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The Ethics of Human Embryo Editing via CRISPR-Cas9 Technology: A Systematic Review of Ethical Arguments, Reasons, and Concerns. HEC Forum (IF 1.3) Pub Date : 2024-09-20 Lindsay Wiley,Mattison Cheek,Emily LaFar,Xiaolu Ma,Justin Sekowski,Nikki Tanguturi,Ana Iltis
The possibility of editing the genomes of human embryos has generated significant discussion and interest as a matter of science and ethics. While it holds significant promise to prevent or treat disease, research on and potential clinical applications of human embryo editing also raise ethical, regulatory, and safety concerns. This systematic review included 223 publications to identify the ethical
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Review of Outpatient Pediatric Ethics Consults at an Academic Medical Center HEC Forum (IF 1.3) Pub Date : 2024-08-22 George E. Freigeh, Hannah Fagen, Janice Firn
Limited data exist in the specific content of pediatric outpatient ethics consults as compared to inpatient ethics consults. Given the fundamental differences in outpatient and inpatient clinical care, we aimed to describe the distinctive nature of ethics consultation in the ambulatory setting. This is a retrospective review at a large, quaternary academic center of all outpatient ethics consults in
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Moral Distress Consultation Services: Insights from Consultants HEC Forum (IF 1.3) Pub Date : 2024-08-03 Vanessa Amos, Phyllis Whitehead, Beth Epstein
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Canada’s Medical Assistance in Dying System can Enable Healthcare Serial Killing HEC Forum (IF 1.3) Pub Date : 2024-08-02 Christopher Lyon
The Canadian approach to assisted dying, Medical Assistance in Dying (MAiD), as of early 2024, is assessed for its ability to protect patients from criminal healthcare serial killing (HSK) to evaluate the strength of its safeguards. MAiD occurs through euthanasia or self-administered assisted suicide (EAS) and is legal or considered in many countries and jurisdictions. Clinicians involved in HSK typically
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Everyday Clinical Ethics: Essential Skills and Educational Case Scenarios HEC Forum (IF 1.3) Pub Date : 2024-07-09 Elaine C. Meyer, Giulia Lamiani, Melissa Uveges, Renee McLeod-Sordjan, Christine Mitchell, Robert D. Truog, Jonathan M. Marron, Kerri O. Kennedy, Marilyn Ritholz, Stowe Locke Teti, Aimee B. Milliken
Bioethics conjures images of dramatic healthcare challenges, yet everyday clinical ethics issues unfold regularly. Without sufficient ethical awareness and a relevant working skillset, clinicians can feel ill-equipped to respond to the ethical dimensions of everyday care. Bioethicists were interviewed to identify the essential skills associated with everyday clinical ethics and to identify educational
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The Structure of Clinical Ethical Decision-Making: A Hospital System Needs Assessment HEC Forum (IF 1.3) Pub Date : 2024-06-08 Leana G. Araujo, Martin Shaw, Edwin Hernández
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On What Grounds? A Pilot Study of References Used in Clinical Ethics Consultation and Education HEC Forum (IF 1.3) Pub Date : 2024-05-31 Kelly Turner, Abram Brummett, Erica Salter
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Vaccine Impact Bonds: An Alternative Way of Allocating the Economic Risks of Mass Vaccination Programs HEC Forum (IF 1.3) Pub Date : 2024-05-24 Pascal René Marcel Kubin
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Against Anti-Abortion Violence HEC Forum (IF 1.3) Pub Date : 2024-05-14 William Simkulet
Jeremy Williams argues that both anti-abortion and pro-choice theories seem to justify two forms of anti-abortion violence – (1) violence against those that perform abortions, and (2) the subjugation of women seeking abortion. He illustrates this by way of his Death Camps analogy. However, Williams does not advocate such violence; rather he seems despondent over his conclusion. Here I argue Williams’
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On Seeing Long Shadows: Is Academic Medicine at its Core a Practice of Racial Oppression? HEC Forum (IF 1.3) Pub Date : 2024-05-10 Thomas S. Huddle
Suggestions that academic medicine is systemically racist are increasingly common in the medical literature. Such suggestions often rely upon expansive notions of systemic racism that are deeply controversial. The author argues for an empirical concept of systemic racism and offers a counter argument to a recent suggestion that academic medicine is systemically racist in its treatment of medical trainees:
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Prognostic Disclosure to Dying Adolescents Against Parental Wishes: A Point-Counter Point Debate HEC Forum (IF 1.3) Pub Date : 2024-04-26 Mariah K. Tanious, Grant Goodrich, Virginia Pedigo, Shelly Ozark, Joshua Arenth
An adolescent’s last moment of life is an emotionally and medically complex time. Children may grapple with understanding the things happening to them and with grief of a future lost; caregivers struggle to simultaneously balance deep sorrow, hope, and love; and healthcare providers fight to maintain sound medical and ethical decision making. Increased discussion regarding adolescent end-of-life care
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Professionalization of Clinical Ethics Consultants: A Need for Liability Protection? HEC Forum (IF 1.3) Pub Date : 2024-04-23 Claudia R. Sotomayor, Christopher Spevak, Edward R. Grant
Clinical Ethics Consultation (CEC) has grown significantly in the last decade, and efforts are being made to professionalize the practice. The American Society for Bioethics and Humanities (ASBH) has been instrumental in this process, having published the Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants and founded and endorsed the creation of the Healthcare Ethics
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Ritual and Power in Medicine: Questioning Honor Walks in Organ Donation HEC Forum (IF 1.3) Pub Date : 2024-03-20 Jay R. Malone, Jordan Mason, Jeffrey P. Bishop
Honor walks are ceremonies that purportedly honor organ donors as they make their final journey from the ICU to the OR. In this paper, we draw on Ronald Grimes’ work in ritual studies to examine honor walks as ceremonial rituals that display medico-technological power in a symbolic social drama (Grimes, 1982). We argue that while honor walks claim to honor organ donors, ceremonies cannot primarily
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“Follow the Science” in COVID-19 Policy: A Scoping Review HEC Forum (IF 1.3) Pub Date : 2024-03-12 Jacob R. Greenmyer
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Specific Trends in Pediatric Ethical Decision-Making: An 18-Year Review of Ethics Consultation Cases in a Pediatric Hospital HEC Forum (IF 1.3) Pub Date : 2024-02-28 Yaa Bosompim, Julie Aultman, John Pope
This is a qualitative examination of ethics consultation requests, outcomes, and ethics committee recommendations at a tertiary/quaternary pediatric hospital in the U.S. The purpose of this review of consults over an 18-year period is to identify specific trends in the types of ethical dilemmas presented in our pediatric setting, the impact of consultation and committee development on the number and
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Can We Be Creative with Communication? Assessing Decision-Making Capacity in an Adult with Selective Mutism HEC Forum (IF 1.3) Pub Date : 2024-02-05 Nicholas R. Mercado
Selective mutism is an anxiety disorder in which an individual is unable to speak in certain social situations though may speak normally in other settings (Hua & Major, 2016). Selective mutism in adults is rare, though people with this condition might have other methods of communicating their needs outside of verbal communication. Healthcare professionals rely on a patient’s ability to communicate
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What is a High-Quality Moral Case Deliberation?-Facilitators’ Perspectives in the Euro-MCD Project HEC Forum (IF 1.3) Pub Date : 2024-02-05 Lena M. Jakobsen, Bert Molewijk, Janine de Snoo-Trimp, Mia Svantesson, Gøril Ursin
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Non-Psychiatric Treatment Refusal in Patients with Depression: How Should Surrogate Decision-Makers Represent the Patient’s Authentic Wishes? HEC Forum (IF 1.3) Pub Date : 2024-01-27 Esther Berkowitz, Stephen Trevick
Patients with mental illness, and depression in particular, present clinicians and surrogate decision-makers with complex ethical dilemmas when they refuse life-sustaining non-psychiatric treatment. When treatment rejection is at variance with the beliefs and preferences that could be expected based on their premorbid or “authentic” self, their capacity to make these decisions may be called into question
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Organizational Ethics in Healthcare: A National Survey HEC Forum (IF 1.3) Pub Date : 2024-01-17 Kelly Turner, Tim Lahey, Becket Gremmels, Jason Lesandrini, William A. Nelson
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Medical-Legal Partnerships and Prevention: Caring for Unrepresented Patients Through Early Identification and Intervention HEC Forum (IF 1.3) Pub Date : 2023-12-23 Cathy L. Purvis Lively
Caring for unrepresented patients encompasses legal, ethical, and moral challenges regarding decision-making, consent, the patient’s values, wishes, best interest, and the healthcare team’s professional integrity and autonomy. In this article, I consider the impact of the aging population and the effects of the social determinants of health and suggest that without preventive intervention, the number
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Clinical Ethics and Professional Integrity: A Comment on the ASBH Code HEC Forum (IF 1.3) Pub Date : 2023-12-21 David M. Adams
The Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants instructs clinical ethics consultants to preserve their professional integrity by “not engaging in activities that involve giving an ethical justification or stamp of approval to practices they believe are inconsistent with agreed-upon standards” (ASBH, 2014, p. 2). This instruction reflects a larger model of how
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What Is It That You Want Me To Do? Guidance for Ethics Consultants in Complex Discharge Cases HEC Forum (IF 1.3) Pub Date : 2023-12-21 Adam Omelianchuk, Aziz A. Ansari, Kayhan Parsi
Some of the most difficult consultations for an ethics consultant to resolve are those in which the patient is ready to leave the acute-care setting, but the patient or family refuses the plan, or the plan is impeded by deficiencies in the healthcare system. Either way, the patient is “stuck” in the hospital and the ethics consultant is called to help get the patient “unstuck.” These encounters, which
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Who Should Be Legitimate Living Donors? The Case of Bangladesh HEC Forum (IF 1.3) Pub Date : 2023-12-08 Md. Sanwar Siraj
In 1999, the Bangladesh government introduced the Human Organ Transplantation Act allowing organ transplants from both brain-dead and living-related donors. This Act approved organ donation within family networks, which included immediate family members such as parents, adult children, siblings, uncles, aunts, and spouses. Subsequently, in January 2018, the government amended the 1999 Act to include
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It’s Worth What You Can Sell It for: A Survey of Employment and Compensation Models for Clinical Ethicists HEC Forum (IF 1.3) Pub Date : 2023-08-05 Jason Adam Wasserman, Abram Brummett, Mark Christopher Navin
This article reports results of a survey about employment and compensation models for clinical ethics consultants working in the United States and discusses the relevance of these results for the professionalization of clinical ethics. This project uses self-reported data from healthcare ethics consultants to estimate compensation across different employment models. The average full-time annualized
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Understanding Rare Disease Experiences Through the Concept of Morally Problematic Situations HEC Forum (IF 1.3) Pub Date : 2023-07-29 Ariane Quintal, Élissa Hotte, Caroline Hébert, Isabelle Carreau, Annie-Danielle Grenier, Yves Berthiaume, Eric Racine
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The SIA Can’t Just Go with the FLO HEC Forum (IF 1.3) Pub Date : 2023-07-13 Joe Slater
Hendricks (2018) has defended an argument that abortion is (usually) immoral, which he calls the impairment argument. This argument purports to apply regardless of the moral status of the fetus. It has recently been bolstered by several amendments from Blackshaw and Hendricks (2021a; 2021b). In this paper, three problems are presented for their Strengthened Impairment Argument (SIA). In the first,
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Evaluation of Interventions to Address Moral Distress: A Multi-method Approach HEC Forum (IF 1.3) Pub Date : 2023-07-10 Lucia D. Wocial, Genina Miller, Kianna Montz, Michelle LaPradd, James E. Slaven
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East-West Dialogues on the Ethics of Sex Robots HEC Forum (IF 1.3) Pub Date : 2023-06-02 Benedict S. B. Chan
The purpose of this essay is to review and evaluate chapters in Fan and Cherry’s Sex Robots: Social Impact and the Future of Human Relations. In this edited volume, the authors of the various chapters present dialogues from the East and West to explore the social and cultural implications of sex robots. They also discuss whether sex robots have a positive, negative, or neutral impact on society and
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Mitigating Moral Distress: Pediatric Critical Care Nurses’ Recommendations HEC Forum (IF 1.3) Pub Date : 2023-05-04 Sadie Deschenes, Shannon D. Scott, Diane Kunyk
In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used
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Credentialing Character: A Virtue Ethics Approach to Professionalizing Healthcare Ethics Consultation Services HEC Forum (IF 1.3) Pub Date : 2023-02-15 Andrea Thornton
In the process of professionalization, the American Society for Bioethics and Humanities (ASBH) has emphasized process and knowledge as core competencies for clinical ethics consultants; however, the credentialing program launched in 2018 fails to address both pillars. The inadequacy of this program recalls earlier critiques of the professionalization effort made by Giles R. Scofield and H. Tristram
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Islamic Jurisprudence on Harm Versus Harm Scenarios in Medical Confidentiality HEC Forum (IF 1.3) Pub Date : 2023-01-07 Sayyed Mohamed Muhsin
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Life Extension and Overpopulation: Demography, Morals, and the Malthusian Objection HEC Forum (IF 1.3) Pub Date : 2022-12-26 Shahin Davoudpour, John K. Davis
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Civility in Health Care: A Moral Imperative HEC Forum (IF 1.3) Pub Date : 2022-12-22 Joel M. Geiderman, John C. Moskop, Catherine A. Marco, Raquel M. Schears, Arthur R. Derse
Civility is an essential feature of health care, as it is in so many other areas of human interaction. The article examines the meaning of civility, reviews its origins, and provides reasons for its moral significance in health care. It describes common types of uncivil behavior by health care professionals, patients, and visitors in hospitals and other health care settings, and it suggests strategies
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Democratizing Conscientious Refusal in Healthcare HEC Forum (IF 1.3) Pub Date : 2022-12-15 David C. Scott
Settling the debate over conscientious refusal (CR) in liberal democracies requires us to develop a conception of the healthcare provider’s moral role. Because CR claims and resulting policy changes take place in specific sociopolitical contexts with unique histories and diverse polities, the method we use for deriving the healthcare norms should itself be a democratic, context-dependent inquiry. To
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Ethical Issues in Sperm, Egg and Embryo Donation: Islamic Shia Perspectives HEC Forum (IF 1.3) Pub Date : 2022-11-12 Md Shaikh Farid
Assisted Reproductive Technologies (ARTs) have been practiced in Islamic societies within married couples since their introduction. However, there are divergent views over the issue of third-party donation among Sunni and Shia scholars. This paper illustrates the different perspectives of Shia Muslims surrounding, sperm, egg, and embryo donation and ethical aspects thereof. The study reveals that there
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Living Organ Donation for Transplantation in Bangladesh: Reality and Problems HEC Forum (IF 1.3) Pub Date : 2022-11-10 Md. Sanwar Siraj
The stipulation of living organ transplantation policy and practice in Bangladesh is family-oriented, with relatives being the only people legally eligible to donate organs. There have been very few transplantations of bone marrows, liver lobes, and kidneys from related-living donors in Bangladesh. The major question addressed in this study is why Bangladesh is not getting adequate organs for transplantation
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From Prohibition to Permission: The Winding Road of Medical Assistance in Dying in Canada HEC Forum (IF 1.3) Pub Date : 2022-11-10 Jocelyn Downie
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Aging, Equality and the Human Healthspan HEC Forum (IF 1.3) Pub Date : 2022-11-08 Colin Farrelly
John Davis (New Methuselahs: The Ethics of Life Extension, The MIT Press, Cambridge, 2018) advances a novel ethical analysis of longevity science that employs a three-fold methodology of examining the impact of life extension technologies on three distinct groups: the “Haves”, the “Have-nots” and the “Will-nots”. In this essay, I critically examine the egalitarian analysis Davis deploys with respect
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Clinical Ethics Consultations and the Necessity of NOT Meeting Expectations: I Never Promised You a Rose Garden HEC Forum (IF 1.3) Pub Date : 2022-09-20 Stuart G. Finder, Virginia L. Bartlett
Clinical ethics consultants (CECs) work in complex environments ripe with multiple types of expectations. Significantly, some are due to the perspectives of professional colleagues and the patients and families with whom CECs consult and concern how CECs can, do, or should function, thus adding to the moral complexity faced by CECs in those particular circumstances. We outline six such common expectations:
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MAiD to Last: Creating a Care Ecology for Sustainable Medical Assistance in Dying Services HEC Forum (IF 1.3) Pub Date : 2022-09-12 Andrea Frolic, Paul Miller, Will Harper, Allyson Oliphant
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The Implementation of Assisted Dying in Quebec and Interdisciplinary Support Groups: What Role for Ethics? HEC Forum (IF 1.3) Pub Date : 2022-09-08 Marie-Eve Bouthillier, Catherine Perron, Delphine Roigt, Jean-Simon Fortin, Michelle Pimont
The purpose of this text is to tell the story of the implementation of the Act Respecting End-of-Life Care, referred to hereafter as Law 2 (Gouvernement du Québec, 2014) with an emphasis on the ambiguous role of ethics in the Interdisciplinary Support Groups (ISGs), created by Quebec's Ministère de la santé et des services sociaux (MSSS). As established, ISGs provide “clinical, administrative and ethical
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Clinical Ethics Consultation in Chronic Illness: Challenging Epistemic Injustice Through Epistemic Modesty HEC Forum (IF 1.3) Pub Date : 2022-09-07 Tatjana Weidmann-Hügle, Settimio Monteverde
Leading paradigms of clinical ethics consultation closely follow a biomedical model of care. In this paper, we present a theoretical reflection on the underlying biomedical model of disease, how it shaped clinical practices and patterns of ethical deliberation within these practices, and the repercussions it has on clinical ethics consultations for patients with chronic illness. We contend that this
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Introducing Medical Assistance in Dying in Canada: Lessons on Pragmatic Ethics and the Implementation of a Morally Contested Practice HEC Forum (IF 1.3) Pub Date : 2022-09-02 Andrea Frolic, Allyson Oliphant
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Access Isn’t Enough: Evaluating the Quality of a Hospital Medical Assistance in Dying Program HEC Forum (IF 1.3) Pub Date : 2022-08-26 Andrea Frolic, Marilyn Swinton, Allyson Oliphant, Leslie Murray, Paul Miller
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Implementation of Medical Assistance in Dying as Organizational Ethics Challenge: A Method of Engagement for Building Trust, Keeping Peace and Transforming Practice HEC Forum (IF 1.3) Pub Date : 2022-08-24 Andrea Frolic, Paul Miller
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Getting Beyond Pros and Cons: Results of a Stakeholder Needs Assessment on Physician Assisted Dying in the Hospital Setting HEC Forum (IF 1.3) Pub Date : 2022-08-23 Andrea Frolic, Leslie Murray, Marilyn Swinton, Paul Miller
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Correction: Medical Assistance in Dying (MAiD) Care Coordination: Navigating Ethics and Access in the Emergence of a New Health Profession HEC Forum (IF 1.3) Pub Date : 2022-08-19 Marta Simpson‑Tirone, Samantha Jansen, Marilyn Swinton
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Responding to Cultural Limitations on Patient Autonomy: A Clinical Ethics Case Study HEC Forum (IF 1.3) Pub Date : 2022-08-09 Sara Kolmes, Christine Ha, Jordan Potter
This paper is a clinical ethics case study which sheds light on several important dilemmas which arise in providing care to patients from cultures with non-individualistic conceptions of autonomy. Medical professionals face a difficult challenge in determining how to respond when families of patients ask that patients not be informed of bad medical news. These requests are often made for cultural reasons
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Tough Clinical Decisions: Experiences of Polish Physicians HEC Forum (IF 1.3) Pub Date : 2022-08-08 Joanna Różyńska, Jakub Zawiła-Niedźwiecki, Bartosz Maćkiewicz, Marek Czarkowski
The paper reports results of the very first survey-based study on the prevalence, frequency and nature of ethical or other non-medical difficulties faced by Polish physicians in their everyday clinical practice. The study involved 521 physicians of various medical specialties, practicing mainly in inpatient healthcare. The study showed that the majority of Polish physicians encounter ethical and other
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Medical Assistance in Dying (MAiD) Care Coordination: Navigating Ethics and Access in the Emergence of a New Health Profession HEC Forum (IF 1.3) Pub Date : 2022-07-23 Marta Simpson-Tirone, Samantha Jansen, Marilyn Swinton
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Special Issue on Jessica Flanigan's Pharmaceutical Freedom: Why Patients Have a Right to Selfmedicate. HEC Forum (IF 1.3) Pub Date : 2022-07-20 James Stacey Taylor
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Bioethics: An International, Morally Diverse, and Often Political Endeavor HEC Forum (IF 1.3) Pub Date : 2022-05-23 Mark J. Cherry
Bioethicists often remind health care professionals to pay close attention to issues of diversity and inclusion. Approaches to ethics consultation, where the perspective of the bioethicist is taken to be more morally correct or necessarily authoritative, have been critiqued as inappropriately authoritarian. Despite such apparent recognition of the importance of respecting moral diversity and the inclusion
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Suppressing Scientific Discourse on Vaccines? Self-perceptions of researchers and practitioners HEC Forum (IF 1.3) Pub Date : 2022-05-19 Ety Elisha, Josh Guetzkow, Yaffa Shir-Raz, Natti Ronel
The controversy over vaccines has recently intensified in the wake of the global COVID-19 pandemic, with calls from politicians, health professionals, journalists, and citizens to take harsh measures against so-called “anti-vaxxers,” while accusing them of spreading “fake news” and as such, of endangering public health. However, the issue of suppression of vaccine dissenters has rarely been studied
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Cost: An Important Question That Must Be Asked HEC Forum (IF 1.3) Pub Date : 2022-04-21 R. Andrew Morgan
Cost conversations are essential to informed consent because patients have a right to information that they think is relevant, and patients overwhelmingly report that cost information is relevant to their medical decisions. Providers have an ethical responsibility to provide necessary information for informed consent, and therefore must discuss costs. The Shared Decision Making model is ideal for enabling
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The “Ladder of Inference” as a Conflict Management Tool: Working with the “Difficult” Patient or Family in Healthcare Ethics Consultations HEC Forum (IF 1.3) Pub Date : 2022-04-18 Autumn Fiester
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Platelets, Puppies, and Payment: How Surveys can be Misleading in the Remuneration Debate HEC Forum (IF 1.3) Pub Date : 2022-04-19 James Stacey Taylor
In a recent article (“The current state of the platelet supply in the US and proposed options to decrease the risk of critical shortages”) published in Transfusion, Stubbs et al. have argued that platelet donors should be paid. Dodd et al. have argued against this proposal, supporting their response with survey data that shows that blood donors (and by extension platelet donors) and potential platelet
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The Need for Specialized Oncology Training for Clinical Ethicists HEC Forum (IF 1.3) Pub Date : 2022-04-15 Eric C Blackstone, Barbara J Daly
Numerous ethical issues are raised in cancer treatment and research. Informed consent is challenging due to complex treatment modalities and prognostic uncertainty. Busy oncology clinics limit the ability of oncologists to spend time reinforcing patient understanding and facilitating end-of-life planning. Despite these issues and the ethics consultations they generate, clinical ethicists receive little
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The Need for Specialized Oncology Training for Clinical Ethicists. HEC Forum (IF 1.3) Pub Date : 2022-04-15 Eric C Blackstone,Barbara J Daly
Numerous ethical issues are raised in cancer treatment and research. Informed consent is challenging due to complex treatment modalities and prognostic uncertainty. Busy oncology clinics limit the ability of oncologists to spend time reinforcing patient understanding and facilitating end-of-life planning. Despite these issues and the ethics consultations they generate, clinical ethicists receive little
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Clinical Ethics Consultation During the First COVID-19 Pandemic Surge at an Academic Medical Center: A Mixed Methods Analysis HEC Forum (IF 1.3) Pub Date : 2022-03-15 Kimberly S. Erler, Ellen M. Robinson, Julia I. Bandini, Eva V. Regel, Mary Zwirner, Cornelia Cremens, Thomas H. McCoy, Fred Romain, Andrew Courtwright
While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort