Should people with exceptionally profound disabilities be given an equal chance of surviving a pandemic, even when their care might require a greater use of limited medical resources? How might an ethics of care be used to shape a policy regarding these patients?

ZusammenfassungKlinische Ethikberatungen sollten dokumentiert werden, wenn dies mit den Klienten entsprechend vereinbart worden ist. Der Beitrag plädiert für eine stetige Dokumentation von Ethikberatungen (interne Dokumentation). Auf diesen Grundlagen können unterschiedliche Berichte über Ethikberatungen mit unterschiedlichen Inhalten und unterschiedlichen Adressaten entstehen. Es wird zwischen einem Ergebnis- und einem Verlaufsbericht unterschieden. Diese werden von summarischen Zeitraumberichten oder einem Berichtssystem Ethikberatung abgegrenzt. Ergebnisberichte mit einer Darlegung des Beratungsergebnisses und den wichtigsten ethischen Argumenten werden häufig in Krankenunterlagen eingeordnet. Verlaufsberichte dienen in der Regel eher (...) Ausbildungs- und Qualitätssicherungszwecken.Dokumentationen in diesem weiten Sinn können zu einer Professionalisierung der Ethikberatung beitragen. Dabei ist es aber von zentraler Bedeutung, sich die Zielsetzung der jeweiligen Form von Dokumentation zu vergegenwärtigen und ehrlich und aufrichtig nach Schwächen und Entwicklungspotenzialen der Beratung zu ethischen Fragen im klinischen Alltag zu suchen. (shrink)

Klinische Ethikberatungen sollten dokumentiert werden, wenn dies mit den Klienten entsprechend vereinbart worden ist. Der Beitrag plädiert für eine stetige Dokumentation von Ethikberatungen (interne Dokumentation). Auf diesen Grundlagen können unterschiedliche Berichte über Ethikberatungen mit unterschiedlichen Inhalten und unterschiedlichen Adressaten entstehen. Es wird zwischen einem Ergebnis- und einem Verlaufsbericht unterschieden. Diese werden von summarischen Zeitraumberichten oder einem Berichtssystem Ethikberatung abgegrenzt. Ergebnisberichte mit einer Darlegung des Beratungsergebnisses und den wichtigsten ethischen Argumenten werden häufig in Krankenunterlagen eingeordnet. Verlaufsberichte dienen in der Regel eher (...) Ausbildungs- und Qualitätssicherungszwecken.Dokumentationen in diesem weiten Sinn können zu einer Professionalisierung der Ethikberatung beitragen. Dabei ist es aber von zentraler Bedeutung, sich die Zielsetzung der jeweiligen Form von Dokumentation zu vergegenwärtigen und ehrlich und aufrichtig nach Schwächen und Entwicklungspotenzialen der Beratung zu ethischen Fragen im klinischen Alltag zu suchen. (shrink)

ZusammenfassungKlinische Ethikberatungen sollten dokumentiert werden, wenn dies mit den Klienten entsprechend vereinbart worden ist. Der Beitrag plädiert für eine stetige Dokumentation von Ethikberatungen (interne Dokumentation). Auf diesen Grundlagen können unterschiedliche Berichte über Ethikberatungen mit unterschiedlichen Inhalten und unterschiedlichen Adressaten entstehen. Es wird zwischen einem Ergebnis- und einem Verlaufsbericht unterschieden. Diese werden von summarischen Zeitraumberichten oder einem Berichtssystem Ethikberatung abgegrenzt. Ergebnisberichte mit einer Darlegung des Beratungsergebnisses und den wichtigsten ethischen Argumenten werden häufig in Krankenunterlagen eingeordnet. Verlaufsberichte dienen in der Regel eher (...) Ausbildungs- und Qualitätssicherungszwecken.Dokumentationen in diesem weiten Sinn können zu einer Professionalisierung der Ethikberatung beitragen. Dabei ist es aber von zentraler Bedeutung, sich die Zielsetzung der jeweiligen Form von Dokumentation zu vergegenwärtigen und ehrlich und aufrichtig nach Schwächen und Entwicklungspotenzialen der Beratung zu ethischen Fragen im klinischen Alltag zu suchen. (shrink)

Communication and Conflict Management Training for Clinical Bioethics Committees Content Type Journal Article Pages 341-349 DOI 10.1007/s10730-009-9116-7 Authors Lauren M. Edelstein, Johns Hopkins Medicine’s Howard County General Hospital 5755 Cedar Lane Columbia MD 21044 USA Evan G. DeRenzo, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Elizabeth Waetzig, Change Matrix Inc. 485 Maylin St. Pasadena CA 91105 USA Craig Zelizer, Georgetown University Department of Government 3240 Prospect St. Washington, D.C. NW 20057 USA Nneka O. (...) Mokwunye, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

In the clinical setting, questions of medical ethics raise a host of perplexing problems, often complicated by conflicting perspectives and the need to make immediate decisions. In this volume, bioethicists and physicians provide a nuanced, in-depth approach to the difficult issues involved in bioethics consultation. Addressing the needs of researchers, clinicians, and other health professionals on the front lines of bioethics practice, the contributors focus primarily on practical concerns -- whether ethics consultation is best done by individuals, teams, or committees (...) how an ethics consult service should be structured the need for institutional support and techniques and programs for educating and training staff -- without neglecting more theoretical considerations, such as the importance of character or the viability of organizational ethics. (shrink)

Consciousness and emotion feature prominently in our personal lives, yet remain enigmatic. Recent advances prompt further distinctions that should provide more experimental traction: we argue that emotion consists of an emotion state (functional aspects, including emo- tional response) as well as feelings (the conscious experience of the emotion), and that consciousness consists of level (e.g. coma, vegetative state and wake- fulness) and content (what it is we are conscious of). Not only is consciousness important to aspects of emotion but structures (...) that are important for emotion, such as brainstem nuclei and midline cortices, overlap with structures that regulate the level of consciousness. The intersection of consciousness and emotion is ripe for experimental investigation, and we outline possible examples for future studies. (shrink)

Tod Chambers suggests that literary theory is a crucial component in the complete understanding of bioethics. _The Fiction of Bioethics_ explores the medical case study and distills the idea that bioethicists study real-life cases, while philosophers contemplate fictional accounts.

Introduction: making the invisible visible -- The nobility of the material -- Research at war -- The guilded age of research -- The doctor as whistle-blower -- New rules for the laboratory -- Bedside ethics -- The doctor as stranger -- Life through death -- Commissioning ethics -- No one to trust -- New rules for the bedside -- Epilogue: The price of success.

The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) requires as a condition of accreditation that every health care institution -- hospital, nursing home, or home care agency -- have a standing mechanism to address ethical issues. Most organizations have chosen to fulfill this requirement with an interdisciplinary ethics committee. The best of these committees are knowledgeable, creative, and effective resources in their institutions. Many are wellmeaning but lack the information, experience, and skills to negotiate adequately the complex ethical (...) issues that arise in clinical and organizational settings. Handbook for Health Care Ethics Committees is the first resource designed to address the range of work performed by ethics committees as part of their multiple responsibilities, including education, case consultation, and policy development. It features an eight-chapter curriculum reviewing the content of contemporary health care bioethics and discussing the ethical foundations of clinical practice, with each subsequent section focusing on a set of ethical issues that commonly arise in the clinical setting. Through case studies, the authors explore issues such as informed consent and refusal, decision making and decisional capacity, truth telling, decision-making concerns of minors, end-of-life issues, palliation, justice in and access to health care services, and organizational ethics. They offer sample policies and procedures, draft guidelines and protocols, and key legal cases. Providing both a strong theoretical foundation and practical applications, this handbook will be essential reading for every member of a health care ethics committee. (shrink)

Introduction In recent years there has been a welcome reawakening of philosophical interest in the emotions. A significant number of contemporary ...

Context Conflicts over treatment decisions have been linked to physicians' emotional states. Objective To measure the prevalence of emotional exhaustion and conflicts over treatment decisions among US obstetrician/gynaecologists (ob/gyns), and to examine the relationship between the two and the physician characteristics that predict each. Methods Mailed survey of a stratified random sample of 1800 US ob/gyn physicians. Criterion variables were levels of emotional exhaustion and frequency of conflict with colleagues and patients. Predictors included physicians' religious characteristics and self-perceived empathy. Results (...) Response rate among eligible physicians was 66% (1154/1760). 36% of ob/gyns reported high levels of emotional exhaustion, and majorities reported conflict with colleagues (59%) and patients (61%). Those reporting conflict were much more likely to report emotional exhaustion (58% vs 29% who never conflict, OR, 95% CI 2.8, 1.6 to 4.8 for conflict with colleagues; 55% versus 26%, OR, 95% CI 2.2, 1.4 to 3.5 for conflict with patients). Physicians with lower self-perceived empathy were more likely to report physician-patient conflicts (65% vs 58% with higher empathy, OR, 95% CI 1.4, 1.0 to 1.9), as were female ob/gyns (66% vs 57% of males, OR, 95% CI 1.5, 1.1 to 2.0). Foreign-born physicians were less likely to report such conflicts (47% vs 64% of US born, OR, 95% CI 0.5, 0.4 to 0.8). Physicians' religious characteristics were not significantly associated with reporting conflict. Conclusions Conflicts over treatment decisions are associated with physicians' empathy, gender, immigration history and level of emotional exhaustion. With respect to the latter, conflict in the clinical encounter may represent an overlooked source or sign of burnout among ob/gyns. (shrink)

As everybody knows, advances in medicine and medical technology have brought enormous benefits to, and created vexing choices for, us all – choices that can, and occasionally do, test the very limits of thinking itself. As everyone also knows, we live in the age of consultants, i.e., of professional experts who are ready, willing, and able to give us advice on any and every conceivable question. One such consultant is the medical ethics consultant, or the medical ethicist who consults.Medical ethics (...) consultants involve themselves in just about every aspect of health care decision making. They help legislators and judges determine law, hospitals formulate policies, medical schools develop curricula, etc. In addition to educating physicians, nurses, and lawyers, amongst others, including medical, nursing, and law students, they participate in clinical decision making at the bedside. (shrink)

As everybody knows, advances in medicine and medical technology have brought enormous benefits to, and created vexing choices for, us all – choices that can, and occasionally do, test the very limits of thinking itself. As everyone also knows, we live in the age of consultants, i.e., of professional experts who are ready, willing, and able to give us advice on any and every conceivable question. One such consultant is the medical ethics consultant, or the medical ethicist who consults.Medical ethics (...) consultants involve themselves in just about every aspect of health care decision making. They help legislators and judges determine law, hospitals formulate policies, medical schools develop curricula, etc. In addition to educating physicians, nurses, and lawyers, amongst others, including medical, nursing, and law students, they participate in clinical decision making at the bedside. (shrink)

Since Clinical Ethics Consultation has become important in the public health sector in the last decade in Germany, there are on-going questions about effectiveness. Targets have been established by the Ethics Committees, in regard to assisting patients, families and health care teams at times of ethical conflicts during the decision-making process in medical care. Of all the ethics consultations over the last eight years at Erlangen University Hospital the consultations carried out in the pediatric department were chosen to be reviewed (...) by a pediatrician and an ethicist. These were evaluated on the basis of team formation, interdisciplinary orientation, ethical criteria, completeness and methods of documentation. Results of the analysis of those records show a well-organized consultation team with regard to its personnel composition. Discrepancies with ethical questions posed in the literature are revealed, and also some partially incomplete documentation regarding medical facts and descriptions of the patients' or parents' opinion. (shrink)