Patient and Family Descriptions of Ethical Concerns

Cho, Hae Lin; Grady, Christine; Tarzian, Anita J.; Povar, Gail J.; Mangal, Jed P.; Danis, Marion

doi:10.1080/15265161.2020.1754500

Cited by 25 publications

(18 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the involvement of patients and families in ethics consultation is not standard practice across all institutions7 9 and patients or their surrogates request very few ethics consultations. At many healthcare organisations in the USA, ethics consultations are predominantly requested by physicians and other clinicians 10–13. At our institution, between 2008 and 2020 only 18 (1.8%) out of 1009 requests for ethics consultation were initiated by patients or families.…”

Section: Introductionmentioning

confidence: 89%

“…However, patients, families and clinicians are equally susceptible to distress, conflict, anguish, burnout and moral challenges 18–21. The narratives collected by Cho et al outline patients’ and families’ distress and unease comparable to those experienced by clinicians as they relate to end-of-life decision-making, capacity and surrogate decision-making, disagreements with providers and suboptimal care 10. We surmise patients and families would commensurately benefit from the support and expertise available during a clinical ethics consultation.…”

Section: Context Of the Concernmentioning

confidence: 99%

“…As we later discuss, some patients and families may be reluctant to voice their concerns to their clinicians. Physicians, nurses and other clinicians are often unaware that their patients and families are experiencing uncertainty and moral distress, and thus are unable to offer the necessary supports 10. Thus, if patients and families do not have direct access to clinical ethics consultations, and do not raise their concerns with clinicians, they may remain unaddressed.…”

Section: Context Of the Concernmentioning

confidence: 99%

“…They may not identify their concerns as ‘ethical issues’ that warrant the unique expertise of a clinical ethics consultant. In a recent survey by Cho et al , patients and families described a range of ‘consultation-worthy’ experiences and concerns they encountered—for example, relationships with providers, decision-making, medical uncertainty and end-of-life care—but they did not share these issues with clinicians, nor request ethics consultations 10. Although healthcare providers do communicate with patients and families regarding their belief systems, treatment options and end-of-life preferences, we theorise that they rarely discuss the availability and utility of ethics consultations.…”

Section: Context Of the Concernmentioning

confidence: 99%

“…For example, patients or families may request ethics consultations for issues related to discrimination or bias, financial and insurance challenges, delays in care or concerns over clinical competence. These will require a different or bolstered skill set than currently embodied by our consultants 10. Therefore an interdisciplinary strategy that engages chaplaincy, palliative care, patient financial services, patient representatives, social work and the leadership at many healthcare organisations should be developed to address the expected rise in ethics consultation requests.…”

Section: Limitationsmentioning

confidence: 99%

See 4 more Smart Citations

Call to action: empowering patients and families to initiate clinical ethics consultations

et al. 2021

View full text Add to dashboard Cite

Clinical ethics consultations exist to support patients, families and clinicians who are facing ethical or moral challenges related to patient care. They provide a forum for open communication, where all stakeholders are encouraged to express their concerns and articulate their viewpoints. Ethics consultations can be requested by patients, caregivers or members of a patient’s clinical or supportive team. Although patients and by extension their families (especially in cases of decisional incapacity) are the common denominators in most ethics consultations, these constituents are the least likely to request them. At many healthcare organisations in the USA, ethics consultations are overwhelmingly requested by physicians and other clinicians. We believe it is vital that healthcare institutions bridge the knowledge gaps and power imbalances over access to ethics consultation services through augmented policies, procedures and infrastructure. With enhanced education and support, patients and families may use ethics consultation to elevate their voices and prioritise their unique characteristics and preferences in the delivery of their healthcare. Empowering patients and families to request ethics consultation can only strengthen the patient/family–clinician relationship, enhance the shared decision-making model of care and ultimately lead to improved patient-centred care.

show abstract

Section: Introductionmentioning

confidence: 89%

Section: Context Of the Concernmentioning

confidence: 99%

Section: Context Of the Concernmentioning

confidence: 99%

Section: Context Of the Concernmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

See 3 more Smart Citations

Call to action: empowering patients and families to initiate clinical ethics consultations

et al. 2021

View full text Add to dashboard Cite

show abstract

Clinical Ethics Consultation in Chronic Illness: Challenging Epistemic Injustice Through Epistemic Modesty

Weidmann-Hügle

Monteverde

2022

HEC Forum

View full text Add to dashboard Cite

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 model, despite its important contribution to capturing the ethical issues of day-to-day clinical ethics deliberation, might not be sufficient for patients presenting with chronic illnesses and navigating as “lay experts” of their medical condition(s) through the health care system. Not fully considering the sources of personal knowledge and expertise may lead to epistemic injustice within an ethical deliberation logic narrowly relying on a biomedical model of disease. In caring “for” and collaboratively “with” this patient population, we answer the threat of epistemic injustice with epistemic modesty and humility. We will propose ideas about how clinical ethics could contribute to an expansion of the biomedical model of care, so that important aspects of chronic illness experience would flow into clinical-ethical decision-making.

show abstract

Difficult situations and moral questions raised during moral case deliberations in Swedish childhood cancer care – A qualitative nationwide study

Weiner

Pergert

Castor

et al. 2022

European Journal of Oncology Nursing

View full text Add to dashboard Cite

Patient and Family Descriptions of Ethical Concerns

Cited by 25 publications

References 12 publications

Call to action: empowering patients and families to initiate clinical ethics consultations

Call to action: empowering patients and families to initiate clinical ethics consultations

Clinical Ethics Consultation in Chronic Illness: Challenging Epistemic Injustice Through Epistemic Modesty

Difficult situations and moral questions raised during moral case deliberations in Swedish childhood cancer care – A qualitative nationwide study

Contact Info

Product

Resources

About