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3How We May Become Detached from Our Patients and What We Can Do If This HappensJournal of Clinical Ethics 29 (3): 167-178. 2018.When clinicians provide clinical care or participate in ethics consultations, they may feel exceptionally painful emotions. When they do, they may distance themselves emotionally from patients and families. This distancing may harm these parties profoundly. It is therefore critical that clinicians avoid this distancing. In this piece, I present an approach that lies outside traditional practice that clinicians may use to try to avoid and even reverse this distancing, if and when they sense that …Read more
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5How to Retain the Trust of Patients and Families Even When We Will Not Provide the Treatment They WantJournal of Clinical Ethics 26 (2): 89-99. 2015.How might clinicians best try to retain the trust of patients and family members after clinicians oppose giving a treatment? If clinicians can maintain the trust of patients and families in these situations, this may soften what may be the greatest possible loss—the death of a loved one.I discuss what clinicians seeking to retain trust should not do—namely impose their values and reason wrongly—and introduce strategies that clinicians may use to reduce both. I present five principles that clinic…Read more
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3How to Help Parents, Couples, and Clinicians When an Extremely Premature Infant Is BornJournal of Clinical Ethics 26 (3): 195-205. 2015.Parents may experience profound stress when their infant is extremely premature or has exceptionally low birth weight. This article presents several approaches that clinicians and ethics consultants can use to reduce this stress when a parent is single and alone, as well as when both parents are present. Offering parents additional options, taking preventative measures, and using approaches based on recent innovations in psychotherapies are emphasized. Since the clinicians who care for these neo…Read more
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2Mediation Approaches at the Beginning or End of LifeJournal of Clinical Ethics 26 (4): 275-285. 2015.The approaches used in mediation may help ethics consultants, especially in difficult cases. In this piece, I primarily discuss these techniques. I also discuss how clinicians may be of the most help to parents of infants with severe genetic conditions, to research participants, and to patients who may be at risk for Alzheimer’s disease and their surrogate decision makers.
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3Fourteen Important Concepts Regarding Moral DistressJournal of Clinical Ethics 28 (1): 3-14. 2017.I suggest that we may want to strive, over time, to change our present professional-cultural view, from one that sees an expression of moral distress as a threat, to a professional-cultural view that welcomes these challenges. Such an effort to better medicine would not only include dissenting clinicians, but patients (and their loved ones) as well.
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8Edge-of-the-Field Ethics Consulting: What Are We Missing?Journal of Clinical Ethics 29 (2): 81-92. 2018.Ethics consultants’ grasp of ethical principles is ever improving. Yet, what still remains and will remain lacking is their ability to access factors that lie outside their conscious awareness and thus still effect suboptimal outcomes. This article will explore several ways in which these poor outcomes may occur. This discussion will include clinicians’ implicit biases, well-intentioned but nonetheless intrusive violations of patients’ privacy, and clinicians’ unwittingly connoting to patients a…Read more
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2Professionalism: One Size Does Not Fit AllJournal of Clinical Ethics 26 (1): 3-15. 2015.When a child is born with or acquires special needs, the parents may find some parental tasks more difficult. They may not know how to make their tasks easier, or that some parents find it exceptionally rewarding and meaningful to raise their children with special needs. This piece explores how clinicians might share this potentially life-altering information. It also explores when and why clinicians might want to make one-of-a-kind exceptions to their usual professional practices.
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4How Clinicians Can Reduce “Bullied Acquiescence”Journal of Clinical Ethics 27 (1): 3-13. 2016.Clinicians and patients and their families may disagree about a course of treatment, and the ensuing conflict may seem intractable. The parties may request mediation, or use mediation-based approaches, to help resolve the conflict. In the process of mediation, and at other times, parties in conflict may feel so pressured to accept a resolution that they acquiesce unwillingly—and such resolutions often unravel. In this article I investigate how “bullied acquiescence” might happen, and how to avoi…Read more
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2Harmful Emotional Responses that Patients and Physicians May Have When their Values ConflictJournal of Clinical Ethics 27 (3): 187-200. 2016.One of the most difficult decisions a clinician may face is when, if ever, to decline what a patient wants, based on the clinician’s own moral conscience. Regardless of what the clinician decides, the outcome may be deeply emotionally painful for both parties, and the pain may last. I will discuss this pain, how it occurs, and what we can do to try to reduce it before, during, and after a conflict arises. Approaches include explaining how we are like the patient or doctor, that no one is perfect…Read more
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12When a Mother Wants to Deliver with a Midwife at HomeJournal of Clinical Ethics 24 (3): 172-183. 2013.In this special issue of The Journal of Clinical Ethics, different views on both the ethical desirability of women delivering in hospitals or at home with midwives are discussed. What careproviders, including midwives, should recommend to mothers in regard to the place of giving birth is considered. Emotional concerns likely to be of importance to mothers, fathers, midwives, and doctors are also presented. Finally, possible optimal approaches at the levels of both policy and the bedside are sugg…Read more
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17Why careproviders may conclude that treating a patient is futileJournal of Clinical Ethics 24 (2): 83-90. 2013.I shall examine one way that careproviders may come to judgments of “futility” in cases that are less than clear-cut, in the hope that, if such judgment is unwarranted, it may be avoided
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18A different approach to patients and loved ones who request "futile" treatmentsJournal of Clinical Ethics 23 (4): 291-298. 2012.The author describes an alternative approach that careproviders 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 …Read more
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9How careproviders can acquire and apply greater wisdomJournal of Clinical Ethics 23 (1): 3-12. 2012.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…Read more
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4How to Help Patients and Families Make Better End-of-Life DecisionsJournal of Clinical Ethics 25 (2): 83-95. 2014.How can clinical ethics consultants best assist patients and their family members when patients may be dying? In this introduction, I consider this concern in light of four articles that appear in this issue of The Journal of Clinical Ethics, by Jeffrey T. Berger; Mary T. White; Linying Hu, Xiuyun Yin, Xiaolei Bao, and Jin-Bao Nie; and Thaddeus Mason Pope and Melinda Hexum.Patients and family members experience extreme stress at the end of life, a high-stakes situation in which few of us have ex…Read more
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3New Approaches with Surrogate Decision MakersJournal of Clinical Ethics 25 (4): 261-272. 2014.A first principle in ethics consultation is that reasoning is essential. A second principle is that the religious and cultural views of patients and their surrogates are usually respected. What can be done when these principles collide—when patients or surrogates have religious or cultural views and beliefs that clinicians find unreasonable or even offensive? Mediation may provide some approaches to assist us in providing the most ethically appropriate assistance.
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1Epilogue: Ethical Goals for the FutureJournal of Clinical Ethics 25 (4): 323-332. 2014.Based on the experiences of the Hearts and Minds of Ghana authors, I present possible approaches to the ethical questions that clinicians who participate in health missions and disaster relief programs often face.
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13The best place for bare-knuckled ethicsJournal of Clinical Ethics 24 (1): 3-10. 2013.In the documentary Boston Med, patients, their family members, and their careproviders agree to be filmed in real medical situations. Why would they do this? The possible answers to this question may help us to make sense of the paradoxical results of a recent study, in which patients with terminal illness ranked their careproviders highly for communication, even though the patients had failed to learn that they had a fatal illness. Based on this analysis, I offer careproviders a practical appro…Read more
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14Increasing consensus with patients and their loved onesJournal of Clinical Ethics 20 (1): 3-12. 2008.
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16A possible application of care-based ethics to people with disabilities during a pandemicJournal of Clinical Ethics 21 (4): 275-283. 2010.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?
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20Three keys to treating inmates and their application in ethics consultationJournal of Clinical Ethics 19 (3): 195-203. 2007.
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18All careproviders need more opportunities to share their ethical concerns with othersJournal of Clinical Ethics 21 (3): 179-188. 2010.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…Read more
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7"Third generation" ethics: what careproviders should do before they do ethicsJournal of Clinical Ethics 21 (1): 3-13. 2010.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.
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6When Careproviders Should Give Advice, Disclose Personal Information, and Reveal Their FeelingsJournal of Clinical Ethics 14 (1-2): 3-17. 2003.
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San Diego, California, United States of America
Areas of Interest
Metaphysics |
Philosophy of Mind |
Philosophy of Cognitive Science |