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6Physicians’ Perspectives on Adolescent and Young Adult Advance Care Planning: The Fallacy of Informed Decision MakingJournal of Clinical Ethics 30 (2): 131-142. 2019.Advance care planning (ACP) is a process that seeks to elicit patients’ goals, values, and preferences for future medical care. While most commonly employed in adult patients, pediatric ACP is becoming a standard of practice for adolescent and young adult patients with potentially life-limiting illnesses. The majority of research has focused on patients and their families; little attention has been paid to the perspectives of healthcare providers (HCPs) regarding their perspectives on the proces…Read more
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6Holding Ashley (X): Bestowing Identity Through Caregiving in Profound Intellectual DisabilityJournal of Clinical Ethics 28 (3): 189-196. 2017.The controversy over the so-called Ashley Treatment (AT), a series of medical procedures that inhibited both growth and sexual development in the body of a profoundly intellectually impaired girl, usually centers either on Ashley’s rights, including a right to an intact, unaltered body, or on Ashley’s parents’ rights to make decisions for her. The claim made by her parents, that the procedure would improve their ability to care for her, is often dismissed as inappropriate or, at best, irrelevant…Read more
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2“Buying-In” and “Cashing-Out”: Patients’ Experience and the Refusal of Life-Prolonging TreatmentJournal of Clinical Ethics 29 (1): 15-19. 2018.Surgical “buy-in” is an “informal contract between surgeon and patient in which the patient not only consents to the operative procedure but commits to the post-operative surgical care anticipated by the surgeon.”1 Surgeons routinely assume that patients wish to undergo treatment for operative complications so that the overall treatment course is “successful,” as in the treatment of a post-operative infection. This article examines occasions when patients buy-in to a treatment course that carrie…Read more
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7Moral Agency, Moral Imagination, and Moral Community: Antidotes to Moral DistressJournal of Clinical Ethics 27 (3): 201-213. 2016.Moral distress has been covered extensively in the nursing literature and increasingly in the literature of other health professions. Cases that cause nurses’ moral distress that are mentioned most frequently are those concerned with prolonging the dying process. Given the standard of aggressive treatment that is typical in intensive care units (ICUs), much of the existing moral distress research focuses on the experiences of critical care nurses. However, moral distress does not automatically o…Read more
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10Launch of the International Philosophy of Nursing Society (IPONS)Nursing Philosophy 5 (1): 91-92. 2004.
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29Perils of proximity: a spatiotemporal analysis of moral distress and moral ambiguityNursing Inquiry 11 (4): 218-225. 2004.
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21Critique of the "tragic case" method in ethics educationJournal of Medical Ethics 32 (11): 672-677. 2006.It is time for the noon conference. Your job is to impart a career-changing experience in ethics to a group of students and interns gathered from four different schools with varying curriculums in ethics. They have just finished 1½ h of didactic sessions and lunch. One third of them were on call last night. Your first job is to keep them awake. The authors argue that this “tragic case” approach to ethics education is of limited value because it limits understanding of moral problems to dilemmas;…Read more
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1Implementing policy to the wider communityIn D. Micah Hester & Toby Schonfeld (eds.), Guidance for healthcare ethics committees, Cambridge University Press. 2012.
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16Book Review: Rethinking life and death: the collapse of our traditional ethics (review)Nursing Ethics 4 (3): 258-259. 1997.
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26Fostering Nurses’ Moral Agency and Moral Identity: The Importance of Moral CommunityHastings Center Report 46 (S1): 18-21. 2016.It may be the case that the most challenging moral problem of the twenty‐first century will be the relationship between the individual moral agent and the practices and institutions in which the moral agent is embedded. In this paper, we continue the efforts that one of us, Joan Liaschenko, first called for in 1993, that of using feminist ethics as a lens for viewing the relationship between individual nurses as moral agents and the highly complex institutions in which they do the work of nursin…Read more
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17Artificial Personhood: Nursing Ethics in a Medical WorldNursing Ethics 2 (3): 185-196. 1995.Artificial persons are those who speak and act for others. Nurses speak and act for patients as well as for physicians and institutions, or, more aptly, institutionalized medicine. Yet, acting for institutionalized medicine can be harmful to nurses, due to the psychological experience of moral distress and the loss of integrity of their practice. This paper illustrates the harm to nurses as expressed in narratives of their practice, and suggests some initial steps we might take in resisting the …Read more
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21Problems with the electronic health recordNursing Philosophy 17 (1): 49-58. 2016.One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). In this paper we argue that the primary change has been a shift in the focus of documentation from monitoring individual patient progress to recording data pertinent to Institutional Priorities (IPs). The specific IPs to which we refer include: finance/reimbursement; risk management/legal considerations; quality improvement/safety initiatives; meetin…Read more
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17The Two-Patient Framework for Research During Pregnancy: A Critique and a Better Way ForwardAmerican Journal of Bioethics 11 (5): 66-68. 2011.
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25Nurses and Physicians on Nutritional Support: A ComparisonJournal of Medicine and Philosophy 16 (3): 259-283. 1991.During the last decade, several court cases have focused attention on the moral and legal aspects of withholding or withdrawing food and fluids from certain patients. The courts have not been unanimous in their judgments on these matters. In attempting to explore this issue, this article reviews both the nursing and medical literature on the withdrawing and withholding of food and fluids with particular attention to empirical studies. Several themes which emerge from the literature are used to e…Read more
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3Book Review: Ethics and evidence-based medicine: fallibility and responsibility in clinical science (review)Nursing Ethics 10 (5): 569-569. 2003.