Hec Forum最新文献

While patients have the right to control who has access to their health information and designate visitors, it is not always clear whether-when a patient lacks capacity-their surrogate also exercises such rights. States and federal laws are often vague about the limits of surrogate authority. Even where legal or institutional guidance on this issue is clear, requests by surrogates to withhold information or restrict visitation with a patient can be a source of ethical uncertainty and distress on the part of the clinical team. This paper explores the ethical issues raised by such requests. To date, there has been little exploration of this issue in the clinical ethics literature. First, we summarize the scant existing ethical and legal guidance on this issue. Second, we present two potential approaches to navigating requests from surrogates to withhold information or restrict visitation. Third, we discuss the merits and limitations of both approaches, and introduce some additional considerations that further complicate the picture. We argue for a flexible restrictive approach to information-sharing, and a constrained permissive approach to visitation. Finally, we propose several considerations that clinicians and clinical ethicists might think through in these situations to help guide their practice.

Healthcare professionals (HCPs) encounter various moral challenges in clinical practice. In various countries, clinical ethics support (CES) services are developed to support HCPs. One of these CES services is clinical ethics committees (CECs): they address moral challenges faced in healthcare settings and offer support for HCPs. However, in Tanzania, CECs have not yet been implemented. For implementation purposes, greater knowledge about how healthcare professionals navigate and respond to moral challenges, their understanding of CECs, and what they perceive as key needs for implementing CECs in hospitals, are valuable. This study explores HCPs' ways of dealing with their moral challenges at the moment and identifies key needs for establishing CECs in Tanzanian healthcare settings in the near future. The findings show that various implicit ways have been acknowledged as being useful in addressing moral challenges (e.g., regular meetings, family conferences, social welfare units, hospital procedures and guidelines, as well as consulting legal and management units). In addition, HCPs reported that a necessity exists for implementing more formal and systematic modalities to address moral challenges in clinical settings. The research in this paper has served as a preparation for establishing the first CEC in Tanzanian healthcare settings.

Clinical ethics are becoming increasingly important in the twenty-first century. Value-laden cases and moral dilemmas in healthcare have led to the creation of clinical ethics support structures. The last decades have shown their implementation in hospitals around the globe. Recent literature investigates their value, function, and integration. Many conclude that they do valuable work yet remain inadequately integrated, lack institutionalization, and struggle with resource shortages. To gain an understanding of this development and pave the way for future implementation and research, a scoping review was chosen to determine which macro-level factors currently influence the heterogeneous approaches. This review used the scientific research databases Medline and CINAHL in April 2025. It included studies, opinion papers, and book chapters in English and German offering explanations, analysis, discussion, and examples of macro-level clinical ethics support structures' adoption and implementation influences. An inductive qualitative content analysis was conducted to extract the desired information. The resulting categories were formatted into an overview frame. The literature search yielded 400 publications, full-text analysis and snowball search resulted in 47 eligible for analysis. Eight main factors with respective subcategories were identified. These vary in their degree of binding authority, ranging from clearly defined regulations, such as national laws, to more ambiguous influences, such as public opinion and advocacy. Further insights reveal that the effectiveness of these factors cannot yet be determined, and their influence may vary based on the values and political context of the country where a support structure is implemented.

Conscientious objection in healthcare is important for at least two reasons: the need for healthcare workers to be conscientious people-even where their objections are mistaken-and their need to respect the core values of their professions. Conscientious objection can be nuanced and/or unexpected: sometimes it is being confronted with a situation in a visceral way that leads to the objection, including after the healthcare worker has already been involved in the practice concerned. Referral to a non-objecting practitioner is often expected but goes against the logic of much conscientious objection: healthcare workers who see some intervention as unjustifiably harmful may not wish to intend its performance by others or even its pursuit. In the end, healthcare professionals need the virtue of conscientiousness: this is necessary, albeit not sufficient, for them to act well in their roles. As patients we also need conscientious professionals: even if their response may occasionally do us harm, the fact the healthcare worker is unwilling to act unethically as she sees it is a valuable and crucial character trait.

The question of whether clinical ethicists should be informed of case resolutions remains unresolved. While the American Society for Bioethics and Humanities (ASBH) recommends retrospective case reviews to assess whether recommendations were followed, it frames this practice solely as a quality improvement measure. While quality enhancement is a compelling rationale for ensuring that clinical ethicists are informed of the resolutions of consultations, it is not the sole justification for such transparency. Access to case resolutions strengthens ethics education, enhances accountability and transparency, facilitates contributions to the field and advocacy, and mitigates the emotional uncertainty that can arise when ethicists lack closure on complex cases. Although concerns about confidentiality and administrative constraints must be considered, they should not hinder efforts to foster a more transparent consultation process.

When a patient with a pre-existing DNR attempts suicide, physicians must decide between two conflicting options: upholding the patient's DNR and risking a potentially avoidable death or suspending the DNR and risking violating the patient's autonomy. The bioethics literature has proposed a variety of principles to guide decision-making in such cases, but provides little clarity and fails to address all principles cited by physicians when confronted with such cases. Furthermore, little attention has been paid to the ongoing ethical dilemmas medical teams may face when treating a patient with a DNR after a suicide attempt. Using a composite case derived from four clinical cases in which patients with pre-existing DNR attempted suicide and the principles their physicians cited, we develop an ethical framework for the ongoing decision-making required of medical teams treating these patients. We analyze three primary factors, assessing their relevance and utility for decision-making: patient decision-making capacity, physician complicity in suicide, and expected quality of life. We conclude that although physician complicity in suicide and a patient's expected quality of life have intuitive appeal and may influence decision-making in practice, clinicians should set these principles aside and instead focus on assessing a patient's decision-making capacity at the time of their DNR request.

Clinical ethics consultation is the practice of using ethical principles and theories to engage in complex interventions with stakeholders (patients, families, healthcare providers) to address moral issues. Ethicists must master ethical principles and apply them to complex healthcare dilemmas, employing critical thinking and practical knowledge to address nuances in healthcare. Essential to a clinical ethics consultant's development is the need for professional identity formation. Central this discussion of professional identity formation is what defines a professional and what qualifies a person to serve in that professional capacity. Are these qualifications skills-based, or are there characteristics that a clinical ethicist must have to be in the profession? Must someone have a professional or educational background that begins the professional identity formation process before entering the field of clinical ethics? Furthermore, can someone be taught these qualifications through structured learning activities with the goal of socializing them to a professional community? This essay will explore the reasons why professional identity formation has eluded the clinical ethics consultation field and how educational and training programs in clinical ethics have a duty to help learners develop a professional identity as a clinical ethicist. These programs must not only impart theoretical knowledge and practical skills but also foster the interpersonal abilities essential for ethics consultation. By embedding reflective practices, values clarification, and mentorship opportunities, such programs can guide learners through the complexities of professional identity formation, ensuring they are equipped to navigate the moral and relational challenges of the field.