Hot Topics: Clinical Ethics

Blog Posts (19)

March 2, 2014

Is there a philosophy of clinical ethics? What does a clinical ethicist do?

<p class="MsoNormal">If someone asked me: What is my philosophy of clinical ethics? I would initially be dumbstruck for an answer. In response, I would probably try to define an answer from my background in bioethics and philosophy. I would pick frameworks in philosophy that represent my approach. For example, I would be inclined to refer to pragmatism and casuistry, as frameworks that determine my clinical ethics approach. <a href="/BioethicsBlog/post.cfm/a-brain-dead-woman-and-her-fetus-calculating-rights-and-wrongs">My last blogpost</a> about Marlise Munoz, the brain dead woman in Texas is a good example of this. My philosophy as a clinical ethicist is based on the facts of the case, a subsequent calculation of rights and wrongs. The outcome of this sum guides my ethics advice about what is practically possible, conform short-handed <a href="http://plato.stanford.edu/entries/pragmatism/">pragmatism</a>. In responding to a case, I start with the specifics of a case and formulate answers that may be acceptable by multiple stakeholders, instead of relying on general theoretical outcomes, as a short-handed <a href="http://plato.stanford.edu/entries/theory-bioethics/#StrParCas">casuist</a>. Finally, I reason along the lines of several relevant principles, such as autonomy, beneficence, non-maleficence, justice and dignity, and seek to apply these principles to the specifics of a case.</p> <p class="MsoNormal">However, given that the background of clinical ethicists lies over a broad spectrum, I doubt that this answer would be satisfactory.  If I hadn’t had a background in bioethics, what would I have answered to this question? Does the fact that I am an ethicist in the clinic mean that I have to frame my answers along philosophical and ethical theories? Would a social worker, an accountant or an attorney equally have a philosophy in their work? Asking myself this latter question, I think that those professions do have a professional philosophy, but that they would be less likely to phrase it in philosophical language. Instead, probably they would describe their philosophy in more layman’s terms and would narrate about their approach in the different cases they see. So how do I approach my cases as a clinical ethicist?</p> <p class="MsoNormal"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
February 19, 2014

Professionalizing Clinical Ethics Consultation: Are we there yet?

<p class="MsoNormal">Over the past few decades, clinical ethics consultations have become an important component in providing quality care in cases where there are value conflicts that must be resolved before viable goals of healthcare can be accomplished. With the development of this service and its acceptance as a necessary part of patient care, questions arise as to how and when will clinical ethics consultation be recognized as a specialized professional service comparable to medicine, nursing, social work and pastoral care? For physicians, nurses, social workers, and chaplains there are well-established pathways for practitioners to take in each of these areas in order to be recognized as fully qualified professionals. There is no such pathway to date for those individuals who provide clinical ethics consultations. For those of us who have been involved in this area it is interesting to reflect upon the vast improvements made in providing clinical ethics consultations and whether the field is ready for professionalization.</p> <p class="MsoNormal">I recall my early years of training in medical ethics as a graduate student in philosophy at the University of Tennessee. As part of the requirements for the PhD in philosophy with a concentration in medical ethics, students had to spend 3 months at the Health Science Center in Memphis where we participated in intensive internship in medical ethics. At that time I was fortunate to have one of the early pioneers in medical ethics as a mentor, Professor David Thomasma, who was beginning to do clinical ethics consultations. During the 1970’s philosophers and others in fields pertaining to ethics were being invited to enter the medical setting to help physicians and nurses grapple with some of the ethical dilemmas that were becoming more evident with the increasing use of dialysis machines and mechanical life supports. There seemed to be an assumption, perhaps naïve in retrospect, that philosophers like professor Thomasma and others had some special understanding of ethical issues that would shed light on the emerging medical ethical dilemmas and therefore would be in a position to give helpful advice.</p> <p class="MsoNormal"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
February 12, 2014

Take Two Aspirin and Let Me Tell You What I Think About the Affordable Care Act

by Kayhan Parsi, JD, PhD

I recently saw a subspecialist for a medical procedure.  I had never met this physician before so as he sat down to review what was going on in the monitor in front of him, the first thing he asked me was what I did for a living. …

September 16, 2013

Patient Informed Consent For The Teaching Hospital "Trainee" Care: Informing Realistic Scenarios

by Maurice Bernstein MD

Informed consent is the ethical and legal hallmark for the support of patient decision-making in medicine.  Though the ethics of patient communication of facts without deceit has been part of medical consideration for generations, it wasn’t until the landmark decision Schloendorff v The Society of the New York Hospital in 1914 that informed consent became United States law. …

July 15, 2013

Clinical Ethics Survey Responses Needed!!!

ATTENTION: HEALTH CARE ETHICS CONSULTANTS

The American Society for Bioethics and Humanities (ASBH) would like your input.

Please take part in this short (8 question) survey to determine whether you endorse the FINAL DRAFT of the Code of Ethics for Health Care Ethics Consultants:

http://www.surveymonkey.com/s/YNBZFLZ

(Paste link in browser if survey doesn’t load by clicking on it.)

It should take about 10-15 minutes to complete.…

May 3, 2013

Check out AJOB's newest publication 13(5)!

Editorial

Military Doctors and Deaths by Torture: When a Witness Becomes an Accessory
Steven H. Miles

Target Articles

Ban the Sunset?

April 4, 2013

Check out the April 2013 issue of AJOB!

DOES CONSENT BIAS RESEARCH? 

SICKLE CELL AND THE “DIFFICULT PATIENT” CONUNDRUM

April 2, 2013

The Ethics of "Hand-Offs" in Medicine

Maurice Bernstein, M.D.

Here is a realistic scenario as written in the U.S. government’s Agency for Healthcare Research and Quality “Web M&M” website which could occur in any teaching or even in non-teaching hospital with hospitalists on duty.

February 17, 2013

Dialysis for a 101-Year-Old Patient?

The February 2013 issue of Clinical Kidney Journal has a case report from Israel describing a 101-year-old male patient with chronic kidney disease, admitted to the ICU with exacerbation of heart failure and sepsis. He experienced acute deteriorat...
February 14, 2013

Diagnosing Art

Craig Klugman, Ph.D.

Every fall, I teach 30 medical and nursing students observation skills in our institution’s Art Rounds course. My colleagues and I take these students to one of our local museums where they learn how to observe their environment and patients by looking at works of art, learning about the role of observation in medicine, and by observing real life models.

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Published Articles (23)

American Journal of Bioethics: Volume 14 Issue 3 - Mar 2014

The Ethics of Advertising for Health Care Services Yael Schenker, Robert M. Arnold & Alex John London

American Journal of Bioethics: Volume 14 Issue 1 - Jan 2014

Structuring a Written Examination to Assess ASBH Health Care Ethics Consultation Core Knowledge Competencies Bruce D. White, Jane B. Jankowski & Wayne N. Shelton

American Journal of Bioethics: Volume 14 Issue 1 - Jan 2014

Developing a Certifying Examination for Health Care Ethics Consultants: Bioethicists Need Help Ellen Fox

American Journal of Bioethics: Volume 13 Issue 12 - Dec 2013

Quality Improvement Ethics: Lessons From the SUPPORT Study Benjamin S. Wilfond

American Journal of Bioethics: Volume 13 Issue 12 - Dec 2013

Informed Consent and Standard of Care: What Must Be Disclosed Ruth Macklin & Lois Shepherd

American Journal of Bioethics: Volume 13 Issue 12 - Dec 2013

What Should Be Disclosed to Research Participants? David Wendler

American Journal of Bioethics: Volume 13 Issue 12 - Dec 2013

The SUPPORT Controversy and the Debate Over Research Within the Standard of Care David Magnus

American Journal of Bioethics: Volume 13 Issue 10 - Oct 2013

Why Misconduct Trumps Patient–Therapist Confidentiality and Ways to Avoid the Disclosure Dilemma Nicholas H. Steneck

American Journal of Bioethics: Volume 13 Issue 10 - Oct 2013

Let Therapists Be Therapists, Not Police Paul S. Appelbaum

AJOB Neuroscience: Volume 4 Issue 3 - Jul 2013

Values at the Crossroads of Neurology, Psychiatry, and Psychology Paul J. Ford

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News (82)

April 17, 2014 5:37 pm

Free samples of prescription drugs are costly to patients, study says

Free samples of prescription drugs may seem like a great deal for patients. But even when doctors think they’re doing patients a favor by handing out the freebies, the real beneficiaries are the drug manufacturers, according to new research in the journal JAMA Dermatology.

April 16, 2014 2:04 pm

Is a patient ‘vegetative?’ The crucial answer may be quite wrong.

It seems as if barely a year goes by without a painful, public and often politicized controversy over whether or not someone is in a “vegetative state,” beyond consciousness and some say the need for life support. The most famous case was that of Terri Schiavo in 1990.

April 2, 2014 2:14 pm

PatientsLikeMe Launches “Data for Good” Campaign to Encourage Health Data Sharing to Advance Medicine

Today, PatientsLikeMe kicks off a new campaign promoting the value of sharing health information to advance research.

March 24, 2014 2:34 pm

Crowdsourcing medical decisions: Ethicists worry Josh Hardy case may set bad precedent

Just hours after social-media supporters of a dying 7-year-old boy pressured a reluctant biotech company into giving him an experimental medication, the backlash began.

March 13, 2014 3:41 pm

Company Makes Drug Available To Ailing Boy Following Public Outcry

Chimerix, a small and unprofitable biotechnology company, will make an experimental drug available to a young Virginia boy who is suffering from an infection he contracted while being treated for cancer.

February 28, 2014 4:00 pm

Nurse Education, Workload Impact Patient Post-Op Mortality

Nurse staffing and education are associated with in-hospital mortality after common surgical procedures, according to a study published online Feb. 26 in The Lancet.

February 24, 2014 1:35 pm

When Doctors Need to Lie

OF course, even when a doctor believes that a paternalistic approach is justified, he should aim to keep it as “soft” as possible. Soft paternalism involves negotiation, persuading a patient to see things from your point of view. Hard paternalism, on the other hand, is coercive.

February 21, 2014 2:37 pm

$5B initiative proposed for stem cell research

Supporters of California’s multibillion-dollar stem cell program plan to ask for $5 billion more to bring the fruits of research to patients.

February 20, 2014 5:47 pm

Mom: Hopeful signs seen in teen called brain dead

The mother of a 13-year-old California girl who was declared brain dead after suffering complications from sleep apnea surgery said she has seen changes in her daughter’s condition that give her hope.

February 20, 2014 5:45 pm

Insured patients are often not transferred for better care, study finds

Patients with insurance may not be transferred to specialized trauma centers as quickly as those without, a Stanford study has found.

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