Current health policy, high‐profile failures and increased media scrutiny have led to a significant focus on patient experience in Britain's National Health Service (NHS). Patient experience data is typically gathered through surveys of satisfaction. The study aimed to support a better understanding of the patient experience and patients' expression of it through consideration of the aspects of the patient experience on NHS wards which are by their nature impossible to capture through patient satisfaction surveys. Existential phenomenology was used to develop (...) an in‐depth exploratory narrative, expressed through the voices of the participants. Data collection involved in‐depth face‐to‐face interviews with 12 purposively sampled participants, with analysis by means of hermeneutics. Though the individuality of each experience was apparent and cannot be overemphasised, common factors emerging from the data included uncertainty and unexpectedness, suffering and finitude, the futility of feedback and bureaucracy and absurdity. Overall, participants demonstrated how their individual personalities and expectations affected their response both to illness or injury and to their hospital admissions, highlighting feelings of vulnerability and voicelessness as a response to hospitalisation. The findings of this study provide useful insight into the patient experience on British hospital wards, and the value of an existential–phenomenological approach is demonstrated. (shrink)

The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of (...) family life, and the intensive utilization of resources—combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay.In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to making clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital. (shrink)

Grace and Freedom in a Secular Age offers a concise exposition of key ideas - contingency, otherness, freedom, vulnerability and mutuality - that inform the work of the Canadian philosopher Charles Taylor, especially concerning the dynamics of religious belief and religious denial in what he calls a "a secular age." The book integrates discussion of Immanuel Kant and Susan Neiman in particular and seeks to show how Taylor's work can be fruitfully engaged by theologians.

Discrimination and inequalities in healthcare can be experienced by many patients due to many characteristics ranging from the obviously visible to the more subtly noticeable, such as race and ethnicity, legal status, social class, linguistic fluency, health literacy, age, gender and weight. Discrimination can take a number of forms including overt racist statement, stereotyping or explicit and implicit attitudes and biases. This paper presents the case study of a complex transcultural clinical encounter between the mother of a young infant in (...) a highly vulnerable social situation and a hospital healthcare team. In this clinical setting, both parties experienced difficulties, generating explicit and implicit negative attitudes that heightened into reciprocal mistrust, conflict and distress. The different factors influencing their conscious and unconscious biases will be analysed and discussed to offer understanding of the complicated nature of human interactions when faced with vulnerability in clinical practice. This case vignette also illustrates how, even in institutions with long-standing experience and many internal resources to address diversity and vulnerability, cultural competence remains a constant challenge. (shrink)

Introduction: Vulnerability is a poorly understood concept in research ethics, often aligned to autonomy and consent. A recent addition to the literature represents a taxonomy of vulnerability developed by Kipnis, but this refers to the conduct of clinical trials rather than qualitative research, which may raise different issues. Aim: To examine issues of vulnerability in cancer and palliative care research obtained through qualitative interviews. Method: Secondary analysis of qualitative data from 26 black Caribbean and 19 white British patients with advanced (...) cancer. Results: Four domains of vulnerability derived from Kipnis’s taxonomy were identified and included: (i) communicative vulnerability, represented by participants impaired in their ability to communicate because of distressing symptoms; (ii) institutional vulnerability, which referred to participants who existed under the authority of others—for example, in hospital; (iii) deferential vulnerability, which included participants who were subject to the informal authority or the independent interests of others; (iv) medical vulnerability, which referred to participants with distressing medical conditions; and (v) social vulnerability, which included participants considered to belong to an undervalued social group. Participants from both ethnic groups populated all these domains, but those who were black Caribbean were more present among the socially vulnerable. Conclusions: Current classifications of vulnerability require reinterpretation when applied to qualitative research at the end of life. We recommend that researchers and research ethics committees reconceptualise vulnerability using the domains identified in this study and consider the research context and interviewers’ skills. (shrink)

Hospitals are places where patients are unwell, where patients and their families may be upset, confused, frustrated, in pain, and vulnerable. The likelihood of these experiences and emotions manifesting in anger and aggressive behaviour is high. In this paper, we describe the involvement of a clinical ethics service responding to a request to discuss family aggression within a rehabilitation department in a large paediatric hospital in Australia. We suggest two key advantages of involving a clinical ethics service in discussions (...) about how to respond to family aggression. First, the process of ethics deliberation provides an opportunity for clinicians to be involved in the solution by articulating their perspectives, tolerance levels, and general concerns about the effects of family aggression towards staff. Second, supporting clinicians to articulate and identify the impact of parental aggression directly counters the disadvantages of the more blunt zero-tolerance policy response, which is necessarily imposed from the top down. (shrink)

This short paper responds to the essays by Shilpi Sinha, Shaireen Rasheed, and Lyudmila Bryzzheva. It considers how racial inequality between teachers and students affects the possibilities of educational hospitality, both in cases of white teachers teaching racialized students and in cases of racialized teachers teaching white students. The response takes a phenomenological turn, considering the relative vulnerability of bodies that encounter each other in educational spaces which, themselves, are not neutral.

Background:In China, the conventional family-based ageing care model is under pressure from social transitions, raising the question of whether and to what extent families are still capable of dealing with the care of the aged.Objective:This article examines the vulnerability and inadequacy of families to bear responsibility for the care of the aged against a backdrop of socioeconomic transformation and diminishing institutional support in rural China.Research design:This article adopts an empirical ethical approach that integrates empirical investigation with ethical inquiry.Participants and research (...) context:The empirical component of this article focuses on the lived experiences of caring for a wife and mother with dementia in one rural Chinese family, collected from a 6-month fieldwork study conducted at one primary hospital.Ethical considerations:Approval was obtained from the university ethics committee.Findings:The empirical study highlights a conflicted family process of managing and negotiating care that indicates the inadequacies and limited ability of families to deal with aged care tasks. In addition, inadequate structures and institutional deficiencies exacerbate the vulnerability of rural families and their inability to offer adequate care.Conclusion:Acknowledging the vulnerability of families as ageing care providers, this article calls for a socially supported family care model for rural older people in China and also proposes policy recommendations. (shrink)

We reinvigorate vulnerability theory as a radically ethical device — ethical vulnerability analysis. We bring together fuller vulnerability analysis as theorized by Fineman and Grear in conversation with Levinas and Derrida’s radical vulnerability and the ethics of hospitality to construct a theoretical framework that is firmly anchored in the realities of the everyday that are vulnerability and migration. This novel framework offers a thinking space to subvert approaches to migrants and migration as it compels us to come face-to face (...) with the “other”, which in turn renders the political accountable by her. We deploy ethical vulnerability analysis to deconstruct the EU’s “migration crisis” and investigate whether the activation of temporary protection for displaced persons from Ukraine signifies a humanizing turn in the EU’s asylum and migration policies. In this regard, we submit that this hospitable moment constitutes an “exception to the rule” rather than a paradigm shift. (shrink)

Discrimination and inequalities in healthcare can be experienced by many patients due to many characteristics ranging from the obviously visible to the more subtly noticeable, such as race and ethnicity, legal status, social class, linguistic fluency, health literacy, age, gender and weight. Discrimination can take a number of forms including overt racist statement, stereotyping or explicit and implicit attitudes and biases. This paper presents the case study of a complex transcultural clinical encounter between the mother of a young infant in (...) a highly vulnerable social situation and a hospital healthcare team. In this clinical setting, both parties experienced difficulties, generating explicit and implicit negative attitudes that heightened into reciprocal mistrust, conflict and distress. The different factors influencing their conscious and unconscious biases will be analysed and discussed to offer understanding of the complicated nature of human interactions when faced with vulnerability in clinical practice. This case vignette also illustrates how, even in institutions with long-standing experience and many internal resources to address diversity and vulnerability, cultural competence remains a constant challenge. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Hospitalization—Bridging the Gap Between Respect and ControlPaul P. ChristopherIntroductionThis issue of Narrative Inquiry in Bioethics offers varied and somewhat unique perspectives on the experience of psychiatric hospitalization. This commentary highlights a number of salient themes that emerge from reading these essays and attempts to explore how they relate to the broader academic literature on psychiatric hospitalization, particularly with regard to ethical considerations. In reading these narratives, each several (...) times, I was repeatedly struck by the courage required of the authors, both to share their stories publicly and to endure the challenges that the writing process no doubt demanded of them—revisiting and suspending themselves in deeply emotional and, at times, traumatic experiences in order to share the most compelling narrative. Their hard work clearly paid off—the stories are at once intimate and indelible. Still, in many instances, I found myself wanting to know more; to enter the story and sit with the individual through these events; to ask what they were thinking or feeling in a particular situation; to see and hear the world in which they found themselves. Such is the nature of good story telling—the reader, left with the lingering vision created in his mind, turns over the last page, eagerly hoping for more.Narrative ThemesI. Loss of Autonomy or ControlPerhaps the most notable theme had to do with the loss of control or freedom that followed from hospitalization. On first consideration, it may seem odd that this issue appears so often since patient autonomy constitutes one of the fundamental principles of medical ethics. Only under specific circumstances—e.g., when there is a risk of imminent harm—may autonomy be curtailed, and even then only to the extent that is minimally necessary. Yet, as these narratives highlight, there are a multitude of ways in which psychiatric hospitalization engenders actual or perceived restrictions in freedom (Newton-Howes & Mullen, 2011).Consistent with prior research (Goodwin et al., 1999), many of the authors describe a fear or the actual experience of not being able to leave the hospital freely, even when the admission seems to have been voluntary. For example, one writer worries, “I was so afraid that if I ever went ‘in,’ I would never get ‘out’... I thought I would never taste freedom again... alive.” Another describes:When it came time for my possible discharge they told me that I might not get discharged because I was ‘acting up the previous evenings.’ My anxiety level at this point went through the roof. The only reason I was discharged was because my father knew some politicians. If not [End Page 29] for him I would have been a patient there for perhaps years and my life would have been ruined.A third gives this example: “When I asked to sign the form to leave after three days, [the psychiatrist] told me if I did that she would have me committed.” Another writer fears not having any control of how the psychiatrist might approach the treatment: “... I was totally vulnerable... would the doctors blame me, drug me, shock me, kill me?”Somewhat surprising, however, was the fact that so few of the narratives take issue with the decision to hospitalize. This omission is especially striking in light of the fact that prior reports consistently note that a substantial minority (up to nearly half) of voluntarily admitted patients nevertheless experience their admission as coerced (Bonsack & Borgeat, 2005; Hiday et al., 1997; Katsakou et al., 2010; Rogers et al., 1993; Sheehan & Burns, 2011). Because many of these narrators had been hospitalized more than once, the relative absence of expressed resistance to being hospitalized seems strange, particularly when earlier hospital experiences or their aftermath are often described as negative. For example, one individual characterized the time after being released from the hospital as, “My sense of self was questioned. I felt as if I lost my soul.” Another put it this way:When I got out of the private hospital, I felt like my soul had been ripped out of me. I felt like I had a gaping hole in the center of my body... I felt psychically raped, dazed, and confused.Given these... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Offering Hospitality: Questioning Christian Approaches to War by Caron E. GentryAndrew C. WrightOffering Hospitality: Questioning Christian Approaches to War Caron E. Gentry notre dame, in: university of notre dame press, 2013. 200 pp. $20.00Caron E. Gentry provides a constructive proposal for transforming jus ad bellum’s last-resort criterion through the reconceptualization of hospitality as “an essential practice” (2) in international relations, one that helps jus ad (...) bellum “operate proactively instead of coercively and reactively” (35) by seeking to protect “without interest the good and the bad of humanity and humans” (3). Gentry is particularly concerned with marginalized peoples who inhabit failed states, whose realities are willfully ignored through the “abstraction” and “hegemonic masculinity” in international relations, as well as in the dominant voices in political theology (Reinhold Niebuhr, Stanley Hauerwas, and Jean Bethke Elshtain) that support an “uncritical complicity with power … unable to deal with vulnerable populations outside of the West” (27). Understood in Christian terms as a practice of “agape,” or “self-giving love,” Gentry demonstrates how hospitality may be a plausible alternative to the paradigmatic approach to power in international relations, suggesting that acting without self-interest is a path to greater and more sustainable security (62).Gentry engages an impressive array of sources to structure her argument. For her critique of international relations discourse, she turns to feminist analyses of state sovereignty to demonstrate how a masculinized understanding of power abstracts the realities of war experienced by human populations (18). Drawing on a “human security” perspective (35), Gentry suggests that the prevention of violent conflict requires a proactive practice—using tools such as the Failed State Index—that attends to the realities of vulnerable populations within states before they erupt into violent conflict (34). Her emphasis on vulnerability and the mutual need for the other reveals Emmanuel Levinas as the primary influence on Gentry’s approach. Refracted through this vision, she opts for a practice of hospitality that moves beyond the realist, pacifist, and just war traditions to cultivate a “proactive last resort” that would extend care to the needs of the vulnerable beyond one’s own borders (136).Strengthening jus ad bellum’s last-resort criterion through a reconceived, proactive practice of hospitality is Gentry’s most compelling contribution, one that is particularly insightful for practitioners and theorists of the just war tradition. Yet readers may get the sense that Gentry wants to push her [End Page 204] contribution beyond the limits of political theology to shape the normative practices of international affairs; this is where Gentry’s persuasive force begins to wane. Specifically, Gentry obscures the genuine differences between an ecclesial practice of agape, embedded in a particular understanding of the nature of God, and the international affairs of a state, embedded in a game of realpolitik, where invulnerability is the rule. In order for Gentry to stake a claim in such a context, she needs to develop a more grounded account of how states could accept vulnerability as a normative practice in order to act without self-interest.Certainly, interdependence and mutual vulnerability are the right place to start. However, this kind of change does not simply concern the dominant patterns of international relations but also involves a change in shared conceptions about basic human nature. As such, her wider contribution may be less about a comprehensive framework and more about a potentially transformational question for theorists in international relations, political philosophy, and Christian ethics alike: What will it require for populations within states to recognize their own vulnerability and dependency, to see the well-being of “the other,” including the enemy, as essential to their own security? After Gentry, any answer to this question must move beyond patterns of hegemony and abstraction, toward proactive engagement with the realities of vulnerable populations.Andrew C. WrightFuller Theological SeminaryCopyright © 2015 Society of Christian Ethics... (shrink)

This paper engages with the topic of hospitality in its reading of Kant as a thinker of ‘globality’; that is, as one who is keenly attuned to the various and complex ways humans strive to ‘hospitalize’ this planet in their attempts to transform it into a working and living environment. Despite having no illusions about actual international traders’ practices, who all too often perpetuate injustices and commit crimes, he sets out a project for a different conception of commercium as (...) a cultural practice which should remind us of the finite nature of our planet and its resources, and of our own vulnerable dependence on it. This account of a more enlightened ‘spirit of trade’, which is sensitive to cultural difference and environmental issues, is the product of a mobile way of thinking which would favour a more fluid communication with people on the move. (shrink)

Food insecurity in the United States is a profound public health challenge that hospitals are uniquely situated to address. Through the enactment of the Hospital Readmission Reduction Program, the Affordable Care Act provides a strong economic incentive for hospitals to actively confront food insecurity within the communities they serve. While there is a spectrum of nutrition interventions that hospitals can look to when engaging in these efforts, healthy food prescriptions and medically tailored meals are two particularly innovative and promising approaches (...) that could help hospitals reduce readmissions by addressing the nutritional needs of vulnerable patients. (shrink)

Meeting the needs of individuals who experience vulnerability due to cognitive impairment presents significant challenges to caregivers. Primary caregiver responsibility is often relegated to professionals in hospitals or long-term care facilities, while proxy decision-making responsibility lies with families. The complex relationship among patients, professional caregivers, and families may be further complicated by the relative cognitive capacity of different patients. While some experience diminished cognitive capacity to such an extent that they cannot make any informed voluntary decisions, others may be able (...) to express global preferences and participate more actively in rehabilitative efforts. With reference to Catholic social teaching, I briefly establish the intrinsic dignity of human persons who experience cognitive impairment and then analyze how the web of relationships and responsibilities among patients, professional caregivers, families, and communities ought to be defined. Finally, I consider how these relationships may be optimized to enhance participation in mutually reinforced caregiving and decision making. (shrink)

This essay explores thematic overlaps in Jacques Derrida's writings on hospitality and stories of hospitality told by Balga Bedouin in Jordan. Why do these overlaps exist? What produces them? What can these likenesses tell us about the relationship between hospitality, politics and moral reasoning? Juxtaposing an exemplary Jordanian tale of hospitality with motifs and claims central to Derrida's work, I argue that a shared and second language pervades this material. The language in question grows out of (...) real historical relations, but it is also rooted in a desire, keenly felt among metropolitan political theorists and Bedouin social philosophers alike, to locate human interaction in idealized spaces that transcend the political and moral systems in which we live. Playing on contradictory themes of welcome and trespass, hospitality is a rich medium in which to imagine worlds that are more open, and more vulnerable, to Others. (shrink)

From Editors' Introduction: "With our invitation to turn over (re-turn) hospitality in these times Marietta Radomska’s response combines her own research within the emerging field of Queer Death Studies6 with a detailed reading of the coronavirus disease pandemic. In her essay, “Viral queerings, amplified vulnerabilities”, Marietta seeks to subvert normative and simplified understandings of our present. Following the thread that the pandemic affects some bodies more than others, Marietta highlights how “the exploitation and degradation of nature mixed with intensifying (...) socio-economic inequalities directly contribute to the emergence of zoonoses”. Untangling the myth of the containable body and human-exceptionalism, Marietta challenges which lives are considered grievable drawing our attention to “more-than-human necropolitics”. In queering the pandemic she asks us to “reimagine the ways we relate to human and nonhuman others, perhaps in a more hospitable register”." Edited by Yvonne Billimore and Jussi Koitela. (shrink)

The source of hospitality lies in the fundamental ethical experiences that make up the fabric of the social lives of people. Therein lies a primary form of humanity. Whether we are guests or hosts, this reveals our situation in a world made up of receiving and meeting, leaving room for the liberty to give and receive beyond the imperatives of reciprocity. This book proposes an ethic that promotes the possibility of stirring emotion before that of protecting ourselves from unexpected (...) encounters. Fundamental ethical competence consists of opening up to the wholly-other and to others, to be accessible to the world s solicitations. There is moral superiority of vulnerable love over control and moderation, of generous passion over rational prudence and of excess over exchange. Constructing an ethic of hospitality is essential at a time when we are torn between the imperatives of modernization and growth and the demands of concern and protection. The experience we all have today, that of the fragility of the world, is giving rise to a powerful tendency toward solicitude. From such a perspective, the duty of individuals no longer consists of protecting themselves from society, but of defending it, taking care of a social fabric outside of which no identity can be formed. ". (shrink)

This is the first book to unpack the legal and ethical issues surrounding unauthorised intimate examinations during labour. The book uses feminist, socio-legal and philosophical tools to explore the issues of power, vulnerability and autonomy. The collection challenges the perception that the law adequately addresses different manifestations of unauthorised medical touch through the lens of women's experiences of unauthorised vaginal examinations during labour. The book unearths several broader themes that are of huge significance to lawyers and healthcare professionals such as (...) the legal status of women and their bodies. The book raises questions about women's experiences during childbirth in hospital settings. It explores the status of women's bodies during labour and childbirth where too easily they become objectified, and it raises important issues around consent. The book highlights links to the law on sexual offences and women's loss of power under the medical gaze. The book includes contributions from leading feminist philosophers, medical professionals, and academics in medicine and law, and offers pioneering analysis relevant to lawyers and healthcare professionals with an interest in medical law and ethics; feminist theory; criminal law; tort law; and human rights law. (shrink)

ABSTRACT Pandemics and plagues function rhetorically, by doing violence to the structures of discourse, sociality, hospitality, and mutual engagement that characterize ethical human interaction. They infect us, as rhetorical subjects, and reorient our capacity for engagement. The coronavirus's “novelty” renders it uncertain as to how long it will last or who will be infected next; the near-uniform response to it has been a forced distance of ourselves from others and a displacement from our itineraries and our locations. Through COVID-19 (...) we are learning that pandemic does violence to our sense of place, to how we think of respite, and has highlighted our sense of vulnerability in the midst of others. (shrink)

Resumen El objetivo principal de este artículo es recrear la práctica de la hospitalidad en el contexto de la realidad migratoria actual, con la intención de aportar luz a la manera de gestionar la diversidad, de repensar la formación de identidad, de acercarnos a ciertas dinámicas políticas y últimamente de incentivar procesos de integración y cohesión social, especialmente en la vida de nuestros barrios. Para ello, el autor se adentra en las raíces bíblicas de la hospitalidad, aportando algunas claves para (...) entender esta virtud hoy. En nuestro mundo actual donde parecería ganar terreno la hostilidad sobre la hospitalidad, la práctica de la hospitalidad constituye un auténtico acto de resistencia.The main aim of this article is to recreate the practice of hospitality in the context of the current migratory reality, with the intention of bringing light to the way of managing diversity, of rethinking identity formation, of approaching certain political dynamics and lately to encourage processes of integration and social cohesion, especially in our vulnerable neighborhoods. For this purpose, the author delves into the biblical roots of hospitality, providing some clues to understand this virtue today. In our current world where hostility over hospitality seems to gain ground, the practice of hospitality constitutes a genuine act of resistance. (shrink)

The COVID-19 pandemic created new conditions for the functioning of all organizations. Suddenly, there was a problem with the lack of appropriate leadership styles models in health care organizations, which are particularly vulnerable to disruptions in a pandemic. Hospitals, in particular, have become exposed to organizational and managerial problems. The article aims to propose an appropriate leadership style model that will guarantee a high level of hospital efficiency, taking into account a pandemic situation in the example of private hospitals (...) in Indonesia. Organizational identification is promoted as a mediating variable due to the high level of this variable in explaining hospital performance in Indonesia based on preliminary studies. During research used a structural equation model using 394 samples at the unit leadership level in private hospitals in Indonesia. The results of this study explain that there is an impact between innovative leadership and strategic leadership styles on hospital performance. Private hospitals in Indonesia need to improve themselves to use the most appropriate leadership style model based on the needs of the hospital itself. (shrink)

Phenomenological healthcare research should include the lived experiences of a broad group of healthcare users. In this paper it is shown how shadowing can give a voice to people in vulnerable situations who are often excluded from interview studies. Shadowing is an observational method in which the researcher observes an individual during a relatively long time. Central aspects of the method are the focus on meaning expressed by the whole body, and an extended stay of the researcher in the (...) phenomenal event itself. Inherent in shadowing is a degree of ambivalence that both challenges the researcher and provides meaningful insights about the phenomenon. A case example of a phenomenological study on the experiences of elderly hospital patients is used to show what shadowing yields. (shrink)

International migration has a female face in the beginning of the twenty-first century; since at least 1990, a total of 49 percent of international migrants have been women (UN 2008).1 Many women relocate in pursuit of goals that they can’t realize in their countries of origin, and many women move on their own to developed countries as caregivers to the very old or the very young, as nurses to attend to the sick in hospitals, and as domestic workers.2 How should (...) we regard their decisions to do so? One way of thinking about such moves is to deplore the fact that women have to move in order to attain certain goals in their lives; it would be more desirable to live in a world that would not make such moves necessary... (shrink)

To address the burden of maternal morbidity and mortality in low‐ and middle‐income countries (LMICs), research with pregnant women in these settings is increasingly common. Pregnant women in LMIC‐context may experience vulnerability related to giving consent to participate in a clinical trial. To recognize possible layers of vulnerability this study aims to identify factors that influence the decision process towards clinical trial participation of pregnant women in an urban middle‐income setting. This qualitative research used participant observation, in‐depth interviews, and focus (...) group discussion with medical staff and pregnant women eligible for trial participation, at a regional hospital in Accra, Ghana. Besides lack of familiarity with modern scientific concepts, specific factors influencing the decision‐making process were identified. These include a wide power difference between health provider and patient, and a different perception of risk through externalization of responsibility of risk management within a religious context as well as a context shaped by authority. Also, therapeutic misconception was observed. The combination of these factors ensued women to rely on the opinion of the medical professional, rather than being guided by their own motivation to participation. Although being a (pregnant) woman per se should not render the label of being vulnerable, this study shows there are factors that influence the decision process of pregnant woman towards trial participation in a LMIC context that can result in vulnerability. The identification of context‐specific factors that can create vulnerability facilitates adaptation of the design and conduct of research in a culturally competent manner. (shrink)

The aim of this study was to explore and describe how Flemish nurses experience their involvement in the care of hospitalized patients with dementia, particularly in relation to artificial nutrition or hydration (ANH). We interviewed 21 hospital nurses who were carefully selected from nine hospitals in different regions of Flanders. ‘Being touched by the vulnerability of the demented patient’ was the central experience of the nurses, having great impact on them professionally as well as personally. This feeling can be described (...) as encompassing the various stages of the care process: the nurses' initial meeting with the vulnerable patient; the intense decision-making process, during which the nurses experienced several intense emotions influenced by supporting or hindering contextual factors; and the final coping process, a time when nurses came to terms with this challenging experience. From our examination of this care process, it is obvious that nurses' involvement in ANH decision-making processes that concern patients with dementia is a difficult and ethically sensitive experience. On the one hand, the feeling of ‘being touched’ can imply strength, as it demonstrates that nurses are willing to provide good care. On the other hand, the feeling of ‘being touched’ can also imply weakness, as it makes nurses vulnerable to moral distress stemming from contextual influences. Therefore, nurses have to be supported as they carry out this ethically sensitive assignment. Practical implications are given. (shrink)

The aim of this study was to explore and describe how Flemish nurses experience their involvement in the care of hospitalized patients with dementia, particularly in relation to artificial nutrition or hydration (ANH). We interviewed 21 hospital nurses who were carefully selected from nine hospitals in different regions of Flanders. ‘Being touched by the vulnerability of the demented patient’ was the central experience of the nurses, having great impact on them professionally as well as personally. This feeling can be described (...) as encompassing the various stages of the care process: the nurses' initial meeting with the vulnerable patient; the intense decision‐making process, during which the nurses experienced several intense emotions influenced by supporting or hindering contextual factors; and the final coping process, a time when nurses came to terms with this challenging experience. From our examination of this care process, it is obvious that nurses' involvement in ANH decision‐making processes that concern patients with dementia is a difficult and ethically sensitive experience. On the one hand, the feeling of ‘being touched’ can imply strength, as it demonstrates that nurses are willing to provide good care. On the other hand, the feeling of ‘being touched’ can also imply weakness, as it makes nurses vulnerable to moral distress stemming from contextual influences. Therefore, nurses have to be supported as they carry out this ethically sensitive assignment. Practical implications are given. (shrink)

BackgroundIn our globalizing world, caregivers are increasingly being confronted with the challenges of providing intercultural healthcare, trying to find a dignified answer to the vulnerable situation of ethnic minority patients. Until now, international literature lacks insight in the intercultural care process as experienced by the ethnic minority patients themselves. We aim to fill this gap by analysing qualitative literature on the intercultural care encounter in the hospital setting, as experienced by ethnic minority patients.MethodsA systematic search was conducted for papers (...) published between 2000 and 2015. Analysis and synthesis were guided by the critical interpretive synthesis approach.ResultsFifty one articles were included. Four dimensions emerged, describing the intercultural care encounter as a meeting of two different cultural contexts of care, in a dynamic and circular process of balancing between the two cultural contexts, which is influenced by mediators as concepts of being human, communication, family members and the hospital’s organizational culture.ConclusionsThis review provides in-depth insight in the dynamic process of establishing intercultural care relationships in the hospital. We call for a broader perspective towards cultural sensitive care in which patients are cared for in a holistic and dignity-enhancing way. (shrink)

Trust is taken to be one of the foundational values in the doctor-patient relationship, facilitating access to the benefits of health care and providing a guarantee against possible harms. Despite this foundational role, some doctors betray the trust of their patients. Trusting involves granting discretionary powers and makes the truster vulnerable to the trustee. Patients trust medical practitioners to act with goodwill and to act competently. Some patients carry pre-existing vulnerabilities, for reasons such as gender, poverty, age, ethnicity, or (...) disability, and these vulnerabilities can be exacerbated when such patients extend their trust to a doctor. Gender stereotypes reduce women's ability to challenge and thereby assess their doctor's competency. In addition, women are more likely to be distrusted by their doctors and have their experiences of medical symptoms discounted. In this paper, we analyze two extreme examples of breaches of medical trust that exploited the vulnerability of women in the health care system: the "unfortunate experiment" at the National Women's Hospital in New Zealand and the Harold Shipman murders of elderly patients in the United Kingdom, examining the potential role of gender in the outcomes with regard to trust. Major breaches of medical trust such as these typically lead to government inquiries, revisions of ethical guidelines, and substantive policy change in an effort to re-establish public and patient trust. We argue that the medical profession has an ethical obligation to put mechanisms in place to protect vulnerable patients from abuses of trust, to monitor colleagues' competence, and to be prepared to blow the whistle to protect patients who are not in a position to recognize misplaced trust. Such mechanisms will act disprosportionately to reduce harm to women as patients. (shrink)

Background A topic of great concern in bioethics is the medical research conducted in poor countries sponsored by wealthy nations. Western drug companies increasingly view Latin America as a proper place for clinical research trials. The region combines a large population, modern medical facilities, and low per capita incomes. Participants from developing countries may have little or non alternative means of treatment other than that offered through clinical trials. Therefore, the provision of a valid informed consent is important. Methods To (...) gain insight about some aspects of the informed consent procedure in a major cancer centre in Mexico, we conducted a three-step evaluation process: 1) a ten point multiple choice survey questionnaires, was used to explore some aspects of the patients' experiences during the informed consent process, 2) researchers' knowledge about specific aspects of the informed consent was evaluated in this study using survey questionnaires; and 3) the comprehensibility, readability and number of pages of the consent forms were analysed. The socioeconomic and educational level of the patients, were also considered. Results were reported using a numerical scale. Results Thirty five patients, 20 doctors, and 10 individuals working at the hospital agreed to participate in the study. Eighty three percent of the patients in the study were classified as living in poverty; education level was poor or non existent, and 31% of the patients were illiterate. The consent forms were difficult to understand according to 49% of the patients, most doctors agreed that the forms were not comprehensible to the patients. The average length of the IC documents analysed was 14 pages, and the readability average score was equivalent to 8TH Grade. Conclusion The results presented in this work describe some relevant characteristics of the population seen at public health care institutions in Mexico. Poverty, limited or no education, and the complexity of the information provided to the patients may question the validity of the informed consent procedure in this group of patients. (shrink)

This paper examines older people’s access to care experiences in rural China by integrating anthropological investigation with ethical inquiry. Six months of fieldwork in a post-reform primary hospital show how rural residents struggle to access gerontological and nursing care under socially disadvantageous conditions. This anthropological investigation highlights the unmet needs in medical and nursing care for older people, as well as some social, institutional and structural elements that impede access to care. Centring on protecting the vulnerable as informed by (...) feminist ethics scholarship, this paper argues that the failure to meet older people’s dependency needs is unjust, on the premise that it suggests a denial of the inherent value, rights and dignity of older people. This paper appeals for the provision of greater care and support by the state through putting in place social arrangements that better advance older people’s access to care. Some policy recommendations concerning health and social care reform for older people in rural China are also proposed. (shrink)

Background and aim Difficult moral situations assume more critical importance in pediatric wards since children are more vulnerable than adults. Given that professional ethics is a substantial part of children treatment, the present study was conducted to determine the ethical performance of nurses from the perspective of mothers and nurses in the pediatric wards of Be'esat Hospital in Hamadan. Materials and methods The present descriptive-analytical study was conducted on 58 nurses and 263 mothers of children referred to the pediatric (...) wards of Be'esat Hospital in Hamadan in 2019. The study samples were randomly selected. Data collection tools included the demographic form and Ethical Performance Assessment Questionnaire developed by Beykmirza et al. The obtained data were analyzed in SPSS software version 23using descriptive and inferential statistics. Results As evidenced by the obtained results, the mean ethical performance of nurses from the perspective of nurses and mothers were reported as 86.72 ± 6.397 and 69.92 ± 18.09. From the mothers' viewpoint, 27%, 39.2%, and 33.8% of nurses had weak, moderate and good levels of performance, respectively. On the other hand, from the nurses' perspective, 24.6% and 75.4% of nurses had moderate and good levels of performance, respectively. The obtained results were indicative of a statistically significant difference between the performance score as reported by mothers and nurses. Conclusion Considering that the majority of mothers rated the ethical performance of nurses as weak and moderate, it is suggested that professional ethical principles be implemented in the form of Retraining programs in an attempt to improve the ethical performance of nurses. (shrink)

Background and AimsRecent studies suggest cognitive, emotional, and behavioral impairments occur in patients after SARS-CoV-2 infection. However, studies are limited to case reports or case series and, to our knowledge, few of them have control groups. This study aims to assess the prevalence of neuropsychological and neuropsychiatric impairment in patients after hospitalization.MethodsWe enrolled 29 COVID+ patients who needed hospitalization but no IC, about 20 days post-dismission, and 29 COVID− healthy matched controls. Neuropsychological and neuropsychiatric assessments were conducted via teleneuropsychology using (...) the following tests: MMSE, CPM47, RAVLT, CDT, Digit-Span Forward/Backward, Verbal fluencies; BDI-II, STAI. People with previous reported cognitive impairment and neurological or psychiatric conditions were excluded. Clinical and demographics were collected. Comparison between groups was conducted using parametric or non-parametric tests according to data distribution. Within COVID+ group, we also evaluated the correlation between the cognitive and behavioral assessment scores and clinical variables collected.ResultsAmong COVID+, 62% had at least one pathological test and significantly worst performances than COVID− in RAVLT learning, RAVLT recall, and recognition. STAI II was higher in COVID−. Chi-square on dichotomous values showed a significant difference between groups in Digit backward test.ConclusionsPatients COVID+ assessed by teleneuropsychology showed a vulnerability in some memory and executive functions. Intriguingly, anxiety was higher in the control group. Our findings therefore confirm the impact of COVID-19 on cognition even in patients who did not need IC. Follow-up is needed to evaluate the evolution of COVID-19-related cognitive deficit.Clinical Trial Registration[ClinicalTrials.gov], identifier [NCT05143320]. (shrink)

This article addresses the conditions that are necessary for non-Indigenous people to learn from Indigenous people, more specifically from women and feminists. As non-Indigenous scholars, we first explore the challenges of epistemic dialogue through the example of Traditional Ecological Knowledge. From there, through the concept of mastery, we examine the social and ontological conditions under which settler subjectivities develop. As demonstrated by Julietta Singh and Val Plumwood, the logic of mastery—which has legitimated the oppression and exploitation of Indigenous peoples—has been (...) reproduced in academia, leaving almost no room for Indigenous knowledge and epistemes. In the same vein, Sámi scholar Rauna Kuokkanen reclaims and suggests the logic of the gift as a means to render academia more hospitable to Indigenous peoples and epistemes. In our view, reclaim as a concept-practice is a promising way to disrupt colonial, racist, and sexist power relations. Thus, we in turn propose to reclaim vulnerability as defined by Judith Butler in order to deconstruct masterful settler subjectivities and reconstruct relational ones instead. As theorized by Erinn Gilson, we propose epistemic vulnerability to imagine the conditions of our learning from Indigenous peoples and philosophies. (shrink)

This article examines CURE Children’s Hospital of Uganda (CURE), a faith-based pediatric neurosurgery hospital in Sub-Saharan Africa, as a unique nexus of Western biomedical and holistic-spiritual healthcare in their philosophy, staff motivation, and delivery. Offering the concept of a healing narrative, the essential core of their practice is captured, I suggest, in the articulation and practice of a healing narrative of human flourishing, and we might productively think of the ethics of their clinical approach as premised on being with the (...) patient, understood as mutual vulnerability and attending to suffering, and being for the patient, understood as advocating joy within and beyond the clinic. Extrapolating from this case study, the ideas being with and being for might be added to our clinical ethical practices and lexicon as we think through alternatives to a fragmented, compartmentalized biomedical care. (shrink)

People who have mental illness are in particular need of what a home can provide, but they are especially vulnerable to not being in a place with a home-like environment, whether due to homelessness, incarceration, or hospitalization. At any given time, approximately 170,000 people are inpatients in psychiatric units or hospitals (NASMHPD 2017). Psychiatric hospitals are not homes, and they are not designed for long-term stay. The main purpose of the modern psychiatric hospital is to stabilize people in mental (...) health crises, such as those who are psychotic or suicidal; hospitals are best thought of as temporary, transitional dwellings. Even though a person may only reside there for a week or a month, however, it is a crucial period of stabilization and healing. As this paper argues, practices of home-making increase epistemic and moral agency, which enables crisis stabilization, healing, and recovery. This paper examines several functions of home and shows some of the ways that patients in psychiatric hospitals try to replicate these functions in the physical space they have given their many constraints. Because practices of home-making support the goals of hospitalization, the hospital experience should be designed to encourage these practices as much as possible. (shrink)

Losing the sense of oneself is no trivial matter regardless of the reasons. But when these reasons have to do with the doubly-marginalizing circumstances of serious physical illness and subsequent hospitalization, the loss can be devastating in ways that extend beyond the patient’s release. Because the hierarchical practices and juridical moral theories that govern physician-patient hospital relationships in the United States largely disregard such losses by paying insufficient attention to power differentials and to the unique dilemmas presented by individual cases, (...) patient care calls for better, nonideal approaches to the well-being of this vulnerable population. Specifically, the medical and administrative norms that pervade patient care both harm and alienate those subject to their power by damaging whatever sense of personal identity that an otherwise seriously ill patient might still have. By stripping away not only patient self-trust and voice, but also any semblance of agency itself, the current normative models of hospital care mark those already burdened by illness as mere bodies—not as morally equal participants in the pursuit of healing. Moving toward any semblance of change requires a fundamental re-assessment of the relationship between the patient and the institutional arrangements and priorities. For such a reevaluation to take place, nothing less than an institutional shift toward nonideal, narratively-grounded approaches to the overall well-being of the patient is required. Only then might the status of the patient as a person begin to matter as an essential part of meaningful practices of hospital care. (shrink)

Background: A better understanding of the pattern of epidemic-related referrals to healthcare centers might allow the identification of vulnerabilities and the required changes that the healthcare management system should undergo. Objectives: This study aimed to investigate the COVID-19 referral pattern and the role of media and health management planning in changing the trends. Methods: Data extracted from the electronic medical database of Imam Khomeini Hospital Complex (IKHC), located in Tehran, Iran, from February 20 to June 4, 2020 were examined. Individuals (...) were divided into two groups, COVID-19 positive and negative. We used Google Trends to evaluate Google Internet search queries and also available policy documents, programs, and official news related to COVID-19 in Iran during the mentioned period. Results: In this study, 8647 individuals aged 46.05 ± 16.5 years were referred to IKHC. Approximately 57% were male, and 70% were COVID-19 positive. The most clinical symptoms were dyspnea, fever, cough, and myalgia. Chronic kidney disease (CKD) and type 2 diabetes mellitus were the most common underlying health conditions. In the first two weeks, the percentage of negative cases was higher than positive cases and then the pattern was reversed, when people searched for information about COVID-19 in media. Conclusions: Proper and timely information and education to people through the media and health management measures can be effective in reducing unnecessary visits to health centers, preventing the exhaustion of medical staff, and controlling the disease during epidemics. (shrink)

This paper explores the notion of hospitality and faith in Derrida and Kierkegaard. The aim is to trace the topological core of existence in relation to an ongoing debate in contemporary continental philosophy of religion about khôra. The paper shows how khôral traces are at work in Kierkegaard’s thinking in relation to the topological proximity of love. The claim is, that Kierkegaard emphasizes, not a hostility but a vulnerability of what I coin khôral love – the vibrating space between (...) the anonymous and the amorous, call and response. The unknown X of the khôral becomes the topos of existence – the “stepping out”, the “you are here (X)”. A “you” called forth by the commandment of love or the visitation of the stranger. (shrink)

BackgroundPsychological support was provided by the Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol within the hospitals in the Northern Italy in favor of healthcare workers during the COVID-19 pandemic. This study aimed at evaluating the effectiveness of treatment in terms of symptomatology reduction related to peri- and post-traumatic stress; clinical improvement over time; and the maintenance of the achieved outcome over time.MethodsThe population was composed of healthcare workers who spontaneously requested psychological intervention in both the first and the (...) second emergency waves. Statistical analyses were carried out to highlight the differences in Impact of Event-Revised and Post-Traumatic Growth Inventory before and after the group intervention.ResultsIn both the first and the second waves, pre-treatment values are higher than post-treatment values for all dimensions of the IES-R. The results show that there are no significant differences between the first and the second wave with regard to the treatment effect. Healthcare workers maintained positive changes over time despite their prolonged exposure to an emergency and the possibility of retraumatization at the onset of a new emergency phase, irrespective of their working place. Healthcare workers who were treated in the first wave showed at the beginning of the second emergency wave less vulnerability and more resilience than those who were treated only in the second wave.Pre-treatment scores of healthcare workers affected by COVID-19 are discussed.ConclusionCOVID-19 had a significant impact on the well-being of healthcare workers who were working in hospitals. Psychological support in case of emergency is needed. (shrink)

Background:Scholarly work is needed to develop the conceptual and theoretical understanding of trust to nursing practice. The transition from hospital care to complex pediatric homecare involves nurses in myriad roles, including management and care provision. Complex pediatric homecare transforms children, families, professionals, and communities, but its exact implications are unclear.Research objectives:To conduct an ethical inquiry into the role and responsibilities of nurses in the qualitative experience of adults involved in the hospital-to-home transition of young, ventilator-dependent children.Research design:We followed methods described (...) by Franco Carnevale. We used a sociologically grounded theoretical orientation—trust—to re-interpret qualitative data for an ethical inquiry into a specific facet of that data.Participants and study context:The participants included 26 adults, including 14 nurses, involved in the hospital-to-home transition in a Canadian province. Participants represented family, hospital, home, and government.Ethical considerations:The Conjoint Health Research Ethics Board at the University of Calgary approved this study.Findings:First, the concept and practice of trust was salient to the experience of transition. For example, responsibilities’ allocation between hospital-based professionals to mothers, home-based nurses, and non-professionals necessitated reliance and vulnerability. Second, the consequences of distrust connected to recognized challenges. For example, tensions along rural–urban, medical-family, and professional–personal divide each revealed suspicion and uncertainty that led to isolation and anxiety for all involved. Third, recommendations to improve the experience and mitigate the challenges of transition can be grounded in trust promotion. For example, transition-specific education programs and codes of ethics would promote openness, recognize mutual vulnerability, and advance trust in transition.Conclusions:The challenges to transition evidenced distrust, while trust represents a powerful tool to counter these challenges and their implications. A climate of trust could bridge divides between mothers and professionals; rural and urban professionals; and professionals with differing relationships with the family. (shrink)

Publication date: 15 October 2018 Source: Author: Ehiosun O. Marvel NHIS was launched officially on 6th of June 2005. The Scheme is designed to provide comprehensive health care at affordable costs, covering employees of the formal sector, self-employed, as well as rural communities, the poor and the vulnerable groups. However, client satisfaction of services rendered continues to be a major concern for the improvement of NHIS. This study is designed to determine the level and causes of dissatisfaction of clients (...) accessing NHIS clinic at the Kubwa General Hospital, Kubwa, FCT, Abuja. This study employed a descriptive cross sectional survey. 279 NHIS enrollees were recruited for this study at the Kubwa General Hospital. Questionnaires were administered and the level of dissatisfaction and satisfaction of NHIS services were analyzed. The satisfaction rate was 69.2% while the dissatisfaction rate was 22.9%. The respondents were satisfied with the attitude of health workers in NHIS clinic, Kubwa. However, they were dissatisfied with waiting time, attitude of record officers and those in pharmacy department. This study found that the level of dissatisfaction with NHIS services is high despite a high satisfaction level. The Attitude of health workers may influence the dissatisfaction of enrollees. NHIS is still limited to the formal sector. (shrink)

Discharge planning for vulnerable infants and children is a collaborative, inter-disciplinary, decision-making activity that is grounded in the ethical complexities of clinical practice. Although it is a psychosocial intervention that frequently causes moral distress for professionals and has the potential to inflict harm on children and their families, the process has received little attention from ethicists. An ongoing study of the transition of technology-dependent children from hospital to home suggests that the ethical issues embedded in the discharge-planning process may (...) be concealed by dominant cultural values, institutional policies, clinical standards, historical precedents, and legal regulations. (shrink)

A balance needs to be struck between facilitating compassionate access to innovative treatments for those in desperate need, and the duty to protect such vulnerable individuals from the harms of untested/unlicensed treatments. We introduced a principle-based framework to evaluate such requests and describe its application in the context of recently evolved UK, US and European regulatory processes. 24 referrals were received by our quaternary children's hospital Clinical Ethics Committee over the 5-year period. The CEC-rapid response group evaluated individual cases (...) within 48-hours; the main referrers being haematology/oncology, immunology or transplant services. Most requests were for drug/vaccine/pre-trial access or biological/cellular therapies. The majority of individual requests were approved ; neutral or negative opinions were given in 5, including 3 group requests. Recently evolved regulatory processes share common criteria and conditions to our framework including: demonstration of clinical need; sound scientific basis with lack of viable alternative; risks-benefit/best interests evaluation; arrangements for fully informed consent; no compromise of arrangements to test treatment for licensing purposes; consideration of resource implications. There are differences between individual processes and with our framework, with respect to procedures, scope, application format, costs and obligation to make available all outcome data. Our experience has emphasized the need for an independent, principled, consistent, fair and transparent response to the increasing demand for innovative treatment on a compassionate basis. We believe that there is a need for harmonization of the recent proliferation of regulation and legislation in this area. (shrink)

Having a decreased sense of security leads to unnecessary suffering and distress for patients. Establishing trust is critical for nurses to promote a patient's sense of security, consistent with trauma‐informed care. Research regarding nursing action, trust, and sense of security is wide‐ranging but fragmented. We used theory synthesis to organize the disparate existing knowledge into a testable middle‐range theory encompassing these concepts in hospitals. The resulting model illustrates how individuals are admitted to the hospital with some predisposition to trust or (...) mistrust the healthcare system and/or personnel. Patients encounter circumstances increasing their emotional and/or physical vulnerability to harm, leading to experiences of fear and anxiety. Without intervention, fear and anxiety lead to a decreased sense of security, increased distress, and suffering. Nurse action can ameliorate these effects by increasing a hospitalized person's sense of security or by promoting the development of interpersonal trust, also leading to an increased sense of security. Increased sense of security results in diminished anxiety and fear, and increased hopefulness, confidence, calm, sense of value, and sense of control. The consequences of a decreased sense of security are harmful to patients and nurses should know that they can intervene in ways that both increase interpersonal trust and sense of security. (shrink)

Restrictive visitation policies produce inequities in healthcare that have meaningful consequences for patients’ health and well-being. There is a surplus of existing literature exploring the consequences of reduced visitation in the setting of pediatric patients lacking decision-making capacity, but relatively little scholarship addressing visitation restriction for less vulnerable adults possessing capacity. Here, we present the case of a patient who suffered serious complications of childbirth, during the delivery of her healthy newborn, leading to prolonged hospitalization. During her treatment course, (...) she was subsequently denied visitation with her newborn, who had been discharged from the hospital, and this had detrimental effects on her recovery. Hospital policies restricting visitation during the COVID-19 pandemic were intended to reduce the risk of disease exposure for both patients and staff, despite conflicting evidence demonstrating this benefit. In contrast, they often have negative effects on patient stress, mood, and physical recovery. The sequelae of this US-based case study argue the need for more holistic hospital visitation policies, placing a specific lens on adult patients receiving a visitation from their newborn children. (shrink)

Pediatric dentists rely on access to hospital operating rooms for safe, effective, and humane delivery of dental care. The children who benefit most from dental treatment in a hospital operating room are those who are very young, have dental anxieties or phobias, are precommunicative or noncommunicative, need extensive or invasive dental treatments, or have special healthcare needs. Diminishing access to hospital operating rooms for pediatric dental treatment has become an escalating problem in contemporary times. Financial barriers, hospital costs, reimbursement rates, (...) health insurance policies and deductibles, out-of-network hospitals, socioeconomic factors, and the COVID-19 pandemic are prominent contributing factors. This problem in access to care has resulted in long waiting times for hospital operating rooms, deferral of medically necessary dental care, and pain and infection among this vulnerable patient population. Pediatric dentists have responded to the problem by utilizing alternative methods of care delivery, such as in-office deep sedation or in-office general anesthesia, and by implementing aggressive medical management of dental caries. However, the youngest of pediatric patients and children with special healthcare needs still remain at a disadvantage in receiving definitive dental treatment. This article aims to highlight the ethical challenges faced by pediatric dentists in contemporary practice in the face of limitations in hospital operating room access through four case scenarios. (shrink)