Search

The article presents the discussion on identifying a potential ethical conflict between the principles of beneficence and respect for patient autonomy. Topics include patients refuse to remain in an emergency department (ED) for observation after overdose reversal with naloxone; and purported conflict between beneficence and autonomy maps poorly to this situation.

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient's interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. [ABSTRACT FROM AUTHOR]

The article argues for the inclusion of large language models (LLMs) as co-reasoners in medical decision-making, extending the "human in the loop" concept to incorporate artificial intelligence (AI). Topics discussed include the role of patient participation, the ethical implications of integrating AI reasoning, and the potential of LLMs to contribute valuable reasons in medical contexts.

The article explores integrating human collaboration in Machine Learning-driven decision support systems (ML_CDSS), suggesting that clinicians and patients should work together as epistemic partners rather than mere decision-makers. Topics discussed include interpretability in AI systems, the role of chain-of-thought reasoning, and the importance of transparency to mitigate automation bias.

The article examines the limitations of integrating patient-physician co-reasoning within artificial intelligence (AI)-driven Clinical Decision Support Systems (AI_CDSS). Topics discussed include the role of patient participation in clinical decision-making, the challenges of AI_CDSS transparency, and the impact on patient autonomy and decision quality.

A commentary on the 2024 article "Affect, Values and Problems Assessing Decision-Making Capacity," by J. Hawkins is presented. Topics covered include how models, including Hawkins,' tend to fall short, a proposed model of capacity assessment and the possible scenarios following a patient decision. It also discusses the issue of testing bias in capacity assessment.

The article presents the discussion on respecting the autonomy of patients with opioid use disorder at face value. Topics include refuse to stay for a subsequent period of evaluation after taking a fast-acting antidote such as naloxone; and easily considered to be autonomous, there is a risk that they will not get what they need in terms of support and services.

The author comments on an article by L. Shavelson and colleagues about the parity or fairness in the assisted dying debate. He discusses parity arguments about a law that permits some form of assisted dying, argument of Shavelson and colleagues on a person who can self-administer a life-terminating intervention, and common denominator among all of the various regimes that regulate assisted dying.

The article discusses the implications of Artificial Intelligence (AI) in reshaping physicians' roles in clinical care, particularly in the context of moral responsibilities and the patient-physician relationship. Topics discussed include the impact of AI on patient-centered medicine and epistemic participation, the challenges physicians face in AI-mediated environments, and the need for a reconsideration of the sphere of clinical care to accommodate the role of AI systems.

The article focuses on the proposal of different role moralities for distinct medical spheres, highlighting the need for a unified moral framework across healthcare roles. Topics discussed include the absence of a justified account of general morality, the potential lack of moral unity in sphere-associated norms, and the importance of moral agency and integrity in addressing role-related tensions.

The article focuses on the historical grounding of fiduciary duties in medicine, emphasizing the evolving nature of the physician-patient relationship and the need for systemic support. Topics discussed include the historical context of fiduciary relationships, the changing landscape of healthcare systems, and the potential tension between fiduciary duties and contemporary medical practice.

The authors comment on the article "Slowing the Slide Down th Slippery Slope of Medical Assistance in Dying: Mutual Learnings for Canada and the US" by Daryl Pullman which uses a rhetorical device to immediately bias readers toward perceiving the increasing sanctioning of medical assistance in dying (MAiD) in Canada as descent into immoral nether regions. Topics include the MAiD legislation in the U.S. and their agreement with Pullman that decisions concerning MAiD are complicated.

The author comments on Daryl Pullman's article in the issue which compares influencing factors in the uptake of assisted suicide and euthanasia practices in Canada and California. Topics include differences that account for greater medical assistance in dying (MAiD) access rates in Canada, implications of the structure of conscientious objection in the Canadian and Californian laws, and significance of the doctor-patient relationship to MAiD.

The article presents the discussion on decision-making processes leading to harmful outcomes being relevant in determining competency. Topics include determinations of competence solely focusing on patients' internal capacities for instance, understanding, reasoning, or deliberating; and patients making while not entailing the standards of competence setting relative to the risk of harmful outcomes.

The article focuses on presence of identified ethical concerns with behavioral contract as a clinical tool to manage aggression and agitation in settings of healthcare. Topics discussed include espoused zero tolerance" policies for violence in healthcare settings, use of coercive interventions in health care facilities, and need of addressing deficit of knowledge due to relation to workplace violence against medical professionals.

The article focuses on concerns regarding use of contracts to manage interpersonal conflict in settings of hospital, and mentions use of behavior contracts to manage the interpersonal conflict. Topics discussed include consequences for negative behaviors imposed by the contracts, unreasonable decorum for medical care demanded by contract, and role altered by the contract when imposed by clinical ethicists.

In 2002, the Dutch Euthanasia Act was put in place to regulate the ending of one's life, permitting a physician to provide assistance in dying to a patient whose suffering the physician assesses as unbearable. Currently, a debate in the Netherlands concerns whether healthy (older) people who value their life as completed should have access to assistance in dying based on their autonomous decision making. Although in European law a right to self-determination ensues from everyone's right to private life, the Dutch Supreme Court recently adopted a position on whether the Dutch Euthanasia Act lacks adequate attention to a patient's autonomous decision making. Specifically, in the Albert Heringa case, the Court ruled that the patient–physician relationship as understood in the Dutch Euthanasia Act limits this plea for more self-determination. This ethical analysis of the Heringa case examines how the Supreme Court's understanding of the Euthanasia Act defines patient autonomy within a reciprocal patient–physician relationship. [ABSTRACT FROM AUTHOR]

The article discusses characteristics or attributes of a healthcare decision qualify it as acceptable to those who are empowered to judge it as adequate. Topics include capable of making adequate decisions. The accepted understanding is that decision-making capacity requires that the individual is able to rationally evaluate and weigh the potential benefits, risks and consequences of consenting or refusing the proposed intervention.

The article presents the discussion on thinking about the concept of autonomy in biomedical and neuroethics. Topics include laws functioning as an expression of autonomy by reflecting a commitment to equality and respect; and locating decision-making among a hierarchy of desires, analogous to neural structure, function and circuit activity.

The article presents the discussion on balancing opinions of multiple stakeholders and best interests of the patient. Topics include triadic nature of interactions between clinicians, pediatric patients, and the parents or other healthcare proxies requiring skillful navigation of disagreements; and primary decision-maker feeling less threatened where the clinician avoiding immediate focus on the point of potential conflict.

The article presents the discussion on the absence of any serious or life-threatening medical illness addressing the patients' existential struggles as much as the medical ones.

The article presents the discussion on Dutch Supreme Court ruling on the Albert Heringa case demonstrating the Dutch approach justifying physician-assisted death. Topics include PAD centering around the autonomy of PAD requesters rather than the patient's suffering and the physician's beneficence-based duty; and freedom taking one's own life and seeking assistance from third parties for the purpose.

The article presents the discussion on cases of family-assisted suicide in East Asia. Topics include preparing poisoned milk for helping the terminally-ill father committing suicide in line with father's request to spare him continued pain and suffering; and considering a more serious crime than ordinary homicide being punishable by capital punishment or life imprisonment.

This open peer commentary refers to the article "Helpful Lessons and Cautionary Tales: How Should COVID-19 Drug Development and Access Inform Approaches to Non-Pandemic Diseases?" by Holly Fernandez Lynch, Arthur Caplan, Patricia Furlong and Alison Bateman-House, that was published within the issue. Topics discussed include conventional medicine for chronic diseases, quality of life and emotional well-being of patients, and palliative unproven therapies for out-of-option patients.

Ethically challenging situations routinely arise in the course of illness and healthcare. However, very few studies have surveyed patients and family members about their experiences with ethically challenging situations. To address this gap in the literature, we surveyed patients and family members at three hospitals. We conducted a content analysis of their responses to open-ended questions about their most memorable experience with an ethical concern for them or their family member. Participants (N = 196) described 219 unique ethical experiences that spanned many of the prevailing themes of bioethics, including the patient-physician relationship, end-of-life care, decision-making capacity, healthcare costs, and genetic testing. Participants focused on relational issues in the course of experiencing illness and receiving medical care and concerns regarding the patient-physician encounters. Many concerns arose outside of a healthcare setting. These data indicate areas for improvement for healthcare providers but some concerns may be better addressed outside of the traditional healthcare setting. [ABSTRACT FROM AUTHOR]

The article offers information related to prediction of lazarus effects in patients facing cancer. Topics discussed include patients having cancer face multiple stresses like contemplating mortality and accuracy of prognostication, loss of functioning, changing family dynamics and financial strain; and rapid development of new cancer therapies, prognostic uncertainty making more complex for patients and providers.

Dr. Elisabeth Kübler-Ross is credited as one of the first clinicians to formalize recommendations for working with patients with advanced medical illnesses. In her seminal book, On Death and Dying, she identified a glaring gap in our understanding of how people cope with death, both on the part of the terminally ill patients that face death and as the clinicians who care for these patients. Now, 50 years later, a substantial and ever-growing body of research has identified "best practices" for end of life care and provides confirmation and support for many of the therapeutic practices originally recommended by Dr. Kübler-Ross. This paper reviews the empirical study of psychological well-being and distress at the end of life. Specifically, we review what has been learned from studies of patient desire for hastened death and the early debates around physician assisted suicide, as well as demonstrating how these studies, informed by existential principles, have led to the development of manualized psychotherapies for patients with advanced disease. The ultimate goal of these interventions has been to attenuate suffering and help terminally ill patients and their families maintain a sense of dignity, meaning, and peace as they approach the end of life. Two well-established, empirically supported psychotherapies for patients at the end of life, Dignity Therapy and Meaning Centered Psychotherapy are reviewed in detail. [ABSTRACT FROM AUTHOR]

Elisabeth Kübler-Ross' seminal 1969 work, On Death and Dying, opened the door to understanding individuals' emotional experiences with serious illness and dying. Patient's emotions, however, are only half the story in the patient-physician relationship. In recent years physicians' emotional reactions have gotten more attention. These sometimes-unacknowledged emotions influence how we approach our work, including life and death decisions. This article reviews some of the main emotions physicians experience when caring for seriously ill and dying patients and the challenges physicians face in regulating their emotions in a professional setting. We also discuss some of the ways that physician emotion may influence medical decision-making and contribute to conflict. Attention to the emotional level of physician experience may promote better care. [ABSTRACT FROM AUTHOR]

The article focuses on trying to Use "Crisis Standards of Care" in the COVID19 Pandemic. Topic discussed include Lowering the standard of care in a pandemic is a recipe for inferior care and discrimination; and the National Academy of Medicine (NAM) has issued two news reports on "crisis standards of care" which seek to return informed consent to its central place in the doctor-patient relationship, and eliminate use of SOFA scores and "triage teams."

In the article, the author discusses the issues over the use of Health-related Digital Autonomy (HRDA) in addressing autonomy-related ethical challenges in relation to potential automatic application of artificial intelligence depression detectors (AIDD) in social media. Other topics include the conventional physician-patient relationship, the ethical issues over the use of AI in medicine, and the concept of patient autonomy.

In the article, the author discusses how a hospital's ethics consultation service should decide on the permissible discharge options for a patient who does not want to be discharged to treat his eczema, which does not require hospitalization. Other topics include the treatment team's dilemma over their commitment to respect a patient's preferences for care and their professional duty to steward medical resources, and the model of shared decision-making (SDM).

The authors propose a model that makes use of community research committees to improve the informed consent process. They cite J. Millum and D. Bromwich's article as something that offer conceptual and practical rationale for reexamining the informed consent process for research and clinical interventions. They note that using their consent continuum model transforms the process to an adaptive one that can be modified to meet the needs of clinicians-patients and researchers-participants.

The article discusses that the Gifts have served as a fundamental aspect of the human experience across time, even as their precise roles and functions have shifted. It mentions that the bioethicists and others have drawn upon anthropologist Marcel Mauss' insights concerning gifts to help understand healthcare issues as diverse as organ transplantation, blood donation and the role of the pharmaceutical industry.

The article offers information on the ethics of immigration policies have become part of the public discourse. It mentions pediatricians have been at the forefront of medical care and advocacy for immigrant children; and also mentions to support the health and well-being of children and families, pediatricians often rely on referrals to basic social services, including access to insurance, food, and housing benefits.

The article offers information on the significant contributions of intersectionality in clinical medicine. It mentions intersectionality requires broader commitment to institutional change, which can be difficult to bring about, given the intransigence of institutional policies and practices; and also mentions intersectionality is concerned with macro-, meso-, and micro-level interactions.

The article offers information on the neuroethical analysis of physicians' dual obligations in clinical research. It mentions this analysis has different implications for physicians who have preexisting treatment relationships with patients based on their individual stances; and also mentions contemporary clinical investigators are trained in the ethical requirements that accompany clinical research.

Classic statements of research ethics advise against permitting physician-investigators to obtain consent for research participation from patients with whom they have preexisting treatment relationships. Reluctance about "dual-role" consent reflects the view that distinct normative commitments govern physician–patient and investigator–participant relationships, and that blurring the research–care boundary could lead to ethical transgressions. However, several features of contemporary research demand reconsideration of the ethics of dual-role consent. Here, we examine three arguments advanced against dual-role consent: that it creates role conflict for the physician-investigator; that it can compromise the voluntariness of the patient-participant's consent; and that it promotes therapeutic misconceptions. Although these concerns have merit in some circumstances, they are not dispositive in all cases. Rather, their force—and the ethical acceptability of dual-role consent—varies with features of the particular study. As research participation more closely approximates usual care, it becomes increasingly acceptable, or even preferable, for physicians to seek consent for research from their own patients. It is time for a more nuanced approach to dual-role consent. [ABSTRACT FROM AUTHOR]

Intersectionality has become a significant intellectual approach for those thinking about the ways that race, gender, and other social identities converge in order to create unique forms of oppression. Although the initial work on intersectionality addressed the unique position of black women relative to both black men and white women, the concept has since been expanded to address a range of social identities. Here we consider how to apply some of the theoretical tools provided by intersectionality to the clinical context. We begin with a brief discussion of intersectionality and how it might be useful in a clinical context. We then discuss two clinical scenarios that highlight how we think considering intersectionality could lead to more successful patient-clinician interactions. Finally, we extrapolate general strategies for applying intersectionality to the clinical context before considering objections and replies. [ABSTRACT FROM AUTHOR]

The article focuses on commentaries that addresses new approaches to bioethics praxis, compliance/adherence and terminology and used terms like surveillance technology and self-acting medical devices (SAMD). It refers to the potential for digital pills to provide the best chance of maintaining or improving individuals' health by enhancing abilities to take their medications as prescribed.

The article discusses the 20th century, many doctors have not view pain management as an important aspect of practice. Topics include the World Health Organization has recognized the importance of palliative care and symptom management; and based on the link between "pain as the fifth vital sign" and opioid addiction, the Joint Commission eliminated the requirement to assess pain in all patients in 2009.

The article discusses failures in COVID-19 Response and Beyond", Alex London soundly argues statements of the core ethical and professional responsibilities of clinicians have flawed in ways that threaten the fundamental goals of medicine. Topics include the primary locus of medical ethics has the clinician patient interaction; and a clinician has not at fault for failing to take into account the impact of actions.

The article examines the ethical challenges of physicians performing simultaneously the dual roles of a caregiver and as a researcher. Particular focus is given on the case of a 70-year-old woman with advanced cancer and facing the dilemma of whether to undergo a risky surgery while becoming a participant in clinical research. It suggests that the consent process and enrollment of a patient be structured to assure patient's and surgeon's best interests.

The article discusses the bogus standards of care exposed by the COVID-19 pandemic. Topics covered include the problem with the proposal about the duty of care physicians owe to their patients, two ways to repudiate crisis standards of care, and examples of flawed thinking in the standard of care arena.

The article discusses the ethical challenges in advance care planning in the U.S. during the COVID-19 pandemic. Topics covered include the importance of good advance care planning, one of the most significant changes to advance care planning during the COVID-19 pandemic, and critical factor to ensuring that care aligns with patient values.

The article discusses the ethical considerations for reopening health care organizations (HCOs) in the wake of COVID-19. Topics covered include the overall negative impact of COVID-19 on the U.S. economy, goals that should be balanced in the plans for HCOs to reopen amid COVId-19, and importance of security in ensuring HCO's reopening plans can safely proceed.

The article offers information on how to support patient and family in dealing with ethical issues has been relevance of moral case deliberation (MCD). Topics inlcude the patients and family in MCD with health care professionals fosters attention of health care professionals, the ethical concerns and moral perspectives of patients and family, and enhances mutual understanding, and the possibility of fostering mutual understanding between them and the professionals.

The article discusses a case in reference to ethical challenges because the patient. Topics discussed include information on Outpatient palliative care programs for ethics consults pertaining to suspected drug diversion; concern of palliative care professionals to ensure end-stage or chronic patients receive the painrelieving medications they need; and risk of urine drug testing for outpatient palliative care patients.

The article discusses a case in reference to appropriateness of drug testing. Topics discussed include need to consider clinician motivations for use, the method of implementation, and how clinicians respond to concerning results; Clinician misinterpretation of urine drug testing results; and opioid-related mistrust in Patients.

The article focuses on Elizabeth Kübler-Ross' work. Topics discussed include consulting with the patient because of a certain diagnosis; need for patient, family, and doctor to fight together in such cases no matter the end result, and Kübler-Ross addressing his issue to continue in caring for dying people.