Pub Date : 2024-09-01Epub Date: 2023-05-04DOI: 10.1007/s10730-023-09506-1
Sadie Deschenes, Shannon D Scott, Diane Kunyk
In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used a qualitative description approach. Participants were recruited using purposive sampling between October 2020 to May 2021 from pediatric critical care units in a western Canadian province. We conducted individual semi-structured interviews via Zoom. A total of 10 registered nurses participated in the study. Four main themes were identified: (1) "I'm sorry, there's nothing else": increasing supports for patients and families; (2) "someone will commit suicide": improving supports for nurses: (3) "Everyone needs to be heard": improving patient care communication; and (4) "I didn't see it coming": providing education to mitigate moral distress. Most participants stated they wanted an intervention to improve communication among the healthcare team and noted changes to unit practices that could decrease moral distress. This is the first study that asks nurses what is needed to minimize their moral distress. Although there are multiple strategies in place to help nurses with difficult aspects of their work, additional strategies are needed to help nurses experiencing moral distress. Moving the research focus from identifying moral distress towards developing effective interventions is needed. Identifying what nurses need is critical to develop effective moral distress interventions.
{"title":"Mitigating Moral Distress: Pediatric Critical Care Nurses' Recommendations.","authors":"Sadie Deschenes, Shannon D Scott, Diane Kunyk","doi":"10.1007/s10730-023-09506-1","DOIUrl":"10.1007/s10730-023-09506-1","url":null,"abstract":"<p><p>In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used a qualitative description approach. Participants were recruited using purposive sampling between October 2020 to May 2021 from pediatric critical care units in a western Canadian province. We conducted individual semi-structured interviews via Zoom. A total of 10 registered nurses participated in the study. Four main themes were identified: (1) \"I'm sorry, there's nothing else\": increasing supports for patients and families; (2) \"someone will commit suicide\": improving supports for nurses: (3) \"Everyone needs to be heard\": improving patient care communication; and (4) \"I didn't see it coming\": providing education to mitigate moral distress. Most participants stated they wanted an intervention to improve communication among the healthcare team and noted changes to unit practices that could decrease moral distress. This is the first study that asks nurses what is needed to minimize their moral distress. Although there are multiple strategies in place to help nurses with difficult aspects of their work, additional strategies are needed to help nurses experiencing moral distress. Moving the research focus from identifying moral distress towards developing effective interventions is needed. Identifying what nurses need is critical to develop effective moral distress interventions.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10158695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10314416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2023-02-15DOI: 10.1007/s10730-023-09505-2
Andrea Thornton
In the process of professionalization, the American Society for Bioethics and Humanities (ASBH) has emphasized process and knowledge as core competencies for clinical ethics consultants; however, the credentialing program launched in 2018 fails to address both pillars. The inadequacy of this program recalls earlier critiques of the professionalization effort made by Giles R. Scofield and H. Tristram Engelhardt, Jr.. Both argue that ethics consultation is not a profession and the effort to professionalize is motivated by self-interest. One argument they offer against professionalization is that ethics consultants lack normative expertise. Although the question of expertise cannot be resolved completely, the accusation of self-interest can be addressed. Underlying these critiques is a concern for hubris, which can be addressed in certification and the vetting of candidates.Drawing on the virtue ethics literature of Alasdair MacIntyre and Edmund D. Pellegrino, I argue that medicine is a moral community in which ethics consultants are moral agents with a duty to foster the virtue of humility (or what Pellegrino and Thomasma call self-effacement). The implications of this argument include a requirement for self-reflection in one's role as a moral agent and reflection on one's progress toward developing or deepening virtuous engagement with the moral community of medicine. I recommend that professionalization of clinical ethics consultants include a self-reflective narrative component in the initial certification and ongoing renewal of certification where clinical ethics consultants address the emotional dimensions of their work as well as their own moral development. Adopting a teleological view of ethics consultation and incorporating narratives that work toward that purpose will mitigate the self-interest and hubris of the professionalization project.
在职业化进程中,美国生命伦理学与人文科学学会(ASBH)一直强调过程和知识是临床伦理顾问的核心能力;然而,2018 年推出的资格认证计划却未能解决这两个支柱的问题。该计划的不足让人想起早先由 Giles R. Scofield 和 H. Tristram Engelhardt, Jr.对职业化努力的批评。他们都认为,伦理咨询不是一种专业,专业化的努力是出于自身利益的考虑。他们反对专业化的一个论点是,伦理咨询师缺乏规范方面的专业知识。虽然专业知识的问题无法彻底解决,但对自我利益的指责是可以解决的。借鉴阿拉斯戴尔-麦金太尔(Alasdair MacIntyre)和埃德蒙-佩莱格里诺(Edmund D. Pellegrino)的美德伦理学文献,我认为医学是一个道德共同体,在这个共同体中,伦理顾问是道德主体,有责任培养谦逊的美德(或佩莱格里诺和托马斯马所说的自我牺牲)。这一论点的含义包括要求我们对自己作为道德代理人的角色进行自我反思,并反思自己在发展或深化与医学道德团体的良性互动方面所取得的进展。我建议,临床伦理顾问的职业化应在初始认证和持续更新的认证中加入自我反思的叙述部分,让临床伦理顾问探讨其工作的情感维度以及自身的道德发展。对伦理咨询采取目的论的观点,并纳入为实现这一目的而努力的叙事,将减轻职业化项目的自利性和自大性。
{"title":"Credentialing Character: A Virtue Ethics Approach to Professionalizing Healthcare Ethics Consultation Services.","authors":"Andrea Thornton","doi":"10.1007/s10730-023-09505-2","DOIUrl":"10.1007/s10730-023-09505-2","url":null,"abstract":"<p><p>In the process of professionalization, the American Society for Bioethics and Humanities (ASBH) has emphasized process and knowledge as core competencies for clinical ethics consultants; however, the credentialing program launched in 2018 fails to address both pillars. The inadequacy of this program recalls earlier critiques of the professionalization effort made by Giles R. Scofield and H. Tristram Engelhardt, Jr.. Both argue that ethics consultation is not a profession and the effort to professionalize is motivated by self-interest. One argument they offer against professionalization is that ethics consultants lack normative expertise. Although the question of expertise cannot be resolved completely, the accusation of self-interest can be addressed. Underlying these critiques is a concern for hubris, which can be addressed in certification and the vetting of candidates.Drawing on the virtue ethics literature of Alasdair MacIntyre and Edmund D. Pellegrino, I argue that medicine is a moral community in which ethics consultants are moral agents with a duty to foster the virtue of humility (or what Pellegrino and Thomasma call self-effacement). The implications of this argument include a requirement for self-reflection in one's role as a moral agent and reflection on one's progress toward developing or deepening virtuous engagement with the moral community of medicine. I recommend that professionalization of clinical ethics consultants include a self-reflective narrative component in the initial certification and ongoing renewal of certification where clinical ethics consultants address the emotional dimensions of their work as well as their own moral development. Adopting a teleological view of ethics consultation and incorporating narratives that work toward that purpose will mitigate the self-interest and hubris of the professionalization project.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9268066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2023-07-10DOI: 10.1007/s10730-023-09508-z
Lucia D Wocial, Genina Miller, Kianna Montz, Michelle LaPradd, James E Slaven
Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs' perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants' moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work environment. We used quantitative instruments and explored participants' perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses.
{"title":"Evaluation of Interventions to Address Moral Distress: A Multi-method Approach.","authors":"Lucia D Wocial, Genina Miller, Kianna Montz, Michelle LaPradd, James E Slaven","doi":"10.1007/s10730-023-09508-z","DOIUrl":"10.1007/s10730-023-09508-z","url":null,"abstract":"<p><p>Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs' perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants' moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work environment. We used quantitative instruments and explored participants' perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10335998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2023-06-02DOI: 10.1007/s10730-023-09507-0
Benedict S B Chan
The purpose of this essay is to review and evaluate chapters in Fan and Cherry's Sex Robots: Social Impact and the Future of Human Relations. In this edited volume, the authors of the various chapters present dialogues from the East and West to explore the social and cultural implications of sex robots. They also discuss whether sex robots have a positive, negative, or neutral impact on society and human relationships. This essay examines the key ideas presented in the book's chapters, evaluates their arguments, and identifies research directions for the ethics of sex robots in the future. Specifically, this essay provides a detailed analysis of certain schools of thought, including the capability approach, Confucianism and Daoism, and their relevance to the topic of sex robots.
本文旨在回顾和评价 Fan 和 Cherry 的《性机器人》中的章节:社会影响与人类关系的未来》一书中的章节。在这本编辑集中,各章节的作者以东西方对话的形式探讨了性爱机器人的社会和文化影响。他们还讨论了性爱机器人对社会和人际关系的影响是积极的、消极的还是中性的。本文探讨了书中各章节提出的主要观点,对其论点进行了评估,并指出了未来性爱机器人伦理的研究方向。具体而言,本文详细分析了某些思想流派,包括能力论、儒家思想和道家思想,以及它们与性机器人话题的相关性。
{"title":"East-West Dialogues on the Ethics of Sex Robots.","authors":"Benedict S B Chan","doi":"10.1007/s10730-023-09507-0","DOIUrl":"10.1007/s10730-023-09507-0","url":null,"abstract":"<p><p>The purpose of this essay is to review and evaluate chapters in Fan and Cherry's Sex Robots: Social Impact and the Future of Human Relations. In this edited volume, the authors of the various chapters present dialogues from the East and West to explore the social and cultural implications of sex robots. They also discuss whether sex robots have a positive, negative, or neutral impact on society and human relationships. This essay examines the key ideas presented in the book's chapters, evaluates their arguments, and identifies research directions for the ethics of sex robots in the future. Specifically, this essay provides a detailed analysis of certain schools of thought, including the capability approach, Confucianism and Daoism, and their relevance to the topic of sex robots.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9566112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2023-07-13DOI: 10.1007/s10730-023-09510-5
Joe Slater
Hendricks (2018) has defended an argument that abortion is (usually) immoral, which he calls the impairment argument. This argument purports to apply regardless of the moral status of the fetus. It has recently been bolstered by several amendments from Blackshaw and Hendricks (2021a; 2021b). In this paper, three problems are presented for their Strengthened Impairment Argument (SIA). In the first, it is observed that even with the new modifications the argument, contrary to their insistence, does seem to depend on Marquis' argument. In order for it not to do so, they would need to provide some other plausible reason why impairing a fetus is wrong that persists in cases of abortion. Because of the restrictions regarding what reasons can be used, they are not entitled to stipulate that some plausible reason can be found. In the second section, the use of an over-ridingness caveat - the most recent modification - is scrutinised. This is shown to either beg the question about the permissibility of abortion by assuming that opposing reasons are insufficient in most cases, or require an entirely separate argument to establish that such reasons are insufficient. Thirdly, I observe that the principle utilised in the latest version of the argument fails to account for undercutting reason, which suggest that the principle, in its current form, is false.
{"title":"The SIA Can't Just Go with the FLO.","authors":"Joe Slater","doi":"10.1007/s10730-023-09510-5","DOIUrl":"10.1007/s10730-023-09510-5","url":null,"abstract":"<p><p>Hendricks (2018) has defended an argument that abortion is (usually) immoral, which he calls the impairment argument. This argument purports to apply regardless of the moral status of the fetus. It has recently been bolstered by several amendments from Blackshaw and Hendricks (2021a; 2021b). In this paper, three problems are presented for their Strengthened Impairment Argument (SIA). In the first, it is observed that even with the new modifications the argument, contrary to their insistence, does seem to depend on Marquis' argument. In order for it not to do so, they would need to provide some other plausible reason why impairing a fetus is wrong that persists in cases of abortion. Because of the restrictions regarding what reasons can be used, they are not entitled to stipulate that some plausible reason can be found. In the second section, the use of an over-ridingness caveat - the most recent modification - is scrutinised. This is shown to either beg the question about the permissibility of abortion by assuming that opposing reasons are insufficient in most cases, or require an entirely separate argument to establish that such reasons are insufficient. Thirdly, I observe that the principle utilised in the latest version of the argument fails to account for undercutting reason, which suggest that the principle, in its current form, is false.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9775128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2023-08-05DOI: 10.1007/s10730-023-09509-y
Jason Adam Wasserman, Abram Brummett, Mark Christopher Navin
This article reports results of a survey about employment and compensation models for clinical ethics consultants working in the United States and discusses the relevance of these results for the professionalization of clinical ethics. This project uses self-reported data from healthcare ethics consultants to estimate compensation across different employment models. The average full-time annualized salary of respondents with a clinical doctorate is $188,310.08 (SD=$88,556.67), $146,134.85 (SD=$55,485.63) for those with a non-clinical doctorate, and $113,625.00 (SD=$35,872.96) for those with a masters as their highest degree. Pay differences across degree level and type were statistically significant (F = 3.43; p < .05). In a multivariate model, there is an average increase of $2,707.84 for every additional year of experience, controlling for having a clinical doctorate (ß=0.454; p < .01). Our results also show high variability in the backgrounds and experiences of healthcare ethics consultants and a wide variety of employment models. The significant variation in employment and compensation models is likely to pose a challenge for the professionalization of healthcare ethics consultation.
{"title":"It's Worth What You Can Sell It for: A Survey of Employment and Compensation Models for Clinical Ethicists.","authors":"Jason Adam Wasserman, Abram Brummett, Mark Christopher Navin","doi":"10.1007/s10730-023-09509-y","DOIUrl":"10.1007/s10730-023-09509-y","url":null,"abstract":"<p><p>This article reports results of a survey about employment and compensation models for clinical ethics consultants working in the United States and discusses the relevance of these results for the professionalization of clinical ethics. This project uses self-reported data from healthcare ethics consultants to estimate compensation across different employment models. The average full-time annualized salary of respondents with a clinical doctorate is $188,310.08 (SD=$88,556.67), $146,134.85 (SD=$55,485.63) for those with a non-clinical doctorate, and $113,625.00 (SD=$35,872.96) for those with a masters as their highest degree. Pay differences across degree level and type were statistically significant (F = 3.43; p < .05). In a multivariate model, there is an average increase of $2,707.84 for every additional year of experience, controlling for having a clinical doctorate (ß=0.454; p < .01). Our results also show high variability in the backgrounds and experiences of healthcare ethics consultants and a wide variety of employment models. The significant variation in employment and compensation models is likely to pose a challenge for the professionalization of healthcare ethics consultation.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10394016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rare diseases, defined as having a prevalence inferior to 1/2000, are poorly understood scientifically and medically. Appropriate diagnoses and treatments are scarce, adding to the burden of living with chronic medical conditions. The moral significance of rare disease experiences is often overlooked in qualitative studies conducted with adults living with rare diseases. The concept of morally problematic situations arising from pragmatist ethics shows promise in understanding these experiences. The objectives of this study were to (1) acquire an in-depth understanding of morally problematic situations experienced by adults living with rare diseases in the province of Québec and (2) to develop an integrative model of the concept of morally problematic situations. To this end, an online survey targeting this population was developed through a participatory action research project. Respondents provided 90 long testimonies on the most important morally problematic situations they faced, often in healthcare settings. An integrative model was developed based on various qualitative analyses of these testimonies and relevant literature. The integrative model showcases that morally problematic situations have causes (i.e., contextual and relational factors, personal factors, jeopardized valuations), have affective repercussions (i.e., emotions and feelings, internal tensions), prompt action (i.e., through empowerment strategies leading to the evolution of situations), and elicit outcomes (i.e., factual consequences, residual emotions and feelings, positive or negative resolutions). In sum, this study advances understanding of the moral experiences of adults living with rare diseases while proposing a comprehensive conceptual tool to guide future empirical bioethics research on moral experiences.
{"title":"Understanding Rare Disease Experiences Through the Concept of Morally Problematic Situations.","authors":"Ariane Quintal, Élissa Hotte, Caroline Hébert, Isabelle Carreau, Annie-Danielle Grenier, Yves Berthiaume, Eric Racine","doi":"10.1007/s10730-023-09511-4","DOIUrl":"10.1007/s10730-023-09511-4","url":null,"abstract":"<p><p>Rare diseases, defined as having a prevalence inferior to 1/2000, are poorly understood scientifically and medically. Appropriate diagnoses and treatments are scarce, adding to the burden of living with chronic medical conditions. The moral significance of rare disease experiences is often overlooked in qualitative studies conducted with adults living with rare diseases. The concept of morally problematic situations arising from pragmatist ethics shows promise in understanding these experiences. The objectives of this study were to (1) acquire an in-depth understanding of morally problematic situations experienced by adults living with rare diseases in the province of Québec and (2) to develop an integrative model of the concept of morally problematic situations. To this end, an online survey targeting this population was developed through a participatory action research project. Respondents provided 90 long testimonies on the most important morally problematic situations they faced, often in healthcare settings. An integrative model was developed based on various qualitative analyses of these testimonies and relevant literature. The integrative model showcases that morally problematic situations have causes (i.e., contextual and relational factors, personal factors, jeopardized valuations), have affective repercussions (i.e., emotions and feelings, internal tensions), prompt action (i.e., through empowerment strategies leading to the evolution of situations), and elicit outcomes (i.e., factual consequences, residual emotions and feelings, positive or negative resolutions). In sum, this study advances understanding of the moral experiences of adults living with rare diseases while proposing a comprehensive conceptual tool to guide future empirical bioethics research on moral experiences.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10247800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1007/s10730-024-09536-3
George E Freigeh, Hannah Fagen, Janice Firn
Limited data exist in the specific content of pediatric outpatient ethics consults as compared to inpatient ethics consults. Given the fundamental differences in outpatient and inpatient clinical care, we aimed to describe the distinctive nature of ethics consultation in the ambulatory setting. This is a retrospective review at a large, quaternary academic center of all outpatient ethics consults in a 6-year period. Encounter-level demographic data was recorded, and primary ethical issue and contextual features were identified using qualitative conceptual content analysis. A total of 48 consults were identified representing 44 unique patients. The most common primary ethical issue was beneficence and best interest concern comprising 20 (42%) consults, followed by refusal of recommended treatment comprising 11 (23%) consults and patient preference/assent comprising 5 (10%) consults. The most common contextual features were staff-family communication dispute/conflict comprising 28 (58%) consults, followed by legal involvement comprising 25 (52%) consults and quality of life comprising 19 (40%) consults. The most common consulting specialty was hematology/oncology. Ethical issues encountered in the provision of outpatient pediatric care are distinct and differ from those in inpatient consults. Further research is necessary to identify strategies and educational gaps in outpatient ethics consultation to increase its effectiveness and utilization.
{"title":"Review of Outpatient Pediatric Ethics Consults at an Academic Medical Center.","authors":"George E Freigeh, Hannah Fagen, Janice Firn","doi":"10.1007/s10730-024-09536-3","DOIUrl":"https://doi.org/10.1007/s10730-024-09536-3","url":null,"abstract":"<p><p>Limited data exist in the specific content of pediatric outpatient ethics consults as compared to inpatient ethics consults. Given the fundamental differences in outpatient and inpatient clinical care, we aimed to describe the distinctive nature of ethics consultation in the ambulatory setting. This is a retrospective review at a large, quaternary academic center of all outpatient ethics consults in a 6-year period. Encounter-level demographic data was recorded, and primary ethical issue and contextual features were identified using qualitative conceptual content analysis. A total of 48 consults were identified representing 44 unique patients. The most common primary ethical issue was beneficence and best interest concern comprising 20 (42%) consults, followed by refusal of recommended treatment comprising 11 (23%) consults and patient preference/assent comprising 5 (10%) consults. The most common contextual features were staff-family communication dispute/conflict comprising 28 (58%) consults, followed by legal involvement comprising 25 (52%) consults and quality of life comprising 19 (40%) consults. The most common consulting specialty was hematology/oncology. Ethical issues encountered in the provision of outpatient pediatric care are distinct and differ from those in inpatient consults. Further research is necessary to identify strategies and educational gaps in outpatient ethics consultation to increase its effectiveness and utilization.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-03DOI: 10.1007/s10730-024-09535-4
Vanessa Amos, Phyllis Whitehead, Beth Epstein
Moral distress reflects often recurrent problems within a healthcare environment that impact the quality and safety of patient care. Examples include inadequate staffing, lack of necessary resources, and poor interprofessional teamwork. Recognizing and acting on these issues demonstrates a collaborative and organizational commitment to improve. Moral distress consultation is a health system-wide intervention gaining momentum in the United States. Moral distress consultants assist healthcare providers in identifying and strategizing possible solutions to the patient, team, and systemic barriers behind moral distress. Moral distress consultants offer unique perspectives on the goals, successes, areas for improvement, and sustainability of moral distress consultation. Their ideas can help shape this intervention's continued growth and improvement. This qualitative descriptive study features 10 semi-structured interviews with moral distress consultants at two institutions with longstanding, active moral distress consultation services. Themes from consultant transcripts included consultant training, understanding the purpose of moral distress consultation, interfacing with leadership teams, defining success, and improving visibility and sustainability of the service. These findings describe the beginnings of a framework that organizations can use to either start or strengthen moral distress consultation services, as well as the first steps in developing an evaluation tool to monitor their utility and quality.
{"title":"Moral Distress Consultation Services: Insights from Consultants.","authors":"Vanessa Amos, Phyllis Whitehead, Beth Epstein","doi":"10.1007/s10730-024-09535-4","DOIUrl":"https://doi.org/10.1007/s10730-024-09535-4","url":null,"abstract":"<p><p>Moral distress reflects often recurrent problems within a healthcare environment that impact the quality and safety of patient care. Examples include inadequate staffing, lack of necessary resources, and poor interprofessional teamwork. Recognizing and acting on these issues demonstrates a collaborative and organizational commitment to improve. Moral distress consultation is a health system-wide intervention gaining momentum in the United States. Moral distress consultants assist healthcare providers in identifying and strategizing possible solutions to the patient, team, and systemic barriers behind moral distress. Moral distress consultants offer unique perspectives on the goals, successes, areas for improvement, and sustainability of moral distress consultation. Their ideas can help shape this intervention's continued growth and improvement. This qualitative descriptive study features 10 semi-structured interviews with moral distress consultants at two institutions with longstanding, active moral distress consultation services. Themes from consultant transcripts included consultant training, understanding the purpose of moral distress consultation, interfacing with leadership teams, defining success, and improving visibility and sustainability of the service. These findings describe the beginnings of a framework that organizations can use to either start or strengthen moral distress consultation services, as well as the first steps in developing an evaluation tool to monitor their utility and quality.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-02DOI: 10.1007/s10730-024-09528-3
Christopher Lyon
The Canadian approach to assisted dying, Medical Assistance in Dying (MAiD), as of early 2024, is assessed for its ability to protect patients from criminal healthcare serial killing (HSK) to evaluate the strength of its safeguards. MAiD occurs through euthanasia or self-administered assisted suicide (EAS) and is legal or considered in many countries and jurisdictions. Clinicians involved in HSK typically target patients with the same clinical features as MAiD-eligible patients. They may draw on similar rationales, e.g., to end perceived patient suffering and provide pleasure for the clinician. HSK can remain undetected or unconfirmed for considerable periods owing to a lack of staff background checks, poor surveillance and oversight, and a failure by authorities to act on concerns from colleagues, patients, or witnesses. The Canadian MAiD system, effectively euthanasia-based, has similar features with added opportunities for killing afforded by clinicians' exemption from criminal culpability for homicide and assisted suicide offences amid broad patient eligibility criteria. An assessment of the Canadian model offers insights for enhancing safeguards and detecting abuses in there and other jurisdictions with or considering legal EAS. Short of an unlikely recriminalization of EAS, better clinical safeguarding measures, standards, vetting and training of those involved in MAiD, and a radical restructuring of its oversight and delivery can help mitigate the possibility of abuses in a system mandated to accommodate homicidal clinicians.
对加拿大截至 2024 年初的协助死亡方法--临终医疗协助(MAiD)--进行了评估,以确定其保护患者免受医疗保健连环杀人犯罪(HSK)侵害的能力,从而评估其保障措施的力度。临终关怀(MAiD)是通过安乐死或自控辅助自杀(EAS)的方式进行的,在许多国家和司法管辖区都是合法的或被考虑采用的。参与 HSK 的临床医生通常会选择与符合 MAiD 条件的患者具有相同临床特征的患者。他们可能基于类似的理由,例如结束病人可感知的痛苦并为临床医生带来愉悦。由于缺乏对工作人员背景的调查、监视和监督不力,以及当局未能就同事、患者或目击者的担忧采取行动,HSK可能在相当长的时间内未被发现或证实。加拿大的MAiD系统实际上是以安乐死为基础的,具有类似的特点,但由于临床医生免于承担杀人罪和协助自杀罪的刑事责任,加上病人资格标准宽泛,因此增加了杀人的机会。通过对加拿大模式的评估,我们可以深入了解如何加强保障措施,以及如何在加拿大和其他拥有或考虑拥有合法 EAS 的司法管辖区发现滥用行为。除了不太可能重新将 EAS 定为刑事犯罪之外,更好的临床保障措施、标准、对参与 MAiD 的人员进行审查和培训,以及对其监督和实施进行彻底重组,都有助于减少在一个受权容纳有杀人倾向的临床医生的系统中出现滥用的可能性。
{"title":"Canada's Medical Assistance in Dying System can Enable Healthcare Serial Killing.","authors":"Christopher Lyon","doi":"10.1007/s10730-024-09528-3","DOIUrl":"https://doi.org/10.1007/s10730-024-09528-3","url":null,"abstract":"<p><p>The Canadian approach to assisted dying, Medical Assistance in Dying (MAiD), as of early 2024, is assessed for its ability to protect patients from criminal healthcare serial killing (HSK) to evaluate the strength of its safeguards. MAiD occurs through euthanasia or self-administered assisted suicide (EAS) and is legal or considered in many countries and jurisdictions. Clinicians involved in HSK typically target patients with the same clinical features as MAiD-eligible patients. They may draw on similar rationales, e.g., to end perceived patient suffering and provide pleasure for the clinician. HSK can remain undetected or unconfirmed for considerable periods owing to a lack of staff background checks, poor surveillance and oversight, and a failure by authorities to act on concerns from colleagues, patients, or witnesses. The Canadian MAiD system, effectively euthanasia-based, has similar features with added opportunities for killing afforded by clinicians' exemption from criminal culpability for homicide and assisted suicide offences amid broad patient eligibility criteria. An assessment of the Canadian model offers insights for enhancing safeguards and detecting abuses in there and other jurisdictions with or considering legal EAS. Short of an unlikely recriminalization of EAS, better clinical safeguarding measures, standards, vetting and training of those involved in MAiD, and a radical restructuring of its oversight and delivery can help mitigate the possibility of abuses in a system mandated to accommodate homicidal clinicians.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}