Subjects -> MEDICAL SCIENCES (Total: 8810 journals)
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INTERNAL MEDICINE (180 journals)                     

Showing 1 - 180 of 180 Journals sorted alphabetically
Abdomen     Open Access  
ACP Hospitalist     Full-text available via subscription   (Followers: 9)
ACP Internist     Full-text available via subscription   (Followers: 10)
ACP Journal Club     Full-text available via subscription   (Followers: 11)
Acta Clinica Belgica     Hybrid Journal   (Followers: 1)
Acute and Critical Care     Open Access   (Followers: 11)
Acute Medicine     Full-text available via subscription   (Followers: 9)
Advances in Hepatology     Open Access   (Followers: 4)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
African Journal of Primary Health Care & Family Medicine     Open Access   (Followers: 6)
African Journal of Thoracic and Critical Care Medicine     Open Access  
American Family Physician     Full-text available via subscription   (Followers: 38)
American Journal of Hypertension     Hybrid Journal   (Followers: 31)
Anales de Medicina Interna     Open Access   (Followers: 1)
Anatomy & Physiology : Current Research     Open Access   (Followers: 9)
Angiology     Hybrid Journal   (Followers: 5)
Annals of Colorectal Research     Open Access   (Followers: 1)
Annals of Internal Medicine     Full-text available via subscription   (Followers: 392)
AORN Journal     Hybrid Journal   (Followers: 27)
Apollo Medicine     Open Access  
Archives of Drug Information     Hybrid Journal   (Followers: 5)
Archivos de Medicina Interna     Open Access   (Followers: 1)
Asia Oceania Journal of Nuclear Medicine & Biology     Open Access   (Followers: 4)
Asian Pacific Journal of Tropical Disease     Full-text available via subscription   (Followers: 3)
Australasian Physical & Engineering Sciences in Medicine     Hybrid Journal   (Followers: 1)
BMI Journal : Bariátrica & Metabólica Iberoamericana     Open Access   (Followers: 1)
BMJ Open Diabetes Research & Care     Open Access   (Followers: 35)
BMJ Quality & Safety     Hybrid Journal   (Followers: 69)
Bone & Joint Journal     Hybrid Journal   (Followers: 138)
Brain Communications     Open Access   (Followers: 4)
Brain Science Advances     Open Access  
Canadian Journal of General Internal Medicine     Open Access   (Followers: 2)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Case Reports in Internal Medicine     Open Access   (Followers: 1)
Cell Death & Disease     Open Access   (Followers: 3)
Cellular and Molecular Gastroenterology and Hepatology     Open Access   (Followers: 3)
Cephalalgia     Hybrid Journal   (Followers: 8)
Cephalalgia Reports     Open Access   (Followers: 4)
Chronic Diseases and Injuries in Canada     Free   (Followers: 1)
Clinical Ethics     Hybrid Journal   (Followers: 13)
Clinical Liver Disease     Open Access   (Followers: 5)
Clinical Nutrition     Hybrid Journal   (Followers: 98)
Clinical Thyroidology     Full-text available via subscription   (Followers: 1)
CNE Pflegemanagement     Hybrid Journal  
Communication Law and Policy     Hybrid Journal   (Followers: 5)
Current Diabetes Reports     Hybrid Journal   (Followers: 30)
Current Hepatology Reports     Hybrid Journal  
Current Research: Integrative Medicine     Open Access  
CVIR Endovascular     Open Access   (Followers: 1)
Der Internist     Hybrid Journal   (Followers: 12)
Diabetes     Full-text available via subscription   (Followers: 603)
Diabetes Care     Full-text available via subscription   (Followers: 578)
Diabetes Internacional     Open Access  
Diabetes Spectrum     Full-text available via subscription   (Followers: 17)
Diagnosis     Hybrid Journal   (Followers: 1)
Egyptian Journal of Bronchology     Open Access  
Egyptian Journal of Internal Medicine     Open Access   (Followers: 1)
Egyptian Journal of Neurosurgery     Open Access  
Egyptian Liver Journal     Open Access   (Followers: 2)
Egyptian Spine Journal     Open Access  
EMC - Aparato Locomotor     Hybrid Journal  
Endovascular Neuroradiology / Ендоваскулярна нейрорентгенохірургія     Open Access   (Followers: 1)
eNeuro     Open Access   (Followers: 3)
Ergonomics     Hybrid Journal   (Followers: 24)
European Journal of Inflammation     Open Access   (Followers: 2)
European Journal of Internal Medicine     Full-text available via subscription   (Followers: 10)
European Journal of Translational Myology     Open Access  
European Radiology Experimental     Open Access   (Followers: 2)
Head and Neck Tumors     Open Access   (Followers: 1)
Health Sociology Review     Hybrid Journal   (Followers: 14)
HemaSphere     Open Access   (Followers: 2)
Hepatology Communications     Open Access  
Hepatoma Research     Open Access   (Followers: 3)
Human Physiology     Hybrid Journal   (Followers: 5)
ImmunoHorizons     Open Access  
Immunological Medicine     Open Access  
Infectious Diseases: Research and Treatment     Open Access   (Followers: 5)
Inflammation and Regeneration     Open Access   (Followers: 2)
Inflammatory Intestinal Diseases     Open Access  
Innere Medizin up2date     Hybrid Journal   (Followers: 1)
Internal and Emergency Medicine     Hybrid Journal   (Followers: 5)
Internal Medicine Journal     Hybrid Journal   (Followers: 9)
International Journal of Abdominal Wall and Hernia Surgery     Open Access   (Followers: 1)
International Journal of Anatomy and Research     Open Access   (Followers: 2)
International Journal of Angiology     Hybrid Journal  
International Journal of Artificial Organs     Hybrid Journal   (Followers: 3)
International Journal of Hyperthermia     Open Access  
International Journal of Internal Medicine     Open Access   (Followers: 3)
International Journal of Noncommunicable Diseases     Open Access  
International Journal of Psychiatry in Clinical Practice     Hybrid Journal   (Followers: 6)
Iranian Journal of Neurosurgery     Open Access   (Followers: 1)
Italian Journal of Anatomy and Embryology     Open Access   (Followers: 1)
JAC-Antimicrobial Resistance     Open Access   (Followers: 4)
JAMA Internal Medicine     Full-text available via subscription   (Followers: 364)
JCSM Clinical Reports     Open Access   (Followers: 3)
JHEP Reports     Open Access  
JIMD Reports     Open Access  
JMV - Journal de Médecine Vasculaire     Hybrid Journal   (Followers: 1)
Joint Commission Journal on Quality and Patient Safety     Hybrid Journal   (Followers: 41)
JOP. Journal of the Pancreas     Open Access   (Followers: 2)
Journal of Basic & Clinical Physiology & Pharmacology     Hybrid Journal   (Followers: 1)
Journal of Bone Oncology     Open Access   (Followers: 1)
Journal of Cancer & Allied Specialties     Open Access  
Journal of Clinical and Experimental Hepatology     Full-text available via subscription   (Followers: 3)
Journal of Clinical Movement Disorders     Open Access   (Followers: 3)
Journal of Community Hospital Internal Medicine Perspectives     Open Access  
Journal of Cutaneous Immunology and Allergy     Open Access  
Journal of Developmental Origins of Health and Disease     Hybrid Journal   (Followers: 2)
Journal of Endoluminal Endourology     Open Access  
Journal of Gastroenterology and Hepatology Research     Open Access   (Followers: 4)
Journal of General Internal Medicine     Hybrid Journal   (Followers: 23)
Journal of Hypertension     Hybrid Journal   (Followers: 14)
Journal of Infectious Diseases     Hybrid Journal   (Followers: 48)
Journal of Interdisciplinary Medicine     Open Access  
Journal of Internal Medicine     Hybrid Journal   (Followers: 11)
Journal of Liver : Disease & Transplantation     Hybrid Journal   (Followers: 7)
Journal of Medical Internet Research     Open Access   (Followers: 24)
Journal of Movement Disorders     Open Access   (Followers: 2)
Journal of Pain and Symptom Management     Hybrid Journal   (Followers: 46)
Journal of Pancreatic Cancer     Open Access  
Journal of Renal and Hepatic Disorders     Open Access  
Journal of Solid Tumors     Open Access   (Followers: 1)
Journal of Sports Medicine and Allied Health Sciences : Official Journal of the Ohio Athletic Trainers Association     Open Access   (Followers: 1)
Journal of the American Board of Family Medicine     Open Access   (Followers: 11)
Journal of the European Mosquito Control Association     Open Access  
Journal of Translational Internal Medicine     Open Access  
Jurnal Vektor Penyakit     Open Access  
La Revue de Medecine Interne     Full-text available via subscription   (Followers: 3)
Lege artis - Das Magazin zur ärztlichen Weiterbildung     Hybrid Journal   (Followers: 1)
Liver Cancer International     Open Access  
Liver Research     Open Access  
Molecular Diagnosis & Therapy     Hybrid Journal   (Followers: 3)
Molecular Therapy - Oncolytics     Open Access  
Multiple Sclerosis and Demyelinating Disorders     Open Access   (Followers: 7)
MYOPAIN. A journal of myofascial pain and fibromyalgia     Hybrid Journal   (Followers: 18)
Neuro-Oncology Advances     Open Access   (Followers: 1)
Neurobiology of Pain     Open Access   (Followers: 2)
Neurointervention     Open Access   (Followers: 6)
Neuromuscular Diseases     Open Access  
Nigerian Journal of Gastroenterology and Hepatology     Full-text available via subscription  
OA Alcohol     Open Access   (Followers: 5)
Oncological Coloproctology     Open Access  
Open Journal of Internal Medicine     Open Access  
Pleura and Peritoneum     Open Access  
Pneumo News     Full-text available via subscription  
Polish Archives of Internal Medicine     Full-text available via subscription   (Followers: 2)
Preventing Chronic Disease     Free   (Followers: 2)
Progress in Transplantation     Hybrid Journal   (Followers: 1)
Prostate International     Open Access   (Followers: 2)
Psychiatry and Clinical Psychopharmacology     Open Access   (Followers: 1)
Pulmonary Therapy     Open Access   (Followers: 2)
Quality of Life Research     Hybrid Journal   (Followers: 20)
Research and Practice in Thrombosis and Haemostasis     Open Access  
Revista Chilena de Fonoaudiología     Open Access   (Followers: 1)
Revista de la Sociedad Peruana de Medicina Interna     Open Access   (Followers: 4)
Revista del Instituto de Medicina Tropical     Open Access  
Revista Hispanoamericana de Hernia     Open Access   (Followers: 1)
Revista Médica Internacional sobre el Síndrome de Down     Full-text available via subscription   (Followers: 1)
Revista Virtual de la Sociedad Paraguaya de Medicina Interna     Open Access   (Followers: 1)
Romanian Journal of Diabetes Nutrition and Metabolic Diseases     Open Access   (Followers: 1)
Romanian Journal of Internal Medicine     Open Access  
Russian Journal of Child Neurology     Open Access   (Followers: 1)
Scandinavian Journal of Primary Health Care     Open Access   (Followers: 8)
Schlaf     Hybrid Journal  
Schmerzmedizin     Hybrid Journal  
Scientific Journal of the Foot & Ankle     Open Access   (Followers: 1)
SciMedicine Journal     Open Access   (Followers: 3)
SEMERGEN - Medicina de Familia     Full-text available via subscription   (Followers: 1)
The Journal of Critical Care Medicine     Open Access   (Followers: 9)
Therapeutic Advances in Chronic Disease     Open Access   (Followers: 8)
Therapeutic Advances in Musculoskeletal Disease     Hybrid Journal   (Followers: 6)
Thieme Case Report     Hybrid Journal   (Followers: 1)
Tijdschrift voor Urologie     Hybrid Journal  
Tissue Barriers     Hybrid Journal   (Followers: 1)
Transactions of the Royal Society of Tropical Medicine and Hygiene     Hybrid Journal   (Followers: 3)
Transgender Health     Open Access   (Followers: 3)
Trends in Anaesthesia and Critical Care     Full-text available via subscription   (Followers: 23)
US Cardiology Review     Open Access  
Vascular and Endovascular Review     Open Access   (Followers: 1)
Ожирение и метаболизм     Open Access  


Similar Journals
Journal Cover
Clinical Ethics
Journal Prestige (SJR): 0.296
Citation Impact (citeScore): 1
Number of Followers: 13  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1477-7509 - ISSN (Online) 1758-101X
Published by Sage Publications Homepage  [1151 journals]
  • The role of emotions in Moral Case Deliberation: Visions and experiences
           of facilitators
    • Authors: Benita Spronk, Guy Widdershoven, Hans Alma
      Abstract: Clinical Ethics, Ahead of Print.
      Moral Case Deliberation is intended to assist healthcare professionals faced with difficult dilemmas in their work. These are situations that involve emotions. During Moral Case Deliberation, participants are invited to reflect on moral views and deliberate on them. Emotions are not explicitly addressed. This article aims to elucidate the role of emotions in Moral Case Deliberation, by analysing experiences of Moral Case Deliberation facilitators. Our research shows the role of emotions varies according to the phase of the Moral Case Deliberation process. One negative aspect of emotions is that they can obstruct the Moral Case Deliberation discussion or distract from the moral question. A positive aspect is that they bring the dilemma into sharper focus. Devoting attention to emotions can help to ensure that responsible decisions are made, while also increasing the moral resilience of participants.
      Citation: Clinical Ethics
      PubDate: 2021-04-29T04:54:20Z
      DOI: 10.1177/14777509211011424
  • Development and validation of the ethical challenges in clinical
           situations-questionnaire (ECCS-Q) by involving health-care providers from
           a tertiary care health setting
    • Authors: Snehil Gupta, Swarndeep Singh, Siddharth Sarkar, Atul Batra
      Abstract: Clinical Ethics, Ahead of Print.
      Background and rationaleClinicians often encounter a variety of ethical challenges in their routine clinical practice, and it varies across healthcare and cultural settings of their practice. Despite of this, there are no clear-cut available guidelines concerning the right course of action in a given ethically challenging situation. A validated instrument that could capture the health care providers’ (HCP’s) viewpoints in this regard is lacking from Indian settings. Thus, the current study aimed at developing an instrument to assess the HCP’s perspective regarding different ethically challenging situations encountered in the Indian settings.MethodsThe questionnaire was developed by involving 15 medical experts. A mixed-method approach, Delphi-technique, and online survey were used for item generation and validation.ResultsThe questionnaire comprised of 11 items (accounts 57% variance; having an α = 0.68) representing four factors: health-resource constraints, medical responsibility of the HCP, obtaining patients/family members’ consent for the treatment, and treatment beyond the standard protocol. The gender and clinical disciplines of the participants were related to their level of endorsement for various domains of the ECCS-Q.ConclusionsEthical challenges in the clinical practice fall in different clusters. The clinicians’ course of action in such situations have many socio-demographic and professional determinants. Future studies are warranted to investigate these phenomena.
      Citation: Clinical Ethics
      PubDate: 2021-04-28T05:22:17Z
      DOI: 10.1177/14777509211011427
  • Addressing organ shortage: An automatic organ procurement model as a
    • Authors: Marina Morla-González, Clara Moya-Guillem, David Rodríguez-Arias, Íñigo de Miguel Beriain, Alberto Molina-Pérez, Iván Ortega-Deballon
      Abstract: Clinical Ethics, Ahead of Print.
      Organ shortage constitutes an unsolved problem for every country that offers transplantation as a therapeutic option. Besides the largely implemented donation model and the eventually implemented market model, a theorized automatic organ procurement model has raised a rich debate in the legal, medical and bioethical community, since it could show a higher potential to solve organ shortage. In this paper, we study the main arguments for and against this model. We show how, in the light of empirical data extracted from countries with a universal health care system, its implementation could lead to a positive impact on organ procurement rates. Three factors are envisioned as fundamental in the comprehension and a possible regulation of the automatic organ procurement model: the lack of recognition of the conscientious objection, the preservation of the right to choose end of life conditions, and the need to avoid incentives for families or healthcare professionals.
      Citation: Clinical Ethics
      PubDate: 2021-04-28T05:22:17Z
      DOI: 10.1177/14777509211011429
  • Ethical dimensions in randomized trials and off-label use of
           investigational drugs for COVID-19 treatment
    • Authors: Pooja Dhupkar, Seema Mukherjee
      Abstract: Clinical Ethics, Ahead of Print.
      Coronavirus disease 2019 (COVID-19) is a fast-developing viral pandemic spreading across the globe. Due to lack of availability of proven medicines against COVID-19, physicians have resorted to treatments through large trials of investigational drugs with poor evidence or those used for similar diseases. Large trials randomize 100–500+ patients at multiple hospitals in different countries to either receive these drugs or standard treatment. In order to expedite the process, some regulatory agencies had also given permission to use drugs approved for other diseases, despite a lack of evidence of efficacy in COVID-19. In this review, we highlight the potential ethical issues that should be addressed during the use of investigational drugs with little prior evidence as a treatment options during a pandemic. We discuss the impact of design of randomized clinical trials using LOTUS trial as an example and that of off-label use of drugs like chloroquine/hydroxychloroquine (CQ/HQ) on the safety of patients during COVID-19. We conclude that the adaptive randomized clinical trial designs offer a flexible and efficient approach, enabling patients to quickly switch to successful treatments, while minimizing the number of patients on standard of care. Randomized clinical trial design should consider blinding of investigators and only representative patients who can provide consent should be included. We also conclude the emergency approvals of drugs should be carefully issued and off-label use should be restricted in pandemics. Streamlined regulatory guidelines for emergency drug use in a pandemic can also help in providing benefit and minimizing harm to patients in the future.
      Citation: Clinical Ethics
      PubDate: 2021-04-28T05:22:16Z
      DOI: 10.1177/14777509211011431
  • A comparison of the ethical climate of operating rooms from the
           perspective of operating room nursing students and staff: An analytical
    • Authors: Fatemeh Esmaelzadeh, Monirsadat Nematollahi
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundThe ethical climate is an essential component of organizational climate or culture. The ethical climate is necessary for clinical practice in operating rooms.ObjectiveThis study aimed to compare the ethical climate from the perspective of operating room nursing students and operating room staff of hospitals affiliated with Mashhad University of Medical Sciences, Iran.MethodThis analytical study was performed on 95 operating room nursing students and 169 operating room staff of hospitals in Mashhad, Iran. The students were selected through the census method and the staff were selected by using stratified random sampling. The data were collected via Olson’s Hospital Ethical Climate Survey and analyzed by using BMI SPSS version 21.ResultsThe total mean scores of the ethical climate were 3.44 ± 0.45 and 3.32 ± 0.48 from students and staff’s perspectives, and the independent t-test showed no significant difference between them (p  0.05). Furthermore, the results of the study indicated a significant difference in communication with physicians’ score between operating room staff (2.82 ± 0.49) and students’ views (3.25 ± 0.6) (p 
      Citation: Clinical Ethics
      PubDate: 2021-04-28T05:22:15Z
      DOI: 10.1177/14777509211011435
  • The ethical impact of mandating childhood vaccination: The importance of
           the clinical encounter
    • Authors: Laura Williamson
      Abstract: Clinical Ethics, Ahead of Print.
      Health ethics can justify the use of vaccination mandates. However, policies that pressurize parents to vaccinate their children can undermine traditional clinical ethics standards (e.g. autonomy and informed consent). The aim of this paper is to argue that the ethical impact of vaccination mandates can only be determined in the context of the clinical encounter. Public debate on the topic tends to be general in nature and, as a result, issues that require clarification to help sustain the trust of service users are underexamined. In addition, ethical debates are hampered by a toxic dichotomy in the public sphere between those (anti-vaccinators) who claim a move away from parental choice is necessarily a serious ethical violation; and others (often health scientists) who neglect serious consideration of ethical issues. This predicament permits flawed ethical claims to be made, and to remain unchallenged. Despite this, ethical concerns – including those relating to trust and individual freedom – are fundamental to sustaining confidence in vaccination. This has recently been highlighted by the Covid-19 pandemic which made accessing childhood vaccinations harder, leading to a further decline in uptake. The pandemic has also revealed the strength of public feeling towards infection control measures that restrict peoples’ freedoms. In this paper I argue that to minimize the ethical disruption associated with the use of vaccination mandates, it is essential to focus more attention on their impact in the clinic and to accurately identify the drivers of such tensions.
      Citation: Clinical Ethics
      PubDate: 2021-04-24T05:21:50Z
      DOI: 10.1177/14777509211011422
  • Death, taxes and uncertainty: Economic motivations in end-of-life decision
    • Authors: George Slade Mellgard, Jacob M Appel
      Abstract: Clinical Ethics, Ahead of Print.
      Economic motivations are key drivers of human behavior. Unfortunately, they are largely overlooked in literature related to medical decisionmaking, particularly with regard to end-of-life care. It is widely understood that the directions of a proxy acting in bad faith can be overridden. But what of cases in which the proxy or surrogate appears to be acting in good faith to effectuate the patient’s values, yet doing so directly serves the decision-maker’s financial interests' Such situations are not uncommon. Many patients care as deeply about economic wellbeing of their families as they do for their own lives and health. This brief work examines three scenarios that raise ethical issues regarding the role of pecuniary motives in making critical medical decisions. Each scenario presents a potential financial conflict of interest between an incapacitated patient and a third-party decision-maker and offers a framework for integrating ethical and legal concerns into clinical care. It is our hope that this work prepares physicians for unexpected ethical conflicts of interest and enables them to further the interests of his or her patients.
      Citation: Clinical Ethics
      PubDate: 2021-04-23T05:16:46Z
      DOI: 10.1177/14777509211011425
  • Ethical pause as a framework for high-value care of hospitalized COVID-19
    • Authors: Benjamin J Martin, Margaret Plews-Ogan, Andrew S Parsons
      Abstract: Clinical Ethics, Ahead of Print.
      Caring for hospitalized patients with COVID-19 raises ethical dilemmas in which clinicians must weigh the unknown value of an intervention against the unknown risk of viral transmission. Current guidelines for delivering high-value care in the time of the COVID-19 pandemic do not directly address ethical dilemmas that arise from the unique concerns of individual patients. We propose an “ethical pause” in which clinicians address ethical dilemmas by taking time to ask three questions that invoke the major bioethical principles of beneficence, nonmaleficence, and distributive justice: will this intervention help my patient' Could this intervention harm my patient' Could this intervention harm or help others' Using two exemplar cases, we demonstrate how the process of deliberately asking and answering structured ethical questions is a mindful problem-solving strategy that facilitates delivery of high-value care.
      Citation: Clinical Ethics
      PubDate: 2021-04-23T05:16:45Z
      DOI: 10.1177/14777509211011434
  • Opinions among pediatric critical care physicians regarding the ethics of
           withdrawal of ventricular assist devices and extracorporeal membrane
    • Authors: Antonia A Melas, Leanna L Huard, Rong Guo, Robert B Kelly
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundPediatric critical care physician attitudes about withdrawal of ventricular assist devices (VAD) and extracorporeal membrane oxygenation (ECMO) in cases of medical futility are poorly defined. Our aim was to define current attitudes regarding the withdrawal of these devices.MethodsIRB-approved, cross-sectional observational survey conducted among pediatric critical care attending physicians and fellow physicians in the United States between 2016 and 2017. Data was collected anonymously and statistically analyzed.ResultsA total of 158 physicians responded with 67% being attending physicians. Compared to a VAD, a higher percentage had taken care of a patient on ECMO where the device was turned off because care was believed to be futile (99% vs. 84%), including currently (95% vs. 57%). Nearly all reported that it can be ethically permissible to withdraw support from a patient with a VAD and on ECMO (97% vs. 99%), but varied opinions existed as to who should ultimately make this decision if the patient/their family disagrees. More respondents agreed that a patient/their family should agree to withdrawal of VAD or ECMO support prior to initiation if futility is later determined (60% vs. 58%) and that protocols should be created for VAD and ECMO withdrawal (77% vs. 76%).ConclusionMost pediatric critical care physicians felt that it can be ethically permissible to withdraw VAD and ECMO support. Our study indicates that pediatric VAD and ECMO withdrawal protocols are desired, but further investigation is needed to determine how to best design protocols that would incorporate multiple stakeholders.
      Citation: Clinical Ethics
      PubDate: 2021-03-17T05:36:20Z
      DOI: 10.1177/14777509211001560
  • The legal ambiguity of advanced assistive bionic prosthetics: Where to
           define the limits of ‘enhanced persons’ in medical treatment
    • Authors: Tyler L Jaynes
      Abstract: Clinical Ethics, Ahead of Print.
      The rapid advancement of artificial (computer) intelligence systems (CIS) has generated a means whereby assistive bionic prosthetics can become both more effective and practical for the patients who rely upon the use of such machines in their daily lives. However, de lege lata remains relatively unspoken as to the legal status of patients whose devices contain self-learning CIS that can interface directly with the peripheral nervous system. As a means to reconcile for this lack of legal foresight, this article approaches the topic of CIS-nervous system interaction and the impacts it may have on the legal definition of “persons” under the law. While other literature of this nature centres upon notions of transhumanism or self-enhancement, the approach herein approached is designed to focus solely upon the legal nature of independent CIS actions when operating alongside human subjects. To this end, it is hoped that further discussion on the topic can be garnered outside of transhumanist discourse to expedite legal consideration for how these emerging relationships ought to be received by law-generating bodies internationally.
      Citation: Clinical Ethics
      PubDate: 2021-02-19T11:16:37Z
      DOI: 10.1177/1477750921994277
  • Moral sensitivity and moral distress correlation in nurses caring of
           patients with spinal cord injury
    • Authors: Naser Sedghi Goyaghaj, Amir Zoka, Mohaddeseh Mohsenpour
      Abstract: Clinical Ethics, Ahead of Print.
      Background and aimEthical sensitivity of nurses often plays an important role in their occupational commitment and moral decision-making. In some working conditions, nurses are affected by ethical distress and fail to pursue correct ethical actions despite having knowledge and a tendency for moral practice. Therefore, the present study aimed to investigate the correlation between sensitivity and ethical distress in the nurses of patients with spinal cord injuries.Materials and methodsThis descriptive-analytical study was performed on 160 of the nurses of patients with spinal cord injuries. The participants were selected through the purposive sampling method out of the nurses in Khatamolanbia and Sasan hospitals, Tehran, Iran. Data collection tools included the Moral Sensitivity Questionnaire by Han and Corley’s Moral Distress Scale. Data were analyzed by the independent t-test and Pearson correlation coefficient using the SPSS software version 19.ResultsThe mean values of ethical sensitivity was 80.48 ± 14.45 and ethical distress among the subjects was 62.39 ± 3.54. Moreover, a significant negative correlation was observed between moral sensitivityand moral distress (P
      Citation: Clinical Ethics
      PubDate: 2021-02-12T06:01:39Z
      DOI: 10.1177/1477750921994279
  • A taxonomy of conscientious objection in healthcare
    • Authors: Nathan Gamble, Toni Saad
      Abstract: Clinical Ethics, Ahead of Print.
      Conscientious Objection (CO) has become a highly contested topic in the bioethics literature and public policy. However, when CO is discussed, it is almost universally referred to as a single entity. Reality reveals a more nuanced picture. Healthcare professionals may object to a given action on numerous grounds. They may oppose an action because of its ends, its means, or because of factors that lay outside of both ends and means. Our paper develops a taxonomy of CO, which makes it possible to describe the refusals of healthcare professional with greater finesse. The application of this development will potentially allow for greater subtlety in public policy and academic discussions – some species of CO could be permitted while others could be prohibited.
      Citation: Clinical Ethics
      PubDate: 2021-02-11T05:07:28Z
      DOI: 10.1177/1477750921994283
  • The relationship between nurses’ conscientious intelligence levels and
           care behaviors: A cross-sectional study
    • Authors: Sadiye Ozcan
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundNurses are the main protectors of goodness, honesty and morality in patient care. Conscience allows nurses to be understanding and careful while they provide patient care. In this research the researcher aimed to determine the relationship between conscientious intelligence levels and caring behaviours of nurses and to determine the factors affecting the conscientious intelligence levels and caring behaviours.MethodsThis research designed as a descriptive, cross-sectional and correlation study included 314 nurses working at three hospitals in eastern Turkey. The data were collected by the researcher at a time when the nurses were available and not working. Written and oral informed consent was obtained from all the participants.ResultsA moderate significant positive correlation was observed between conscientious intelligence levels and caring behaviours of nurses. The length of service in nursing, sex and being pleased with the nursing profession were associated with conscientious intelligence levels and caring behaviours.ConclusionAt the end of this research, it was determined that nurses with high conscientious intelligence had better caring behaviours. Although it is very important for nurses to be knowledgeable of and competent at providing care, taking their conscience into consideration in the care of his or her patients is more important. If a nurse is not pleased with the nursing profession, his or her behaviour should be monitored when he or she provides care for the patient. Persons without conscientious values should not be accepted into the nursing profession.
      Citation: Clinical Ethics
      PubDate: 2021-02-11T05:07:26Z
      DOI: 10.1177/1477750921994286
  • Workplace silence behavior and its consequences on nurses: A new Egyptian
           validation scale of nursing motives
    • Authors: Nagah Abd El-Fattah Mohamed Aly, Safaa M El-Shanawany, Maha Ghanem
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundWorkplace silence behavior is a social collective phenomenon. It refers to nurses choosing to withhold their ideas, opinions and concerns about critical issues in their workplace. Workplace silence behavior poses a threat to organizational ethics and success. It also has adverse effects on the performance of nurses in health organizations. Underlying nursing causes of silence behaviors could be related to individual, social and organizational attributes in health care settings.ObjectivesThe study aimed to develop a new Egyptian validation scale for measuring nursing motives of workplace silence behavior and identify consequences of workplace silence behavior on nurses.MethodsA cross-sectional correlational study was implemented using questionnaires on workplace silence behavior, nursing motives and nurses' consequences, collected from 332 nurses working in critical and toxicology care settings of Alexandria Main University Hospital.ResultsEgyptian scale was shown to be a good fit model of exploratory (36 nursing motives emerged in six dimensions with total variance of 73.3%) and confirmatory factor analysis tests (X2 = 1381.47, NNFI =0. 90, CFI = 0.91, RMSEA = 0.057). It also had high reliability tests with coefficient of alpha (0.85), Pearson (0.75) and Kendall coefficient of 0.72. High level of workplace silence behaviors showed a negative association with organizational dis-identification, fair citizenship behavior, and fair nurses' performance and declined reporting of patient adverse events. It also appeared to be in a positive association with higher levels of cynicism.ConclusionThe Egyptian scale was proved to be reliable and valid for measuring the underlying nursing causes of silence behaviors in the hospital workplace. Measuring nursing motives of workplace silence behaviors will help nurse managers to reduce negative outcomes of workplace silence behaviors and improve organizational outcomes.
      Citation: Clinical Ethics
      PubDate: 2021-02-10T04:43:38Z
      DOI: 10.1177/1477750921994284
  • The ethics of interpreter use
    • Authors: Ben Gray, Jo Hilder
      Abstract: Clinical Ethics, Ahead of Print.
      Consulting with a patient where there is a language barrier is unethical unless the barrier is overcome. Every patient with a language barrier should have this prominently documented on their file. Much of the literature relating to working with interpreters suggests that a professional interpreter should be used all the time, although in practice this is far from standard practice. In this paper we look at the issue using normative ethics, utilitarian ethics, an argument based on equality of health outcomes before making an argument for an approach based on clinical judgement in each consultation of what form of language assistance is acceptable.
      Citation: Clinical Ethics
      PubDate: 2021-02-09T03:46:22Z
      DOI: 10.1177/1477750921994276
  • The practice of obtaining informed consent for elective surgery and
           anesthesia from patients’ perspective: An institutional based
           cross-sectional study
    • Authors: Tadese Tamire, Aragaw Tesfaw
      Abstract: Clinical Ethics, Ahead of Print.
      IntroductionInformed consent is a body of shared decision-making process and voluntary authorization of patients to receive medical or surgical intervention. There are limited studies conducted so far to examine the practice of informed consent in Ethiopia. This study aimed to assess the practice of informed consent process for surgery and Anesthesia.MethodA cross-sectional study was conducted from March to May 2019. The data were collected using interviewer-administered structured questionnaire and analyzed in SPSS version 23.ResultsA total of 139 patients were interviewed in this study. Most 42(30.2%) of patients were in the age group of 29–38 years. Nearly half 68 (48.9%) of the patients were informed the benefits of the surgical procedure and 78(56.1%) of the patients were informed on the type of anesthesia to be administered while 65 (46.8%) were not informed on any complication related to the anesthesia. About 66 (47.5%) of patients were informed on alternatives to the surgery. Of these patients, 39(59%) were not informed of any benefits and possible risks associated with the alternative modes of treatment. About half (54%) of the patients were reported as they were understood the information provided during the pre-operative informed consent process.ConclusionThis research revealed that patients were inadequately informed on the complications of proposed procedure, alternative forms of treatment, risks and benefits of the proposed procedure. Therefore, healthcare providers should provide adequate information regarding the proposed procedure and make sure whether patients understood the risks and benefits before the consent.
      Citation: Clinical Ethics
      PubDate: 2021-02-09T03:46:22Z
      DOI: 10.1177/1477750921994281
  • The effect of providing usual care only for control subjects on the
           reliability of results obtained by controlled clinical trials assessing
           the benefits of diabetes self-management educational programs
    • Authors: Ehab Mudher Mikhael, Mohamed Azmi Hassali, Saad Hussain
      Abstract: Clinical Ethics, Ahead of Print.
      Diabetes self-management (DSM) is a crucial part in the management of diabetic patients. Most randomized controlled clinical trials reported significant benefits by diabetes self-management education (DSME) on DSM behaviors and metabolic control. Although the randomized clinical trials are the gold standard method in assessing the effectiveness of any intervention, including DSME interventions, the outcomes of these studies may reflect exaggerated effects; because in most of these studies, subjects in control group receive usual (standard) care with no any DSME. The lack of such education in the control group had many drawbacks: () make blindness impossible; at which non blinded studies may result in false-positive findings; () it may be unethical to recruit patients for participation in DSME studies as control subjects, most of these studies with long periods of follow up, without any direct benefit to them during the study period; the lack of direct benefit to control subjects in any clinical trial may results in high attrition (drop-out) rate. The high attrition rate in clinical trials especially in the control group can lower the statistical power of the study results; thus, the DSME program would appear to have positive effects even if the program had no real benefit. This problem of the DSME exaggerated effects can be solved partially through providing control subjects with education about some DSM behaviors or comparing the effect of DSME through different educational approaches (for example DSME by didactic vs interactive approach).
      Citation: Clinical Ethics
      PubDate: 2021-02-08T07:13:18Z
      DOI: 10.1177/1477750921994282
  • Main challenges in adoption of consultation services of hospital ethics
           committees: A systematic review of the literature
    • Authors: Mir Sajjad Seyyed Mousavi, Rahim Khodayari-Zarnaq, Alireza Hajizadeh
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundThere are numerous challenges in the consultation services of the Hospital Ethics Committees (HEC) that can impact the means of providing healthcare. This review aimed to identify the main challenges in the application of consultation services of the HEC and propose possible solutions.MethodsThis systematic review was conducted through searching electronic databases including PubMed, Scopus, Science Direct, ProQuest, and Embase. Inclusion criteria included studies published in English language in a peer-reviewed journal, from 2000 to 2019 were identified, which clearly defined the design, method, and results of the study. Study selections, quality assessments, data extraction, and analysis were completed by two researchers, independently. The thematic analysis was used to analyze the data.ResultsThe search yielded 1204 articles and 6 of these, included the analyses. Challenges were categorized into 9 themes: (a) personal views and believes in healthcare professionals, (b) sense of fear in the healthcare professionals, (c) medical culture, (d) environmental factors, (e) managerial and structural factors, (f) characteristics of the HEC members, (g) factors related to the HEC, (h) problematic process for HEC consultations, and (i) weakness of knowledge about HEC. Accordingly, proposed solutions were organized according to five themes: reforming the HEC executive processes, creating the appropriate communications, developing awareness about HEC, improving the competencies of HEC members, and (e) receiving support from HEC consultations.ConclusionsThis review highlights that proposed solutions serve as examples of strategies, which attempt to solve challenges related to the application of the consultation services of HEC by healthcare professionals.
      Citation: Clinical Ethics
      PubDate: 2021-02-08T07:13:16Z
      DOI: 10.1177/1477750921994278
  • Children’s medical treatment decision-making: Reform or review'
    • Authors: Jo Bridgeman
      Abstract: Clinical Ethics, Ahead of Print.
      This article considers proposals to reform the law in response to recent high profile cases concerning the medical treatment of children, currently before Parliament in the Access to Palliative Care and Treatment of Children Bill 2019–21. It considers the proposed procedural change, to introduce a requirement for mediation before court proceedings, and argues that dispute resolution processes should be a matter of good practice rather than enshrined in law. It argues that the proposed substantive change to determination of best interests would not result in different outcomes because the best interests analysis co-exist with the legal and professional duties of doctors to children in their care. It argues that if there is to be reform of the law it needs to follow from a comprehensive review of all the issues in which the minimum standards imposed by law fit together with good practice standards and not in response to individual cases.
      Citation: Clinical Ethics
      PubDate: 2021-02-05T05:30:38Z
      DOI: 10.1177/1477750921994280
  • Regulation in research ethics: a scarecrow for physicians'
    • Authors: T Haaser, D Berdaï, S Marty, V Berger, E Augier, B L’Azou, V Avérous, MC Saux
      Abstract: Clinical Ethics, Ahead of Print.
      Background Regulations on research ethics in France have evolved considerably over the past four years: the implementation of the Jardé law and of the General Data Protection Regulations have changed the landscape of research ethics for research involving or not involving human persons. In a context of creation of an Institutional Review Board at the University of Bordeaux, France, we sought to explore research ethics practices and perceptions in the medical community of our University Hospital.MethodsA short questionnaire was sent to all physicians of the University Hospital of Bordeaux. The questionnaire included closed questions and main topics were: physicians’ education in research ethics, ethics practices concerning researches non implying human persons, and physicians’ perceptions about current regulations.Results86 questionnaires were sent back (response rate: 24.2%). If a majority of physicians have validated Good Clinical Practices (GCPs) trainings (76%), there was a low rate of specific training on fundamental references in research ethics and a high proportion of responders do not consider themselves as educated in research ethics after completion of GCPs (56%). Regulations on research ethics have many implications on medical research, especially by inducing changes in protocols in order to alleviate ethical requirements (57%). Malpractices were acknowledged like false mention of positive opinion from an ethics committee (21%). If If a majority of responders considers regulations as a positive answer to research ethics, a large majority considers it as a constraint and a complexification of research process. For 58%, regulations in research ethics are perceived as a hindrance for research initiatives.ConclusionBecause of their impact on research process, regulations seem to constitute a scarecrow for physicians. Lack of training, bad representations and questionable practices (or even malpractices) highlight the need to improve education and to propose concrete guidance for medical researchers.
      Citation: Clinical Ethics
      PubDate: 2021-01-22T06:14:31Z
      DOI: 10.1177/1477750920983574
  • Personal prenatal ultrasound use by women’s health professionals: An
           ethical analysis
    • Authors: Marielle S Gross, Gail Geller, Anne Drapkin Lyerly
      Abstract: Clinical Ethics, Ahead of Print.
      Prenatal ultrasound use is skyrocketing despite limited evidence of improved outcomes. One factor driving this trend is the widely recognized psychological appeal of real-time fetal imaging. Meanwhile, considering imperfect safety evidence, U.S. professional guidelines dictate that prenatal ultrasound—a screening test—should be governed by expected clinical benefits—an opportunity for intervention. However, when women’s healthcare professionals themselves are pregnant, their access to ultrasound technology permits informal, personal use that may deviate from standard-of-care, e.g., for reassurance. Highlighting a poignant case wherein a pregnant obstetrician’s personal ultrasound use had unforeseen negative consequences, we explore this issue within context of professional ethics and informal medical care. We discuss how women’s health professionals’ self-care may influence and inform prenatal care at large. We advocate curtailing informal prenatal ultrasound use, but also potentially broadening accepted indications for or relaxing proscriptions against ultrasounds for patients. Further research and updated, evidence-based, ethically-sound guidelines are needed.
      Citation: Clinical Ethics
      PubDate: 2021-01-12T06:13:25Z
      DOI: 10.1177/1477750920983576
  • Siblings and Discordant Eligibility for Gene Therapy Research: Considering
           Parental Requests for Non-Trial "Compassionate Use”
    • Authors: Jamie Webb, Lesha D Shah, Alison Bateman-House
      Abstract: Clinical Ethics, Ahead of Print.
      Deciding whether to grant an expanded access request for a child whose sibling is enrolled in a gene therapy trial involves a number of complex factors: considering the best interests of the child, the psychosocial and economic impact on the family, and the concerns and obligations of researchers. Despite the challenges in coming to a substantively fair outcome in cases of discordant eligibility, creating a procedurally fair decision-making process to adjudicate requests is essential.
      Citation: Clinical Ethics
      PubDate: 2021-01-08T04:51:39Z
      DOI: 10.1177/1477750920983571
  • Supporting the call for improving the code of publication ethics to
           incorporate editorial decisions regarding the causation of harm by
    • Authors: Henk P Giele
      Abstract: Clinical Ethics, Ahead of Print.
      It is argued that editors have a moral responsibility to reject submissions that they felt publication of which may cause harm. However, Ploeg and others suggest that there may exist better alternatives to rejection. He also called for the code of publication ethics to incorporate acknowledgement of the moral responsibility for the effects of publishing, define benefits and harms of publishing, and specify a range of actions an editor may take. This letter highlights a recent such rejection ostensibly made on the basis of harm, but could easily be construed as editorial bias, and supports the call for improving the code of publication ethics to guide editors and secure consistency in decisions.
      Citation: Clinical Ethics
      PubDate: 2021-01-07T06:01:36Z
      DOI: 10.1177/1477750920983575
  • Exposing futility by searching beneath the concept
    • Authors: Stephen Richards
      Abstract: Clinical Ethics, Ahead of Print.
      The concept of futility in medicine refers to the incapability of an intervention to achieve its goal. Futility determinations form the basis for withholding and withdrawing life-sustaining interventions. Criticisms of attempted futility definitions relate to inconstant probability and value judgements concerning the goal pursued. This variability frustrates efforts to define futility. Language modifications and procedural approaches, both important ancillary measures, inherently lack the ability to resolve this difficulty. Beneath the notion of futility lie foundational factors whose revised understanding is required to advance a definition. These factors include autonomy, death and the goals of medicine. Reconsidering the essence and influence of foundational factors is necessary to move beyond a seemingly irresolvable problem. In this essay, I assert that defining futility is not pointless but rather possible, necessary and unavoidable. With this assertion, I respond to the criticisms of futility. These responses together with a corrective understanding of foundational factors lead to a definition of futility. This definition balances respect for patients’ autonomy whilst allowing for interventions that do not undermine the essence of medicine and integrity of those practising it. Defining futility is an exercise in necessity requiring renewed perceptual foundations.
      Citation: Clinical Ethics
      PubDate: 2020-12-26T12:27:48Z
      DOI: 10.1177/1477750920983577
  • Death determination and donation after circulatory death: Can physicians
           reconcile cardiorespiratory death and irreversible loss of brain
    • Authors: Ahmeneh Ghavam
      Abstract: Clinical Ethics, Ahead of Print.
      Declaration of cardiorespiratory death, as defined by the Uniform Determination of Death Act (UDDA), requires irreversible cessation of circulatory and respiratory function. A physician’s ability to confidently declare death is paramount because death is both a biological and social construct, and can afford a dying patient the opportunity to be an organ donor via donation after circulatory death (DCD). Inconsistencies related to cardiorespiratory death and DCD include the specific language used in the UDDA, specifically the use of the word “irreversible”. Additionally, in DCD there is a large focus on the auto-resuscitative capacity of the heart, however recently some have argued that instead the focus should shift to the brain and a determination of how long it needs to be without circulation to cease functioning prior to declaring death. In this paper, I discuss inconsistencies with cardiorespiratory death as they pertain to organ donation and posit several possible solutions to mitigate these inconsistencies.
      Citation: Clinical Ethics
      PubDate: 2020-12-25T04:14:29Z
      DOI: 10.1177/1477750920983573
  • The role of compassion in ethical frameworks and medical practice
    • Authors: Acadia Fairchild
      Abstract: Clinical Ethics, Ahead of Print.
      Medicine has made great strides with advances in technology and outcomes. However, compassion is an element that often is missing from medical care and ethics. The paper discusses why compassion is the ideal physician and why it is important to medicine. The benefit of compassion in biomedical ethics by exploring three ethical frameworks is also explored. Compassion is an important concept that has a place in both medical care and ethical practice.
      Citation: Clinical Ethics
      PubDate: 2020-12-25T04:14:28Z
      DOI: 10.1177/1477750920983572
  • Using Q methodology in research with head and neck cancer patients as an
           ethical procedure
    • Authors: Susana SA Miguel, Sílvia Caldeira
      Abstract: Clinical Ethics, Ahead of Print.
      This article describes how nurses can use the Q methodology to include head and neck cancer patients in research. These patients are often excluded from participating in research based on temporary or permanent voiceless, disfigurement, or impaired communication. Q methodology is defined as the method for the study of subjectivity and related procedures seem to facilitate the participation of head and neck cancer patients. As so, this inclusive dimension should be taken into consideration in research project design also as an ethical aspect of the study, in particular when involving these patients or others in similar conditions.
      Citation: Clinical Ethics
      PubDate: 2020-12-25T04:14:27Z
      DOI: 10.1177/1477750920983570
  • Dementia, beauty, and play: A way of seeing and being with the wearisome
    • Authors: Abram Brummett, Michelle Bach
      Abstract: Clinical Ethics, Ahead of Print.
      We describe a case of an elderly patient suffering from advanced dementia (Mrs. M) whose chronic confusion has become a source of frustration for her caregivers. Mrs. M experiences a touching interaction with a new nurse (Nathan) who takes a different approach with her. We describe this interaction and elaborate upon it by drawing from Catholic social teaching and the philosophy of play. Cases like these do not involve dramatic or esoteric ethical problematics, but rather the sort of dilemma born of the everyday tragedies of lingering illness, aging and caretakers’ fatigue. Nathan’s approach offers a different way of seeing and being with the wearisome patient.
      Citation: Clinical Ethics
      PubDate: 2020-12-07T04:28:29Z
      DOI: 10.1177/1477750920977104
  • Moral distress and intention to leave intensive care units: A
           correlational study
    • Authors: Abbas Naboureh, Masoomeh Imanipour, Tahmine Salehi
      Abstract: Clinical Ethics, Ahead of Print.
      Moral distress is a fundamental problem in the nursing profession that affects nurses. Critical care nurses are more susceptible to this problem due to the nature of their work. Moral distress may, in turn, lead to several undesirable consequences. This study aimed to determine the relationship between moral distress and intention to leave the ward among critical care nurses. This descriptive-correlational study was conducted by census method on all eligible nurses who worked in Coronary Care Unit (CCU) and Intensive Care Unit (ICU) of AhVaz hospitals, Iran. Data was collected by Corley’s moral distress questionnaire and a researcher-made questionnaire to investigate the intention to leave the ward. Questionnaires were completed through self-report and data were analyzed using a t-test and Pearson correlation coefficient. The results showed that there was a direct association between moral distress and intension to leave the ward in critical care nurses (P 
      Citation: Clinical Ethics
      PubDate: 2020-12-03T03:11:57Z
      DOI: 10.1177/1477750920977094
  • A novel ethical approach to moral distress during COVID 19 in New York
    • Authors: Janet Dolgin, Renee McLeod-Sordjan, Walter Markowitz, Maria Sanmartin
      Abstract: Clinical Ethics, Ahead of Print.
      The initial surge of COVID19 patients in New York, created a surge of unprecedented numbers in the largest integrated hospital system of the New York City and surrounding Long Island region. Due to innovation and clinician ingenuity ventilator allocation was going to have an easier solution than alleviating the moral distress of overworked and understaffed clinicians. Through the innovative work of clinicians, leadership and the leadership of Governor Cuomo and hospital executives, the need for triaging ventilators did not become a reality. Yet the need for ethicists to support and aid clinicians in the discernment and need for escalation for scarce ICU resources and personnel was key. The transition from an allocation strategy of ventilators organically occurred as rapidly as the surge of COVID19 as it became clear that addressing clinician distress was imperative to maintain the level of human capital. An allocation strategy was envisioned that would assess the urgency of need for intensive care resources utilizing established decision aid calculators. In a mixed method quantitative and qualitative review, this article utilizes descriptive data to illustrate the lessons learned from utilizing ethics consultants to review pandemic decision making and alleviate clinician moral distress.
      Citation: Clinical Ethics
      PubDate: 2020-12-01T10:48:39Z
      DOI: 10.1177/1477750920977100
  • Lying to patients: Ethics of deception in nursing
    • Authors: Drew A Curtis, Jennifer M Braziel, Robert A Redfearn, Jaimee Hall
      Abstract: Clinical Ethics, Ahead of Print.
      While the ethical use of deception has been discussed in literature, the ethics and acceptability of nursing deception has yet to be studied. The current study examined nurses’ and nursing students’ ratings of the ethics and acceptability of nursing deception. We predicted that nurses and nursing students would rate a truthful vignette as more ethical than a deceptive vignette. We also predicted that participants would rate nursing deception as unethical and unacceptable. A mixed design was used to examine ethics scores as a within-subjects factor and order as a between-groups design factor. A total of 131 nurses and nursing students were recruited from university nursing programs and hospitals in Texas. Participants were provided with a truthful vignette and deceptive vignette and used the Multidimensional Ethics Scale-Revised 1 to rate each vignette. Participants also completed the Lies in Nursing Ethics Questionnaire. The truthful nursing vignette was rated as more ethical than the deceptive vignette. Results indicated that most participants rated nursing deception as unethical, unacceptable, and a violation of the ANA ethical code. Some participants deemed that nursing deception may be acceptable within some cases. Age and years of experience were not related to the perceived ethics and acceptability of nursing deception.Nurses and nursing students believe that using deception with patients is unethical and unacceptable. However, some participants believed that deception may be warranted within some cases. These findings may reflect nurses’ placing the patient at the core of their values and viewing honesty as important for the nurse-patient relationship. Further implications and directions are discussed.
      Citation: Clinical Ethics
      PubDate: 2020-12-01T07:11:33Z
      DOI: 10.1177/1477750920977103
  • Assessment of nurses’ ethical performance from the perspective of
           mothers and nurses in pediatric wards of beast hospital, Hamadan, 2019
    • Authors: Danial Shadi, Saba Bashiri, Naser Mohammad Gholi Mezerji, Tayebeh Hasan Tehrani
      Abstract: Clinical Ethics, Ahead of Print.
      Background and aimDifficult moral situations assume more critical importance in pediatric wards since children are more vulnerable than adults. Given that professional ethics is a substantial part of children treatment, the present study was conducted to determine the ethical performance of nurses from the perspective of mothers and nurses in the pediatric wards of Be'esat Hospital in Hamadan.Materials and methodsThe present descriptive-analytical study was conducted on 58 nurses and 263 mothers of children referred to the pediatric wards of Be'esat Hospital in Hamadan in 2019. The study samples were randomly selected. Data collection tools included the demographic form and Ethical Performance Assessment Questionnaire developed by Beykmirza et al. The obtained data were analyzed in SPSS software version 23using descriptive and inferential statistics.ResultsAs evidenced by the obtained results, the mean ethical performance of nurses from the perspective of nurses and mothers were reported as 86.72 ± 6.397 and 69.92 ± 18.09. From the mothers' viewpoint, 27%, 39.2%, and 33.8% of nurses had weak, moderate and good levels of performance, respectively. On the other hand, from the nurses' perspective, 24.6% and 75.4% of nurses had moderate and good levels of performance, respectively. The obtained results were indicative of a statistically significant difference between the performance score as reported by mothers and nurses (P 
      Citation: Clinical Ethics
      PubDate: 2020-11-30T04:04:08Z
      DOI: 10.1177/1477750920977105
  • Rationing health and social goods during pandemics: Guidance for Ghanaian
           decision makers
    • Authors: Amos Laar, Debra DeBruin, Richard Ofori-Asenso, Matilda Essandoh Laar, Barbara Redman, Arthur Caplan
      Abstract: Clinical Ethics, Ahead of Print.
      Healthcare rationing during pandemics has been widely discussed in global bioethics literature. However, existing scenarios and analyses have focused on high income countries, except for very few disease areas such as HIV treatment where some analyses related to African countries exist. We argue that the lack of scholastic discourse, and by extension, professional and democratic engagement on the subject constitute an unacceptable ethical omission. Not only have African governments failed to develop robust ethical plans for pandemics, ethicists in this region have been unable to ignite public discourse on rationing. Therefore, we aim to initiate a debate on how rationing health and social goods could be done ethically in Ghana during the current and future pandemics.The paper discusses and critiques some moral considerations (utilitarian, equity, equal worth, urgent need, and the prioritarian principles) for rationing and their relevance in the Ghanaian context. This contribution may facilitate ethical decision-making during the current (COVID-19) pandemic - in Ghana and other African settings where hardly any rationing guidelines exist
      Citation: Clinical Ethics
      PubDate: 2020-11-30T04:04:07Z
      DOI: 10.1177/1477750920977095
  • The concept of futility in health: A scoping review
    • Authors: João Vítor da Silva Vieira, Sérgio Deodato, Felismina Mendes
      Abstract: Clinical Ethics, Ahead of Print.
      IntroductionDue to the constant scientific and technological development, health professionals are regularly confronted with situations in which there are always therapeutic options, regardless of the severity of the patient’s condition. However, regarding these therapeutic options as feasible in all situations can be harmful, since it is universally accepted that, despite all advances in health, there are inevitable limits and the promotion of some interventions may be useless or futile.ObjectiveTo characterize the use of the concept of futility in the health literature.MethodReview of the literature following the Scoping Review protocol of the Joanna Briggs Institute. The research was performed in CINAHL, Cochrane, Pubmed, Scopus e Web of Science to identify studies published prior to 2020. Nineteen studies were selected.ResultsThere is no universally accepted definition for the concept of futility. In the literature there are different conceptions for the concept of futility that point to qualitative and quantitative roots and that are associated with ethical dilemmas that make it difficult to conceptualize this concept and make it operational in clinical practice.ConclusionThe central elements of the concept of futility include: the diagnosis of futility is closely related to clinical judgment; futility has both quantitative and qualitative roots; futility is always appreciated posteriori; futility is related to the lack of benefit. It is essential to promote a discussion that enables the definition of the concept and that makes it possible to promote ethical principles in care, especially when the inevitable limits of treatments are reached.
      Citation: Clinical Ethics
      PubDate: 2020-11-26T12:12:17Z
      DOI: 10.1177/1477750920977109
  • Confronting medication scarcity in the era of COVID-19
    • Authors: Yoram Unguru
      Abstract: Clinical Ethics, Ahead of Print.
      Over the past decade, US patients and clinicians have endured medication shortages of nearly every class, including many lifesaving medications. These shortages have persisted despite determined efforts by federal, academic, and professional organizations. Medication shortages have resulted in lost lives, medication errors, and substantial financial cost. Economic drivers are the primary cause for drug shortages, exacerbated by manufacturing and quality problems, and unreliable and uncertain sources for many raw materials required to synthesize these drugs. Drug shortages force clinicians to make untenable choices and decide which of their patients should receive a lifesaving scarce medication. The COVID-19 pandemic has stressed many hospitals’ ability to provide basic care and aggravated existing drug shortages. The influx of patients suffering from COVID-19 has exposed flaws in the fractured manner in which essential medications reach patients. The unique nature of COVID-19, often requiring prompt and decisive clinical decision-making, challenges the accepted approach for ethical analysis adopted by clinical ethicists. The author, a clinician and bioethicist, notes the ethical challenges he and other frontline providers have faced in deciding which patients are “more deserving” of a scarce medication.
      Citation: Clinical Ethics
      PubDate: 2020-11-26T12:12:16Z
      DOI: 10.1177/1477750920977096
  • Social perceptions and bioethical implications of birth plans: A
           qualitative study
    • Authors: Maria José Sánchez-García, Francisco Martínez-Rojo, Jesús A Galdo-Castiñeiras, Paloma Echevarría-Pérez, Isabel Morales-Moreno
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundThe birth plan is a tool that allows the self-learning and thoughtful analysis of the women during the birthing process, facilitating their making of decisions and participation, in agreement with the bioethical principles of autonomy and no malfeasance.Goal: To understand the perception and satisfaction of women who presented a birth plan.Methodology: Qualitative, descriptive, observational, retrospective and cross-sectional study. The population of the study was composed of 21 women who presented a birth plan regulated in a Hospital ever since the recording of the presentation of the birth plan was started (2011) until 2015.Place: Cartagena (Murcia, Spain).Techniques/methods: Semistructured interview.Results-Discussion: Most women considered the plan as a useful self-learning tool on the meaning of the birthing process, as it favored the communication between the expectant mothers/health professionals. Our informants sought information related to the birthing process from informal sources; most perceived a level of respect of their wishes during the process of giving birth. The use of the birth plan did not imply the perception of loss of the degree of control during the birth, although attention to the written document could be improved.ConclusionsThe use of the birth plan is a very satisfactory and useful experience for their involvement in their self-care, although in some cases, the births did not proceed according to their plans. Nevertheless, the prevalence of the principle of Non-Malfeasance over Autonomy was evidenced.
      Citation: Clinical Ethics
      PubDate: 2020-11-12T04:21:19Z
      DOI: 10.1177/1477750920971798
  • Electronic fetal monitoring in the twenty-first century: Language, logic
           and Lewis Carroll
    • Authors: Thomas P Sartwelle, James C Johnston, Berna Arda, Mehila Zebenigus
      Abstract: Clinical Ethics, Ahead of Print.
      The Alice Books, full of illogical thoughts, words, and contradictions, were unrivaled entertainment until the publication of the medical literature promoting electronic fetal monitoring (EFM) for every pregnancy. The modern-day EFM advocates acknowledge EFM’s decades long failure but simultaneously recommend EFM use for lawsuit protection and because the profession has used EFM for every pregnancy for fifty years, therefore, it must be efficacious. These self-indulgent, illogical rationalizations ignore the half century of evidence-based scientific research proving that EFM is a complete failure as well as ignoring the fact that continued EFM use violates the fundamental principles of modern bioethics. This blind advocacy perpetuates four pernicious EFM harms occurring to mothers, babies, and the medical profession itself. This article sets out these four EFM harms with the goal of abolishing the misguided, illogical, contradictory, arguments used by the twenty-first century EFM Lewis Carroll mimics.
      Citation: Clinical Ethics
      PubDate: 2020-11-06T06:10:16Z
      DOI: 10.1177/1477750920971800
  • COVID-19 and consent for research: Navigating during a global pandemic
    • Authors: Ran D Goldman, Luke Gelinas
      Abstract: Clinical Ethics, Ahead of Print.
      The modern ethical framework demands informed consent for research participation that includes disclosure of material information, as well as alternatives. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (COVID-19) results in illness that often involves rapid deterioration. Despite the urgent need to find therapy, obtaining informed consent for COVID-19 research is needed. The current pandemic presents three types of challenges for investigators faced with obtaining informed consent for research participation: (1) uncertainty over key information to informed consent, (2) time and pressure constraints, and (3) obligations regarding disclosure of new alternative therapies and re-consent. To mitigate consenting challenges, primary investigators need to work together to jointly promote urgent care and research into COVID-19. Actions they can take include (1) prior plan addressing ways to incorporate clinical research into clinical practice in emergency, (2) consider patients vulnerable with early deliberation on the consent process, (3) seek Legally Authorized Representatives (LARs), (4) create a collaborative research teams, (5) aim to consent once, despite evolving information during the pandemic, and (6) aim to match patients to a trial that will most benefit them. The COVID-19 pandemic both exacerbates existing challenges and raises unique obstacles for consent that require forethought and mindfulness to overcome. While research teams and clinician-investigators will need to be sensitive to their own contexts and adapt solutions accordingly, they can meet the challenge of obtaining genuinely informed consent during the current pandemic.
      Citation: Clinical Ethics
      PubDate: 2020-11-06T06:10:16Z
      DOI: 10.1177/1477750920971801
  • Managing aggression in hospitals: A role for clinical ethicists
    • Authors: Clare Delany, Anusha Hingalagoda, Lynn Gillam, Neil Wimalasundera
      Abstract: Clinical Ethics, Ahead of Print.
      Hospitals are places where patients are unwell, where patients and their families may be upset, confused, frustrated, in pain, and vulnerable. The likelihood of these experiences and emotions manifesting in anger and aggressive behaviour is high. In this paper, we describe the involvement of a clinical ethics service responding to a request to discuss family aggression within a rehabilitation department in a large paediatric hospital in Australia. We suggest two key advantages of involving a clinical ethics service in discussions about how to respond to family aggression. First, the process of ethics deliberation provides an opportunity for clinicians to be involved in the solution by articulating their perspectives, tolerance levels, and general concerns about the effects of family aggression towards staff. Second, supporting clinicians to articulate and identify the impact of parental aggression directly counters the disadvantages of the more blunt zero-tolerance policy response, which is necessarily imposed from the top down.
      Citation: Clinical Ethics
      PubDate: 2020-11-06T06:10:15Z
      DOI: 10.1177/1477750920971802
  • An investigation into ethical issues in occupational therapists in adult
           with physical disabilities: Using the qualitative approach
    • Authors: Hassan Vahidi, Narges Shafaroodi
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundOccupational therapists may be encountered with a variety of ethical issues. The aim of this study was to explore ethical issues of Occupational therapist’s practice in adult physical dysfunction field.MethodsTen graduated Occupational therapists were selected by purposive sampling method. Data were gathered by semi-structured interview. Data were analyzed by content analysis approach.ResultsData analysis ultimately leads to the emergence of three themes which reflects Ethical issues in Occupational Therapy. These themes include: unethical practice of Occupational therapists, factors influencing ethical practice and Strategies to improving ethical practice.ConclusionThe findings show that occupational therapists have various ethical problems related to client’s rights in addition to their clinical practice, that according to the participants in this study, lack of awareness about professional ethics related to the occupational therapy and also lack of comprehensive monitoring rules in this field are the major causes of unethical practice.
      Citation: Clinical Ethics
      PubDate: 2020-11-02T05:08:41Z
      DOI: 10.1177/1477750920971799
  • Ethics of triage for intensive-care interventions during the COVID-19
           pandemic: Age or disability related cut-off policies are not justifiable
    • Authors: Luciana Riva, Carlo Petrini
      Abstract: Clinical Ethics, Ahead of Print.
      Public health emergencies such as pandemics can put health systems in a position where they need to ration medical equipment and interventions because the resources available are not sufficient to meet demand. In public health management, the fair allocation of resources is a permanent and cross-sector issue since resources, and especially economic resources, are not infinite. During the COVID-19 pandemic resources need to be allocated under conditions of extreme urgency and uncertainty. One very problematic aspect has concerned intensive care medicine and age discrimination has been among the most hotly discussed issues, as age has been touted as a probable criterion for selection. In this paper we analyse some documents originating from scientific societies and medical associations, mainly related to EU sphere and available in English, French, Spanish and Italian (Switzerland, Spain, Belgium, France, England and Italy), concerning the criteria for admission to the intensive care units. We highlights how, in most of these documents, it is explicitly stated that “age itself” is not a criterion for patient selection. Our conclusion is that these criteria should be defined in advance of a crisis situation and be grounded in clinical indicators. Establishing “cut-off” policies with regard to criteria such as age or chronic disability is definitely an unjustifiable form of discrimination even in the context of a public health emergency.
      Citation: Clinical Ethics
      PubDate: 2020-11-02T05:08:40Z
      DOI: 10.1177/1477750920971803
  • Forgoing life sustaining treatment decision-making in critically ill
           children: Parental views and factor’s influence
    • Authors: Nurnaningsih Nurnaningsih, Sri Setiyarini, Syafa’atun Al Mirzanah, Retna Siwi Padmawati, Mohammad Juffrie
      Abstract: Clinical Ethics, Ahead of Print.
      ObjectiveExplore parents’ point of view about forgoing life sustaining treatment (LST) in terminal critically ill children and factors affecting their decisions.MethodThis was a qualitative study using in-depth interviews with parents whose child died between 6–12 months old in pediatric intensive care unit (PICU) of a university-affiliated teaching hospital. Interviews were audiotaped and transcribed. Data were analyzed using interpretive description method.ResultA total of 7 parents of 5 children decided to withhold or withdraw LST. Five parents from 4 children decided to sign the do not attempt resuscitation (DNAR), and none choose to withdrew the LST, including mechanical support. Factors influenced their decision were communication, value of children, child best interest, intuition, religious belief, and emotions. Economic factors did not influence the decision-making.ConclusionMost parents decided to sign the DNAR, none choose to withdrew mechanical support. Communication was the most important factor that influenced parents to make a forgoing LST decision.
      Citation: Clinical Ethics
      PubDate: 2020-10-22T05:37:35Z
      DOI: 10.1177/1477750920958560
  • “The ultimate risk:” How clinicians assess the value and meaning of
           genetic data in cardiology
    • Authors: Kellie Owens
      Abstract: Clinical Ethics, Ahead of Print.
      In modern medicine, health risks are often managed through the collection of health data and subsequent intervention. One of the goals of clinical genetics, for example, is to identify genetic predisposition to disease so that individuals can intervene to prevent potential harms. But recently, some clinicians have suggested that patients should undergo less testing and monitoring in an effort to reduce overdiagnosis and overtreatment. In this paper, I explore how clinicians navigate the tension between identifying real disease risks for their patients with concerns about overdiagnosis and overtreatment. I focus on clinicians ordering genetic testing for inherited cardiovascular diseases. Of the genes determined to be “clinically actionable” by the American College of Medical Genetics and Genomics (ACMG), half are related to cardiovascular diseases. But, due in part to high levels of uncertainty surrounding cardiovascular genetics, there is still disagreement within the field about how to order and interpret these tests. Based on semi-structured, in-depth interviews with 20 clinicians who order genetic testing for cardiovascular diseases, I find that there is considerable variability in the ways that clinicians determine which types of genetic tests are appropriate for their patients and how they interpret test results. Most importantly, I find that many providers do not presume that more genetic data will lead to better care. Instead, increased genetic data can lead to confusion and inappropriate treatment. This re-valuation of the utility of medical data is crucial for bioethicists to explore, especially as medical fields are sorting through increasing amounts of data.
      Citation: Clinical Ethics
      PubDate: 2020-10-09T05:35:28Z
      DOI: 10.1177/1477750920959562
  • Ethical conflicts in patient-centred care
    • Authors: Sven Ove Hansson, Barbro Fröding
      Abstract: Clinical Ethics, Ahead of Print.
      It could hardly be denied that healthcare should be patient-centred. However, some of the practices commonly described as patient-centred care may have ethically problematic consequences. This article identifies and discusses twelve ethical conflicts that may arise in the application of (some variants of) person-centred care. The conflicts concern e.g. privacy, autonomous decision-making, safeguarding medical quality, and maintaining professional egalitarianism as well as equality in care. Awareness of these potential conflicts can be helpful in finding the best way to ensure that healthcare has its focus on the needs and interests of the patients. Patient-centred care may have to take different forms, depending of the nature of the disease, the patient’s life situation, and the economic, organizational and technological resources available to the healthcare unit.
      Citation: Clinical Ethics
      PubDate: 2020-10-07T06:17:57Z
      DOI: 10.1177/1477750920962356
  • An audit of questions asked by participants during the informed consent
           process for regulatory studies at a tertiary referral centre – An
           analysis of consent narratives
    • Authors: Unnati Saxena, Debdipta Bose, Mitesh Kumar Maurya, Nithya Jaideep Gogtay, Urmila Mukund Thatte
      Abstract: Clinical Ethics, Ahead of Print.
      ObjectiveTo evaluate the questions asked during the informed consent process by adult and adolescent participants as well as their parents in five interventional regulatory studies conducted at our center from 2018 to 2019.MethodsThe study protocol was approved by Institutional Ethics Committee [EC/OA-116/2019]. Consent narratives in the source documents for the studies were evaluated. Questions asked were classified as per Indian Council of Medical Research’s (ICMR) guidelines (2017). We evaluated total number of questions, nature of questions and whether there was an association between education, gender, phase of trials, physician taking consent and number questions being asked.ResultsA total of five studies that had N = 297 consent narratives were evaluated. Narratives of n = 284 adult participants/Guardians and of n = 13 children were analysed. A total of 374 questions were asked of which children asked only 10 questions. A total of 131/284 (40%) of the participants did not ask any question. Among the participants who asked questions, the majority132/171 (77%) participants asked about risks related to investigational products followed by questions related to study procedures 83/171 (49%). Participants/guardians with higher education (relative to those who were educated upto the secondary school and primary school) and those who consented for Phase III studies (relative to Phase I studies) asked significantly more questions (p 
      Citation: Clinical Ethics
      PubDate: 2020-09-21T05:59:26Z
      DOI: 10.1177/1477750920958565
  • Nursing errors and their causes among nursing students
    • Authors: Mohaddeseh Mohsenpour, Zahra Shamabadi, Amir Zoka, Fariba Borhani, Fatemeh Chakani
      Abstract: Clinical Ethics, Ahead of Print.
      IntroductionErrors are inevitable in medical practice and this issue has attracted the attention of healthcare systems worldwide. Therefore, it is of utmost importance to pay attention in educational systems. The present study aimed to investigate the frequency and cause of nursing students’ errors.MethodsThis descriptive study conducted based on a cross-sectional design. The researcher provided nursing students with a questionnaire. The participants were selected through a purposive sampling method. Eventually, the collected data were analyzed by SPSS17.ResultsThe mean value of errors in students was 32.83 ± 28.5 and the prevalence rate of the errors ranged from 0 to 175. In total, 2922 errors were reported by the students, the most frequent of which were wearing the same pair of gloves for the care of more than one patient (2.61 ± 2.83), negligence to wash the hands (2.41 ± 2.95) and clean the thermometer before utilization (2.19 ± 4.68). Moreover, errors in oxygen therapy (0.69 ± 1.03) and medication (0.87) obtained the lowest frequency. Furthermore, most of the students’ errors were due to not having enough knowledge about medicines (2.1 ± 7.4), lack of appropriate equipment (2.6 ± 1.7), and poor clinical skills (2.1 ± 5.6).Discussion and conclusion: The most frequent nursing students’ errors are related to hand hygiene and personal protection. In addition, the lack of enough skills and appropriate equipment are prevalent causes of nursing students’ errors. Authorities in this field should attend to these errors in nursing education, clinical practice, and nursing studies in order to promote this profession in all of these three dimensions.
      Citation: Clinical Ethics
      PubDate: 2020-09-15T05:15:13Z
      DOI: 10.1177/1477750920958561
  • The ethical conflict of truth, hope, and the experience of suffering: A
           discussion of non-disclosure of terminal illness and clinical placebos
    • Authors: Acadia Fairchild
      Abstract: Clinical Ethics, Ahead of Print.
      In medical practice, physicians are often faced with tough ethical and moral dilemmas, one such example is the reoccurring conflict between a patient’s hope and the truth. This paper explores two ethical dilemmas centered on compassion and the reduction of suffering: truth-telling with terminal patients and the clinical use of placebos. In each case the disclosure of truthful information could interfere with hope and suffering relief.
      Citation: Clinical Ethics
      PubDate: 2020-09-15T05:15:13Z
      DOI: 10.1177/1477750920959556
  • Enrolment of children in clinical research: Understanding Ghanaian
           caregivers’ perspectives on consent/assent procedures, and their
           attitudes towards storage of biological samples for future use
    • Authors: George O Adjei, Amos Laar, Jorgen AL Kurtzhals, Bamenla Q Goka
      Abstract: Clinical Ethics, Ahead of Print.
      Child assent is recommended in addition to parental consent when enrolling children in clinical research; however, appreciation and relevance ascribed to these concepts vary in different contexts, and information on attitudes towards storage of biological samples for future research is limited, especially in developing countries. We assessed caregivers’ understanding and appreciation of consent and assent procedures, and their attitudes towards use of stored blood samples for future research prior to enrolling a child in clinical research. A total of 17 in-depth interviews were conducted with primary caregivers of children (fathers [n = 3], mothers [n = 12], and grandmothers [n = 2]) at enrolment or on the immediate follow-up date. All caregivers recalled significant amount information from the study information sheet and were able to appropriately link such information to the consent process. While all participants confirmed information received prior to blood sampling as adequate, a few noted that the purpose was not sufficiently well communicated. Caregivers felt children were cognitively vulnerable, and prone to decisions that were not necessarily in their best interest. Nearly all caregivers felt it was their right and responsibility to overrule objections from their ward’s regarding enrolment into specific study or receipt of a therapeutic procedure. There were no objections or concerns regarding use of stored biological samples for future research purposes. There is thus, a need to improve understanding of caregivers on the information provided during the informed consent process. Context-specific studies on the age of assent in specific populations are needed.
      Citation: Clinical Ethics
      PubDate: 2020-09-14T04:46:05Z
      DOI: 10.1177/1477750920958570
  • Suicide and “do not resuscitate”: An ethical dilemma
    • Authors: Muhammad Tariq Shakoor, Abdul Ahad, Samia Ayub, James Kruer
      Abstract: Clinical Ethics, Ahead of Print.
      Advance directives allow people to accept or decline medical interventions and to appoint surrogate decision makers if they become incapacitated. Living wills are written in ambiguous terms and require interpretation by clinical providers. Living wills cannot cover all conceivable end-of-life decisions. There is too much variability in clinical decision making to make an all-encompassing living will possible. While there are many limitations of advance directives, this article reviews some of the most troublesome ethical dilemmas with regard to advance directives.
      Citation: Clinical Ethics
      PubDate: 2020-09-14T04:46:04Z
      DOI: 10.1177/1477750920959555
  • The barriers to observing professional ethics in the practice of nursing
           care from nurses’ viewpoints
    • Authors: Marzieh Azadian, Azar Rahimi, Mohammad Mohebbi, Raziyeh Iloonkashkooli, Maryam Maleki, Abbas Mardani
      Abstract: Clinical Ethics, Ahead of Print.
      AimsThis study aimed to investigate barriers in the observation of professional ethics during clinical care from a nursing viewpoint. Also, it examined the association between these barriers and nurse demographic variables.MethodsA descriptive-analytic design was carried out on 207 nurses working in selected hospitals within an urban area of Iran in 2019. Data were collected using a standard questionnaire containing 33 questions that measured barriers to observation of professional ethics. The questionnaire measures three domains of management, environment and individual care.ResultsIn the management dimension, the most important barrier preventing observation of professional ethics was the shortage of personnel. For the environmental dimension, biological changes due to working on the nightshift, and for the individual care dimension, a lack of time were the most important barriers preventing observation of clinical ethics. Findings additionally highlighted a significantly inverse association between barriers to observing professional ethics and the male gender, participating in the ethics workshop and high work-level experiences.ConclusionsIt is suggested that nursing managers in hospitals correct and remove obstacles with careful planning and emphasis on principles and standards of care including environmental and managerial factors and training professional ethics to nurses.
      Citation: Clinical Ethics
      PubDate: 2020-09-14T04:46:02Z
      DOI: 10.1177/1477750920959549
  • How to deliver bad news to me' Suggestions for preparing Muslim
           patients before breaking bad news
    • Authors: Akram Sadat Sadat Hoseini
      Abstract: Clinical Ethics, Ahead of Print.
      There are several models for delivering bad news, the most important and widely used being the SPIKES protocol. Cultural differences in breaking bad news in different societies with different cultures call for special attention. Muslim societies are examples of communities with special cultural and religious requirements. Then, when collecting information about a person's perception of the illness or the incident, consider his or her view of spirituality and the effect of calamities on human transcendence so as to assess the type and amount of information the patient or the family needs. When preparing a suitable setting for delivering bad news, pay attention to the spiritual needs of Muslims such as the possibility of prostration, recitation of Qur'an, and talking to God in private or even aloud. Be aware of, pay attention to, and respect particular religious views of the patient, and if necessary, correctly exploit such views to deliver bad news. Although some Muslim patients may have no demands for transcendence and human growth at the first stage, but over time and after accepting the condition, they will have demands. Therefore, health care providers must provide the necessary facilities for Muslim patients in terms of the required information, setting, and people present in the setting and provide information appropriate to the culture of these patients so as to give an excellent and comprehensive care.
      Citation: Clinical Ethics
      PubDate: 2020-09-11T04:58:45Z
      DOI: 10.1177/1477750920959545
  • Moral distress and occupational wellbeing in audiologists: an Australian
           case study
    • Authors: Andrea Simpson, Alana M Short, Alicja N Malicka, Sandy Clarke-Errey
      Abstract: Clinical Ethics, Ahead of Print.
      ObjectiveThe purpose of this study was to assess if a relationship existed between (i) audiologists’ perceptions of moral distress, (ii) occupational wellbeing, and (iii) patient-practitioner orientation.DesignThe Moral Distress Thermometer, Health and Safety Executive (HSE) Management Standards Indicator Tool and Patient-Practitioner Orientation Scale (PPOS) was sent out to all audiologists registered with the professional body Audiology Australia.Study sample: A total of 43 audiologists completed the questionnaires.ResultsUsing a multiple linear regression model there was no evidence of a relationship between patient-practitioner orientation and either moral distress or occupational wellbeing. However, an association between higher moral distress and lower occupational wellbeing was demonstrated. The occupational wellbeing subscales of ‘managerial support’, ‘peer support’, ‘relationships’, ‘role’, and ‘change’ were strongly associated with poorer scores on moral distress.ConclusionFor our sample of audiologists, ethical conflict appeared to be linked to reduced job satisfaction. There is a need to consider ways of providing supportive organisational structures in which ethical conflicts can be openly discussed and negotiated in order to improve occupational wellbeing in the profession.
      Citation: Clinical Ethics
      PubDate: 2020-08-04T06:31:34Z
      DOI: 10.1177/1477750920946591
  • Resuscitation during the pandemic: Optional obligation' or
    • Authors: Jonathan Perkins, Mark Hamilton, Charlotte Canniff, Craig Gannon, Marianne Illsley, Paul Murray, Kate Scribbins, Martin Stockwell, Justin Wilson, Ann Gallagher
      Abstract: Clinical Ethics, Ahead of Print.
      This paper is a response to a recent BMJ Blog: ‘The duty to treat: where do the limits lie'’ Members of the Surrey Heartlands Integrated Care Service Clinical Ethics Group (CEG) reflected on arguments in the Blog in relation to resuscitation during the COVID-19 pandemic.Clinicians have had to contend with ever-changing and conflicting guidance from the Resuscitation Council UK and Public Health England regarding personal protective equipment (PPE) requirements in resuscitation situations. St John Ambulance had different guidance for first responders.The situation regarding resuscitation led the CEG to consider ethical aspects of health care professionals’ responses to the need for resuscitation during COVID-19. Members agreed that professionals should, ideally, have the level of PPE required for an aerosol generating procedure. However, there was no consensus regarding professionals’ duty to care when this is not available. On the one hand, it was agreed that the casualty/patient’s interests regarding resuscitation should be prioritised due to professionals’ contract with the public and professional privilege. On the other hand, risk thresholds were considered relevant to individual decision-making and professionals’ duty to care. All agreed that decision-making should not be influenced by rewards or reprimands. It was agreed also that decisions to resuscitate should not be considered as moral heroism or supererogatory - regardless of PPE availability - but rather as ‘minimally decent’. We agreed that it may be acceptable for professionals, with good reasons, to opt out of resuscitation attempts and these should be reflected on and discussed before the event.
      Citation: Clinical Ethics
      PubDate: 2020-07-31T04:11:43Z
      DOI: 10.1177/1477750920946684
  • The moral challenges of health care providers brain drain phenomenon
    • Authors: Faith Atte
      Abstract: Clinical Ethics, Ahead of Print.
      The migration of health-care professionals has often produced morally charged discussions among ethicists, politicians, and policy makers in the migrant-sending and migrant-receiving countries because of its devastating effects on the health of those left behind in the countries of origin.This movement of skilled professionals – their decision to leaving their countries of origin in search of better work environments – has created a phenomenon that has been described as brain drain. Although the migration of health workers continue to bring prosperity to millions of people around the world, they have also evoked hopelessness in many more people. Thus, questions of global justice manifest themselves when it comes to the matters of brain drain and the just distribution of health and healthcare professionals.
      Citation: Clinical Ethics
      PubDate: 2020-07-30T06:04:59Z
      DOI: 10.1177/1477750920946614
  • Refractory suffering at the end of life and the assisted dying debate: An
           interview study with palliative care nurses and doctors
    • Authors: Kristine Espegren Gustad, Åsta Askjer, Per Nortvedt, Olav Magnus S Fredheim, Morten Magelssen
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundHow often does refractory suffering, which is suffering due to symptoms that cannot be adequately controlled, occur at the end of life in modern palliative care' What are the causes of such refractory suffering' Should euthanasia be offered for refractory suffering at the end of life' We sought to shed light on these questions through interviews with palliative care specialists.MethodsSemi-structured interviews with six nurses and six doctors working in palliative care in five Norwegian hospitals. Transcripts were analysed with systematic text condensation, a qualitative analysis framework.ResultsInformants find that refractory suffering is rare, and that with palliative sedation satisfactory symptom control can nearly always be achieved at the end of life. However, the process of reaching adequate symptom control can be protracted, and there can be significant suffering in the meantime. Both somatic, psychological, social and existential factors can contribute to refractory suffering and potentiate each other. However, informants also place significant weight on factors pertaining to the organization of palliative care services as contributing to insufficient symptom control.ConclusionsIf refractory suffering is indeed rare, then this arguably weakens a common prima facie argument for the legalization of assisted dying. However, the process of reaching adequate symptom control can be protracted and involve significant suffering. The experiences of palliative care clinicians constitute important empirical premises for the assisted dying debate. The study points to several areas in which palliative care can be improved.
      Citation: Clinical Ethics
      PubDate: 2020-07-29T04:36:58Z
      DOI: 10.1177/1477750920946613
  • The adapted CoRE-Values framework: A decision-making tool for new clinical
           ethics advisory groups
    • Authors: Helen Manson, Elizabeth Fistein, James Heathcote, Anne Whiteside, Laura Wilkes, Kevin Dodman, Marcia Schofield
      Abstract: Clinical Ethics, Ahead of Print.
      A new Clinical Ethics Advisory Group (CEAG) was created to contribute to NHS Trust policies and guidelines in response to ethical issues arising from the COVID-19 pandemic. An ethical analysis framework used in medical education, the CoRE-Values Compass and Grid, was adapted to form a step-wise ‘ABC’ decision-making process. CEAG members found the framework simple to understand and use and the model facilitated time-efficient decisions that were explicitly justifiable on moral, ethical, professional and legal grounds. The adapted CoRE-Values framework might help facilitate decision-making processes for similar new clinical ethics advisory or support committees.
      Citation: Clinical Ethics
      PubDate: 2020-07-29T04:36:55Z
      DOI: 10.1177/1477750920946601
  • When conscientious objection runs amok: A physician refusing HIV
           preventative to a bisexual patient
    • Authors: Abram Brummett
      Abstract: Clinical Ethics, Ahead of Print.
      This paper reports of a case where a physician conscientiously objected to prescribing PrEP to a bisexual patient so as not to “enable immoral sexual behavior.” The case represents an instance of conscience creep, a phenomenon whereby clinicians invoke conscientious objection in sometimes objectionable ways that extend beyond the traditional contexts of abortion, sterilization, or physician aid in dying. This essay uses a reasonability view of conscientious objection to argue that the above case represents a discriminatory instance of conscience creep that should not be permitted.
      Citation: Clinical Ethics
      PubDate: 2020-07-29T04:31:49Z
      DOI: 10.1177/1477750920946686
  • Attitudes toward assisted death amongst doctors in Northern Portugal
    • Authors: Ferraz Gonçalves
      Abstract: Clinical Ethics, Ahead of Print.
      IntroductionContext: In Portugal assisted death was approved in February 2020 by the Parliament, although the law is not yet in force.ObjectivesTo find out what doctors think about those practices.MethodsA link to a questionnaire was sent by email three times, at intervals of one week, to the doctors registered in the Northern Section of the Portuguese Medical Association, before the Parliamentary approval.ResultsThe questionnaire was returned by 1148 (9%) physicians. A minority of doctors would practice a form of assisted death under the present law or if it was legalized, but a higher percentage think that euthanasia should be legalized, and more would like to have that option if they themselves were in a terminal phase of a disease. Religion has a strong influence on the attitudes of doctors, so too does their contact with patients in a terminal phase, as doctors who deal with more patients with far advanced diseases are more likely to be unfavorable to assisted death. On the other hand, younger doctors are more in favor of these practices.ConclusionThe small percentage of questionnaires sent back is a weakness in this study and casts doubts on the generalizability of the conclusions. However, this is, so far, the best approximation to the opinions of Portuguese doctors on assisted death.
      Citation: Clinical Ethics
      PubDate: 2020-07-21T04:38:34Z
      DOI: 10.1177/1477750920942916
  • Readability of the informed consent forms in Flanders using the Douma
           index: Analyzing the documents that help patients make decisions
    • Authors: María del Valle Ramírez-Durán, María del Valle Coronado-Vázquez, María Isabel Mariscal-Crespo
      Abstract: Clinical Ethics, Ahead of Print.
      Informed consent forms have been useful in clinical practice and they constitute a part of the shared decision making in the informed consent process. They provide information to patients about clinical procedures and techniques. They also act as a remainder of the information discussed after the medical interview. Sometimes these documents are not readable to everybody. Belgian law specifies that all information that patients receive has to be proportionate verbally, but written information is also handled. The present research analyzes the readability of the Flemish informed consent forms located in the webs of all General Hospitals using a simple random sample of 75 informed consent forms.By using the Douma tool, which bases its analysis in the length of words and sentences, the readability mean of the sample was 46, level “Difficult”. The 59% of them had a difficult level. The 11% were normal. It is a fact, then, that the 59% of the informed consent forms evaluated in this study are not suitable for everybody in Flanders, especially those people with low literacy. There were some researches made in other countries that agreed with these results. Written clinical information was poorly written so the informed consent forms were not working helping patients to recall information nor helping patients to become a part in the shared decision making about their health. The use of readability formulas represented a simple way to discriminate those informed consent forms that had normal readability scores from those that should be adapted.
      Citation: Clinical Ethics
      PubDate: 2020-07-10T05:07:46Z
      DOI: 10.1177/1477750920930373
  • Possible advantages of the clinical policy ethics assessment tool:
           institutional support or unnecessary bureaucracy'
    • Authors: Alfonso Rubio-Navarro, Diego Jose Garcia-Capilla, Maria Jose Torralba-Madrid, Jane Rutty
      First page: 1
      Abstract: Clinical Ethics, Ahead of Print.
      Contemporary healthcare practice has been progressively more regulated to increase efficiency, service user safety and practice quality. However, ethical issues in clinical practice that have not been implemented into regulations are undervalued by policymakers and healthcare institutions Considering the issues found by other authors, the use of a simple tool for policymakers to consider recurrent ethical issues could reduce those issues in a policy-driven clinical practice. The lack of tools to support structured ethical assessment of clinical policies was the main reason to create the Clinical Policy Ethics Assessment Tool, but we realised of its possible advantages: limiting ethical dilemmas posed by policies, ensuring ethical practice by the use of policies and developing a consistent process for policymakers, institutions and healthcare professionals. Nonetheless, even if a tool can be implemented and it supports the creation of policies that reduce ethical issues, if the healthcare professionals are not aware of them they will not be implemented and the issues will continue.
      Citation: Clinical Ethics
      PubDate: 2020-07-30T06:04:59Z
      DOI: 10.1177/1477750920946685
  • Do moral development levels of the nurses affect their ethical decision
           making' A descriptive correlational study
    • Authors: Sümeyye Arslan, Sinem Türer Öztik, Nevin Kuzu Kurban
      First page: 9
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundIn the globalizing world, nurses often meet humans from different cultures and values. This fact has led them to make ethical decisions, which do not comply with their own moral jurisdictions at care setting.ObjectivesThe objective of the study was to investigate the relationships between moral development levels of the nurses and their scores of nursing principled thinking and practical consideration during decision making for ethical dilemmas.MethodsThis was a descriptive correlational study. Nursing Dilemma Test, Moral Development Scale for Professionals and socio-demographic form were used. Study was conducted with 227 nurses.Ethical considerations: An institutional authorization, an ethics approval from non-interventional ethics committee of the respective university, permission from the authors of the scales used and informed consents from the nurses were obtained in order to conduct the study.ResultsIn this study, nurses were found to be at post-conventional level according to Kohlberg’s moral development theory. Sociodemographic and working characteristics of the nurses have not affected their scores of moral development level and their scores of nursing principled thinking, practical consideration and familiarity (p > 0.05). Nurses take attention for moral principles during decision making although not at a desirable level, and they are relatively affected by environmental factorsConclusionAlthough nurses are familiar with ethical problems at scenarios including ethical dilemmas, they cannot make decisions in accordance with their moral development levels during decision making for ethical dilemmas. Nurses should be instructed and supported for ethical decision making by recognizing factors that may be effective on their decision making.
      Citation: Clinical Ethics
      PubDate: 2020-06-04T03:43:45Z
      DOI: 10.1177/1477750920930375
  • Perceptions of intensive care unit nurses of therapeutic futility: A
           scoping review
    • Authors: João V. Vieira, Sérgio Deodato, Felismina Mendes
      First page: 17
      Abstract: Clinical Ethics, Ahead of Print.
      IntroductionIntensive care units are contexts in which, due to the remarkable existence of particularly technological resources, interventions are promoted to extend the life of people who experience highly complex health situations. This ability can lead to a culture of death denial where the possibility of implementing futile care and treatment cannot be excluded.ObjectiveTo describe nurses’ perceptions of adult intensive care units regarding the therapeutic futility of interventions implemented to persons in critical health conditions.MethodReview of the literature following the Scoping Review protocol of the Joanna Briggs Institute. The Population, Concept, and Context mnemonic was used to elaborate the research question and the research was performed using the EBSCOHost search engine in the CINAHL Complete databases, MEDLINE Complete, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews to identify studies published between 1990 and 2019. Seven studies were selected.ResultsNurses consider that therapeutic futility, a current problem in adult intensive care units, may have a negative impact on persons in critical health conditions and that contributes directly to resource expenditure and moral conflicts and consequently leads to emotional exhaustion.ConclusionDue to the complexity of this concept, knowing and understanding people’s and families’ perceptions is crucial to the decision-making process, for which reason nurses can play a key role in managing these situations.
      Citation: Clinical Ethics
      PubDate: 2020-06-10T04:16:26Z
      DOI: 10.1177/1477750920930376
  • Factors affecting moral distress in nurses working in intensive care
           units: A systematic review
    • Authors: Foroozan Atashzadeh-Shoorideh, Faraz Tayyar-Iravanlou, Zeynab Ahmadian Chashmi, Fatemeh Abdi, Rosana Svetic Cisic
      First page: 25
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundMoral distress is a major issue in intensive care units that requires immediate attention since it can cause nurses to burnout. Given the special conditions of patients in intensive care units and the importance of the mental health of nurses, the present study was designed to systematically review the factors affecting moral distress in nurses working in intensive care units.MethodsPubMed, EMBASE, Web of Science, Scopus, and Science Direct were systematically searched for papers published between 2009 and 2019. Original articles from quantitative and qualitative studies were reviewed. The CONSORT and STROBE checklists were used to assess the quality of the quantitative papers. The JBI checklist was applied for qualitative studies.ResultsFactors affecting moral distress in nurses include lack of nursing staff, nurses with inadequate experience, lack of support from organizations and colleagues, inadequate education and lack of knowledge of nurses, poor collaboration of physicians with nurses, ethical insensitivity and lack of teamwork, heavy workload, poor quality of care and moral violence and they are considered as risk factors for moral distress.ConclusionMany of the related causes are due to the nature of nurses’ work and it is necessary to manage the underlying conditions of this phenomenon so that it can be effectively prevented from spreading. Levels of moral distress require more attention of authorities in the use of prevention strategies and the reduction of effective factors in distress.
      Citation: Clinical Ethics
      PubDate: 2020-06-18T06:40:56Z
      DOI: 10.1177/1477750920927174
  • Does a comic style informed assent form improve comprehension for minors
           participating in clinical trials'
    • Authors: Cristina Ferrer-Albero, Javier Díez-Domingo
      First page: 37
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundSeveral authors have shown that children and adolescents have limited understanding of critical elements of the research studies in which they are participating. The inclusion of graphic elements is a promising approach to increase the understandability of assent forms of clinical trials.ObjectivesTo design a new assent form in comic strip format for minors participating in clinical trials and to compare the comprehension of this new document with a traditional assent form.MethodsThis study included an assessment of the readability of standard informed assents, the evaluation of the comprehension of one of these documents, the development of a new (comic format) informed assent from the original document previously evaluated, and the analysis of readability and comprehension of the new informed assent. The readability of the documents was assessed using previously validated formulas, whereas comprehension analyses were performed through a questionnaire taken by two groups of 12-year-old students of secondary schools.Ethical considerations: All procedures involving human participants were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments.FindingsCompared with the original document, the comic assent form improved the grammatical readability of the “Aims, Risks and Benefits and How to Get More Information” sections, the comprehension scores in the Aims and Procedure sections, the understanding of ideas, and the formation of macro-ideas. The benefits of the comic strip format were more noticeable among participants in the lower percentiles of the comprehension score.ConclusionsOur results show that the comic assent form has high readability and comprehensibility compared with its original form, particularly in the domains of knowledge-based inferences and macro-ideas formation. The use of forms that combine text and comic strips may help the comprehension of minors participating of a clinical trial, supporting their autonomy in decision-making.
      Citation: Clinical Ethics
      PubDate: 2020-07-03T05:24:08Z
      DOI: 10.1177/1477750920930377
  • The prisoner dilemma: Inconsistent decisions for continuing
           life-sustaining treatment between a patient with very limited
           communication and their surrogate
    • Authors: Abram Brummett
      First page: 46
      Abstract: Clinical Ethics, Ahead of Print.
      This case raises the difficult question of how to respond to patients who appear to lack decision-making capacity, yet retain limited communication that allows them to state a preference for life-sustaining treatment that conflicts with the choice of their surrogate. I argue that the patient’s preference should be honored, even though the patient lacks decision-making capacity, and the preference contradicts the wishes of the surrogate.
      Citation: Clinical Ethics
      PubDate: 2020-06-06T05:04:25Z
      DOI: 10.1177/1477750920930374
  • Challenges in shared decision-making in pediatric neuro-oncology: Two
           illustrative cases of the pursuit of postoperative alternative medicine
    • Authors: Mandana Behbahani, Laura S McGuire, Laura Burokas, Emily Obringer, Demetrios Nikas
      First page: 49
      Abstract: Clinical Ethics, Ahead of Print.
      In caring for pediatric patients, a multifaceted approach in decision-making is utilized. The role of the medical team in complementary and alternative medicine is controversial. In cases of conventional treatment refusal by parents in pursuit of complementary and alternative medicine, there must be balanced decision-making, autonomy, and the best interest of the child. This report highlights two illustrative cases (ages 4, 17 years) of patients with brain tumor, whereby parents refused postoperative conventional therapy involving chemoradiotherapy, in pursuit of complementary and alternative medicine alone. Parental decision-making in complementary and alternative medicine, in lieu of medical recommendations, poses an ethical and legal dilemma that may impede care of the pediatric patient and compromise outcome of oncological care.
      Citation: Clinical Ethics
      PubDate: 2020-07-03T05:24:07Z
      DOI: 10.1177/1477750920928899
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