How careproviders can acquire and apply greater wisdom

In this issue of JCE, Baum-Baicker and Sisti present senior psychoanalysts' views of wisdom. Although views on wisdom differ widely, there is agreement that when ethical conflicts arise, wisdom may be critical in bringing about an optimal result. Here I will present recent empirical findings on wisdom and the ways careproviders may acquire and apply it, especially in ethical conflicts.The findings are not well-known and may seem counterintuitive; I selected them, in large part, for those reasons. A core challenge may be to decide when to give patients standard care and when to make exceptions. In this issue of JCE, Baum-Baicker and Sisti discuss exceptions and Bursztajn and colleagues consider how these exceptions may be further validated as evidence-based treatments.

A different approach to patients and loved ones who request "futile" treatments

The author describes an alternative approach that care-providers may want to consider when caring for patients who request interventions that careproviders see as futile. This approach is based, in part, on findings of recent neuroimaging research. The author also provides several examples of seemingly justifiable "paternalistic omissions," taken from articles in this issue of The Journal of Clinical Ethics (JCE). The author suggests that while careproviders should always give patients and their loved ones all potentially relevant information regarding "futile" decisions, care-providers may wish to consider, paradoxically, not giving advice in these situations, when the advice is based mostly or wholly on their own moral views, based on this same, ethical rationale.

An ethical priority greater than life itself

This article discusses a case in this issue of The Journal of Clinical Ethics by McCrary and colleagues, "Elective Delivery Before 39 Weeks' Gestation Reconciling Maternal, Fetal, and Family Circumstances," in which parents asked the medical team to deliver their fetus "early." The author discusses (1) the importance that parents have to a child when they are able to love the child, and how important it is for decision makers to consider this; (2) exceptional approaches that may enable parents to "change their minds"; and (3) substantive and procedural innovations that may help to prevent clinicians' views from playing too big a role and/or being arbitrary. The author concludes by describing how he felt when reading the case and uses this to illustrate how clinicians may benefit by assessing their feelings.

How should careproviders respond to patients' requests that may be refused?

Some requests made to careproviders by patients may be of great personal importance to patients. Careproviders may assign proportionally greater weight to these exceptional requests, and may choose to take exceptional measures to assist. A strong trust relationship may be formed with patients as a result.

How can careproviders most help patients during a disaster?

This article reviews careproviders' most difficult emotional challenges during disasters and provides approaches for responding optimally to them. It describes key approaches that careproviders may pursue to best help patients and others during a catastrophe. It raises unanswered questions regarding when, if ever, careproviders should provide active euthanasia to patients who are incompetent, and when, if ever, careproviders should give their own food and water to patients or others who may otherwise soon die without them.

Helping patients by involving their families

Patients and their family members may become highly interdependent as patients near the end of life. To best help these patients, healthcare providers can try to become a member of the patient/family team. By becoming a member, careproviders can improve patients' and family members' access to medical information, more effectively offer advice, and assure patients and family members that they can still choose to do what they think is best.

Ethical challenges when patients have dementia

Dementia is among the most terrible diseases humans can have. Of all of the things that careproviders could do to enhance the quality of life that persons with dementia have, which ones should they do?

How mediation (and other) approaches may improve ethics consultants' outcomes

Articles in this issue of JCE recommend a number of approaches to clinical ethics consultation. Given these various approaches, how should ethics consultants proceed?

Sliding "off" the sliding scale: allowing hope, determining capacity, and providing meaning when an illness is becoming worse but a treatment may help

In this issue of The Journal of Clinical Ethics, Emily Bell and Eric Racine are guest editors of a special section focusing on the use of deep brain stimulation (DBS) to treat Parkinson's disease. In "Deep Brain Stimulation, Ethics, and Society," Bell and Racine report that DBS already has been used to treat more than 50,000 patients. The ethical issues raised in this special section are important not only in regard to Parkinson's disease and DBS, but in many areas of medicine. The articles discuss sound, state-of-the-art ethical approaches. This introduction to the issue presents approaches that are adjunctive and intended to increase careproviders' options, that should increase careproviders' ability to individualize the care that they provide to their patients.

"Third generation" ethics: what careproviders should do before they do ethics

The author suggests that a "first generation" task in bioethics is to give patients the information they need; a "second generation" task is to do this in the most effective way; and a "third generation" task is to avoid harming patients by imposing value biases. The author discusses ways to pursue this third generation task.

All careproviders need more opportunities to share their ethical concerns with others

Attention to the ethical concerns of healthcare aides can provide important information about patients' needs to careproviders, improve the ethical environment of an institution, and benefit aides who suffer from bearing ethical concerns alone. All persons benefit from sharing their ethical concerns with others. Among other benefits, ethics consultation offers careproviders, caregivers, healthcare aides, patients, and patients' loved ones an opportunity to have their concerns heard. John Fletcher tried to follow every ethics consultation with a debriefing for all participants, including patients and family members, to increase the possibility for continued healing after the conclusion of the consultation, and there are good reasons to follow this practice.

A possible application of care-based ethics to people with disabilities during a pandemic

Should people with exceptionally profound disabilities be given an equal chance of surviving a pandemic, even when their care might require a greater use of limited medical resources? How might an ethics of care be used to shape a policy regarding these patients?