Browsing by Subject "Ethics Consultation"
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Item Avoiding harm and improving care near the end of life: what good can ethics do? (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)(2013-11-12) Berlinger, NancyPatient care situations in which there is uncertainty about how to relieve suffering, make medical decisions on behalf of others, work with families in conflict, resolve disagreements among team members, or respond to institutional priorities and pressures are frequently described as ethically challenging situations. Why do these situations present themselves so often in care near the end of life? How can "ethics," including clinician education, ethics consultation services, and institutional policy development, help professionals and organizations involved in the care of seriously ill patients to anticipate these challenges, avoid harms, and prevent care problems? As our nation's health care system changes, what steps should we take to improve care near the end of life? The publication of a new edition of the landmark Hastings Center Guidelines offers an opportunity to explore these questions.Item The "difficult patient" reconceived: an expanded moral mandate for clinical ethics(2020-10-13) Fiester, Autumn M.Between 15%-60% of patients are considered "difficult" by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed "difficult." But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as responses to problematic interactions related to healthcare delivery. If there are grounds to reconceive the "difficult" patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.