Hec Forum最新文献

In vitro fertilization (IVF) offers transformative opportunities for women facing infertility; however, it also presents significant challenges to their mental health. Clinical research has substantiated the need for adequate mental health support for women undergoing IVF. In this article, I argue that ethics consultation should be recognized as an important resource for providing this support. Drawing on the cognitive theory of emotion, which posits that emotions are or are caused by cognitive evaluations, I analyze the evaluative judgments and conflicts that underlie women's emotional responses to IVF. I contend that ethics consultation can offer a distinctive form of mental health support in resolving those evaluative conflicts. Unlike cognitive therapy, which often aims to modify or correct evaluative judgments, ethics consultation validates these judgments as meaningful reflections of patients' values and facilitates deliberative prioritization among competing values. This paper offers a theoretical framework for understanding the role of ethics consultation in providing mental health support in IVF care.

Limited data exists that examines the reasons clinical ethics consultations in the healthcare industry are requested. To add to the literature, we have evaluated the reasons clinic ethics consults were requested at Indiana Health University (IUH) in 2023 to improve future patient care, identify quality improvement opportunities, educate fellow team members at IUH, as well as to inform research and address institutional policy changes. This information was identified through data collected using the REDCap Database and Cerner, the electronic medical record that is used at IUH. Our results show 170 ethics consultations were requested between the dates of January 1, 2023, to December 31, 2023, for adult patients, including inpatient and outpatient locations. Provider moral distress was identified to be the most frequent ethics issue that arose, along with patient best interest and decision-making capacity. The ethics consultation service at IUH has reviewed the data collected in this study and is actively working to improve ethics education opportunities for bedside team members, identifying recurrent ethical dilemmas, and improving the overall function of the ethics consultation service.

Sometimes patients or their legally authorized representatives/surrogate decision makers request interventions that clinicians believe ought not to be provided because, for example, they will merely prolong the life of a patient whose quality of life clinicians deem poor. When such disagreements cannot be resolved, clinicians may request a clinical ethics consultation. Some institutions have policies and some jurisdictions have laws addressing such conflicts, many of which involve procedures that ultimately allow for unilaterally withholding life-sustaining interventions. Autumn Fiester has argued that a radically new approach for addressing such conflicts is needed. I argue that Fiester's analysis relates closely to and has implications for other debates and key topics in the bioethics literature and raises important questions that merit further exploration. These include the concept of professional values or professional ethics and of values imposition, both of which are important in the literature on conscientious objection.

Conflicts involving end-of-life care between healthcare providers (HCPs) and surrogate decision-makers (SDMs) have received sustained attention for more than a quarter of a century, with early studies demonstrating a frequency of HCP-SDM conflict in ICUs ranging from 32-78% of all admissions (Abbott et al. 2001; Breen et al. 2001; Studdert et al. 2003; Azoulay et al. 2009). More recent studies not only acknowledge the persistence of clinical conflict in end-of-life care (Leland et al. 2017), but they have begun to focus on the ways in which these conflicts escalate to verbal or physical violence in the ICU (Slack et al. 2023; Bass et al. 2024; Berger et al. 2024; Sjöberg et al. 2024). I will argue that part of the explanation for the persistence-and even escalation-of ICU disputes is the incommensurable value systems held by many conflicting HCPs and SDMs. I will argue that a common value system among HCPs can be understood as a "Best Interest Values" (BIV) hierarchy, which I will argue is irreconcilable with the set of "Life-Continuation Values" (LCV) held by a sizable minority of families in the United States. I argue this values-conflict undergirds many ICU disputes. If I am correct that an incommensurable value system underlies many ICU conflicts, then it is not just ineffectual for HCPs to impose their BIV system on LCV families, but also wrong given the American commitment to values pluralism. I conclude that the way to navigate continuous ICU surrogate wars is for BIV-focused healthcare institutions to engage more constructively with LCV stakeholders.

Medical futility laws protect surrogate decision makers by constraining clinicians and hospitals. Professor Fiester shows that clinicians and surrogate decision makers often have different value systems. Clinicians espouse the "Best Interest Values" (BIV) system, while surrogates often espouse the "Life-Continuation Values" (LCV) system. Professor Fiester argues that there is no way to adjudicate between the BIV and LCV value systems. They are incommensurable and irreconcilable. Surrogates are not "wrong" about the patient's best interest. They just measure it differently. Consequently, because clinicians have no superior ethical claim to determine the patient's best interest, they should not impose their value-laden notion onto surrogates. I question whether clinicians are as powerful as Professor Fiester suggests. In fact, laws in many U.S. states materially constrain clinicians and hospitals, requiring them to do precisely what the LCV surrogate wants. Therefore, in these jurisdictions, clinicians are already forced to undertake the "constructive engagement" that Professor Fiester calls for. In these states, the BIV does not subjugate the LCV. Rather, the LCV likely subjugates the BIV.