scholarly journals Ethical challenges in management of critically ill pregnant patients with coronavirus disease 2019 (COVID-19)

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Moti Gulersen ◽  
Burton Rochelson ◽  
Eran Bornstein ◽  
Laurence B. McCullough ◽  
Frank A. Chervenak
Keyword(s):  
Clinical Judgment ◽  
Mode Of Delivery ◽  
Fetal Monitoring ◽  
Ethical Framework ◽  
Decision Making Process ◽  
Ethical Challenges ◽  
Moral Management ◽  
Surrogate Decision ◽  
Preventive Ethics ◽  
Critical Care Team

Abstract Despite the overwhelming number of coronavirus disease 2019 (COVID-19) cases worldwide, data regarding the optimal clinical guidance in pregnant patients is not uniform or well established. As a result, clinical decisions to optimize maternal and fetal benefit, particularly in patients with critical COVID-19 in the early preterm period, continue to be a challenge for obstetricians. There is often uncertainty in clinical judgment about fetal monitoring, timing of delivery, and mode of delivery because of the challenge in balancing maternal and fetal interests in reducing morbidity and mortality. The obstetrician and critical care team should empower pregnant patients or their surrogate decision maker to make informed decisions in response to the team’s clinical evaluation. A clinically grounded ethical framework, based on the concepts of the moral management of medical uncertainty, beneficence-based obligations, and preventive ethics, should guide the decision-making process.

An ethical framework for counseling about mode of delivery for desired psychosocial benefit in pregnancies complicated by severe fetal anomalies

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Michelle T. Nguyen ◽  
Laurence B. McCullough ◽  
Frank A. Chervenak ◽  
Kathryn J. Shaw ◽  
Dominique Luckey
Keyword(s):  
Cesarean Delivery ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Traumatic Shock ◽  
Informed Decision ◽  
Trisomy 18 ◽  
Ethical Framework ◽  
Ethical Challenges ◽  
Fetal Diagnosis ◽  
Elective Cesarean

Abstract Background A fetal diagnosis poses ethical challenges when a woman requests elective cesarean delivery for psychosocial reasons. We address the ethical challenges of counseling such patients. Case presentation A 36-year-old G4P2012 has chosen to continue a pregnancy despite a high likelihood of trisomy 18. At 36.5 weeks she was admitted for preeclampsia with severe features and requested to be delivered by primary cesarean section. Due to the poor prognosis associated with trisomy 18, the patient’s request for cesarean delivery was declined even when her baby changed to breech presentation with Category 2 fetal heart rate (FHT). The patient subsequently experienced a traumatic stillbirth and post-traumatic shock disorder (PTSD). Conclusion The obstetrician’s goal should be to transform the patient’s request into an informed decision. The obstetrician should explain that, while a cesarean could increase the likelihood of a live birth, it will not alter long-term neonatal outcomes and entails net biomedical risk for the current and future pregnancies. The obstetrician should ensure that the patient understands these clinical realities. The obstetrician should support the patient’s decision-making about whether to accept the risks of cesarean delivery for psychosocial benefit. The obstetrician should initiate counseling during prenatal visits to empower the patient with information to meaningfully exercise her autonomy. If the patient makes an informed decision for cesarean delivery, it becomes ethically permissible. Plans regarding intrapartum management and mode of delivery should be documented in case the patient is delivered by a physician who was not involved in prenatal counseling.

A Qualitative Analysis of Unethical Behaviors in Projects: Insight From Moral Psychology

2021 ◽  
pp. 875697282110377
Author(s):  
Mehrdad Sarhadi ◽  
Sogand Hasanzadeh
Keyword(s):  
Ethical Framework ◽  
Paradigm Change ◽  
Ethical Challenges ◽  
Late Modernism ◽  
Wide Range ◽  
Unethical Behaviors ◽  
Multiple Case ◽  
Stakeholder Behavior ◽  
Unconscious Desire

Ethical aspects of stakeholder behavior can have a wide range of implications for other areas of project management. This research critically reviewed project ethics under the philosophical paradigm change from modernism to late modernism, which led to a flexible and realizable ethical framework based on Levinasian and Nietzschean moral psychologies. A qualitative approach was adopted through a multiple-case study to confront the theoretical framework with the empirical world, evaluate its authenticity, and obtain a better understanding of its challenges. Research results showed that stakeholders’ unconscious desire for existential meaning can provide considerable potential for dealing with ethical challenges.

Intrapartum Care

2019 ◽  
Author(s):  
Jessica M. Hart ◽  
Brett C. Young
Keyword(s):  
Mode Of Delivery ◽  
Fetal Monitoring ◽  
Intrapartum Care ◽  
Delivery Methods ◽  
Intraamniotic Infection ◽  
Electronic Fetal Monitoring ◽  
Occiput Posterior Position ◽  
Prelabor Rupture Of Membranes ◽  
Group B ◽  
Term Labor

Intrapartum care encompasses the treatment of pregnancy during labor and delivery. Knowledge of the normal labor process is essential to effectively recognize and treat abnormalities, and thus optimize maternal and fetal health. This review aims to outline the physiology of labor and discuss contemporary features of spontaneous labor, prolonged labor, and arrest of labor. It addresses management of group B streptoccocous colonization and electronic fetal monitoring practices. Additionally, issues associated with term labor such as prelabor rupture of membranes, abruption, intrapartum intraamniotic infection, and persistent occiput posterior position are discussed. The review concludes with a brief overview of delivery methods.  This review contains 7 figures, 14 tables, and 49 references. Keywords: term labor, intrapartum monitoring, induction of labor, Group B Streptococcous prophylaxis, prelabor rupture of membranes, intraamniotic infection, mode of delivery

Ethics in obstetrics and gynaecology

2020 ◽  
pp. 33-43
Author(s):  
Frank A. Chervenak ◽  
Laurence B. McCullough
Keyword(s):  
Clinical Competence ◽  
Ethical Challenges ◽  
Obstetrics And Gynaecology ◽  
Wide Range ◽  
Health Related ◽  
History Of ◽  
Practical Guidance ◽  
Responsibility Model ◽  
Preventive Ethics ◽  
History Of Medical Ethics

Obstetrician-gynaecologists confront a wide range of ethical challenges in clinical practice. To guide obstetrician-gynaecologists in responding to these challenges in a responsible way, this chapter provides a concise overview based on the professional responsibility model of ethics in obstetrics and gynaecology. This model is based on the transformative contributions of Drs John Gregory (1724–1773) and Thomas Percival (1740–1804) to the global history of medical ethics. This model requires three commitments of physicians: to scientific and clinical competence; to the primacy of the patient’s health-related interests; and to sustaining medicine as a public trust rather than a self-interested merchant guild. This model emphasizes the professional virtues of doctors and ethical principles and the obligations to patients generated by these virtues and principles. The result is a model for ethics in obstetrics and gynaecology that is ethically sound and clinically comprehensive and practical. Taking a preventive ethics approach, this chapter provides ethically justified, practical guidance on the professional responsible management of clinical ethical challenges in gynaecology, in obstetrics, and in professionally responsible advocacy.

Using Neuroimaging to Detect Covert Awareness and Determine Prognosis of Comatose Patients: Informing Surrogate Decision Makers of Individual Patient Results

2018 ◽  
Vol 38 (05) ◽  
pp. 555-560 ◽  
Author(s):  
Mackenzie Graham ◽  
Colin Doherty ◽  
Lorina Naci
Keyword(s):  
Functional Neuroimaging ◽  
Recovery Of Function ◽  
Decision Makers ◽  
Ethical Framework ◽  
Prognostic Indicators ◽  
Ethical Guidelines ◽  
Highly Sensitive ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Patient Prognosis

AbstractRobust prognostic indicators of neurological recovery are urgently needed for acutely comatose patients. Functional neuroimaging is a highly sensitive tool for uncovering covert cognition and awareness in behaviorally nonresponsive patients with prolonged disorders of consciousness, and may be applicable to acutely comatose patients. Establishing a link between early detection of covert awareness in acutely comatose patients and eventual recovery of function could have significant implications for patient prognosis, treatment, and end-of-life decisions. Because functional neuroimaging of acutely comatose patients is currently limited to the research context, ethical guidelines for disseminating a patient's individual research results to clinical teams and surrogate decision makers are needed. We propose an ethical framework composed of four conditions that can guide ethical disclosure of individual results of neuroimaging research in the acute care context.

Discontinuation of Life-Sustaining Therapies

2017 ◽  
Author(s):  
Kathy Plakovic
Keyword(s):  
Healthcare Providers ◽  
Biomedical Ethics ◽  
Artificial Nutrition ◽  
Decision Making Process ◽  
Blood Products ◽  
Life And Death ◽  
Technological Advances ◽  
Surrogate Decision ◽  
The Right ◽  
Guide Care

Technological advances allow healthcare providers to delay the dying process for critically and terminally ill patients. For patients lingering between life and death, decisions frequently need to be made regarding withholding or withdrawing life-sustaining treatments such as withholding and withdrawing antibiotics, blood products, dialysis, and artificial nutrition. Biomedical ethics guide all health care. The ethical principle of autonomy offers patients or their surrogate decision-maker the right to accept or reject any treatment. The benefits and burdens of treatment often guide care and should be aligned with preferences, values, and goals of care. This chapter reviews these treatments and the decision-making process that must be a part of any discussion to discontinue treatments.

scholarly journals Can Wearable Cameras be Used to Validate School-Aged Children’s Lifestyle Behaviours?

Children ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 20 ◽  
Author(s):  
Bethan Everson ◽  
Kelly A. Mackintosh ◽  
Melitta A. McNarry ◽  
Charlotte Todd ◽  
Gareth Stratton
Keyword(s):  
Physical Activity ◽  
Self Report ◽  
Ethical Framework ◽  
Ethical Challenges ◽  
Lifestyle Behaviours ◽  
Wearable Camera ◽  
Parents And Children ◽  
Wearable Cameras ◽  
Health Related ◽  
Almost All

Wearable cameras combined with accelerometers have been used to estimate the accuracy of children’s self-report of physical activity, health-related behaviours, and the contexts in which they occur. There were two aims to this study; the first was to validate questions regarding self-reported health and lifestyle behaviours in 9–11-year-old children using the child’s health and activity tool (CHAT), an accelerometer and a wearable camera. Second, the study sought to evaluate ethical challenges associated with taking regular photographs using a wearable camera through interviews with children and their families. Fourteen children wore an autographer and hip-worn triaxial accelerometer for the waking hours of one school and one weekend day. For both of these days, children self-reported their behaviours chronologically and sequentially using the CHAT. Data were examined using limits of agreement and percentage agreement to verify if reference methods aligned with self-reported behaviours. Six parent–child dyads participated in interviews. Seven, five, and nine items demonstrated good, acceptable, and poor validity, respectively. This demonstrates that the accuracy of children’s recall varies according to the behaviour or item being measured. This is the first study to trial the use of wearable cameras in assessing the concurrent validity of children’s physical activity and behaviour recall, as almost all other studies have used parent proxy reports alongside accelerometers. Wearable cameras carry some ethical and technical challenges, which were examined in this study. Parents and children reported that the autographer was burdensome and in a few cases invaded privacy. This study demonstrates the importance of adhering to an ethical framework.

Forensic patients, treating psychiatrist and the Mental Health Review Tribunal – An ethical question?

2019 ◽  
Vol 27 (5) ◽  
pp. 441-443
Author(s):  
Rajesh Maheshwari ◽  
Yvonne Skinner
Keyword(s):  
Reference Points ◽  
Ethical Framework ◽  
Expert Advice ◽  
Ethical Question ◽  
Ethical Challenges ◽  
Dual Roles ◽  
Forensic Patients ◽  
Forensic Practice ◽  
Medical Paradigm ◽  
Health Review

Objective: In inpatient forensic settings, a psychiatrist is expected to wear ‘Two Hats’, as a treating physician and as an expert to provide risk assessments and expert advice to the judicial authorities for leave and release decisions. Although dual roles have long been accepted as an inevitable part of independent forensic practice, there are additional ethical challenges for the treating psychiatrist to provide an expert opinion. This paper examines the specific ethical ambiguities for a treating psychiatrist at the interface of legal process related to leave and release decisions in the treatment of forensic patients. Conclusions: While respect for justice is the prevailing ethical paradigm for court-related forensic work, the medical paradigm should remain the key ethical framework for psychiatrists in treatment settings. Thus, psychiatrist should be aware of possible adverse consequences in acting as forensic experts for their patients. A conscientious adherence to clinical facts and awareness of the ‘Two Hats’ ethical pitfall can serve as important reference points in framing the psychiatric evidence in the decision-making process and safeguard treating psychiatrist’s role.

The importance of clinically and ethically fine-tuning decision-making about cesarean delivery

2017 ◽  
Vol 45 (5) ◽  
Author(s):  
Michelle T. Nguyen ◽  
Laurence B. McCullough ◽  
Frank A. Chervenak
Keyword(s):  
Decision Making ◽  
Cesarean Delivery ◽  
Clinical Judgment ◽  
Fetal Heart ◽  
Breech Presentation ◽  
Organizational Factors ◽  
Fine Tuning ◽  
Ethical Framework ◽  
Training Experience ◽  
Significant Harm

AbstractIn obstetric practice, each pregnant woman presents with a composite of maternal and fetal characteristics that can alter the risk of significant harm without cesarean intervention. The hospital’s availability of resources and the obstetrician’s training, experience, and skill level can also alter the risk of significant harm without cesarean intervention. This paper proposes a clinical ethical framework that takes these clinical and organizational factors into account, to promote a deliberative rather than simplistic approach to decision-making and counseling about cesarean delivery. The result is a clinical ethical framework that should guide the obstetrician in fine-tuning his or her evidence-based, beneficence-based analysis of specific clinical and organizational factors that can affect the strength of the beneficence-based clinical judgment about cesarean delivery. We illustrate the clinical application of this framework for three common obstetric conditions: Category II fetal heart rate tracing, prior non-classical cesarean delivery, and breech presentation.

Ethical and Methodological Issues in Large Qualitative Participatory Studies

2018 ◽  
Vol 63 (5) ◽  
pp. 584-603 ◽  
Author(s):  
Naomi Hossain ◽  
Patta Scott-Villiers
Keyword(s):  
Action Research ◽  
International Development ◽  
Participatory Research ◽  
Large Scale ◽  
Well Being ◽  
Ethical Framework ◽  
Human Society ◽  
Ethical Challenges ◽  
Research Participants ◽  
Time Space

Participatory research studies utilizing qualitative data drawn from large, diverse samples appear increasingly common in the social sciences, particularly in international development. This reflects demand for participatory approaches to researching human well-being at scale, comparative research on globalization and development, and breadth and scale in evidence-based policy making. “Big Qual” studies in international development increasingly combine qualitative with participatory methods and incorporate action research, oral histories, case studies, and visual methods. Apart from their scale (more sites and research participants than conventional “face-to-face” research) and diversity of contexts, these studies broadly share a focus on application, and an epistemological and ideological commitment to hearing and amplifying the voices of research participants and contributing to positive change in their lives. Some ethical challenges of Big Qual research—for example, reuse, storage, and sharing of third party data—have been thoroughly debated. Less is known of how complexities across time, space, and culture may shape researcher relations in large-scale participatory research, biasing results against context-specificity and meaningful local political analysis. Drawing on almost a decade’s experience with large participatory research, this article explores why and how scale, encompassing a complex network of institutions, relationships, contexts, and cultures, affects the ethics of these studies. We propose that Bradbury and Reason’s (2001) five criteria for judging the value and contribution of social inquiry are helpful: (a) the quality of relationships built, (b) the usefulness of the research, (c) its trustworthiness, (d) its relevance to vital issues of human society, and (e) its enduring consequence. Drawn from an action research tradition, these criteria constitute a comprehensive ethical framework particularly applicable to Big Qual participatory work in development studies. Through an empirical application of these criteria, the article highlights emerging ethical challenges facing applied social research in increasingly complex, multiscalar, and globalized contexts.

Sign in / Sign up

Export Citation Format

Share Document