Clinical Ethics最新文献

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Health policy narratives contributing to health inequities experienced by people with intellectual/developmental disabilities: New evidence from COVID-19 卫生政策叙述助长了智力/发育障碍者所经历的卫生不平等:来自COVID-19的新证据

Q1 Arts and Humanities

Clinical Ethics

Pub Date : 2023-09-12 DOI: 10.1177/14777509231196704

Sandra Marquis, Renee O'Leary, Nilanga Aki Bandara, Jennifer Baumbusch

This paper discusses three cultural narratives that threaten the health of people with intellectual/developmental disabilities (IDD) and which have become more evident during the COVID-19 pandemic. These meta-narratives are the medical model of health/disability; the population health approach to health inequalities; and policies premised on the assumption of the importance of national economic growth as an incentive for reducing health inequalities. Evidence exists that health research is more likely to become policy if it fits within a medical model and addresses national economic growth. These two criteria are particularly problematic for people who have IDD. The paper also proposes a research model to facilitate the inclusion of IDD related issues in future policy regarding health inequalities.

本文讨论了威胁智力/发育障碍(IDD)患者健康的三种文化叙事，这些叙事在COVID-19大流行期间变得更加明显。这些元叙述是健康/残疾的医学模式;解决保健不平等问题的人口保健办法;政策的前提假设是国家经济增长的重要性是减少健康不平等的激励因素。有证据表明，如果健康研究符合医学模式并解决国家经济增长问题，那么它更有可能成为政策。这两个标准对缺乏症患者来说尤其成问题。本文还提出了一个研究模型，以促进将缺碘症相关问题纳入未来关于保健不平等的政策。

引用次数: 0

Corrigendum to ‘Ethical challenges in clinical studies with adaptive design in oncology 肿瘤学适应性设计临床研究中的伦理挑战的勘误表

Q1 Arts and Humanities

Clinical Ethics

Pub Date : 2023-09-11 DOI: 10.1177/14777509231202190

引用次数: 0

What is 'medical necessity'? 什么是“医疗需要”?

Q1 Arts and Humanities

Clinical Ethics

Pub Date : 2023-09-01 DOI: 10.1177/14777509231190521

Dominic Jc Wilkinson

Imagine that we are considering whether our healthcare system (or insurer) should fund treatment or procedure X. One factor that may be cited is that of so-called 'medical necessity'. The claim would be that treatment X should be eligible for funding if it is medically necessary, but ineligible if this does not apply. Similarly, (and relevant to the debates in this special issue), if considering whether a particular treatment should be ethically and/or legally permitted, we may wish to distinguish between cases where the treatment is medically necessary, and those were it is not. But what do we mean by this concept? Here I will propose and briefly defend one plausible and practical definition.

想象一下，我们正在考虑我们的医疗保健系统(或保险公司)是否应该为治疗或x手术提供资金。一个可能被引用的因素是所谓的“医疗需要”。这种说法是，如果X治疗在医学上是必要的，它应该有资格获得资助，但如果这一点不适用，它就不合格。同样，(与本期特刊的辩论有关)，如果考虑某一特定治疗是否应该在道德和/或法律上得到允许，我们不妨区分治疗在医学上是必要的情况和在医学上不是必要的情况。但是这个概念是什么意思呢?在这里，我将提出并简要地捍卫一个合理而实用的定义。

引用次数: 2

'Maternal Request' Caesarean Sections and Medical Necessity. “产妇请求”剖腹产和医疗需要。

Q1 Arts and Humanities

Clinical Ethics

Pub Date : 2023-09-01 Epub Date: 2023-06-26 DOI: 10.1177/14777509231183365

Rebecca Ch Brown, Andrea Mulligan

引用次数: 0

Medical need and health need. 医疗需要和健康需要。

Q1 Arts and Humanities

Clinical Ethics

Pub Date : 2023-09-01 DOI: 10.1177/14777509231173561

Ben Davies

I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an overly strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort.

我介绍了健康需求和医疗需求之间的区别，并就它们之间的相互作用提出了几个问题。健康需求是与我们的健康状况直接相关的需求。医疗需求是指与医疗机构或医疗过程有一定关系的需求。我认为，医疗保险或公共保健是应包括医疗需要、健康需要，还是只包括两种需要，这是一个无法得到明确解决的政治问题。我也反对对医疗需求过于严格的定义，因为这错误地预设了医疗干预应该永远是最后的手段。

引用次数: 2

Navigating conflict: The role of mediation in healthcare disputes 导航冲突:调解在医疗纠纷中的作用

Q1 Arts and Humanities

Clinical Ethics

Pub Date : 2023-08-29 DOI: 10.1177/14777509231196699

Jaime Lindsey, M. Doyle, Katarzyna Wazynska-Finck

Navigating conflict in healthcare settings can be challenging for all parties involved. Here, we analyse disputes about the provision of healthcare to patients, specifically exploring how mediation might be used to resolve disputes where healthcare professionals may disagree with the patient themselves or the patient's family about what healthcare is in the patient's best interests. Despite concerns about compromise over the patient's best interests, there is often room for the parties to come together and think about how the dispute might be resolved in a way that is acceptable to all. It is in this space where mediation might step in. We set out the potential benefits and risks of mediation in this article, and argue that there is a need for clearer, empirically grounded evidence on the use of mediation in healthcare disputes.

在医疗环境中处理冲突对所有相关方都具有挑战性。在这里，我们分析了关于向患者提供医疗保健的争议，特别是探索如何使用调解来解决医疗保健专业人员可能不同意患者自己或患者家属关于患者最佳利益的医疗保健的争议。尽管担心会损害病人的最大利益，但双方通常还是有空间走到一起，考虑如何以一种各方都能接受的方式解决争议。在这个领域，调解可能会介入。我们在本文中列出了调解的潜在好处和风险，并认为需要更清晰、基于经验的证据来证明在医疗纠纷中使用调解。

引用次数: 0

Changes in abortion legislation and admissions to paediatric intensive care in Ireland 爱尔兰堕胎立法的变化和儿科重症监护的入院情况

Q1 Arts and Humanities

Clinical Ethics

Pub Date : 2023-08-21 DOI: 10.1177/14777509231196700

N. Tierney, M. Healy, B. Lyons

The Health (Regulation of Termination of Pregnancy) Act 2018 was commenced on 01/01/2019 in Ireland. The Act provides for legal termination of pregnancy under defined circumstances including for any reason at < 12 weeks gestation; and where two doctors agree there is ‘a condition affecting the foetus that is likely to lead to the death of the foetus either before, or within 28 days of, birth’. As such, abortion for congenital anomaly (CA) can occur at a number of time points, depending on the adjudged severity. Infants born with CAs frequently require significant medical intervention and account for a high proportion of admissions to paediatric intensive care units (PICUs). The purpose of this paper was to evaluate the number of infants with CAs admitted to an Irish PICU in the period before and after the implementation of the Act. All PICU admissions < 1 month of age to a single Irish paediatric hospital between 2012 and 2021 were analysed. CAs were recorded, and the periods before and after the commencement of the Act compared. We found a difference in admissions involving CAs, particularly those related to congenital heart disease involving single ventricle anatomy. It is plausible that this difference was as a result of improved access to abortion services following the implementation of the Act. This article explores the legal conditions related to the abortion of a foetus with a CA in Ireland, and the possible impact of the Independent Review of the Operation of the Health ( Regulation of Termination of Pregnancy) Act 2018.

《2018年健康（终止妊娠条例）法》于2019年1月1日在爱尔兰生效。该法规定在特定情况下合法终止妊娠，包括在妊娠12周以下因任何原因终止妊娠；两名医生一致认为“存在影响胎儿的情况，可能导致胎儿在出生前或出生后28天内死亡”。因此，先天性畸形（CA）的流产可能发生在多个时间点，具体取决于判定的严重程度。出生时患有CA的婴儿经常需要大量的医疗干预，并且在儿科重症监护室（PICU）的入院人数中占很大比例。本文的目的是评估该法案实施前后爱尔兰PICU收治的CA婴儿数量。分析了2012年至2021年间爱尔兰一家儿科医院收治的所有小于1个月大的PICU患者。对CA进行了记录，并对法案生效前后的时期进行了比较。我们发现涉及CAs的入院率存在差异，尤其是与涉及单心室解剖的先天性心脏病相关的入院率。这种差异似乎是由于该法案实施后获得堕胎服务的机会增加所致。本文探讨了爱尔兰与CA胎儿堕胎相关的法律条件，以及《2018年健康运作独立审查（终止妊娠条例）法》可能产生的影响。

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引用次数: 0

The child's right to bodily integrity and autonomy: A conceptual analysis 儿童身体完整和自主的权利:概念分析

Q1 Arts and Humanities

Clinical Ethics

Pub Date : 2023-07-25 DOI: 10.1177/14777509231188817

J. Pugh

It is widely accepted that children enjoy some form of a right to bodily integrity. However, there is little agreement about the precise nature and scope of this right. This paper offers a conceptual analysis of the child's right to bodily integrity, in order to further elucidate the relationship between the child's right to bodily integrity and considerations of autonomy. Following a discussion of Leif Wenar's work on the structure and justification of rights, I first explain how the adult's right to bodily integrity can be distilled into separate elements that may plausibly be justified by different moral considerations. In particular, I claim that this analysis suggests that whilst the adult's right to bodily integrity is not wholly reducible to bodily autonomy, autonomy nonetheless remains entwined with our understanding of this right in a number of ways. On the basis of this discussion, I go on to outline three important complexities that arise when we consider the child's right to bodily integrity, before particularly focusing on the question of how third parties should determine whether or not to perform a physical interference upon a child who lacks decision-making capacity. Here, I raise some objections to Earp and Mazor's recent attempts to answer this question, before briefly defending an ‘autonomy-based interests’ account of permissible interference, an account that shares in what I take to be the spirit, if not the precise letter, of these earlier views.

人们普遍认为，儿童享有某种形式的身体完整权。然而，对这项权利的确切性质和范围几乎没有达成一致意见。本文对儿童身体完整权进行了概念分析，以进一步阐明儿童身体完整权利与自主考虑之间的关系。在讨论了Leif Wenar关于权利的结构和正当性的工作之后，我首先解释了成年人的身体完整权如何被提炼成不同的元素，这些元素可能会因不同的道德考虑而合理。特别是，我声称，这一分析表明，虽然成年人的身体完整权并不能完全归结为身体自主，但自主在许多方面仍然与我们对这一权利的理解息息相关。在这一讨论的基础上，我接着概述了当我们考虑儿童的身体完整权时出现的三个重要复杂性，然后特别关注第三方应如何决定是否对缺乏决策能力的儿童进行身体干预的问题。在这里，我对Earp和Mazor最近试图回答这个问题提出了一些反对意见，然后简要地为允许干涉的“基于自主的利益”的说法辩护，我认为这种说法与这些早期观点的精神（如果不是确切的文字的话）是一致的。

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引用次数: 3

The paradox of medical necessity 医疗需要的悖论

Q1 Arts and Humanities

Clinical Ethics

Pub Date : 2023-07-17 DOI: 10.1177/14777509231188830

S. Godwin, B. Earp

The concept of medical necessity is often used to explain or justify certain decisions—for example, which treatments should be allowed under certain conditions—as though it had an obvious, agreed-upon meaning as well as an inherent normative force. In introducing this special issue of Clinical Ethics on medical necessity, we argue that the term, as used in various discourses, generally lacks a definition that is clear, non-circular, conceptually plausible, and fit for purpose. We propose that future work on this concept should address three main questions: what medical necessity is (i.e., what makes something medically necessary, as opposed to something else); what the concept does (what ‘work’ is it doing when invoked in different settings); and what should follow, normatively, from the fact that something is indeed medically necessary (on some plausible conception).

医疗必要性的概念经常被用来解释或证明某些决定的合理性——例如，在某些条件下应该允许哪些治疗——就好像它有一个明显的、一致同意的含义以及一种固有的规范性力量。在介绍这期关于医疗必要性的《临床伦理学》特刊时，我们认为，在各种论述中使用的这个术语通常缺乏清晰、非循环、概念合理且符合目的的定义。我们建议，未来关于这一概念的工作应解决三个主要问题：什么是医疗必要性（即，是什么使某种东西在医学上是必要的，而不是其他东西）；概念的作用（当在不同的设置中调用时，它所做的“工作”是什么）；以及从某种医学上确实是必要的这一事实（在某种看似合理的概念上），规范地说应该遵循什么。

引用次数: 2

Fixing bodies and shaping narratives: Epistemic injustice and the responses of medicine and bioethics to intersex human rights demands 修复身体和塑造叙事:认识上的不公正以及医学和生物伦理学对双性人人权要求的反应

Q1 Arts and Humanities

Clinical Ethics

Pub Date : 2023-06-25 DOI: 10.1177/14777509231180412

Morgan Carpenter

Children with innate variations of sex characteristics (also termed differences of sex development or intersex traits) are routinely subjected to medical interventions that aim to make their bodies appear or function more typically female or male. Many such interventions lack clear evidence of benefit, they have been challenged for thirty years, and they are now understood to violate children’s rights to bodily autonomy and bodily integrity. In this paper I argue that these persist in part due to epistemic injustices and biomedical authority. Epistemic injustices include limited disclosure of current practices, the systemic marginalisation of community voices and psychosocial professionals, and attempts to discredit or misrepresent testimony. Bioethics has largely failed to change medical practice, and sometimes plays a role in perpetuating epistemic injustices. I find that the development of an intersex movement provides opportunities for epistemic justice and liberation by engaging with other disciplines and promoting oversight of medical decision-making. The paper draws particularly on Australian sources, including internationally influential ethical principles.

具有先天性别特征差异(也称为性发育差异或双性人特征差异)的儿童经常接受医疗干预，目的是使他们的身体看起来或功能更典型地为女性或男性。许多此类干预措施缺乏明确的益处证据，30年来一直受到质疑，现在人们认为它们侵犯了儿童的身体自主权和身体完整权。在本文中，我认为这些持续存在的部分原因是由于认识上的不公正和生物医学权威。认识上的不公正包括对当前做法的披露有限，社区声音和社会心理专业人员的系统性边缘化，以及试图诋毁或歪曲证词。生物伦理学在很大程度上未能改变医疗实践，有时在延续认知不公正方面发挥作用。我发现，阴阳人运动的发展通过与其他学科的合作和促进对医疗决策的监督，为认识正义和解放提供了机会。该论文特别引用了澳大利亚的资料，包括具有国际影响力的伦理原则。

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引用次数: 1

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