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FORENSIC SCIENCES (43 journals)

Showing 1 - 39 of 39 Journals sorted alphabetically
American Journal of Forensic Medicine and Pathology     Hybrid Journal   (Followers: 26)
Australian Journal of Forensic Sciences     Hybrid Journal   (Followers: 352)
Canadian Society of Forensic Science Journal     Hybrid Journal   (Followers: 255)
Clinical Ethics     Hybrid Journal   (Followers: 12)
Colombia Forense     Open Access  
Cuadernos de Medicina Forense     Open Access   (Followers: 2)
Egyptian Journal of Forensic Sciences     Open Access   (Followers: 8)
European Polygraph     Open Access  
Forensic Chemistry     Hybrid Journal   (Followers: 9)
Forensic Imaging     Full-text available via subscription   (Followers: 3)
Forensic Medicine and Anatomy Research     Open Access   (Followers: 7)
Forensic Science International     Hybrid Journal   (Followers: 362)
Forensic Science International : Mind and Law     Open Access   (Followers: 4)
Forensic Science International : Reports     Open Access   (Followers: 5)
Forensic Science International : Synergy     Open Access   (Followers: 5)
Forensic Science International: Animals and Environments     Open Access   (Followers: 1)
Forensic Science International: Genetics     Hybrid Journal   (Followers: 15)
Forensic Science, Medicine, and Pathology     Hybrid Journal   (Followers: 26)
Forensic Sciences Research     Open Access   (Followers: 6)
Forensic Toxicology     Hybrid Journal   (Followers: 18)
Forensische Psychiatrie, Psychologie, Kriminologie     Hybrid Journal   (Followers: 3)
International Journal of Forensic Mental Health     Hybrid Journal   (Followers: 12)
Journal of Clinical Pathology and Forensic Medicine     Open Access   (Followers: 12)
Journal of Criminology and Forensic Science     Open Access   (Followers: 9)
Journal of Forensic and Legal Medicine     Hybrid Journal   (Followers: 286)
Journal of Forensic Investigation     Open Access   (Followers: 9)
Journal of Forensic Practice     Hybrid Journal   (Followers: 68)
Journal of Forensic Psychology Research and Practice     Hybrid Journal   (Followers: 16)
Journal of Forensic Science and Medicine     Open Access   (Followers: 14)
Journal of Forensic Science and Research     Open Access   (Followers: 3)
Journal of Forensic Sciences     Hybrid Journal   (Followers: 367)
Journal of Forensic Toxicology and Pharmacology     Hybrid Journal   (Followers: 6)
Journal of Veterinary Forensic Sciences     Open Access   (Followers: 1)
Research and Reports in Forensic Medical Science     Open Access   (Followers: 7)
Revista Brasileira de Criminalística     Open Access  
Scandinavian Journal of Forensic Science     Open Access   (Followers: 15)
Sri Lanka Journal of Forensic Medicine, Science & Law     Open Access   (Followers: 3)
Theory and Practice of Forensic Science     Open Access   (Followers: 1)
Wiley Interdisciplinary Reviews : Forensic Science     Hybrid Journal  
Similar Journals
Journal Cover
Clinical Ethics
Journal Prestige (SJR): 0.296
Citation Impact (citeScore): 1
Number of Followers: 12  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1477-7509 - ISSN (Online) 1758-101X
Published by Sage Publications Homepage  [1174 journals]
  • Voluntary assisted death in present-day Japan: A case for dignity

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      Authors: Atsushi Asai, Miki Fukuyama
      Abstract: Clinical Ethics, Ahead of Print.
      No laws or official guidelines govern medical assistance for dying in Japan. However, over the past several years, cases of assisted suicide or voluntary euthanasia, rarely disclosed until recently, have occurred in close succession. Inspired by these events, ethical, legal, and social debates on a patient’s right to die have arisen in Japan, as it has in many other countries. Several surveys of Japanese people’s attitudes towards voluntary assisted dying suggest that a certain number of Japanese prefer active euthanasia. Against this background, it is important to discuss voluntary assisted dying cases in Japan and the Japanese views on them and to consider their implications. We review three recent Japanese voluntary assisted dying cases and discuss the various objections to voluntary assisted dying that have been published in response to these in various media outlets. Our counterarguments include the double suffering of people who are unable to give up their desire to die, individuality of death, variability of culture, problem of being an annoyance to (burden on) others, a slippery slope argument supporting voluntary assisted dying, and unfair claims about responsibility and excessive burden on people who are unable to give up their desire to die. We also point out the psychocultural and social problems in Japanese society that these objections reflect, and argue that voluntary assisted dying can be ethically acceptable under certain conditions. We conclude that Japanese society must change in order to enable those who sincerely wish to die to do so in a better way.
      Citation: Clinical Ethics
      PubDate: 2022-06-03T07:45:54Z
      DOI: 10.1177/14777509221105746
       
  • Perspectives on early sex assignment and communication with parents in
           children with disorders of sexual development

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      Authors: Husrav Sadri, Sheza Abootty, Aureen D'Cunha, Sandeep Rai, Rathika Damodara Shenoy
      Abstract: Clinical Ethics, Ahead of Print.
      Disorders of sexual development are a heterogeneous group of disorders in which chromosomal, gonadal or anatomical sex development is atypical. The majority of these children are recognized at birth by ambiguous genitalia. Legal and societal pressures require the physician and parents to assign sex rapidly. Though sex assignment is undebated in several disorders of sexual development, many others need an individualized approach to gender-related concerns. Gender dysphoria is prevalent in disorders of sexual development, and early gender-defining surgeries have potentially lifelong consequences.We use two cases, one of partial androgen insensitivity and another of simple virilizing congenital adrenal hyperplasia to illustrate that in disorders of sexual development, the ethical management principles remain the same at their core despite the vast differences in phenotypes. Sex assignment should maximize functional, psychological and sexual needs. Sex assigned should coincide with gender identity. We propose that we manage such children with the mutual participation of the physician, parents and the child. Though the parents and the physician have the child's best interests when making a decision, the child's developing autonomy should be protected. The communication of the health provider to the parent must be honest if early sex assignment is difficult.
      Citation: Clinical Ethics
      PubDate: 2022-06-03T07:45:40Z
      DOI: 10.1177/14777509221105457
       
  • Vulnerability, health information right and the contributions of
           augmentative and alternative communication for people with aphasia

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      Authors: Ana Inês de Almeida Frade, Luísa d’Espiney, Vanda Marques Pinto
      Abstract: Clinical Ethics, Ahead of Print.
      Due to impaired communication, people with aphasia are often in a vulnerable situation and face barriers in accessing health information. This article discusses the contributions ofaugmentative and alternative communication for people with aphasia in optimizing communication, improving language recovery, and mainly in providing education and increasing access to healthinformation. This can be translated into a positive impact on respect for autonomy right, well-being, quality of life, and health outcomes (further participation in the decision-making process, involvement,independence, and control of the rehabilitation process). Health professionals, including nurses, must have communication skills to communicate effectively with this population and also be prepared to useaugmentative and alternative communication strategies.
      Citation: Clinical Ethics
      PubDate: 2022-06-01T05:35:48Z
      DOI: 10.1177/14777509221105397
       
  • The ethics of forced care in dementia: Perspectives of care home staff

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      Authors: Anne A Fetherston, Julian Hughes, Simon Woods
      Abstract: Clinical Ethics, Ahead of Print.
      Some care home residents with dementia have the capacity, some do not. Staff may need to make decisions about administering care interventions to someone whom they believe lacks the capacity to consent to it, but also resists the intervention. Such intervention can be termed forced care. The literature on forced care (especially reflecting empirical work) is scant. This study aims to investigate how the ethics of forced care is navigated in practice, through ten semi-structured interviews with staff in 1 care home in the North East of England. Participants generally avoided situations where there was overt restraint, taking a flexible approach by either modifying their own behaviour or using covert techniques. The underlying justification given for decisions or actions tended to be that the recipients of care should be valued because of their intrinsic worth as fellow human beings. Participants attempted to put themselves in the position of the resident or think about what a beloved elderly relative would want. The intervention seemed acceptable to staff if the resident was not distressed. When staff were presented with scenario-based questions around capacity they were more successful than when asked direct questions relating to the Mental Capacity Act. Scenario-based training may be helpful to reinforce familiarity and facility with the principles of the Mental Capacity Act.
      Citation: Clinical Ethics
      PubDate: 2022-05-09T11:05:47Z
      DOI: 10.1177/14777509221097909
       
  • Engaging the values beneath communication in treatment disputes in the
           intensive care unit

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      Authors: John Seago
      Abstract: Clinical Ethics, Ahead of Print.
      Disputes over life-sustaining treatment between clinicians and patients or their surrogates are common in the intensive care unit and expected to increase in America because of an aging population, shifts in medical training, and trends in popular opinions on end-of-life decisions. Clinicians struggle to effectively communicate the recommendation that withdrawing life-sustaining treatment is appropriate when the burdens of treatment outweigh the benefits. This view seems foreign and unimaginable to surrogates like family members with deeply held values motivate them to insist “everything be done” as long as the patient can be physiologically kept alive. For over three decades now, clinicians and bioethicists have sought preventative ethical and policy solutions to avoid or resolve these treatment disputes, including efforts to improve the communication between medical professionals and surrogates. Looking at the history of proposed solutions shows that giving providers more and better communication and negotiation tools may be inadequate on its own. However, better communication has the potential to unearth the motivations and deeper values of the disagreeing parties so that differing perspectives can be recognized and common ground can be established. The latest emphasize on communication has the potential to succeed where other historical solutions have failed. If bioethics is going to successfully analyze and remedy these disputes, the values motivating these views, even ones outside the bioethical consensus, must be acknowledged and respected. In short, better communication will not avoid or resolve life-sustaining treatment disputes in the intensive care unit unless the deeper ethical convictions of the disagreeing parties are recognized and engaged.
      Citation: Clinical Ethics
      PubDate: 2022-05-05T05:11:17Z
      DOI: 10.1177/14777509221094486
       
  • Physician self-reported use of empathy during clinical practice

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      Authors: Amber Comer, Lyle Fettig, Stephanie Bartlett, Lynn D’Cruz, Nina Umythachuk
      Abstract: Clinical Ethics, Ahead of Print.
      ObjectivesThe use of empathy during clinical practice is paramount to delivering quality patient care and is important for understanding patient concerns at both the cognitive and affective levels. This study sought to determine how and when physicians self-report the use of empathy when interacting with their patients.MethodsA cross-sectional survey of 76 physicians working in a large urban hospital was conducted in August of 2017. Physicians were asked a series of questions with Likert scale responses as well as asked to respond to open-ended questions.ResultsAll physicians self-report that they always (69%) or usually (29.3%) use empathic statements when engaging with patients. 93.1% of physicians believe that their colleagues always (20.7%) or usually (69%) use empathic statements when communicating with patients. Nearly one-third of physicians (33%) indicated that using the words “I understand” denotes an empathic statement. Although 36% of physicians reported that they would like to receive more training or assistance about how and when to use empathy during clinical practice.Significance of Results: Despite the self-reported prevalent use of empathic statements, one-third of physicians indicate a desire for more training in what empathy means and when it should be used in a clinical setting. Additionally, nearly one-third of physicians in this study reported using responses that patients may not perceive as being empathic, even when intended to be empathic. This suggests that many physicians feel uncertain about a clinical skill they believe should be used in most, if not all, encounters.
      Citation: Clinical Ethics
      PubDate: 2022-05-04T05:23:42Z
      DOI: 10.1177/14777509221096630
       
  • Children, futility and parental disagreement: The importance of ethical
           reasoning for clinicians in the paediatric intensive care setting

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      Authors: Chiara Baiocchi, Edmund Horowicz
      Abstract: Clinical Ethics, Ahead of Print.
      The provision of intensive care enables the lives of neonates, infants and children to be sustained or extended in circumstances previously regarded as impossible. However, as well as benefits, such care may confer burdens that resultingly frame continuation of certain interventions as futile, conferring more harm than or any, benefit. Subsequently, clinicians and families in the paediatric intensive care unit are often faced with decisions to withdraw, withhold or limit intensive care in order to act in the best interests of the child. An integral consideration in respect of these decisions is that futility is a concept that has to be contextualised for all those involved. Recent high-profile legal cases highlight the professional, clinical, legal and social conflicts that can arise when parents and clinicians have different interpretations of futility. In acknowledging the complexity of these conflicts for clinicians, this paper aims to support a better understanding of futility as an integral concept in such difficult and emotive decisions within professional practice. We utilise the concept of futility to frame how these decisions to withdraw or withhold certain invasive life-prolonging interventions are ethically and legally justifiable, even when they disagree or conflict with parental views. To support clinicians in understanding these decisions, we in part use the familiar bioethical framework of Principlism developed by Beauchamp and Childress. We suggest that understanding legal and ethical analysis of futility ultimately will help clinicians in approaching and reflecting on such decision-making.
      Citation: Clinical Ethics
      PubDate: 2022-04-29T04:54:01Z
      DOI: 10.1177/14777509221096628
       
  • Ethics of recommending weight loss in older adults: A case study

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      Authors: Christine Marie Mills
      Abstract: Clinical Ethics, Ahead of Print.
      Healthcare professionals may confront ethical issues in practice, particularly when their values conflict with that of their patients or clients. This paper explores an ethical case study in which a dietitian who practices Health at Every Size® has an older adult client who wishes to lose weight. The dietitian believes that losing weight is inappropriate for this client. Using a framework for ethical decision making, this article explores the problem or dilemma, identifies the potential issues involved, discusses the relevant ethical codes, laws, and regulations, and explores possible courses of action and their consequences. By exploring an ethical issue that healthcare professionals may encounter in practice, we can gain a deeper understanding of ethical decision making.
      Citation: Clinical Ethics
      PubDate: 2022-04-28T07:25:34Z
      DOI: 10.1177/14777509221096629
       
  • Ethical considerations in the treatment of chronic psychosis in a
           periviable pregnancy

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      Authors: Michelle T. Nguyen, Eric Rafla-Yuan, Emily Boyd, Laurence B. Mccullough, Frank A. Chervenak, Emily C. Dossett
      Abstract: Clinical Ethics, Ahead of Print.
      Background: Treatment of psychotic disorders in pregnancy is often ethically and clinically challenging, especially when psychotic symptoms impair decision-making capacity. There are several competing ethical obligations to consider: the ethical obligation to maternal autonomy, the maternal and fetal beneficence-based obligations to treat peripartum psychosis, and the fetal beneficence-based obligation to minimize teratogenic exposure. Objective: This article outlines an ethical framework for clinical decision-making for the management of chronic psychosis in pregnancy, with an emphasis on special considerations in the previable and periviable period. Case Presentation: A 31-year-old gravida 2, para 1 with intrauterine pregnancy at 12 weeks and 4 days gestation was brought to the emergency department by her husband seven months after delivering her first child, due to sudden onset of behavioral changes that included self-isolation, not eating, and not taking care of her child. Her past medical history included hypothyroidism and inflammatory bowel disease, but no prior psychiatric illness. After being admitted to the psychiatric hospital, she continued to have poor oral intake and weight loss despite initial inpatient treatment with antipsychotics, levothyroxine, and discontinuation of corticosteroids. Her pregnancy was also complicated by the diagnosis of multiple fetal anomalies at 20 weeks gestation, when the fetus was periviable. Conclusions: For previable or periviable pregnancies, the patient and/or surrogate should decide whether to pursue prenatal genetic screening and invasive diagnostic testing, as well as whether to continue or terminate the pregnancy. When the choice is made to continue the pregnancy, initiation of long-term psychiatric treatment (including medications with potential adverse fetal effects) should be based on shared decision-making between the physician and the patient and/or surrogate. Although some pharmacologic interventions may have potential adverse effects on the developing fetus, the use of psychotropic medications can be ethically justified, even if the patient herself does not have the capacity to consent and requires a surrogate, when the goal is to restore maternal autonomy and minimize the risks of maternal and fetal harm from untreated psychiatric illness.
      Citation: Clinical Ethics
      PubDate: 2022-04-26T04:06:38Z
      DOI: 10.1177/14777509221096623
       
  • Evaluation of physician–patient relationship and bioethical
           principles in COVID-19 patients

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      Authors: Irma Eloísa Gómez Guerrero, América Arroyo-Valerio, Arturo Reding-Bernal, Nuria Aguiñaga Chiñas, Ana Isabel García, Guillermo Rafael Cantú Quintanilla
      Abstract: Clinical Ethics, Ahead of Print.
      The COVID-19 pandemic has impacted medical care in many ways; previously, a patient would enter a hospital and had an approximate idea of what would happen upon his admission, the physician informed them about it, but in the last two years this scenario has changed. Therefore, our aim was to identify if bioethical principles are present in the physician–patient relationship and the effect of these in the health care provided, through an observational and descriptive study where patients answered the validated ReMePaB questionnaire that measures the presence of bioethical principles in the physician–patient relationship, on the seventh day of their hospital stay and 24 h after discharge, during the period from 1 August to 5 November 2020. In autonomy, an improvement in the score was observed in the second application compared to the first measurement; in the principle of non-vulnerability, the same scenario was observed for the first and second measurements, respectively. In the principles of beneficence, dignity, and justice, no statistically significant differences were observed. Considering the presence or absence of bioethical aspects in health care in this pandemic creates an area of opportunity to know the feelings of the patient during the care received and to maintain what is done well and improve those aspects that can be improved.
      Citation: Clinical Ethics
      PubDate: 2022-04-26T04:06:22Z
      DOI: 10.1177/14777509221094490
       
  • Machine learning applications in healthcare and the role of informed
           consent: Ethical and practical considerations

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      Authors: Giorgia Lorenzini, David Martin Shaw, Laura Arbelaez Ossa, Bernice Simone Elger
      Abstract: Clinical Ethics, Ahead of Print.
      Informed consent is at the core of the clinical relationship. With the introduction of machine learning (ML) in healthcare, the role of informed consent is challenged. This paper addresses the issue of whether patients must be informed about medical ML applications and asked for consent. It aims to expose the discrepancy between ethical and practical considerations, while arguing that this polarization is a false dichotomy: in reality, ethics is applied to specific contexts and situations. Bridging this gap and considering the whole picture is essential for advancing the debate. In the light of the possible future developments of the situation and the technologies, as well as the benefits that informed consent for ML can bring to shared decision-making, the present analysis concludes that it is necessary to prepare the ground for a possible future requirement of informed consent for medical ML.
      Citation: Clinical Ethics
      PubDate: 2022-04-25T05:33:32Z
      DOI: 10.1177/14777509221094476
       
  • The ethical implications of preventing hospital delirium in older adults:
           A scoping review

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      Authors: Janet Delgado, Ana Toledo Chávarri, Ana María de Pascual y Medina, Beatriz León Salas, María del Mar Trujillo Martín, Pedro Serrano Aguilar
      Abstract: Clinical Ethics, Ahead of Print.
      IntroductionHospital delirium is a frequent, serious, costly, and underrecognized acute disorder of attention and cognition. Therefore, the prevention of hospital delirium is not only desirable for patients, caregivers, healthcare professionals, and the health system itself, but also a moral duty.ObjectiveTo identify and synthetize the main ethical aspects that arise related to the prevention of hospital delirium in patients 65 years and older.MethodsA scoping review was carried out in Embase, Medline, and Web of Science (January 2009–January 2022). Articles published in English or Spanish analyzing any pharmacologic, non-pharmacologic, or multicomponent intervention for prevention of delirium in hospitalized patients aged 65 years and over were included.ResultsTwenty-seven studies were included. Based on the frequency of appearance and the relevance, our findings were organized into three main areas. The first one was related to the principle of nonmaleficence and collected findings about the iatrogenic causes of hospital delirium and the use of restraints systems. The second area analyzed the impact of delirium in patients, families, and healthcare professionals from a relational ethics perspective, and addressed the family presence as a factor to prevent delirium. Finally, the third area is related to the quality of care.ConclusionPrevention of delirium in hospitals is essential to avoid the discomfort and potential clinical complications of patients, as well as the suffering of their relatives, caregivers, and healthcare professionals. Policymakers and healthcare managers are encouraged to make the required efforts to prevent delirium in hospitalized older patients.
      Citation: Clinical Ethics
      PubDate: 2022-04-22T06:56:57Z
      DOI: 10.1177/14777509221094483
       
  • The ethical and legal considerations of young people and their parents
           using a hospital patient portal: Hospital Ethics Committee members
           perspectives

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      Authors: Pippa Sipanoun, Jo Wray, Kate Oulton, Faith Gibson
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundIn April 2019, our hospital transitioned to an electronic patient record system and patient portal (MyGOSH). MyGOSH enables young people aged 12 years or older and their parents to access results, documentation, appointments, and to communicate with their care team.AimsA focus group was conducted to explore the ethical and legal considerations of young people and their parents using a patient portal from the perspective of hospital Ethics Committee members.Participants and research contextMembers of the hospital Paediatric Bioethics Centre were recruited (n = 7). Written informed consent was provided by all participants.Research designThe focus group discussion was recorded, transcribed verbatim and analysed using thematic analysis.Ethical considerationsHealth Research Authority Research Ethics Committee (REC) Approval was granted by London Southeast REC (IRAS Project ID: 248793; REC Reference: 18/LO/1945).ResultsFour themes, and sub-themes, were identified: (1) granting access – complexities of assessing competence/capacity, exclusion from MyGOSH due to non-disclosure of diagnosis, and truth-telling; (2) inequalities resulting in inequities – complexities of inequity in access; (3) responding to change – providing support and managing expectations; (4) engagement, empowerment and understanding – data safety, empowering young people to take ownership of their health data, a one-size fits all system may not meet the needs of all families, and early engagement with young people/parents.DiscussionGiving families portal access can increase engagement, empowering them to be more involved in care, yet poses challenges for all. Complexities exist in the assessment for portal access, and supporting and managing user expectations whilst providing an equitable service.ConclusionsOngoing support is required for all stakeholders following patient portal implementation to navigate the ethical and legal complexities, and to promote equity and portal utility for patient benefit.
      Citation: Clinical Ethics
      PubDate: 2022-04-21T04:48:36Z
      DOI: 10.1177/14777509221094475
       
  • Rethinking systemic ableism: A response to Zagouras, Ellick, and Aulisio

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      Authors: Erin E Andrews, Kara B Ayers, Joseph A Stramondo, Robyn M Powell
      Abstract: Clinical Ethics, Ahead of Print.
      IntroductionThis article is a response to Zagouras, Ellick, and Aulisio who presented a case study justifying the questioning of the capacity and autonomy of a young woman with a physical disability who was pregnant and facing coercive pressure to terminate.Case descriptionJulia is described as a 26-year-old woman with a neurological disability that requires her to receive assistance with activities of daily living. She was described as living with her parents who provided her with personal care assistance. Julia became pregnant and her parents wished her to terminate because they did not want to care for her child in addition to her. In fact, Julia's parents threatened her with institutionalization if she did not elect to terminate the pregnancy. Her health care team questioned her decision-making capacity based on her alleged “mental age” and experiences of being sheltered and excluded. The health care team used directive tactics to convince Julia to terminate the pregnancy, which describe as both an ethical and feminist intervention.DiscussionThe current authors take issue with the case analysis provided by and argue that they neglected to account for numerous instances of systemic ableism that adversely affected Julia, demonstrated prejudicial and judgmental attitudes toward pregnancy and disability, inappropriately questioned her decision-making capacity by infantilizing her, misconstrued the feminist concept of relational autonomy, and colluded with coercive interference from family members. This is a classic example of discriminatory and culturally incompetent reproductive health care for a disabled woman.
      Citation: Clinical Ethics
      PubDate: 2022-04-21T04:47:02Z
      DOI: 10.1177/14777509221094472
       
  • Rationing in pediatric hospitalizations during COVID-19: A step back to
           move forward

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      Authors: Binh Phung
      Abstract: Clinical Ethics, Ahead of Print.
      The latest Omicron variant of the novel coronavirus has itself created a novel situation—bringing attention to the topic of healthcare rationing among hospitalized pediatric patients. This may be the first time that many pediatricians, nurses, parents, and public health officials have been compelled to engage in uncomfortable discussions about the allocation of medical care/resources. Simply put, finite budgets, resources, and a dwindling healthcare workforce do not permit all patients to receive unlimited medical care. Triage and bedside rationing decisions are happening in a range of difficult everyday circumstances both implicitly and explicitly, but in ways not recognized by even the best ethically framed intentions. Clinicians and hospital administrators have largely been left on their own “to flatten the rationing curve” in hopes that resources never have to be explicitly rationed at their facility. Unfortunately, the downstream result is a misinformed and distrustful public (i.e. parents, guardians, and caregivers) filled with people who are already burdened with inflammatory pseudoscience narratives and deficits in health literacy. This paper aims to elevate a more thoughtful conversation about healthcare rationing by analyzing some existing ethical principles/framework developed for rationing decision making during previous emergency responses and drawing from the day-to-day clinical perspectives of a frontline pediatric acute care/hospitalist.
      Citation: Clinical Ethics
      PubDate: 2022-04-18T09:04:37Z
      DOI: 10.1177/14777509221094471
       
  • A lay perspective on prioritization for intensive care in pandemic times:
           Vaccination status matters

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      Authors: Philipp Sprengholz, Lars Korn, Lisa Felgendreff, Sarah Eitze, Cornelia Betsch
      Abstract: Clinical Ethics, Ahead of Print.
      During a pandemic, demand for intensive care often exceeds availability. Experts agree that allocation should maximize benefits and must not be based on whether patients could have taken preventive measures. However, intensive care units (ICUs) are often overburdened by individuals with severe COVID-19 who have chosen not to be vaccinated to prevent the disease. This article reports an experiment that investigated the German public's prioritization preferences during the fourth wave of the coronavirus pandemic (N = 1014). In a series of scenarios, participants were asked to decide on ICU admission for patients who differed in terms of health condition, expected treatment benefits, and vaccination status. The results reveal an in-group bias, as vaccinated individuals preferred to allocate more resources to the vaccinated than to the unvaccinated. Participants also favored admitting a heart attack patient rather than a COVID-19 patient with the same likelihood of benefiting from ICU admission, indicating a preference for maintaining regular ICU services rather than treating those with severe COVID-19. Finally, participants were more likely to admit a patient to intensive care when this meant withholding rather than withdrawing care from another patient. The results indicate that lay prioritizations violate established allocation principles, presaging potential conflicts between those in need of intensive care and those who provide and allocate it. It is therefore recommended that allocation principles should be explained to enhance public understanding. Additionally, vaccination rates should be increased to relieve ICUs and reduce the need for such triage decisions.
      Citation: Clinical Ethics
      PubDate: 2022-04-18T01:50:10Z
      DOI: 10.1177/14777509221094474
       
  • Teaching ethical principles through narrative-based story is more
           effective in the moral sensitivity among BSc nursing students than lecture
           method : A quasi-experimental study

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      Authors: Behnaz Bagherian, Roghayeh Mehdipour-rabori, Monirsadat Nematollahi
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundEthics education can be developed in undergraduate nursing curriculum using a variety of teaching and learning strategies, and the content of narrative-based stories has rarely been evaluated in ethics courses.ObjectiveThis study aimed to compare the effect of teaching ethical principles through narrative ethics and lectures on the moral sensitivity of undergraduate nursing students.MethodsThis was a pretest and posttest quasi-experimental study with a control group. A total of 105 undergraduate nursing students from the nursing department of Kerman University of medical science were included in the study (35 in the narrative-based story group, 36 in the lecture group and 34 in the control group). The narrative-based story and lecture lasted for four two-hour sessions. The outcomes were measured by a moral sensitivity questionnaire.ResultsThe study results showed that teaching ethical principles had a significant effect on the mean score of moral sensitivity in the intervention groups after the intervention, but it was not significant in the control group (p > 0.05). Based on the mean score of moral sensitivity, the students in the narrative story group got a higher score in all subscales of moral sensitivity questionnaire.ConclusionBased on this study’s findings, it can be concluded that narrative-based education is an effective way for undergraduate nursing students to promote their moral sensitivity and the ability to make ethical decisions.
      Citation: Clinical Ethics
      PubDate: 2022-04-13T07:00:24Z
      DOI: 10.1177/14777509221091094
       
  • Look back to look forward…

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      Authors: Lisa Wilks-Gallo
      Abstract: Clinical Ethics, Ahead of Print.

      Citation: Clinical Ethics
      PubDate: 2022-04-12T07:34:43Z
      DOI: 10.1177/14777509221094485
       
  • Taking care of the beloved patient

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      Authors: Jacob M Appel
      Abstract: Clinical Ethics, Ahead of Print.
      While the management of treating “hateful” patients has been the subject of considerable commentary, far less attention has been paid to the ethical challenges involved in the treatment of “beloved” patients. This essay offers a non-exhaustive taxonomy of “beloved” patients that includes relatable patients, inspiring patients, empathy-inducing patients, and joyful patients, and then discusses the potential pitfalls involved in the optimal care of each group. By drawing attention to these often overlooked and unwitting risks, the hope is to mitigate both their direct impact upon individual “beloved” patients and their residual impact upon those patients who are not viewed as “beloved” by their providers.
      Citation: Clinical Ethics
      PubDate: 2022-04-12T07:34:22Z
      DOI: 10.1177/14777509221094484
       
  • Family conflict and aggression in the paediatric intensive care unit:
           Responding to challenges in practice

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      Authors: Shreerupa Basu, Anne Preisz
      Abstract: Clinical Ethics, Ahead of Print.
      The paediatric intensive care unit (PICU) is a high-stress environment for parents, families and health care professionals (HCPs) alike. Family members experiencing stress or grief related to the admission of their sick child may at times exhibit challenging behaviours; these exist on a continuum from those that are anticipated in context, through to unacceptable aggression. Rare, extreme behaviours include threats, verbal or even physical abuse. Both extreme and recurrent ‘subthreshold’ behaviours can cause significant staff distress, impede optimal clinical care and compromise patient outcomes. The unique PICU environment and model of care may magnify stressors for both families and staff and the family-centred approach to care (FCC) central to paediatric practice, may also contribute to contextual challenges. Pervasive conflict in paediatric healthcare is harmful for patients, families, PICU staff and the institution more broadly. We propose that caring for children and caring for staff are inseparable goals and the latter has been inadvertently but detrimentally deprioritised as FCC has become a primary focus. A transparent and graded hierarchy of responses to variable levels of challenging behaviour is necessary to ensure that families are supported, while HCPs remain protected in the workplace. This requires establishing firm limits supported by all teams and levels of the institution. As such, we aim to identify and clarify the context and impact of challenging parent and family behaviour in the PICU and to offer potential, proactive mitigation strategies, based on reflections and stakeholder discussion following recent clinical challenges and experiences in our unit.
      Citation: Clinical Ethics
      PubDate: 2022-04-12T07:34:06Z
      DOI: 10.1177/14777509221091081
       
  • Living bioethics, theories and children’s consent to heart surgery

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      Authors: Priscilla Alderson, Deborah Bowman, Joe Brierley, Nathalie Dedieu, Martin J Elliott, Jonathan Montgomery, Hugo Wellesley
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundThis analysis is about practical living bioethics and how law, ethics and sociology understand and respect children’s consent to, or refusal of, elective heart surgery. Analysis of underlying theories and influences will contrast legalistic bioethics with living bioethics. In-depth philosophical analysis compares social science traditions of positivism, interpretivism, critical theory and functionalism and applies them to bioethics and childhood, to examine how living bioethics may be encouraged or discouraged. Illustrative examples are drawn from research interviews and observations in two London paediatric cardiac units. This paper is one of a series on how the multidisciplinary cardiac team members all contribute to the complex mosaic of care when preparing and supporting families’ informed consent to surgery.ResultsThe living bioethics of justice, care and respect for children and their consent depends on theories and practices, contexts and relationships. These can all be undermined by unseen influences: the history of adult-centric ethics; developmental psychology theories; legal and financial pressures that require consent to be defined as an adult contract; management systems and daily routines in healthcare that can intimidate families and staff; social inequalities. Mainstream theories in the clinical ethics literature markedly differ from the living bioethics in clinical practices.ConclusionWe aim to contribute to raising standards of respectful paediatric bioethics and to showing the relevance of virtue and feminist ethics, childhood studies and children’s rights.
      Citation: Clinical Ethics
      PubDate: 2022-04-07T11:29:50Z
      DOI: 10.1177/14777509221091086
       
  • The benefits, risks and alternatives of mitochondrial replacement therapy
           – bringing proportionality into public policy debate

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      Authors: Gregory K Pike
      Abstract: Clinical Ethics, Ahead of Print.
      Mitochondrial replacement therapy (MRT) utilises nuclear transfer technology to replace defective mitochondria with healthy ones and thereby minimise the risk of a mitochondrial disease passing from a mother to her child. It promises much but comes with ethical controversy, significant risk of harm and many unknowns. Forming a position on MRT requires accurate information about the current state of knowledge, and an appreciation of the ethical issues at stake. Ethical deliberations will vary depending on the framework used. There are in principle objections to MRT on the grounds of direct harm to human embryos and germline genetic modification. But even without these objections MRT can be weighed in terms of the balance between risks and benefits, alternatives and uncertainties. This paper explores the evidence and lays out the relevant issues to assist such a deliberation.
      Citation: Clinical Ethics
      PubDate: 2022-04-04T08:16:09Z
      DOI: 10.1177/14777509221091097
       
  • The Patients Changing Things Together (PATCHATT) ethics pack: A tool to
           support inclusive ethical decision-making in the development of a
           community-based palliative care intervention

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      Authors: Amanda Jane Roberts
      Abstract: Clinical Ethics, Ahead of Print.
      The Patients Changing Things Together (PATCHATT) programme supports individuals with a life-limiting illness to lead a change that matters to them. Individuals join a facilitated online peer support group to identify an issue they feel strongly about, plan for change and take action to bring that change about. The programme is developed and guided by a Programme Advisory Group with clinical and lay membership. This article charts the trialling of the patients changing thing together ethics pack, designed to support all members of the Programme Advisory Group in taking an equal role in ethical decision-making as they guide the programme's ongoing development. As a trial of its efficacy, the pack was used by the author to consider an ethical dilemma at the heart of the development of the Patients Changing Things Together programme, that is, is it ethical to offer a community palliative care programme which has the potential to bring participants harm as well as good' The author reports a strong ethical argument for offering this programme, while concluding the need for the Programme Advisory Group to make the final decision, using the Patients Changing Things Together ethics pack to consider the results of the evaluation of the programme's pilot. The article concludes that this pack provides an effective tool to guide ethical novices through the ethical complexities of developing a community-based palliative care intervention programme. It raises the issue that such inclusivity is achieved through a normative decision-making process which denies the fluidity and creativity which may inform the best ethical decision-making practice.
      Citation: Clinical Ethics
      PubDate: 2022-04-04T08:15:53Z
      DOI: 10.1177/14777509221091093
       
  • Pandemic journey to prestige at nursing

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      Authors: Nerıman Ozge Calıskan, Hayat Yalın, Fatma Eti Aslan
      Abstract: Clinical Ethics, Ahead of Print.
      Respect, which is human virtue by its very nature, is a universal feeling and action. Prestige; it is expressed as being respected, valuable, and reliable. These intertwined concepts draw attention basically for nursing, in which interpersonal interactions stand out compared to other professions. Moreover, while continuing the services in a kind of mobilization environment during the pandemic process that we have been faced with since 11 March 2020 and will obviously be affected for a long time in our country, the most common sense and respectful perspectives and approaches are needed. Respectful actions and respectful practices which are also included in the scope of professional ethics are more strategically important as we experience such a mass and historical human experience in which each of us is responsible for each other's health. The reputation of nursing continues to be formed and differentiated with how this profession is perceived by members of the profession and society, influenced by various processes from past to present. In this article, the change/development of the reputation of the nursing profession during the COVID-19 pandemic period was discussed.
      Citation: Clinical Ethics
      PubDate: 2022-03-31T05:17:12Z
      DOI: 10.1177/14777509221091091
       
  • Department of Humanism and Bioethics at the Fundación Santa Fe de
           Bogotá, Colombia: An update based on 8 years of service

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      Authors: Paula Prieto-Martínez, Nathalia Rodríguez Suárez, Diana Lucía Zárate-Velasco
      Abstract: Clinical Ethics, Ahead of Print.
      A humane and respectful treatment of patients by the staff has inspired the creation of the Department of Humanism and Bioethics at the University Hospital of Fundación Santa Fe de Bogotá which not only has met, but even surpassed established goals. Since 2013, the Department has developed different activities that have made it possible to respond more ethically to the daily needs of patients and to strengthen other humanization processes. Currently, the Department of Humanism and Bioethics addresses five lines of work: a continuing education program, an assistance advisory program, support, and strengthening of existing committees, support for the activities of our institutional humanization program and research activities. This article updates the experience of this Department, specifically focusing on notable changes in the last years.
      Citation: Clinical Ethics
      PubDate: 2022-03-04T11:55:07Z
      DOI: 10.1177/14777509221077389
       
  • Is there a right to a fully vaccinated care team'

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      Authors: Jordan L Schwartzberg, Jeremy Levenson, Jacob M Appel
      Abstract: Clinical Ethics, Ahead of Print.
      Although COVID-19 vaccines are free and readily available in the United States, many healthcare workers remain unvaccinated, potentially exposing their patients to a life-threatening pathogen. This paper reviews the ethical and legal factors surrounding patient requests to limit their care teams exclusively to vaccinated providers. Key factors that shape policy in this area include patient autonomy, the rights of healthcare workers, and the duties of healthcare institutions. Hospitals must also balance the rights of interested parties in the context of logistical constraints, equity, and public health considerations.
      Citation: Clinical Ethics
      PubDate: 2022-02-08T10:11:04Z
      DOI: 10.1177/14777509221077391
       
  • Values at stake at the end of life: Analyses of personal preferences among
           Swedish physicians

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      Authors: Niels Lynøe, Anna Lindblad, Ingemar Engström, Mikael Sandlund, Niklas Juth
      Abstract: Clinical Ethics, Ahead of Print.
      BackgroundPhysician-assisted suicide is a controversial issue and has sometimes raised emotion-laden reactions. Against this backdrop, we have analyzed how Swedish physicians are reasoning about physician-assisted suicide if it were to be legalized.Methods and participantsWe conducted a cross-sectional study and analyzed 819 randomly selected physicians’ responses from general practitioners, geriatricians, internists, oncologists, psychiatrists, surgeons, and all palliativists. Apart from the main questions about their attitude toward physician-assisted suicide, we also asked what would happen with the respondents’ own trust in healthcare if physician-assisted suicide were legalized. Response options were that trust would decrease, not be influenced, or would increase.ResultsWe identified a strong statistical association between on the one hand those whose own trust would increase and who were pro physician-assisted suicide, and on the other hand those who were against physician-assisted suicide and whose own trust would decrease [relative risk: 16.7 (95% confidence interval: 10.2–27.2)]. Among those whose own trust would not be influenced (n = 456), 60% were pro pysician-assisted suicide, 16% were against, and 24% were undecided. Of those whose trust would increase or not be influenced, a large majority supported autonomy-based arguments, whereas those whose trust would decrease supported non-maleficence-based arguments.ConclusionAnalyzing the answers after having divided respondents into those whose own trust in healthcare would decrease or increase and not be influenced brings about interesting results such as how the three groups prioritize arguments for and against physician-assisted suicide. This way of analyzing the data seems to be a promising strategy when identifying value-impregnated factual claims.
      Citation: Clinical Ethics
      PubDate: 2022-02-08T10:10:47Z
      DOI: 10.1177/14777509221077387
       
  • Patient attitudes towards side effect information: An important foundation
           for the ethical discussion of the nocebo effect of informed consent

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      Authors: Mette Sieg, Lene Vase
      Abstract: Clinical Ethics, Ahead of Print.
      A growing body of evidence suggests that the informed consent process, in which patients are warned about potential side effects of a treatment, can trigger a nocebo effect where expectations about side effects increase side effect occurrence. This has sparked an ethical debate about how much information patients ought to receive before a treatment while trying to balance the moral principles of patient autonomy and nonmaleficence. In keeping with the principle of patient autonomy, the opinion of patients themselves in relation to how much information they want about side effects is of utmost relevance in this debate. The literature was searched to identify surveys assessing patient attitudes towards side effect information. Across a broad variety of patient populations, treatment types, and countries, the majority of patients wished to be fully informed of potential side effects, particularly in relation to frequent and severe side effects, while only a small minority wanted minimal or no information at all. Results from this review suggest that nocebo research should focus on methods of avoiding nocebo effects of informed consent while ensuring that patients are well-informed about potential side effects.
      Citation: Clinical Ethics
      PubDate: 2022-02-02T05:26:53Z
      DOI: 10.1177/14777509221077390
       
  • Comparison of the views of patients and rehabilitation therapists on the
           importance and respecting of the patients’ rights charter

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      Authors: Zahra Ghayoumi-Anaraki, Mina Forough Bakhsh, Seyed Ahmad Rezaei Anbarake, Mohaddeseh Mohsenpour
      Abstract: Clinical Ethics, Ahead of Print.
      IntroductionRespecting the Patients’ Rights Charter leads to the demands of patients for their rights and the response of rehabilitation therapists by increasing their compliance. The present study aimed to compare the views of patients and rehabilitation therapists about the importance and extent of compliance with the Patients’ Rights Charter.MethodsThis cross-sectional study was conducted for 3 months on 114 patients and 55 therapists who were selected using the convenience sampling method. The data collection tools included a demographic information form and the Justification and Practice of Patient Rights Questionnaire. The collected data were analyzed using descriptive statistics, independent t-test, paired t-test, and Pearson correlation coefficient.ResultsMean scores of the importance of compliance with the Patients’ Rights Charter were 2.21 ± 0.40 and 2.31 ± 0.43 in the group of patients and therapists, respectively. Moreover, the mean scores of compliance with the Patients’ Rights Charter were 1.45 ± 0.48 and 1.53 ± 0.61 from the perspective of patients and therapists, respectively. There was no statistically significant difference between the views of patients and therapists on the importance and extent of compliance with the Patients’ Rights Charter.Discussion and ConclusionThe importance of respecting the Patients’ Rights Charter from the perspective of patients and therapists was at a desirable level while the level of compliance with it from the perspective of both groups was moderate. It seems that more research is needed to explain the causes of this discrepancy and increase compliance with the Patients’ Rights Charter in rehabilitation clinics.
      Citation: Clinical Ethics
      PubDate: 2022-02-02T05:26:46Z
      DOI: 10.1177/14777509221077388
       
  • The duty of candour: Open disclosure of medical errors

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      Authors: Eimear C Bourke, Jessica Lochtenberg
      Abstract: Clinical Ethics, Ahead of Print.

      Citation: Clinical Ethics
      PubDate: 2022-01-05T02:19:05Z
      DOI: 10.1177/14777509211070490
       
 
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