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Sotomayor CR, Spevak C, Grant ER. Professionalization of Clinical Ethics Consultants: A Need for Liability Protection? HEC Forum 2024:10.1007/s10730-024-09527-4. [PMID: 38652193 DOI: 10.1007/s10730-024-09527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/25/2024]
Abstract
Clinical Ethics Consultation (CEC) has grown significantly in the last decade, and efforts are being made to professionalize the practice. The American Society for Bioethics and Humanities (ASBH) has been instrumental in this process, having published the Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants and founded and endorsed the creation of the Healthcare Ethics Consultant Certified (HCEC) Certification Commission. The ASBH also published "core competencies" for healthcare ethics consultants and has delineated a clear identity and role of such consultants distinct from that other healthcare professionals. In addition, more enter the field armed with advanced degrees (MA and PhD) or certification in clinical ethics consultation. While some have questioned the trend toward professionalization, the momentum is clearly in its favor. This paper explores three questions: Does the professionalization of healthcare ethics consultation expose those engaged in the field to the types of liability claims faced by professionals in other fields? What specific liabilities could affect a healthcare ethics consultant? And finally, what should healthcare ethics consultants do to protect themselves against liability claims? We conclude that while the risk of liability remains low, those engaged in the field should accept that risk just as part of their status as professionals and, like those in allied professions, seek appropriate protection in the form of liability insurance.
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Affiliation(s)
- Claudia R Sotomayor
- Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, 37Th & O Streets, NW, Healy 421, Washington, DC, 20057, USA.
| | - Christopher Spevak
- Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, 37Th & O Streets, NW, Healy 421, Washington, DC, 20057, USA
| | - Edward R Grant
- Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, 37Th & O Streets, NW, Healy 421, Washington, DC, 20057, USA
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van Schaik M, Pasman HRR, Widdershoven GA, De Snoo-Trimp J, Metselaar S. Effectiveness of CURA: Healthcare professionals' moral resilience and moral competences. Nurs Ethics 2023:9697330231218344. [PMID: 38031920 DOI: 10.1177/09697330231218344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences.Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences.Design: Single group pre-/post-test design with two questionnaires.Methods: Questionnaires used were the Rushton Moral Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18 months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist.Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents.Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales.Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice.
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Affiliation(s)
- Malene van Schaik
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H Roeline Rw Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Guy Am Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Janine De Snoo-Trimp
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Metselaar
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Affirming the Existence and Legitimacy of Secular Bioethical Consensus, and Rejecting Engelhardt's Alternative: A Reply to Nick Colgrove and Kelly Kate Evans. HEC Forum 2023; 35:95-109. [PMID: 34156607 DOI: 10.1007/s10730-021-09452-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
One of the most significant and persistent debates in secular clinical ethics is the question of ethics expertise, which asks whether ethicists can make justified moral recommendations in active patient cases. A critical point of contention in the ethics expertise debate is whether there is, in fact, a bioethical consensus upon which secular ethicists can ground their recommendations and whether there is, in principle, a way of justifying such a consensus in a morally pluralistic context. In a series of recent articles in this journal, Janet Malek defends a positive view of ethics expertise, claiming that secular ethicists should comport their recommendations with bioethical consensus. In response, Nick Colgrove and Kelly Kate Evans deny the existence of a secular bioethical consensus; question why, even if it did exist, consensus should be considered a reliable way of resolving bioethical questions; and recommend a friendlier approach to clinical ethics based on the thought of H. Tristram Engelhardt Jr. In this article, I respond to Colgrove and Evans on all three points. In part one, I show there is a secular bioethical consensus but note it could be better consolidated and created through a more systematic and inclusive process. In part two, I argue that bioethical consensus is morally justified but note that this justification cannot be plausibly based upon claims that it only invokes moral principles available to or shared by all. In part three, I argue Engelhardt's approach cannot be described as "friendlier" to clinical ethics because it is incompatible with many current healthcare laws and policies.
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Thornton A. Credentialing Character: A Virtue Ethics Approach to Professionalizing Healthcare Ethics Consultation Services. HEC Forum 2023:10.1007/s10730-023-09505-2. [PMID: 36790544 DOI: 10.1007/s10730-023-09505-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/30/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
In the process of professionalization, the American Society for Bioethics and Humanities (ASBH) has emphasized process and knowledge as core competencies for clinical ethics consultants; however, the credentialing program launched in 2018 fails to address both pillars. The inadequacy of this program recalls earlier critiques of the professionalization effort made by Giles R. Scofield and H. Tristram Engelhardt, Jr.. Both argue that ethics consultation is not a profession and the effort to professionalize is motivated by self-interest. One argument they offer against professionalization is that ethics consultants lack normative expertise. Although the question of expertise cannot be resolved completely, the accusation of self-interest can be addressed. Underlying these critiques is a concern for hubris, which can be addressed in certification and the vetting of candidates.Drawing on the virtue ethics literature of Alasdair MacIntyre and Edmund D. Pellegrino, I argue that medicine is a moral community in which ethics consultants are moral agents with a duty to foster the virtue of humility (or what Pellegrino and Thomasma call self-effacement). The implications of this argument include a requirement for self-reflection in one's role as a moral agent and reflection on one's progress toward developing or deepening virtuous engagement with the moral community of medicine. I recommend that professionalization of clinical ethics consultants include a self-reflective narrative component in the initial certification and ongoing renewal of certification where clinical ethics consultants address the emotional dimensions of their work as well as their own moral development. Adopting a teleological view of ethics consultation and incorporating narratives that work toward that purpose will mitigate the self-interest and hubris of the professionalization project.
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Brummett AL, Watson JC. An Argument for Standardized Ethical Directives for Secular Healthcare Services. THE JOURNAL OF CLINICAL ETHICS 2022. [DOI: 10.1086/jce2022333175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Fiester A. Developing Skills in the HEC Communication Competency: Diagnostic Listening and the ADEPT Technique. THE JOURNAL OF CLINICAL ETHICS 2022. [DOI: 10.1086/jce2022331042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Brummett A. Defending secular clinical ethics expertise from an Engelhardt-inspired sense of theoretical crisis. THEORETICAL MEDICINE AND BIOETHICS 2022; 43:47-66. [PMID: 35366754 DOI: 10.1007/s11017-022-09566-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
The national standards for clinical ethics consultation set forth by the American Society for Bioethics and Humanities (ASBH) endorse an "ethics facilitation" approach, which characterizes the role of the ethicist as one skilled at facilitating consensus within the range of ethically acceptable options. To determine the range of ethically acceptable options, ASBH recommends the standard model of decision-making (informed consent, advance directives, surrogates, best interests), which is grounded in the values of autonomy, beneficence, nonmaleficence, and justice. H. Tristram Engelhardt Jr. has sharply criticized the standard model for presuming contentful moral claims in circumscribing the range of ethically acceptable options, which, he argues, cannot be rationally justified in a pluralistic context. Engelhardt's solution is a secular clinical ethics based on a contentless principle of permission. The first part of this article lays out Engelhardt's negative claim, that reason cannot establish contentful moral claims, and his positive claim, that secular clinical ethics ought to be based on a contentless principle of permission. The second part critiques these negative and positive claims. The purpose of this paper is to defend secular clinical ethics expertise-defined as the ability of ethicists to offer justified moral recommendations grounded in consensus positions endorsed by the American Society for Bioethics and Humanities-from the radical critiques of Engelhardt, who argues that no moral or metaphysical claims, and hence no bioethical consensus, can be rationally justified. Engelhardt's critiques have caused some to worry that secular clinical ethics is in a state of theoretical crisis; this article concludes that Engelhardt's view is an unstable basis for that worry.
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Affiliation(s)
- Abram Brummett
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
- Royal Oak Beaumont Hospital, Royal Oak, MI, USA.
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Brummett AL. Secular Clinical Ethicists Should Not Be Neutral Toward All Religious Beliefs: An Argument for a Moral-Metaphysical Proceduralism. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:5-16. [PMID: 33372859 DOI: 10.1080/15265161.2020.1863512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Secular clinical ethics has responded to the problem of moral pluralism with a procedural approach. However, defining this term stirs debate: H. Tristram Engelhardt Jr. has championed a contentless proceduralism (P1), while others, conversely, argue for a proceduralism that permits some content in the form of moral claims (P2). This paper argues that the content P2 permits ought to be expanded to include some metaphysical commitments, in an approach referred to as P2+. The need for P2+ is demonstrated by analyzing and rejecting three standards (the best interest or harm principle, internal reasonability, and the child's right to an open future) used by P2 to justify overriding religiously motivated refusals of treatment for children. These approaches fail because each maintains a neutral stance regarding the truth of religious belief. This paper drives at the broader thesis that the proceduralism of secular clinical ethics requires some moral and metaphysical commitments.
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Schmitz D, Groß D, Pauli R. Is there a need for a clear advice? A retrospective comparative analysis of ethics consultations with and without recommendations in a maximum-care university hospital. BMC Med Ethics 2021; 22:20. [PMID: 33653322 PMCID: PMC7927398 DOI: 10.1186/s12910-021-00590-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background The theory and practice of ethics consultations (ECs) in health care are still characterized by many controversies, including, for example, the practice of giving recommendations. These controversies are complicated by an astonishing lack of evidence in the whole field. It is not clear how often a recommendation is issued in ethics consultations and when and why this step is taken. Especially in a facilitation model in which giving recommendations is optional, more data would be helpful to evaluate daily practice, ensure that this practice is in line with the overarching goals of this approach and support the development of standards. Methods We analyzed all consultations requested from an EC service working under a facilitation approach at a maximum-care university hospital in Germany over a period of more than 10 years. Our aim was to better understand why—and under what circumstances—some consultation requests result in a recommendation, whereas others can be sufficiently addressed solely by facilitated meetings. We especially wanted to know when and why clients felt the need for clear advice from the EC service while in other cases they did not. We compared ethics consultations in terms of the differences between cases with and without recommendations issued by the ethics consultants using χ2 difference tests and Welch’s t-test. Results A total of 243 ECs were carried out between September 2008 and December 2019. In approximately half of the cases, a recommendation was given. All recommendations were issued upon the request of clients. When physicians asked for an EC, the consultation was significantly more likely to result in a recommendation than when the EC was requested by any other party. ECs in cases on wards with ethics rounds resulted in comparably fewer recommendations than those in wards without ethics rounds. When interpersonal conflicts were part of the problem or relatives were present in the meeting, clients less frequently asked for a recommendation. Conclusion From the client’s point of view, there does not seem to be only one “right” way to provide ethics consultations, but rather several. While facilitated meetings are obviously appreciated by clients, there also seem to be situations in which a recommendation is desired (especially by physicians). Further empirical and theoretical research is needed to validate our single-center results and re-evaluate the role of recommendations in ethics consultations. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00590-x.
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Affiliation(s)
- Dagmar Schmitz
- Institute for History, Theory and Ethics in Medicine, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany.
| | - Dominik Groß
- Institute for History, Theory and Ethics in Medicine, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Roman Pauli
- Institute for History, Theory and Ethics in Medicine, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
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Koch P. How Should Ethics Consultants Weigh the Law (and other Authoritative Directives)? THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:768-777. [PMID: 33404326 DOI: 10.1177/1073110520979388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In the continuing debate about the role of the Clinical Ethics Consultant in performing clinical ethics consultations, it is often assumed that consultants should operate within ethical and legal standards. Recent scholarship has focused primarily on clarifying the consultant's role with respect to the ethical standards that serve as parameters of consulting. In the following, however, I wish to address the question of how the ethics consultant should weigh legal standards and, more broadly, how consultants might weigh authoritative directives, whether legal, institutional, or professional, against other normative considerations. I argue that consultants should reject the view that authoritative directives carry exclusionary reason for actions and, further, ethicists should interpret directives as lacking any moral weight qua authoritative directive. I then identify both implications and limitations of this view with respect to the evolving role of the ethics consultant in an institutional setting, and in doing so propose the kinds of considerations the ethicist should weigh when presented with an authoritative directive.
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Affiliation(s)
- Peter Koch
- Peter Koch, Ph.D., is an assistant professor of philosophy at Villanova University. His research interests include clinical and biomedical ethics, philosophy of law, and philosophy of medicine. Along with experience as a clinical ethics consultant, Peter has published on a range of topics, including patient welfare, the metaphysics of brain death, medical professionalism, and harm in medicine
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Salloch S. Clinical Ethics as a Profession? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:87-89. [PMID: 31661420 DOI: 10.1080/15265161.2019.1665747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Adams DM. Justifying Ethical Expertise. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:67-68. [PMID: 31661421 DOI: 10.1080/15265161.2019.1665746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Nelson RH, Malek J. Clinical Ethics Expertise: Beyond Justified Normative Recommendations? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:82-84. [PMID: 31661422 DOI: 10.1080/15265161.2019.1665744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Crutchfield P. Moral Normative Force and Clinical Ethics Expertise. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:89-91. [PMID: 31661411 DOI: 10.1080/15265161.2019.1665733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Farroni JS. Ethicist as Healer: Is Offering Justified Normative Recommendations All We Are Doing in Active Patient Cases? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:85-87. [PMID: 31647763 DOI: 10.1080/15265161.2019.1665741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Inguaggiato G, Metselaar S, Widdershoven G, Molewijk B. Clinical Ethics Expertise as the Ability to Co-Create Normative Recommendations by Guiding a Dialogical Process of Moral Learning. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:71-73. [PMID: 31661408 DOI: 10.1080/15265161.2019.1665735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Watson J. Ethics Expertise Demystified: Using the Brummett/Salter Taxonomy. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:80-82. [PMID: 31661417 DOI: 10.1080/15265161.2019.1665750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Churchill LR. How Is Ethics Consultation Work Justified? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:63-64. [PMID: 31661409 DOI: 10.1080/15265161.2019.1665732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Feldman SL, DeMarco JP, Stewart DO, Ford PJ. A Taxonomy and an Ethicist's Toolbox: Mapping a Plurality of Normative Approaches. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:78-80. [PMID: 31661404 DOI: 10.1080/15265161.2019.1665739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Meyers C. Realism, Correspondence, and Expertise 1. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:76-77. [PMID: 31661416 DOI: 10.1080/15265161.2019.1665731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Fiester A. Taxonomizing the Clinical Ethics Critics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:62-63. [PMID: 31661413 DOI: 10.1080/15265161.2019.1665730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Wasson K. Engaging With a New Taxonomy for Clinical Ethics Consultation: What Are the Implications? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:69-70. [PMID: 31661414 DOI: 10.1080/15265161.2019.1665752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Rasmussen LM. The Hard Question of Justification in Health Care Ethics Consultation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:65-66. [PMID: 31661406 DOI: 10.1080/15265161.2019.1665737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Fox E, Tarzian A. Unanswered Questions About Clinical Ethics Expertise. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:91-94. [PMID: 31661412 DOI: 10.1080/15265161.2019.1669733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Ellen Fox
- Fox Ethics Consulting and Center for Ethics in Health Care, Altarum
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