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2.
Chest ; 149(6): 1577-8, 2016 06.
Article in English | MEDLINE | ID: mdl-27287576
3.
HEC Forum ; 28(4): 283-299, 2016 Dec.
Article in English | MEDLINE | ID: mdl-26790861

ABSTRACT

Despite the interpersonal nature of family meetings and the frequency in which they occur, the clinical ethics literature is devoid of any rich descriptions of what clinical ethicists should actually be doing during family meetings. Here, we propose a framework for describing and understanding "transitioning" facilitation skills based on a retrospective review of our internal documentation of 100 consecutive cases (June 01, 2013-December 31, 2014) wherein a clinical ethicist facilitated at least one family meeting. The internal documents were analyzed using qualitative methodologies, i.e., "codes", to identify emergent themes. We identified four different transitioning strategies clinical ethicists use to reach a meaningful resolution. These transitioning strategies serve as a jumping-off point for additional analyses, future research, evaluating clinical ethics consultation, and overall performance improvement of a consultation service.


Subject(s)
Ethicists , Family/psychology , Professional Role/psychology , Case-Control Studies , Decision Making , Documentation/standards , Ethics Consultation/standards , Humans , Qualitative Research , Retrospective Studies
4.
Chest ; 149(2): 562-567, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26502321

ABSTRACT

There is little guidance on what clinicians should do when advance directives (or living wills, specifically) are challenged, particularly when surrogate decision-makers' interpretations of patients' wishes conflict with the living will. In our commentary, we make a controversial argument suggesting that overriding living wills can be ethically preferable to the alternative of strictly adhering to them. We propose four ethical considerations for determining whether it is ethically supportable to override living wills.


Subject(s)
Advance Directives/ethics , Decision Making , Living Wills/ethics , Terminal Care/ethics , Humans , Morals
6.
HEC Forum ; 27(1): 35-45, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25274503

ABSTRACT

While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: (1) train-the-trainer, (2) local capacity-building, (3) circuit-riding, and (4) consolidated accountability. We note each model's benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations.


Subject(s)
Ethics Consultation , Ethics, Medical , Health Facility Merger/economics , Health Facility Merger/ethics , Humans , Models, Organizational , Social Responsibility
8.
J Clin Ethics ; 25(1): 65-7, 2014.
Article in English | MEDLINE | ID: mdl-24779320

ABSTRACT

A recent study published in the American Journal of Organ Transplantation proposes that an organ donor application in Facebook can increase the rates at which individuals donate organs. While I offer support for the use of social media mechanisms in the service of the promotion of organ donation public health initiatives, there are several ethical concerns surrounding informed consent. While Facebook has made a noble effort to aid public health initiatives focused on organ donation, the current application does not promote decisions that are based on individuals' personal values and goals. Without an intervention that promotes an understanding and appreciation of a decision for or against donation, the application does not obtain informed consent. Without first ensuring that a Facebook member has registered with her or his own state donor registry, this social media mechanism may create more confusion than clarity about an individual's organ donor status. If Facebook desires to have a positive impact on the rates of organ donation, it must do so in a manner that obtains proper consent and promotes ethically informed decisions.


Subject(s)
Attitude to Health , Health Services Needs and Demand , Social Media , Tissue Donors/psychology , Tissue and Organ Procurement , Humans
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