Public health agencies regularly survey randomly selected anonymous students to track drug use, sexual activities, and other risk behaviors. Students are unidentifiable, but a recent project that i...

Volume 20, Issue 10, October 2020, Page W4-W7.

This paper explores the relationship between teaching and consulting in clinical ethics teaching and the role of the ethics teacher in clinical decision-making. Three roles of the clinical ethics teacher are discussed and illustrated with examples from the authors' experience. Two models of the ethics consultant are contrasted, with an argument presented for the ethics consultant as decision facilitator. A concluding section points to some of the challenges of clinical ethics teaching.

Physicians traditionally have been given role-specific obligations to promote the well-being of their individual patients, one patient at a time. They are not expected to be concerned with how health care is best allocated between patients, or with how health-care allocations compare to other social goods and services. The assumption seems to be that our society’s health-care allocation should be the cumulative result of individual clinical decisions made on behalf of individual patients. In this view, physicians are the gatekeepers of (...) health-care allocation, because they are responsible for making clinical decisions about prescriptions and admissions to health-care institutions and other services. But they should... (shrink)

Discussion of the ethics of forgoing medically provided nutrition and hydration tends to focus on adults rather than infants and children. Many appellate court decisions address the legal propriety of forgoing medically provided nutritional support of adults, but only a few have ruled on pediatric cases that pose the same issue.The cessation of nutritional support is implemented most commonly for patients in a permanent vegetative state ). An estimated 4,000 to 10,000 American children are in the permanent vegetative state, compared (...) to 10,000 to 25,000 adults. Yet the dearth of literature, case reports, and court decisions suggests that physicians and families of pediatric patients stop medically provided nutrition or seek court orders much less frequently. (shrink)

In 2016, the Colorado legislature passed an amendment to Colorado’s medical proxy law that established a process for the appointment of a physician to act as proxy decision maker of last resort for an unrepresented patient (Colorado HB 16-1101: Medical Decisions For Unrepresented Patients). The legislative process brought together a diverse set of stakeholders, not all of whom supported the legislation. Following passage of the statutory amendment, the Colorado Collaborative for Unrepresented Patients (CCUP), a group of advocates responsible for initiating (...) the legislative process, coordinated a unique effort to engage these stakeholders in the creation of a set of voluntary guidelines to assist facilities and individual careproviders in the implementation of policies and procedures enabled by the statute. This article delineates the questions and concerns of stakeholders, describes how those issues were addressed within the guidelines, and proposes additional opportunities for research to assess the impact of the legislation in Colorado. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bedside VoicesJacqueline J. GloverThis issue of Narrative Inquiry in Bioethics features ten stories of Certified Nursing Assistants (CNAs) who work primarily in long-term care. This is a voice of direct care at the bedside that is not often heard. The addition of these stories in the literature is long overdue and I am honored to be asked to comment. There is much to learn from these bedside caregivers. All (...) of these stories reflect the deep struggle to be respected as a member of the health care team. But I also hear the pain of being caught in the tension between the desire to be skilled, qualified, and professional and the desire to be present in a way that emphasizes service, caring and common human touch. My commentary is informed by my experience in Rural Bioethics and my work at the Center for Bioethics and Humanities at the University of Colorado which has a commitment to Interprofessional Education. The CNAs' stories reveal much that they share with other health care professionals, but also some unique features that can teach us much.CommonalitiesSelf Care and Being Cared ForThe voice of the CNA is a voice that is echoed in a way by all health care professionals. Each of the stories bears witness to the need to take care of yourself and to be cared for in order to be able to continue to care for others. Leilani Roseberry writes "This unresolved grief and constant exposure to dying and death had me looking at every day, even every moment, through the eyes of a dying person. This is an emotion that is very difficult to put into words." She continues elsewhere, "I believe that if I had grief support opportunities available to me in my professional life, my level of care and compassion would have been much more resilient from the very beginning of my work as a CNA. Instead, only after sorting through emotions affecting my personal life and learning they were a compilation of what I experienced professionally, only then have I become much more resilient in the face of grief and mourning." Danny Reed writes, "Caregivers benefit from the same thing patients and residents do: genuine kindness. Take care of the caregivers because one day they will be all you have left in the world." And from James Bradley, "The work itself can be very draining, but to beat the stress of it, you can follow all the usual stuff like going for walks, playing with your kids, watch TV etc. The best advice though is to, as far as possible, leave the work behind when you walk off at the end of your shift. That may be the hardest thing to do but it is the only way to retain the correct professional approach."Self care can certainly be about boundaries and stress management. Health care institutions, including professional schools, increasingly have wellness programs (Johnson, 2000). It was once thought that [End Page 159] professional and emotional distance was necessary to maintain healthy relationships and avoid burn out. But current thinking seems to indicate the opposite. If a health care professional views his or her work only in terms of tasks to be performed without some connection to the meaning of what he or she is doing for the patient as a human being, that person is more likely to burn out (Halpern, 2003). Bradley's use of "correct professional approach" prompted me to think beyond wellness and health to the need to nurture meaning in one's work. The CNAs' essays are filled with the call to recognize the deeper meaning of their work. Tracy Dudzinski writes, "Most people think anyone can do this job. I thought that myself, twelve years ago. But now I know that it takes someone special. Direct care workers do not do this work because they are getting rich. They do it because they love the work and because it is the right thing to do. This is the hardest job I have ever done but it is also the most rewarding job I have ever done."There is increasing attention to the use of reflective writing in... (shrink)

Medical decision making on behalf of unrepresented patients is one of the most challenging ethical issues faced in clinical practice. The legal environment surrounding these patients is equally complex. This article describes the efforts of a small coalition of interested healthcare professionals to address the issue in Colorado. A brief history of the effort is presented, along with discussion of the legal, ethical, practical, and political dimensions that arose in Colorado’s effort to address decision making for unrepresented patients through an (...) extension of the existing Colorado Medical Treatment Decision Act (CRS 15-18). A discussion of lessons learned in the process is included. (shrink)

Volume 19, Issue 7, July 2019, Page 66-67.

The case of a dying baby with is one of the most difficult in pediatric ethics. I have been involved in several such cases and they are extremely challenging for all parties, especially the parents. With the luxury of being an I will comment on this case from the perspective of when it first began and at the end point described in the narrative.