Clinical Ethics

ISSN: 1477-7509

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  1.  4
    Psychiatry as a vocation: Moral injury, COVID-19, and the phenomenology of clinical practice.Matthew R. Broome, Jamila Rodrigues, Rosa Ritunnano & Clara Humpston - 2024 - Clinical Ethics 19 (2):157-170.
    In this article, we focus on a particular kind of emotional impact of the pandemic, namely the phenomenology of the experience of moral injury in healthcare professionals. Drawing on Weber's reflections in his lecture Politics as a Vocation and data from the Experiences of Social Distancing during the COVID-19 Pandemic Survey, we analyse responses from healthcare professionals which show the experiences of burnout, sense of frustration and impotence, and how these affect clinicians’ emotional state. We argue that this may relate (...)
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  2.  17
    Informal caregivers – A missing voice in clinical ethics.Aleksandra Glos - 2024 - Clinical Ethics 19 (2):143-149.
    This paper argues that the missing voice in clinical ethics is that of informal caregivers. Despite their substantial contribution to care provided to individuals with disabilities, chronic illness or dementia, informal caregivers are rarely thought of as members of the healthcare team and their narratives are rarely listened to and included in clinical and ethical decisions. Addressing this gap, this paper discusses the reasons for the systemic misrecognition of informal caregivers in healthcare systems and argues for their greater narrative inclusion (...)
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  3. Loneliness in medicine and relational ethics: A phenomenology of the physician-patient relationship.John D. Han, Benjamin W. Frush & Jay R. Malone - 2024 - Clinical Ethics 19 (2):171-181.
    Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws (...)
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  4.  7
    Chemo sickness as existential feeling: A conceptual contribution to person-centered phenomenological oncology care.Ryan Hart - 2024 - Clinical Ethics 19 (2):182-188.
    In response to cancer, patients may be thrown into precarious processes of remaking their purpose, identity, and connections to the world around them. Thoughtful and thorough responses to these issues can be supported by person-centered phenomenological approaches to caring for patients. The importance of perspectives on illness offered by theoretical phenomenology will become apparent through the example of the experience of nausea, or perhaps more accurately put—chemo sickness. The focus here is on how chemo sickness alters one's way of relating (...)
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  5.  5
    Phenomenologies of care: Integrating patient and caregiver narratives into clinical care.Jenny Krutzinna & Anna Gotlib - 2024 - Clinical Ethics 19 (2):133-135.
    This special issue aims to spotlight the individual, lived experiences of caregivers and those receiving care–areas often overshadowed by clinical and medicalized narratives within clinical ethics. Our aim is to enrich the discourse by incorporating stories and narratives of medical care and challenge existing clinical practices by emphasizing patient and practitioner experiences. Through a blend of clinical and academic insights, this issue provides phenomenological narratives, highlighting the importance of lived experiences in understanding and improving clinical caregiving practices. The contributions, ranging (...)
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  6.  16
    Shame, health literacy and consent.Barry Lyons & Luna Dolezal - 2024 - Clinical Ethics 19 (2):150-156.
    This paper is particularly concerned with shame, sometimes considered the ‘master emotion’, and its possible role in affecting the consent process, specifically where that shame relates to the issue of diminished health literacy. We suggest that the absence of exploration of affective issues in general during the consent process is problematic, as emotions commonly impact upon our decision-making process. Experiencing shame in the healthcare environment can have a significant influence on choices related to health and healthcare, and may lead to (...)
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  7. Caregiving and role conflict distress.Jordan MacKenzie - 2024 - Clinical Ethics 19 (2):136-142.
    When our nearest and dearest experience medical crises, we may need to step into caregiving roles. But in doing so, we may find that our new caregiving relationship is actually in tension with the loving relationship that motivated us towards care. What we owe and are entitled to as friends, spouses, and family members, can be different from what we owe and are entitled to as caregivers. For this reason, caregiving carries with it the risk of a type of moral (...)
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  8.  11
    From a phenomenology of birth towards an ethics of obstetric care.Tatjana Noemi Tömmel - 2024 - Clinical Ethics 19 (2):189-203.
    The aim of this paper is to get from a phenomenology of birth towards an ethics of obstetric care: Human rights violations in obstetrics are currently a globally debated phenomenon. Research suggests that maltreatment is widespread and a global phenomenon. However, the prevalence cannot yet be clearly quantified. In view of this problem, it is necessary to take the subjective perspective of those affected seriously. Narrative and phenomenological accounts of birth experiences could help to foster the dialogue between persons giving (...)
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  9. Clinical equipoise: Why still the gold standard for randomized clinical trials?Charlemagne Asonganyi Folefac & Hugh Desmond - 2024 - Clinical Ethics 19 (1):1-11.
    The principle of clinical equipoise has been variously characterized by ethicists and clinicians as fundamentally flawed, a myth, and even a moral balm. Yet, the principle continues to be treated as the de facto gold standard for conducting randomized control trials in an ethical manner. Why do we hold on to clinical equipoise, despite its shortcomings being widely known and well-advertised? This paper reviews the most important arguments criticizing clinical equipoise as well as what the most prominent proposed alternatives are. (...)
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  10.  21
    Fixing bodies and shaping narratives: Epistemic injustice and the responses of medicine and bioethics to intersex human rights demands.Morgan Carpenter - 2024 - Clinical Ethics 19 (1):3-17.
    Children with innate variations of sex characteristics (also termed differences of sex development or intersex traits) are routinely subjected to medical interventions that aim to make their bodies appear or function more typically female or male. Many such interventions lack clear evidence of benefit, they have been challenged for thirty years, and they are now understood to violate children’s rights to bodily autonomy and bodily integrity. In this paper I argue that these persist in part due to epistemic injustices and (...)
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  11.  19
    Physician self-reported use of empathy during clinical practice.Amber Comer, Lyle Fettig, Stephanie Bartlett, Lynn D’Cruz & Nina Umythachuk - 2024 - Clinical Ethics 19 (1):75-79.
    Objectives The 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. Methods A 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 (...)
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  12.  21
    Attitudes toward end-of-life decisions other than assisted death amongst doctors in Northern Portugal.José António Ferraz-Gonçalves - 2024 - Clinical Ethics 19 (1):91-101.
    Background Doctors often deal with end-of-life issues other than assisted death, such as incompetent patients and treatment withdrawal, including food and fluids. Methods A link to a questionnaire was sent by email three times, at one-week intervals, to the doctors registered in the Northern Section of the Portuguese Medical Association. Results The questionnaire was returned by 1148 (9%) physicians. This study shows that only a minority of Portuguese doctors were willing to administer drugs in lethal doses to cognitively incompetent patients (...)
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  13.  20
    The ethics of forced care in dementia: Perspectives of care home staff.Anne A. Fetherston, Julian Hughes & Simon Woods - 2024 - Clinical Ethics 19 (1):80-87.
    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 (...)
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  14.  20
    Vulnerability, health information right and the contributions of augmentative and alternative communication for people with aphasia.Ana Inês de Almeida Frade, Luísa D’Espiney & Vanda Marques Pinto - 2024 - Clinical Ethics 19 (1):88-90.
    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 (...)
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  15.  45
    Evaluation of physician–patient relationship and bioethical principles in COVID-19 patients.Irma Eloísa Gómez Guerrero, América Arroyo-Valerio, Arturo Reding-Bernal, Nuria Aguiñaga Chiñas, Ana Isabel García & Guillermo Rafael Cantú Quintanilla - 2024 - Clinical Ethics 19 (1):71-74.
    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 (...)
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  16.  32
    The ethics of informed consent for infants born to adolescents: A case study from Malaysia.Jeffrey Soon-Yit Lee, Benjamin Wei-Liang Ng & Mohammad Firdaus bin Abdul Aziz - 2024 - Clinical Ethics 19 (1):125-131.
    Adolescent pregnancy results from the complex interaction between various internal and external vulnerabilities. These vulnerabilities persist after the infant's birth when the adolescent becomes a parent. Adolescent parents are unfairly stereotyped as unmotivated and incompetent. Some legislations prohibit adolescents from giving consent on the grounds of incompetency. Despite being different, “competency” is frequently used interchangeably with “capacity”; thus, incompetent individuals are often mistaken to lack capacity. Consequently, legally incompetent adolescents who became parents are frequently disregarded during their infant's decision-making process. (...)
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  17.  81
    Publishing in the field of medical ethics: From describing ethical issues to ethical analysis.Jonathan Lewis - 2024 - Clinical Ethics 19 (1):1-2.
  18.  13
    Navigating conflict: The role of mediation in healthcare disputes.Jaime Lindsey, Margaret Doyle & Katarzyna Wazynska-Finck - 2024 - Clinical Ethics 19 (1):26-34.
    Navigating conflict in healthcare settings can be challenging for all parties involved. Here, we analyse disputes about the provision of healthcare to patients, specifically exploring how mediation might be used to resolve disputes where healthcare professionals may disagree with the patient themselves or the patient's family about what healthcare is in the patient's best interests. Despite concerns about compromise over the patient's best interests, there is often room for the parties to come together and think about how the dispute might (...)
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  19.  20
    Is compulsory care ethically justified for patients with borderline personality disorder?Antoinette Lundahl, Gert Helgesson & Niklas Juth - 2024 - Clinical Ethics 19 (1):35-46.
    Patients with borderline personality disorder (BPD) are overrepresented in compulsory inpatient care for suicide-protective reasons. Still, much evidence indicates negative effects of such care, including increased suicide risk. Clinical guidelines are contradictory, leaving clinicians with difficult ethical dilemmas when deciding on compulsory care. In this study, we analyse the arguments most commonly used in favour of compulsory care of BPD patients, to find out in what situations such care is ethically justified. The aim is to guide clinicians when deciding on (...)
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  20.  19
    Health policy narratives contributing to health inequities experienced by people with intellectual/developmental disabilities: New evidence from COVID-19.Sandra Marquis, Renee O'Leary, Nilanga Aki Bandara & Jennifer Baumbusch - 2024 - Clinical Ethics 19 (1):54-61.
    This paper discusses three cultural narratives that threaten the health of people with intellectual/developmental disabilities (IDD) and which have become more evident during the COVID-19 pandemic. These meta-narratives are the medical model of health/disability; the population health approach to health inequalities; and policies premised on the assumption of the importance of national economic growth as an incentive for reducing health inequalities. Evidence exists that health research is more likely to become policy if it fits within a medical model and addresses (...)
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  21.  68
    Euthanasia and assisted suicide: Who are the vulnerable?Meta Rus & Chris Gastmans - 2024 - Clinical Ethics 19 (1):18-25.
    One of the common domains in health care in which the concept of vulnerability is used is end-of-life care, including euthanasia and assisted suicide (EAS). Since different uses and implications of the notion have been recognised in the literature on EAS, this paper aims to analyse them and reflect on who is the most vulnerable in the context of EAS. A prior exploratory review of the literature has served as a starting point for the discussion. We concluded that vulnerability is (...)
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  22.  12
    Engaging the values beneath communication in treatment disputes in the intensive care unit.John Seago - 2024 - Clinical Ethics 19 (1):62-70.
    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 (...)
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  23.  17
    One should not separate a newborn from their hospitalized parent: A retrospective case analysis.Dylan Z. Taylor, Amy E. Caruso-Brown & Jay Brenner - 2024 - Clinical Ethics 19 (1):119-124.
    Restrictive visitation policies produce inequities in healthcare that have meaningful consequences for patients’ health and well-being. There is a surplus of existing literature exploring the consequences of reduced visitation in the setting of pediatric patients lacking decision-making capacity, but relatively little scholarship addressing visitation restriction for less vulnerable adults possessing capacity. Here, we present the case of a patient who suffered serious complications of childbirth, during the delivery of her healthy newborn, leading to prolonged hospitalization. During her treatment course, she (...)
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  24.  20
    Changes in abortion legislation and admissions to paediatric intensive care in Ireland.Niall Tierney, Martina Healy & Barry Lyons - 2024 - Clinical Ethics 19 (1):47-53.
    The Health (Regulation of Termination of Pregnancy) Act 2018 was commenced on 01/01/2019 in Ireland. The Act provides for legal termination of pregnancy under defined circumstances including for any reason at < 12 weeks gestation; and where two doctors agree there is ‘a condition affecting the foetus that is likely to lead to the death of the foetus either before, or within 28 days of, birth’. As such, abortion for congenital anomaly (CA) can occur at a number of time points, (...)
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  25.  17
    Rational suicide and schizophrenia.Naista Zhand & David Attwood - 2024 - Clinical Ethics 19 (1):113-118.
    The concept of rational suicide argues that suicide could be a rational choice, in certain circumstances. Such an argument faces criticism when there is an accompanying mental illness, as many view suicide as a symptom of mental illness rather than as a rational choice about one's life. More specifically, the rational suicide debate has mostly excluded individuals with schizophrenia, as it is widely seen as a disorder that impairs rational decision making. This paper aims to examine the concept of rational (...)
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