Bioethics forum最新文献

The mistreatment of elders by their adult children, spouses, or other caregivers is a problem of increasing magnitude. We have few laws and even fewer policies to help caregivers identify and prevent abuse, partly because it has no common pattern, and partly because it so often goes unreported. Abuse can be intentional or unintentional, and as often results from failing to act, as from acts of anger or cruelty. Therefore, we must do a better job of enforcing mandatory reporting and educating and supporting our caregivers to prevent stress and burnout. Above all, we must seek an ethical course of action, knowing that there are legal, personal, and professional ethical ideals and standards that can guide us, whether the elderly are being cared for in their own home or in nursing homes.

Healthcare that is respectful and ethical must also be culturally competent, and a variety of tools are available to empower caregivers to provide culturally competent care. This article reviews the tools that the University of Michigan Health Care System's Program for Multicultural Health provides to caregivers throughout its many services. Cultural competency begins with self-awareness and knowledge, but it is also to embark upon a lifelong journey. Progress is cumulative, and assessment is an important part of the process.

The way we think about and care for people with developmental disability has changed. Twenty-five years ago, society believed that caregivers always knew what was best for their individual and that he or she must be shielded, even shut away from, the harms that could occur in society. Now, people with disability participate in all aspects of community life. They are educated in local schools, live at home or in their own home, and compete with others in the job market. Caregiving for people with developmental disability is no longer modeled on medicine or stigmatizing labels. Instead, caregivers have become support persons who focus on identifying community resources and making the environment friendlier and safer for persons with disability.

As science progresses, new issues in bioethics grab the headlines, but in neonatal medicine communication and decision making for sick and premature infants is as important today as it was thirty years ago. Decisions have to be made and made well, despite suboptimal time, data, or knowledge. To this end, the authors propose good communication and a cooperative model as key to interpreting the best interest standard in a way that respects parental rights and responsibility and allows best interest to be decided from an amalgam of medical facts and human values.

The success of our future efforts to understand and improve the ethics of pediatric informed consent may depend, in large measure, on our willingness and ability to conceive of child assent and parental permission as joint, mutually affective processes. Given current trends, our empirical efforts may need to unfold at the interface of assent and parental permission, rather than exclusively or even primarily in one domain or the other. This shift will permit researchers to identify those areas in which the two mechanisms function in concert--in the best interests of patients, parents, and clinicians--and those in which they do not. Targeting these problematic areas for intervention and improvement may result in a more effective consent process for clinical research involving minors.

Moral distress in healthcare results from a professional's inability to provide compassionate care to patients because of individual, organizational, or societal barriers. Research suggests that moral distress is a growing concern among nurses, and may be a major reason why nurses leave one job for another or abandon the profession of nursing. Some professionals, however, have identified strategies that help them work through their moral distress toward an experience of moral comfort. These strategies may be individual, organizational, or societal. The focus of this paper is to identify examples of strategies professionals have used to alleviate distressful feelings and enhance moral comfort.

Children always merit special ethical concern in mental health research and treatment. But children with depression are a particularly vulnerable population because of developmental considerations and the severity of the illness. This article reviews ethical concerns regarding assessment of depression, clinical care, and research with children.