Communication and conflict management training for clinical bioethics committees.
Johns Hopkins Medicine's Howard County General Hospital, 5755 Cedar Lane, Columbia, MD 21044, USA.HEC Forum 10/2009; 21(4):341-9. DOI:10.1007/s10730-009-9116-7
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ABSTRACT: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Random sample of 600 U.S. general hospitals, stratified by bed size. The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices.The American Journal of Bioethics 03/2007; 7(2):13-25. · 4.00 Impact Factor
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ABSTRACT: The increased presence of moral consultants, or bioethicists, within hospitals and clinics in the last two decades has begun to raise questions about their sources of authority and norms of practice. Under pressure from critics in the social sciences, a number of bioethicists have recently raised the ideal of democratic deliberation to defend and reconstruct their place in the medical field. This article sheds light on these developments by placing bioethics in a historical context that shows an early tension between bioethicists as whistle-blowers and bioethicists as incremental reformers of medical practice. This article also develops a conceptual framework for analysis that indicates how such tensions have grown more complicated for contemporary bioethicists because they occupy a fluid and structurally ambiguous role in which there are multiple sources of normative expectations and little guidance for meeting these expectations. The liminality of the role and the overload of expectations have made bioethics vulnerable to methodological criticisms from social scientists. This article concludes that such methodological criticisms cannot address the more systemic problems of liminality and overload. The ideal of democratic deliberation, though imperfect, does address these systemic problems because it shows bioethicists how to gain guidance and share responsibility for moral consultation.Journal of Health Politics Policy and Law 05/2002; 27(2):177-211. · 1.24 Impact Factor
- The Journal of clinical ethics 02/2007; 18(4):357-61. · 0.47 Impact Factor
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