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The Roles of Understanding and Belief in Prognostic Awareness. 理解和信念在预后意识中的作用。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-22 DOI: 10.1017/S0963180124000628
Alexander T Yahanda, Bryan A Sisk

Conventional understanding and research regarding prognostic understanding too often focuses on transmission of information. However, merely overcoming barriers to patient understanding may not be sufficient. In this article the authors provide a more nuanced understanding of prognostic awareness, using oncological care as an overarching example, and discuss factors that may lead to prognostic discordance between physicians and patients. We summarize the current literature and research and present a model developed by the authors to characterize barriers to prognostic awareness. Ultimately, multiple influences on prognostic understanding may impede acceptance by patients even when adequate transfer of information takes place. Physicians should improve how they transmit prognostic information, as this information may be processed in different ways. A model of misunderstandings in awareness, ranging from patient understanding to patient belief, may be useful to guide future discussions. Future decision-making studies should consider these many variables so that interventions may be created to address all aspects of the prognostic disclosure process.

有关预后理解的传统认识和研究往往侧重于信息传递。然而,仅仅克服患者理解方面的障碍可能还不够。在这篇文章中,作者以肿瘤治疗为例,对预后意识进行了更细致的理解,并讨论了可能导致医生和患者之间预后不一致的因素。我们总结了当前的文献和研究,并提出了作者开发的一个模型来描述预后意识的障碍。最终,对预后认识的多种影响因素可能会阻碍患者对预后的接受,即使在信息传递充分的情况下也是如此。医生应该改进他们传递预后信息的方式,因为这些信息可能会以不同的方式进行处理。从患者理解到患者信念的认知误区模型可能有助于指导未来的讨论。未来的决策研究应考虑这些变量,以便制定干预措施,解决预后信息披露过程中的各方面问题。
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引用次数: 0
Clinical Ethics and the Observant Jewish and Muslim Patient: Shared Theocentric Perspectives in Practice. 临床伦理与笃信犹太教和穆斯林的病人:在实践中共享以神论为中心的观点。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-22 DOI: 10.1017/S0963180124000379
Fahmida Hossain, Ezra Gabbay, Joseph J Fins

Patients from religious minorities can face unique challenges reconciling their beliefs with the values that undergird Western Medical Ethics. This paper explores homologies between approaches of Orthodox Judaism and Islam to medical ethics, and how these religions' moral codes differ from the prevailing ethos in medicine. Through analysis of religious and biomedical literature, this work examines how Jewish and Muslim religious observances affect decisions about genetic counseling, reproductive health, pediatric medicine, mental health, and end-of-life decisions. These traditions embrace a theocentric rather than an autonomy-based ethics. Central to this conception is the view that life and the body are gifts from God rather than the individual and the primacy of community norms. These insights can help clinicians provide care that aligns Muslim and Jewish patients' health goals with their religious beliefs and cultural values. Finally, dialogue in a medical context between these faith traditions provides an opportunity for rapprochement amidst geopolitical turmoil.

来自宗教少数群体的病人在协调其信仰与支撑西方医学伦理的价值观时可能会面临独特的挑战。本文探讨了东正教犹太教和伊斯兰教在医学伦理方面的相同之处,以及这些宗教的道德准则与医学界流行的风气有何不同。通过对宗教和生物医学文献的分析,本文研究了犹太教和穆斯林的宗教信仰如何影响有关遗传咨询、生殖健康、儿科医学、心理健康和临终决定的决策。这些传统信奉的是以神为中心的伦理学,而不是以自主为基础的伦理学。这种观念的核心是认为生命和身体是上帝而非个人的恩赐,以及社区规范的首要地位。这些观点可以帮助临床医生提供符合穆斯林和犹太患者的健康目标及其宗教信仰和文化价值观的医疗服务。最后,在地缘政治动荡的背景下,这些信仰传统之间的医学对话为和解提供了机会。
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引用次数: 0
Decreasing Perceived Moral Distress in Pediatrics Residents: A Pilot Study. 降低儿科住院医师的道德压力感:试点研究。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-20 DOI: 10.1017/S0963180124000355
Allison N J Lyle, Angela Quain, Sara Ali, Zeynep N Inanc Salih

Pediatric residents experience ethical dilemmas and moral distress during training. Few studies have identified meaningful methods in reducing moral distress in pediatric trainees. The authors aimed to determine how residents perceive ethics case discussions, whether such a program affects trainee ethics knowledge and perceived moral distress, and if residents' perceived moral distress changes before, during, and after a discussion series. Participants included pediatric residents in a single residency program. Five separate 1-hour sessions were presented over a 5-month period. Each session consisted of a case presentation by a resident developed under the guidance of an ethicist. Multidisciplinary services and content experts were present during sessions. Baseline, postsession, and final surveys were distributed to resident attendees. Open-ended responses were recorded. When comparing baseline and final responses, the only significance was increased preparedness to navigate ethical decisions (p = 0.004). A 10.2% decline was observed in perceived moral distress. An increase in ethics knowledge was observed. Residents favored case-based, multidisciplinary discussions. Residents desire more sessions, time for small-group discussions, and legal insight. Satisfaction was high with 90.7% of respondents feeling better prepared to address ethical concerns. Pediatric trainees desire case-based ethics training that incorporates small-group discussions and insight from multidisciplinary topic experts.

儿科住院医师在培训期间会遇到伦理困境和道德困扰。很少有研究发现了减少儿科学员道德困扰的有效方法。作者旨在确定住院医师如何看待伦理案例讨论,此类项目是否会影响学员的伦理知识和感知到的道德困扰,以及住院医师感知到的道德困扰在系列讨论之前、期间和之后是否会发生变化。参与者包括一个住院医师培训项目中的儿科住院医师。在为期 5 个月的时间里,他们分别参加了 5 次每次 1 小时的讨论。每节课都由一名住院医师在伦理学家的指导下进行病例陈述。多学科服务和内容专家在课程期间出席。向参加会议的住院医师发放了基线、会后和最终调查问卷。对开放式回答进行了记录。在比较基线和最终答复时,唯一有意义的是提高了引导伦理决策的准备程度(p = 0.004)。感知到的道德困扰下降了 10.2%。伦理知识有所增加。住院医生更喜欢基于案例的多学科讨论。住院医师希望有更多的课程、小组讨论时间和法律见解。满意度很高,90.7% 的受访者认为自己为解决伦理问题做好了更充分的准备。儿科受训人员希望在以案例为基础的伦理培训中加入小组讨论和多学科专家的见解。
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引用次数: 0
"Intellectual Lightening": A Tribute to John Harris through a Collection of Memories, Imaginary Books, Fictional Reviews, and an Interview. "智慧之光":通过回忆、想象书籍、小说评论和访谈集向约翰-哈里斯致敬。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-20 DOI: 10.1017/S0963180124000574
Inez de Beaufort

"INTELLECTUAL LIGHTENING": A tribute to John Harris through a collection of memories, imaginary books, fictional reviews, and an interview. John Harris' impressive and diverse academic career is illustrated and remembered by his colleagues who each contribute with a special memory, story or fake book review, in order to thank John and to cherish the memories. A good philosopher, a kind person, a teacher, different aspects of his work are discussed.

"智慧之光":通过回忆、想象中的书籍、虚构的书评和访谈向约翰-哈里斯致敬。约翰-哈里斯令人印象深刻而又丰富多彩的学术生涯被他的同事们绘声绘色地描绘出来,他们每个人都贡献了一段特别的回忆、故事或虚构的书评,以此来感谢约翰并怀念他。约翰-哈里斯是一位优秀的哲学家,一位善良的人,一位教师,他的工作涉及方方面面。
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引用次数: 0
An Educational Framework for Healthcare Ethics Consultation to Approach Structural Stigma in Mental Health and Substance Use Health. 医疗保健伦理咨询的教育框架,以解决心理健康和药物使用健康中的结构性污名问题。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-19 DOI: 10.1017/S0963180124000410
Zahra S Hasan, Daniel Z Buchman

This paper addresses the need for, and ultimately proposes, an educational framework to develop competencies in attending to ethical issues in mental health and substance use health (MHSUH) in healthcare ethics consultation (HCEC). Given the prevalence and stigma associated with MHSUH, it is crucial for healthcare ethicists to approach such matters skillfully. A literature review was conducted in the areas of bioethics, health professions education, and stigma studies, followed by quality improvement interviews with content experts to gather feedback on the framework's strengths, limitations, and anticipated utility. The proposed framework describes three key concepts: first, integrating self-reflexive practices into formal, informal, and hidden curricula; second, embedding structural humility into teaching methods and contexts of learning; and third, striking a balance between critical consciousness and compassion in dialogue. The proposed educational framework has the potential to help HCEC learners enhance their understanding and awareness of ethical issues related to structural stigma and MHSUH. Moreover, context-specific learning, particularly in MHSUH, can play a significant role in promoting competency-building among healthcare ethicists, allowing them to address issues of social justice effectively in their practice. Further dialogue is encouraged within the healthcare ethics community to further develop the concepts described in this framework.

本文论述了在医疗保健伦理咨询(HCEC)中发展处理精神健康和药物使用健康(MHSUH)伦理问题能力的教育框架的必要性,并最终提出了这一框架。鉴于 MHSUH 的普遍性和耻辱感,医疗伦理学家必须熟练地处理此类问题。我们对生物伦理学、卫生专业教育和污名化研究等领域进行了文献综述,随后与内容专家进行了质量改进访谈,以收集有关该框架的优势、局限性和预期效用的反馈意见。建议的框架描述了三个关键概念:第一,将自我反思实践融入正式、非正式和隐性课程;第二,将结构性谦逊融入教学方法和学习环境;第三,在对话中兼顾批判意识和同情心。拟议的教育框架有可能帮助幼儿保育和教育学习者提高对与结构性成见和 MHSUH 相关的伦理问题的理解和认识。此外,针对具体情境的学习,尤其是在 MHSUH 方面的学习,可以在促进医疗保健伦理学家的能力建设方面发挥重要作用,使他们能够在实践中有效地解决社会正义问题。我们鼓励医疗伦理界进一步开展对话,以进一步发展本框架中描述的概念。
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引用次数: 0
Teaching Ethics Consultation Using a Tabletop Exercise. 利用桌面练习教授伦理咨询。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-19 DOI: 10.1017/S0963180124000409
Hilary Mabel, Susan McCammon, Margot M Eves

Drawing on pedagogical tools utilized in clinical scenario simulation and emergency preparedness training, the authors describe an innovative method for teaching clinical ethics consultation skills, which they call a "tabletop" exercise. Implemented at the end of a clinical ethics intensive course, the tabletop enables learners to implement the knowledge and practice the skills they gained during the course. The authors highlight the pedagogical tools on which the tabletop exercise draws, describe the tabletop exercise itself, offer how to best operationalize such an exercise, reflect on the method's strengths and weaknesses, and provide insights for others who may want to implement their own tabletop for ethics consultation education.

作者借鉴了临床情景模拟和应急准备培训中使用的教学工具,介绍了一种创新的临床伦理咨询技能教学方法,他们称之为 "桌面 "练习。在临床伦理学强化课程结束时进行的 "桌面 "练习,可以让学员运用在课程中获得的知识和技能。作者重点介绍了 "桌面 "练习所借鉴的教学工具,描述了 "桌面 "练习本身,提出了如何以最佳方式操作此类练习,反思了该方法的优缺点,并为其他可能希望在伦理咨询教育中实施自己的 "桌面 "练习的人提供了见解。
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引用次数: 0
The Contested Value of Life. 有争议的生命价值
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-15 DOI: 10.1017/S0963180124000598
Søren Holm

Putting a specific value on human life is important in many contexts and forms part of the basis for many political, administrative, commercial, and personal decisions. Sometimes, the value is set explicitly, sometimes even in monetary terms, but much more often, it is set implicitly through a decision that allows us to calculate the valuation of a life implicit in a certain rule or a certain resource allocation. We also value lives in what looks like a completely different way when we evaluate whether a particular life is being or has been lived well. Both of these ways of valuing are done from an outside or third-person perspective, but there is also a third way of valuing a life which is from the first-person perspective, and which essentially asks how much my life is worth to me. Is there any connection between these different ways of valuing life, and if so what is the connection between them? This paper provides an account of John Harris' analysis of the value of life and discusses whether it can bridge the gap between first-person and third-person evaluations of the value of life, and whether it can do so in a way that still allows for resource allocation decisions to be made in health care and other sectors.

为人的生命确定具体的价值在许多情况下都很重要,是许多政治、行政、商业和个人决策的基础之一。有时,这种价值是明确确定的,有时甚至是以货币形式确定的,但更常见的情况是,这种价值是通过一项决定隐含地确定的,这项决定使我们能够计算出某项规则或某种资源分配中隐含的生命价值。当我们评估某个生命是否正在或已经活得很好时,我们也会以一种看似完全不同的方式对生命进行估价。这两种估价方式都是从外部或第三人称的角度进行的,但还有第三种估价方式,即从第一人称的角度进行估价,主要是问我的生命对我来说值多少钱。这些不同的生命价值评估方式之间是否有任何联系,如果有,它们之间的联系是什么?本文介绍了约翰-哈里斯对生命价值的分析,并讨论了这种分析能否弥合第一人称和第三人称生命价值评价之间的差距,以及这种分析能否在医疗保健和其他部门做出资源分配决策时仍能做到这一点。
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引用次数: 0
Developing a Postpandemic Model for Hybrid Clinical Ethics Rotations in Postgraduate Medical Education. 为医学研究生教育中的混合临床伦理轮训开发一种后流行模式。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-13 DOI: 10.1017/S0963180124000458
Sara Kolmes, Kevin M Dirksen

Bioethics education in residency helps trainees achieve many of the Accreditation Council for Graduate Medical Education milestones and gives them resources to respond to bioethical dilemmas. For this purpose, The Providence Center for Health Care Ethics has offered a robust clinical ethics rotation since 2000. The importance of bioethics for residents was highlighted as the COVID-19 pandemic raised significant bioethical concerns and moral distress for residents. This, combined with significant COVID-19-related practical stressors on residents led us to develop a virtual ethics rotation. A virtual rotation allowed residents flexibility as they were called to help respond to the unprecedented demands of a pandemic without compromising high quality education. This virtual rotation prioritized flexibility to support resident wellbeing and ethical analysis of resident experiences. This article describes how this rotation was able to serve residents without overstraining limited bandwidth, and address the loci of resident pandemic distress. As pandemic pressures lessened, The Providence Center for Health Care Ethics transitioned to a hybrid rotation which continues to prioritize resident wellbeing and analysis of ongoing stressors while incorporating in-person elements where they can improve learning. This article provides a description of the rotation in its final form and resident feedback on its effectiveness.

住院医师培训中的生命伦理学教育有助于学员实现毕业医学教育认证委员会的许多里程碑,并为他们提供应对生命伦理学困境的资源。为此,普罗维登斯医疗保健伦理中心自 2000 年起就开设了强大的临床伦理轮转课程。COVID-19 大流行给住院医师带来了重大的生命伦理问题和道德困扰,这凸显了生命伦理学对住院医师的重要性。再加上 COVID-19 给住院医生带来的巨大实际压力,促使我们开发了虚拟伦理轮转课程。虚拟轮转使住院医师能够灵活应对前所未有的大流行病需求,同时又不影响高质量的教育。这种虚拟轮转优先考虑灵活性,以支持住院医师的健康和对住院医师经历的伦理分析。本文介绍了这一轮换如何在不过度占用有限带宽的情况下为住院医师提供服务,并解决住院医师在大流行病中的困扰。随着大流行压力的减小,普罗维登斯医疗保健伦理中心过渡到了混合轮转,继续优先考虑住院医师的福利和对持续压力的分析,同时在可以提高学习效果的地方加入了亲临现场的元素。本文介绍了轮转的最终形式以及住院医师对其有效性的反馈意见。
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引用次数: 0
What It Means to Be Human: A Response to Harzheim. 做人意味着什么?对哈茨海姆的回应
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-12 DOI: 10.1017/S0963180124000525
Ezra N S Lockhart

This response engages critically with Harzheim's review of Thomas Fuchs' In Defense of the Human Being: Foundational Questions of an Embodied Anthropology. Fuchs' work offers a profound exploration of embodied cognition, arguing that human cognition and existence are deeply shaped by our physical interactions. Harzheim's critique highlights significant aspects of Fuchs' framework, including his critique of functionalist models, the impact of transhumanist technologies, and ethical concerns in healthcare technology. This paper extends Harzheim's review by proposing an integration of functionalist and embodied cognitive models, emphasizing the need for a comprehensive evaluation of technological impacts, and advocating for a more robust ethical framework that considers social equity. Additionally, it addresses the is-ought distinction and explores the implications of technological advancements on human identity and mental health. Doede's critique is also discussed, underscoring the importance of integrating diverse cognitive models and addressing technological determinism. Overall, this response calls for a more nuanced and inclusive approach to the discourse on embodied cognition, aiming to enrich the scholarly conversation and address the complexities and implications of Fuchs' analysis.

这篇回应对哈茨海姆对托马斯-福克斯的《为人类辩护》的评论进行了批判:体现人类学的基本问题》一书的评论。福克斯的著作对具身认知进行了深刻的探讨,认为人类的认知和存在深深地受到我们身体互动的影响。哈兹海姆的评论强调了福克斯框架的重要方面,包括他对功能主义模型的批判、超人类技术的影响以及医疗保健技术中的伦理问题。本文对哈茨海姆的评论进行了延伸,提出了功能主义和具身认知模型的整合方案,强调了全面评估技术影响的必要性,并主张建立一个考虑社会公平的更健全的伦理框架。此外,报告还讨论了是与非的区别,并探讨了技术进步对人类身份和心理健康的影响。还讨论了 Doede 的批评意见,强调了整合不同认知模型和解决技术决定论的重要性。总之,本回应呼吁对具身认知的讨论采取更加细致入微、更具包容性的方法,旨在丰富学术对话,解决福克斯分析的复杂性和影响。
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引用次数: 0
The Value of Life and Reproductive and Professional Autonomy. 生命价值与生殖和职业自主权。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-11 DOI: 10.1017/S0963180124000537
Lucy Frith

This article considers John Harris' work on autonomy, specifically reproductive autonomy, outlined in The Value of Life and developed throughout his career. Harris often used the concept of reproductive autonomy to make the case for liberal approaches to developments in reproductive and genetic technologies. Harris argued that reproductive autonomy should be highly valued, and therefore we need compelling arguments to justify limiting it in anyway. When discussing reproductive autonomy, Harris focused mainly on restrictions on the potential users of reproductive technologies autonomy, that is, prospective parents. This article extends the discussion of autonomy and the appropriate limits to individuals exercising their autonomy to medical professionals working in this area. Given reproductive technologies have become part of routine medical practice, this article considers whether the current restrictions on both patients and clinicians, as imposed by regulators and professional guidelines, remain ethically justified.

本文探讨了约翰-哈里斯在《生命的价值》(The Value of Life)一书中概述并在其整个职业生涯中发展的关于自主权,特别是生殖自主权的工作。哈里斯经常使用生育自主权的概念来为生育和基因技术的发展提供自由主义的论据。哈里斯认为,生殖自主权应得到高度重视,因此我们需要令人信服的论据来证明限制生殖自主权是合理的。在讨论生育自主权时,哈里斯主要关注对生育技术潜在使用者(即未来父母)自主权的限制。本文将自主权以及对个人行使自主权的适当限制的讨论扩展到从事这一领域工作的医疗专业人员。鉴于生殖技术已成为常规医疗实践的一部分,本文探讨了目前监管机构和专业准则对患者和临床医生的限制在伦理上是否仍然合理。
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引用次数: 0
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Cambridge Quarterly of Healthcare Ethics
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