenting to the procedure. The patient previously had multiple sedated EGDs without complications. Concerns are raised by the anesthesia, GI, and operating room teams about the ethics and child safety of performing an unsedated EGD, given this is not the typical standard of care at the performing hospital. In this paper we analyze prior literature and ethical principles, and explore whether unsedated EGD with appropriate monitoring is an ethically acceptable alternative to sedated EGD in this instance.","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
During a clinical ethics fellow’s first week of independent supervised service, two unhoused patients on the same floor were resisting the medical team’s recommendations to discharge. In the team’s view, both were medically stable and no longer required hospitalization in an acute setting. The medical team suspected malingering for both. The social worker and case manager had employed their usual means of gentle persuasion and eliminating psychosocial barriers to no avail. Rather than call the police, the attending physician, social worker, and case manager decided to call ethics. These cases lead the fledgling fellow to consider the appropriate role for ethicists in difficult discharge cases. The article analyzes each case, evaluates their similarities and differences in the context of suspected malingering, and comments on ethical issues surrounding cases of suspected malingering. Finally, I reflect on the value and importance of developing and maintaining epistemic and professional independence.
{"title":"Difficult Discharge in the Context of Suspected Malingering: Reflections on the Value of Epistemic and Professional Independence","authors":"Amitabha Palmer, Colleen Gallagher","doi":"10.1353/nib.0.a926015","DOIUrl":"https://doi.org/10.1353/nib.0.a926015","url":null,"abstract":"During a clinical ethics fellow’s first week of independent supervised service, two unhoused patients on the same floor were resisting the medical team’s recommendations to discharge. In the team’s view, both were medically stable and no longer required hospitalization in an acute setting. The medical team suspected malingering for both. The social worker and case manager had employed their usual means of gentle persuasion and eliminating psychosocial barriers to no avail. Rather than call the police, the attending physician, social worker, and case manager decided to call ethics. These cases lead the fledgling fellow to consider the appropriate role for ethicists in difficult discharge cases. The article analyzes each case, evaluates their similarities and differences in the context of suspected malingering, and comments on ethical issues surrounding cases of suspected malingering. Finally, I reflect on the value and importance of developing and maintaining epistemic and professional independence.","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140758716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The authors present a case study involving truth telling responsibilities in the setting of nonepileptic seizures. Specifically, over the course of several suspected nonepileptic seizures, a patient’s seizures stopped after he received a saline flush meant to precede the administration of anti-seizure medication. The patient and his surrogate believed he had received the medication each time, and the team wondered whether they should disclose the truth. Some worried that disclosure would reinforce the suspected psychogenic behavior, exacerbating the patient’s condition. In this way, the case study presents a twist on the traditional truth telling archetype. While most truth telling cases center on navigating cultural differences or worries about emotional harm, this case presented concerns about medical harm in the form of exacerbating the patient’s condition. The authors describe the complex patient-family-team dynamic that preceded this ethical dilemma, describe the case, analyze the ethical issue, and describe the outcome.
{"title":"“Do We Have to Tell Him He Hasn’t Been Getting Ativan?”: Truth Telling for a Patient with Nonepileptic Seizures","authors":"Lexi C. White, Hilary Mabel","doi":"10.1353/nib.0.a926016","DOIUrl":"https://doi.org/10.1353/nib.0.a926016","url":null,"abstract":"The authors present a case study involving truth telling responsibilities in the setting of nonepileptic seizures. Specifically, over the course of several suspected nonepileptic seizures, a patient’s seizures stopped after he received a saline flush meant to precede the administration of anti-seizure medication. The patient and his surrogate believed he had received the medication each time, and the team wondered whether they should disclose the truth. Some worried that disclosure would reinforce the suspected psychogenic behavior, exacerbating the patient’s condition. In this way, the case study presents a twist on the traditional truth telling archetype. While most truth telling cases center on navigating cultural differences or worries about emotional harm, this case presented concerns about medical harm in the form of exacerbating the patient’s condition. The authors describe the complex patient-family-team dynamic that preceded this ethical dilemma, describe the case, analyze the ethical issue, and describe the outcome.","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140762706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1353/nib.2024.a934187
Michelle Prong
{"title":"Whose Voice Matters? The Role of Ethics Consultation in Supporting the 16-Year-Old Healthcare Decision-Maker of a Critically Ill Neonate.","authors":"Michelle Prong","doi":"10.1353/nib.2024.a934187","DOIUrl":"https://doi.org/10.1353/nib.2024.a934187","url":null,"abstract":"","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1353/nib.2024.a934184
Laura J Hoeksema
{"title":"The Healing Power of an Ethics Consult.","authors":"Laura J Hoeksema","doi":"10.1353/nib.2024.a934184","DOIUrl":"https://doi.org/10.1353/nib.2024.a934184","url":null,"abstract":"","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1353/nib.2024.a934177
Austin Morris
{"title":"Against Their Wishes: The Gift of a Goodbye.","authors":"Austin Morris","doi":"10.1353/nib.2024.a934177","DOIUrl":"10.1353/nib.2024.a934177","url":null,"abstract":"","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1353/nib.2024.a934185
Lisa P Wife Of Patient, Jeanne Kerwin
{"title":"Lisa's Story.","authors":"Lisa P Wife Of Patient, Jeanne Kerwin","doi":"10.1353/nib.2024.a934185","DOIUrl":"https://doi.org/10.1353/nib.2024.a934185","url":null,"abstract":"","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1353/nib.2024.a934176
Anonymous One
{"title":"My Father Dies Alone.","authors":"Anonymous One","doi":"10.1353/nib.2024.a934176","DOIUrl":"https://doi.org/10.1353/nib.2024.a934176","url":null,"abstract":"","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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