It is a common practice for family members to bring food to hospitalized loved ones. However, in some cases, this food contravenes a patient's dietary plan. Such situations can create significant ...tension and distrust between health care professionals and families and may lead the former to doubt a family's willingness or ability to support patient recovery. This case‐study essay offers an ethical analysis of these situations. We draw on Hilde Lindemann's work to argue that providing food to family members is an important way that families discharge their moral functions of caring for their members and holding them in their identities. When family members are hospitalized, other means of performing these functions are limited. Acknowledging the ethical importance of feeding family members alongside the medical need for dietary restrictions, we offer strategies for creative problem‐solving that center diet as a subject for shared decision‐making and regular, ongoing communication among health care professionals, patients, and families.
Ableist attitudes and structures are increasingly recognized across all sectors of health care delivery. After Dobbs, novel questions arose in the United States concerning how to protect reproductive ...autonomy while avoiding discrimination against and devaluation of disabled persons. In this essay, we examine the Louisiana Department of Health's emergency declaration, “List of Conditions That Shall Deem an Unborn Child ‘Medically Futile,’” issued August 1, 2022. We raise a number of medical, ethical, and public health concerns that lead us to argue that the declaration should be rescinded. Analysis of this ethically objectionable declaration provides valuable lessons about how to uphold both reproductive and disability justice in a post‐Dobbs landscape.
The concept of vulnerability is widely used in bioethics, particularly in research ethics and public health ethics. The traditional approach construes vulnerability as inherent in individuals or the ...groups to which they belong and views vulnerability as requiring special protections. Florencia Luna and other bioethicists continue to challenge traditional ways of conceptualizing and applying the term. Luna began proposing a layered approach to this concept and recently extended this proposal to offer two new concepts to analyze the concept of vulnerability, namely understanding external conditions that trigger vulnerability and layers of vulnerability with cascading effects. Luna's conception of vulnerability is useful, which we demonstrate by applying her layered view and the new analyses in multiple contexts. We begin by outlining Luna's view and we use vignettes from healthcare involving transgender patients, the care of patients in psychiatric contexts, and research involving prisoners to illustrate how each part of Luna's concept elucidates important moral issues.
Ask any clinical ethics consultant, and they can tell you about their transformative cases. Some stick with us because all roads led nowhere. Cassandra Lee had a history of pulling out lines and ...tubes and a distaste of warming blankets. Her admission marked her thirtieth over the past year. Many of the challenges facing the hospital caring for her were not unique: significant psychiatric issues, prolonged nonadherence to medical advice, and end‐of‐life decision‐making combined to create an ethically dense and vexing situation. Ms. Lee, like so many patients, was suffering because of system failures.
In this issue of the Hastings Center Report, Jason Wasserman and Mark Navin argue that patients without decisional capacity can still have relatively stable wishes or inclinations toward one ...treatment option over another and that these preferences are “not devoid of moral weight and might therefore guide or at least influence treatment decisions when they cannot be defeated by other considerations.” This position is not controversial among most bioethicists. The hard work comes in sussing out the details of this position. How much moral weight do these preferences have? When should preferences be defeated by other considerations? How should we identify actual preferences, and how should preferences be differentiated and weighed against one another?
In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine ...(National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both distributive and recognitive justice. The disability rights movement's demand “Nothing about us, without us” requires substantive inclusion of disabled people in decision‐making related to their interests, including in crisis planning before, during, and after a pandemic like Covid‐19.
Modelling psychiatric disability Guidry-Grimes, Laura
Journal of evaluation in clinical practice,
06/2015, Letnik:
21, Številka:
3
Journal Article
Recenzirano
Rationale, aims and objectives
There has been inadequate philosophical attention to the claims of psychiatric user/survivor activist groups, although these groups represent a significant social ...justice movement. Many of the core concerns and claims emerging from this activism can be found in disability activism. A first step that must be taken is to question how mental illnesses are modelled. Biomedical modelling is heavily criticized by psychiatric users/survivors for being reductionistic and for perpetuating damaging presumptions about decline and pathology. Social constructionist modelling, on the other hand, tends to be overly dismissive of biological factors that are often at play with these sorts of impairments. A middle‐ground approach, interactionist modelling, promises to be responsive to demands for recognition from psychiatric users/survivors.
Method
I will first outline the core commitments of psychiatric users/survivors. Next, I will evaluate different models for mental illness by bringing together insights from user/survivor and disability activism.
Conclusions
I conclude that interactionist modelling holds the best hope for supporting shared decision making. This type of model braids together the expertise of patients and medical professionals.
In response to Anne L. Dalle Ave and David M. Shaw, we agree with their general argument but emphasize a moral risk of HIV disclosure in deceased donation cases: the risk of relational rupture. ...Because of the importance that close relationships have to our sense of self and our life plans, this kind of rupture can have long-ranging implications for surviving loved ones. Moreover, the now-deceased individual cannot participate in any relational mending. Our analysis reveals the hefty moral costs that disclosure can bring, which should influence what information is given to would-be donors and how organ procurement coordinators approach these conversations.
Reframing Mental Health Ethics Knopes, Julia; Guidry-Grimes, Laura
Community mental health journal,
02/2024, Letnik:
60, Številka:
2
Journal Article
Recenzirano
Mental health ethics has been classically focused on ethical concepts and problems in clinical mental health spaces. Psychiatric and psychotherapeutic ethics are main threads of analysis in this ...subfield of bioethics. However, ethical issues emerge around mental health and illness both within and beyond clinical settings. In particular, ethical quandaries arise in employment, education, family caregiving, and incarceration of people with mental health conditions outside of the clinical setting. Likewise, ethics are an important consideration within alternative care systems where mentally ill people seek support beyond biomedicine, psychotherapy, and case management. In this article, we argue that our understanding of “mental health ethics” should expand to be more inclusive of value questions and conflicts that arise in all areas of the lives of people with mental health conditions, rather than focusing more narrowly on how clinical practitioners and researchers should best respond to ethical quandaries in the delivery of mental healthcare. Community mental health is an ideal space in which to think about such ethical issues, as scholars and practitioners in the field strive to meet not only medical needs but the broader social needs of people with mental health conditions. We begin by providing an overview of psychiatric and psychotherapeutic ethics, and then describe broader applications of ethics in the lives of people experiencing mental illness. We encourage community mental health practitioners and researchers to reconceptualize disciplinary boundaries to consider the vast scope of ethical issues related to mental health in and out of the clinic.
Robert Veatch argues that physician oaths should not be valued as substantive moral commitments, transformational rituals, or symbolic acts. Further, he insists that oath recitation in medical ...schools is immoral. I respond to Veatch's criticisms and argue that, with alterations to their content and practice, oaths can have value for articulating moral commitments and building a sense of moral community within the profession. I break down Veatch's multitude of objections to oaths over his career, and I suggest how medical schools can avoid the pitfalls identified by Veatch. A promising and innovative path forward is to integrate a commitment to diversity, equity, and inclusion—though with an understanding that a few lines in an oath are far from sufficient for institutional culture, faculty accountability, or students' education.
