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Autumn Fiester [52]Autumn M. Fiester [2]Autumn Marie Fiester [1]
  1.  35
    Ethical Issues in Using Behavior Contracts to Manage the “Difficult” Patient and Family.Autumn Fiester & Chase Yuan - 2021 - American Journal of Bioethics 23 (1):50-60.
    Long used as a tool for medical compliance and adhering to treatment plans, behavior contracts have made their way into the in-patient healthcare setting as a way to manage the “difficult” patient and family. The use of this tool is even being adopted by healthcare ethics consultants (HECs) in US hospitals as part of their work in navigating conflict at the bedside. Anecdotal evidence of their increasing popularity among clinical ethicists, for example, can be found at professional bioethics meetings and (...)
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  2.  32
    Neglected Ends: Clinical Ethics Consultation and the Prospects for Closure.Autumn Fiester - 2015 - American Journal of Bioethics 15 (1):29-36.
    Clinical ethics consultations are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult's endpoint runs the risk of overemphasizing the conflict's resolution at the expense of the consult's process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, lingering (...)
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  3.  27
    From “Longshot” to “Fantasy”: Obligations to Pediatric Patients and Families When Last-Ditch Medical Efforts Fail.Elliott Mark Weiss & Autumn Fiester - 2018 - American Journal of Bioethics 18 (1):3-11.
    Clinicians at quaternary centers see part of their mission as providing hope when others cannot. They tend to see sicker patients with more complex disease processes. Part of this mission is offering longshot treatment modalities that are unlikely to achieve their stated goal, but conceivably could. When patients embark on such a treatment plan, it may fail. Often treatment toward an initial goal continues beyond the point at which such a goal is feasible. We explore the progression of care from (...)
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  4.  41
    The “Difficult” Patient Reconceived: An Expanded Moral Mandate for Clinical Ethics.Autumn Fiester - 2012 - American Journal of Bioethics 12 (5):2-7.
    Between 15 and 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 a response to problematic interactions related to health care delivery. If there are grounds to reconceive the ?difficult? patient as reacting to the perception of ill treatment, then there is an (...)
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  5.  38
    Addressing Consent Issues in Donation After Circulatory Determination of Death.Kim J. Overby, Michael S. Weinstein & Autumn Fiester - 2015 - American Journal of Bioethics 15 (8):3-9.
    Given the widening gap between the number of individuals on transplant waiting lists and the availability of donated organs, as well as the recent plateau in donations based on neurological criteria, there has been a growing interest in expanding donation after circulatory determination of death. While the prevalence of this form of organ donation continues to increase, many thorny ethical issues remain, often creating moral distress in both clinicians and families. In this article, we address one of these issues, namely, (...)
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  6.  27
    Ill-Placed Democracy: Ethics Consultations and the Moral Status of Voting.Autumn M. Fiester - 2011 - Journal of Clinical Ethics 22 (4):363-372.
    As groups around the country begin to craft standards for clinical ethics consultations, one focus of that work is the proper procedure for conducting ethics consults. From a recent empirical look into the workings of ethics consult services (ECSs), one worrisome finding is that some ECSs rely on a committee vote when making a recommendation. This article examines the practice of voting and its moral standing as a procedural strategy for arriving at a clinical ethics recommendation. I focus here on (...)
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  7.  36
    Weaponizing Principles: Clinical Ethics Consultations & the Plight of the Morally Vulnerable.Autumn M. Fiester - 2014 - Bioethics 29 (5):309-315.
    Internationally, there is an on-going dialogue about how to professionalize ethics consultation services . Despite these efforts, one aspect of ECS-competence that has received scant attention is the liability of failing to adequately capture all of the relevant moral considerations in an ethics conflict. This failure carries a high price for the least powerful stakeholders in the dispute. When an ECS does not possess a sophisticated dexterity at translating what stakeholders say in a conflict into ethical concepts or principles, it (...)
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  8.  7
    Developing Skills in the HEC Communication Competency: Diagnostic Listening and the ADEPT Technique.Autumn Fiester - 2022 - Journal of Clinical Ethics 33 (1):42-49.
    Proficient listening has been viewed as a critical skill in HEC (healthcare ethics consultation) from the inception of the practice, and it is included in the field’s set of core competencies that practitioners need to master to become a certified healthcare ethics consultant (HEC-C). Despite its centrality to the work of HEC, practitioners and trainees receive little or no formal training in the craft of listening, and there are few available resources that ethics consultants and trainees can access to enhance (...)
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  9.  22
    Mediation and Advocacy.Autumn Fiester - 2012 - American Journal of Bioethics 12 (8):10 - 11.
    The American Journal of Bioethics, Volume 12, Issue 8, Page 10-11, August 2012.
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  10.  16
    The failure of the consult model: Why "mediation" should replace "consultation".Autumn Fiester - 2007 - American Journal of Bioethics 7 (2):31 – 32.
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  11.  16
    Mediation and Recommendations.Autumn Fiester - 2013 - American Journal of Bioethics 13 (2):23-24.
    In their systematic review of the work of the ASBH Core Competencies Update Task Force, Anita Tarzian and ASBH Core Competencies Update Task Force (2013) write, “The ethics facilitation approach do...
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  12.  34
    Queer bioethics: Why its time has come.Lance Wahlert & Autumn Fiester - 2011 - Bioethics 26 (1):ii-iv.
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  13.  23
    Contentious Conversations: Using Mediation Techniques in Difficult Clinical Ethics Consultations.Autumn Fiester - 2015 - Journal of Clinical Ethics 26 (4):324-330.
    Mediators utilize a wide range of skills in the process of facilitating dialogue and resolving conflicts. Among the most useful techniques for clinical ethics consultants (CECs)—and surely the least discussed—are those employed in acrimonious, hostile conversations between stakeholders. In the context of clinical ethics disputes or other bedside conflicts, good mediation skills can reverse the negative interactions that have prevented the creation of workable treatment plans or ethical consensus. This essay lays out the central framework mediators use in distinguishing positions (...)
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  14.  52
    Justifying a presumption of restraint in animal biotechnology research.Autumn Fiester - 2008 - American Journal of Bioethics 8 (6):36 – 44.
    Articulating the public's widespread unease about animal biotechnology has not been easy, and the first attempts have not been able to provide an effective tool for navigating the moral permissibility of this research. Because these moral intuitions have been difficult to cash out, they have been belittled as representing nothing more than fear or confusion. But there are sound philosophical reasons supporting the public's opposition to animal biotechnology and these arguments justify a default position of resistance I call the Presumption (...)
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  15.  43
    Repaving the Road of Good Intentions: LGBT Health Care and the Queer Bioethical Lens.Lance Wahlert & Autumn Fiester - 2014 - Hastings Center Report 44 (s4):56-65.
    As the saying goes, “The road to hell is paved with good intentions.” And in the recent burst of clinical attention being paid to the needs of lesbian, gay, bisexual, and transgender patients, good intentions abound. But while this long‐overdue interest in LGBT health care aims to highlight important gaps and bring into relief serious issues in health care delivery for LGBT persons, such work can inadvertently reinforce both the marginalization of sexual minorities and the cultural norms related to sexuality, (...)
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  16.  11
    Values Imposition and Ethical Pluralism: An Argument Against Standardized Ethical Directives for Healthcare Ethics Consultants.Autumn Fiester - 2022 - Journal of Clinical Ethics 33 (3):189-197.
    In the article “An Argument for Standardized Ethical Directives for Secular Healthcare Services,” Abram L. Brummett and Jamie C. Watson argue that, parallel to the directives of the Roman Catholic Church, secular healthcare ethics consultants (HECs) need substantive standardized ethical guidelines (what they call SEGs) that would constitute a best practice across all HECs in the U.S. Brummett and Watson believe that the absence of such directives constitutes an important deficit in clinical ethics consultation (CEC) that needs to be rectified (...)
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  17.  15
    The ASBH’s Obligation to Create Cost-Free Basic HEC Training.Autumn Fiester - 2022 - American Journal of Bioethics 22 (4):66-67.
    There were several worrisome results in the long-awaited studies on clinical ethics consultation by Fox et al, but one of the most sobering was the self-assessments made by ECSs (Ethics Consult Ser...
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  18.  38
    The “Quality Attestation” Process and the Risk of the False Positive.Autumn Fiester - 2014 - Hastings Center Report 44 (3):19-22.
    The Quality Attestation Presidential Task Force's recent proposal for “quality attestation” (QA) of clinical ethics consultants was advanced on the premise that, “[g]iven the importance of clinical ethics consultation, the people doing it should be asked to show that they do it well.” To this end, the task force attempted to develop “a standardized system for proactively assessing the knowledge, skills, and practice of clinical ethicists.” But can this proposed method deliver? If the proposed QA process is flawed, it will (...)
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  19.  52
    Pedagogical Goals for Academic Bioethics Programs.Denise M. Dudzinski, Rosamond Rhodes & Autumn Fiester - 2013 - Cambridge Quarterly of Healthcare Ethics 22 (3):284-296.
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  20.  18
    Clinical Ethics Expertise & the Antidote to Provider Values-Imposition.Autumn Fiester - 2018 - In Jamie Carlin Watson & Laura K. Guidry-Grimes (eds.), Moral Expertise: New Essays from Theoretical and Clinical Bioethics. Springer International Publishing.
    Many clinical ethics services issue recommendations about ethical controversies that arise in patient care. Their role is configured to be arbiters of moral permissibility, rendering verdicts on which option of those available constitute the morally superior course of action. They produce moral judgements on questions, such as: Should dialysis be started or foregone? Should life-sustaining care be withdrawn or continued? Is it permissible for the clinician to refuse a course of treatment desired by a particular patient or family? But decisions (...)
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  21.  17
    Teaching Nonauthoritarian Clinical Ethics: Using an Inventory of Bioethical Positions.Autumn Fiester - 2015 - Hastings Center Report 45 (2):20-26.
    One area of bioethics education with direct impact on the lives of patients, families, and providers is the training of clinical ethics consultants who practice in hospital‐based settings. There is a universal call for increased skills and knowledge among practicing consultants, broad recognition that many are woefully undertrained, and a clear consensus that CECs must avoid an “authoritarian approach” to consultation—an approach, that is, in which the consultant imposes his or her values, ethical priorities, or religious convictions on the stakeholders (...)
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  22.  29
    Questioning Scrutiny: Bioethics, Sexuality, and Gender Identity.Lance Wahlert & Autumn Fiester - 2012 - Journal of Bioethical Inquiry 9 (3):243-248.
    The clinic is a loaded space for LGBTQI persons. Historically a site of pathology and culturally a site of stigma, the contemporary clinic for queer patient populations and their loved ones is an ethically fraught space. This paper, which introduces the featured articles of this special issue of the Journal of Bioethical Inquiry on “Bioethics, Sexuality, and Gender Identity,” begins by offering an analysis of scrutiny itself. How do we scrutinize? When is it apt for us to scrutinize? And what (...)
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  23.  85
    Gender Transports: Privileging the “Natural” in Gender Testing Debates for Intersex and Transgender Athletes.Lance Wahlert & Autumn Fiester - 2012 - American Journal of Bioethics 12 (7):19 - 21.
    The American Journal of Bioethics, Volume 12, Issue 7, Page 19-21, July 2012.
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  24.  14
    Bioethics and Democracy: Competing Roles of National Bioethics Organisations.Susan Dodds, Colin Thomson, Robert M. Veatch, Arthur Caplan, Autumn Fiester, H. Tristram Engelhardt, Ana Smith Iltis, Fabrice Jotterand, Wenmay Rei & Jiunn-Rong Yeh - 2006 - Bioethics 20 (6):326-338.
    ABSTRACT In establishing National Bioethics Organisations (NBOs), liberal democracies seek to acknowledge the diversity of strongly held ethical positions and the imperative to engage in public debate about important bioethical decisions. NBOs are typically given a range of responsibilities, including contributing to and stimulating public debate; providing expert opinion on relevant issues for policy deliberations; and developing public policy. The state is now found to have an interest in areas previously thought to be a matter of individual choice. NBOs can (...)
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  25.  18
    Mediation and Surrogate Decision-Making for LGBTQ Families in the Absence of an Advance Directive: Comment on “Ethical Challenges in End-of-Life Care for GLBTI Individuals” by Colleen Cartwright.Lance Wahlert & Autumn Fiester - 2012 - Journal of Bioethical Inquiry 9 (3):365-367.
    In this commentary on a clinical ethics case pertaining to a same-sex couple that does not have explicit surrogate decision-making or hospital-visitation rights (in the face of objections from the family-of-origin of one of the queer partners), the authors invoke contemporary legal and policy standards on LGBTQ health care in the United States and abroad. Given this historical moment in which some clinical rights are guaranteed for LGBTQ families whilst others are in transition, the authors advocate for the implementation of (...)
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  26.  82
    Physicians and strikes: Can a walkout over the malpractice crisis be ethically justified?Autumn Fiester - 2004 - American Journal of Bioethics 4 (1):12 – 16.
    Malpractice insurance rates have created a crisis in American medicine. Rates are rising and reimbursements are not keeping pace. In response, physicians in the states hardest hit by this crisis are feeling compelled to take political action, and the current action of choice seems to be physician strikes. While the malpractice insurance crisis is acknowledged to be severe, does it justify the extreme action of a physician walkout? Should physicians engage in this type of collective action, and what are the (...)
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  27.  28
    The Penn Center Guide to Bioethics.Vardit Ravitsky, Autumn Fiester & Arthur L. Caplan (eds.) - 2009 - Springer Publishing Company.
    This book will also inform the general public, patients, and family members as they seek answers to the bioethical issues of the day.
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  28.  10
    Teaching and Learning the Techniques of Conflict Resolution for Challenging Ethics Consultations.Autumn Fiester & Edward J. Bergman - 2015 - Journal of Clinical Ethics 26 (4):312-314.
    Professional mediators have long possessed a skill set that is uniquely suited to facilitation of difficult conversations between and among individuals in emotionally charged situations. This skill set has increasingly been recognized as invaluable to the work of clinical ethics consultants as they navigate conflicts involving families, surrogates, and providers. Given widespread acknowledgment that communication difficulties lie at the root of many clinical ethics conflicts, mediation offers techniques to enhance communication between conflicting parties. This special section of The Journal of (...)
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  29.  20
    Taxonomizing the Clinical Ethics Critics.Autumn Fiester - 2019 - American Journal of Bioethics 19 (11):62-63.
    Volume 19, Issue 11, November 2019, Page 62-63.
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  30.  33
    De-Escalating Conflict: Mediation and the “Difficult” Patient.Autumn Fiester - 2013 - American Journal of Bioethics 13 (4):11 - 12.
    (2013). De-Escalating Conflict: Mediation and the “Difficult” Patient. The American Journal of Bioethics: Vol. 13, No. 4, pp. 11-12. doi: 10.1080/15265161.2013.768855.
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  31.  14
    Mediation and Moral Aporia.Autumn Fiester - 2007 - Journal of Clinical Ethics 18 (4):355-356.
  32.  24
    The Ethical Mandate of Fertility Preservation Coverage for Transgender and Gender Diverse Individuals.Moira Kyweluk & Autumn Fiester - 2023 - International Journal of Feminist Approaches to Bioethics 16 (2):182-198.
    For individuals pursuing medically assisted gender transition, gender-affirming surgical treatments, such as oophorectomy (removal of the ovaries) and orchiectomy (removal of the testicles), cause sterility, and gender-affirming hormone treatment with medications (i.e., testosterone and estrogen) may negatively impact infertility. The major United States (US) medical associations already endorse fertility preservation (FP) through cryopreservation (i.e., “freezing” egg and sperm) for transgender individuals. Despite these endorsements from the relevant medical societies, medical insurance coverage for FP remains very limited in the US. Given (...)
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  33.  6
    Commentary: The Questions We Shouldn’t Ask.Lance Wahlert & Autumn Fiester - 2012 - Cambridge Quarterly of Healthcare Ethics 21 (2):282-284.
  34.  21
    Introduction: Providing Care When Patients Are "Difficult".Autumn Fiester - 2023 - Narrative Inquiry in Bioethics 13 (1):1-5.
    Abstract:This symposium includes twelve personal narratives from healthcare professionals who have worked with patients whose behavior, attitudes, or life situations make providing care challenging. At the lower end of the estimates, at least 15% of adult patient encounters are with patients described as "difficult" by the treating team, and these encounters often evoke feelings of dread, frustration, and anger in healthcare professionals. Verbal abuse of staff, repeat hospital admissions due to self-injurious behaviors, and negative beliefs about health may make providing (...)
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  35.  20
    A Worrisome Misappropriation of “Mukallaf” in Life-Sustaining Treatment.Kholoud Alnakshabandi & Autumn Fiester - 2015 - American Journal of Bioethics 15 (1):25-27.
  36.  22
    Creating Fido's Twin: Can Pet Cloning Be Ethically Justified?Autumn Fiester - 2005 - Hastings Center Report 35 (4):34.
    Taken at face value, pet cloning may seem at best a frivolous practice, costly both to the cloned pet's health and its owner's pocket. At worst, its critics say, it is misguided and unhealthy—a way of exploiting grief to the detriment of the animal, its owner, and perhaps even animal welfare in general. But if the great pains we are willing to take to clone Fido raise the status of companion animals in the public eye, then the practice might be (...)
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  37.  28
    Clinical Ethics Credentialing and the Perilous Cart-Before-the-Horse Problem.Autumn Fiester - 2014 - American Journal of Bioethics 14 (1):25-26.
    In the zeal to find a workable credentialing process for clinical ethics consultants (CECs), the current motto in the field seems to be “something is better than nothing.” Although the field has be...
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  38.  36
    The “Ladder of Inference” as a Conflict Management Tool: Working with the “Difficult” Patient or Family in Healthcare Ethics Consultations.Autumn Fiester - 2024 - HEC Forum 36 (1):31-44.
    Conflict resolution is a core component of healthcare ethics consultation (HEC) and proficiency in this skill set is recognized by the national bioethics organization and its HEC certification process. Difficult interpersonal interactions between the clinical team and patients or their families are often inexorably connected to the normative disputes that are the catalyst for the consult. Ethics consultants are often required to navigate challenging dynamics that have become entrenched and work with patient-provider or family-provider relationships that have already broken down. (...)
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  39.  23
    Queer in the Clinic.Lance Wahlert & Autumn Fiester - 2013 - Journal of Medical Humanities 34 (2):85-91.
    Beginning with a rumination on the AIDS-inspired poetry of Thom Gunn, this article by the guest editors introduces the special issue of the Journal of Medical Humanities titled “Queer in the Clinic.” After providing an overview of the historical legacy and contemporary dilemmas of LGBTQ persons in biomedical practice, the authors describe the rationale of the issue and the contributions included.
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  40.  13
    Response to Open Peer Commentaries on “Ethical Issues in Using Behavior Contracts to Manage the ‘Difficult’ Patient Family”.Autumn Fiester - 2023 - American Journal of Bioethics 23 (3):1-4.
    In the piece, “Ethical Issues in Using Behavior Contracts to Manage the ‘Difficult’ Patient and Family,” Chase Yuan and I (Fiester and Yuan 2023) argue that an important set of ethical concerns nee...
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  41.  6
    Reducing Moral Distress by Teaching Healthcare Providers the Concepts of Values Pluralism and Values Imposition.Autumn Fiester - 2023 - Journal of Clinical Ethics 34 (4):296-306.
    There is a clear need for interventions that reduce moral distress among healthcare providers (HCPs), given the high prevalence of moral distress and the far-ranging negative consequences it has for them. Healthcare ethics consultants are frequently called upon to manage moral distress, especially among nursing staff. Recently, researchers have both broadened the definition of moral distress and demarcated subcategories of the phenomenon with the intent of creating more targeted and effective interventions. One of the most frequently occurring subcategories of moral (...)
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  42.  15
    A dubious export: The moral perils of american-style ethics consultation.Autumn Fiester - 2012 - Bioethics 27 (1):ii-iii.
  43.  8
    A nimal biotechnology is the use of scientific princi-ples and techniques to produce or modify animals for research.Autumn Fiester - 2009 - In Vardit Ravitsky, Autumn Fiester & Arthur L. Caplan (eds.), The Penn Center Guide to Bioethics. Springer Publishing Company. pp. 425.
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  44.  61
    Creating fido's twin: Can pet cloning be ethically justified?Autumn Fiester - 2005 - Hastings Center Report 35 (4):34-39.
    : Taken at face value, pet cloning may seem at best a frivolous practice, costly both to the cloned pet's health and its owner's pocket. At worst, its critics say, it is misguided and unhealthy—a way of exploiting grief to the detriment of the animal, its owner, and perhaps even animal welfare in general. But if the great pains we are willing to take to clone Fido raise the status of companion animals in the public eye, then the practice might (...)
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  45. Pet cloning does not harm animals.Autumn Fiester - 2006 - In William Dudley (ed.), Animal rights. Detroit, [Mich.]: Thomson Gale.
     
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  46.  32
    Response to open Peer commentaries on “justifying a presumption of restraint in animal biotechnology research”.Autumn Fiester - 2008 - American Journal of Bioethics 8 (6):W1 – W2.
    Articulating the public's widespread unease about animal biotechnology has not been easy, and the first attempts have not been able to provide an effective tool for navigating the moral permissibility of this research. Because these moral intuitions have been difficult to cash out, they have been belittled as representing nothing more than fear or confusion. But there are sound philosophical reasons supporting the public's opposition to animal biotechnology and these arguments justify a default position of resistance I call the Presumption (...)
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  47.  21
    Response to Open Peer Commentaries on “Neglected Ends: Clinical Ethics Consultation and the Prospects for Closure”.Autumn Fiester - 2015 - American Journal of Bioethics 15 (1):9-10.
    Clinical ethics consultations are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult's endpoint runs the risk of overemphasizing the conflict's resolution at the expense of the consult's process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, lingering (...)
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  48.  3
    Response to Perry and Venkat.Autumn Fiester - 2015 - Journal of Clinical Ethics 26 (2):190-191.
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  49.  6
    Who’s at the Table? Moral Obligations to Equal-Priority Surrogates in Clinical Ethics Consultations.Autumn Fiester & Meghan O’Brien - 2014 - Journal of Clinical Ethics 25 (4):273-280.
    Existing state surrogate decision-maker laws are fragmented and inconsistent and fail to ensure that all eligible decision makers of the same surrogate priority class are included in the healthcare decisions made for an incapacitated loved one. In this article, we explore three categories of harm that result from failing to include all surrogates of equal priority in a patient’s healthcare decision, namely harms to the patient, harms to the excluded surrogate, and harms to the family. Given these harms, we argue (...)
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  50.  19
    Response to Open Peer Commentaries on “Addressing Consent Issues in Donation After Circulatory Determination of Death”.Kim J. Overby, Michael S. Weinstein & Autumn Fiester - 2015 - American Journal of Bioethics 15 (9):3-5.
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