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":"264 1‐7","pages":""},"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":"133 ","pages":""},"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":"308 ","pages":""},"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.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":"14 1","pages":"5-7"},"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.a934184
Laura J Hoeksema
{"title":"The Healing Power of an Ethics Consult.","authors":"Laura J Hoeksema","doi":"10.1353/nib.2024.a934184","DOIUrl":"10.1353/nib.2024.a934184","url":null,"abstract":"","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":"14 1","pages":"21-23"},"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.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":"14 1","pages":"19-21"},"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.a944469
Erin L Bakanas
Grief is an emotion that reaches across multiple disciplines in healthcare. In this series we hear from medical students, residents and fellows, physicians, nurses, chaplains and social workers. Writers share their challenges with vulnerability, uncertainty, and emotional exhaustion. Many identify a sense of isolation within the very system they are seeking to support. While not all are confident, they have reached a new grounding after grief, these authors do offer a sense of hope for recovery and rediscovery of the joy in the privilege of the practice of medicine.
{"title":"Grief and Re(dis)covery.","authors":"Erin L Bakanas","doi":"10.1353/nib.2024.a944469","DOIUrl":"https://doi.org/10.1353/nib.2024.a944469","url":null,"abstract":"<p><p>Grief is an emotion that reaches across multiple disciplines in healthcare. In this series we hear from medical students, residents and fellows, physicians, nurses, chaplains and social workers. Writers share their challenges with vulnerability, uncertainty, and emotional exhaustion. Many identify a sense of isolation within the very system they are seeking to support. While not all are confident, they have reached a new grounding after grief, these authors do offer a sense of hope for recovery and rediscovery of the joy in the privilege of the practice of medicine.</p>","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":"14 2","pages":"95-99"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048598","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.a947848
Yilu Ma
{"title":"\"Call me Dr. XXX!\"","authors":"Yilu Ma","doi":"10.1353/nib.2024.a947848","DOIUrl":"https://doi.org/10.1353/nib.2024.a947848","url":null,"abstract":"","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":"14 3","pages":"151-152"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878127","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.a947869
Patricia Coronado
{"title":"Being an Interpreter-Beyond Linguistics.","authors":"Patricia Coronado","doi":"10.1353/nib.2024.a947869","DOIUrl":"https://doi.org/10.1353/nib.2024.a947869","url":null,"abstract":"","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":"14 3","pages":"E10-E12"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878177","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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