Martin L Smith's research while affiliated with Cleveland Clinic and other places

... In paper II we discuss both the professional autonomy of the GPs and the autonomy of the patients. Generally, autonomy refers to the human capacity for making independent choice (153,154). One could argue that absolute autonomy does not exist, as this requires the actor to be fully informed and free from external influence, which of course is unrealistic. ...

... At many centers, patients without caregivers may not be considered for LVAD therapy as lack of social support has been associated with worse outcomes. 50 ...

... The field of clinical ethics is no exception and hence is not immune from such expectation. Indeed, the question about meeting expectation is being deeply rooted in the earliest days of clinical ethics (White et al., 2018), and recognizing, acknowledging, articulating, and responding to expectations have been taken to be a key activity-and responsibility-in clinical ethics consultation given the ways expectations add layers to the moral complexity faced by ethics consultants in any particular circumstance and context (Agich, 2005;Barnard, 1992;Bliton & Finder, 2002.This may well explain why over the past 20 years concerns about expectations have occasionally risen to a fever-pitch, especially in the context of credentialing, certification, and other aspects of professionalization (Andereck et al., 2012;Aulisio et al., 2000;Dubler et al., 2009;Fins et al., 2016;Kodish et al., 2013). What is clear is that clinical ethics consultants work in complex environments where multiple types of expectations emerge about their roles and responsibilities as well as about the particular activities in which they are (or are not) to engage for fulfilling such expectations (Bliton & Finder, 1999, 2002Frolic, 2011;Zaner, 1984Zaner, , 1988)all of which often practically leads to those working in clinical ethics encountering the question of whether their services are valued by others (Gaucher et al., 2013;Tarzian, 2013). ...

... There is an increasing need for better integration of ethics in multiple areas (Pansera et al. 2020;Sugarman and Bredenoord 2020), public health , clinical settings (Bruce et al. 2014), and education (Langerman et al. 2020). In all cases, the authors agreed that richer descriptions of both good and bad experiences with ethics engagement are needed to help inform the refinement of these approaches (McLennan et al. 2022;Sugarman and Bredenoord 2020). ...

... Furthermore, it has been suggested that women are more likely to decline LVAD support than men. 30,31 In a multinational European screening study, women were somewhat less likely to be eligible for LVAD and/or heart transplantation but considerably less likely to accept LVAD and/or transplantation if indicated. 32 Additionally, it could be that physicians and patients wait too long with the decision to proceed towards LVAD implantation, as reflected by the strikingly high proportion of women in the worst INTERMACS profile and the higher need for mechanical circulatory support in women. ...

... These and related questions should guide the assessment process during direct patient interview (rather than curbside consults). Similar to their role on solid organ transplant teams (40,41), clinical ethicists commonly assist VCA teams with various aspects of the VCA program, including the assessment of recipient candidates. The ethicist does not work in isolation of the team psychologist, psychiatrist or social worker; however, the ethics assessment is additional to the psychosocial assessment performed by social workers. ...

... Die Frage der Beratungsmethodik gerät bislang jedoch kaum in den Blick der wissenschaftlichen Beschäftigung mit Themen der Klinischen Ethik. Zwar werden formale und die Struktur betreffende Fragen von Ethikberatung aufgegriffen (Agich 2001;Steinkamp und Gordijn 2010;May 2013;Flicker et al. 2014;Vollmann 2021) und Moderationsgeschick wird angemahnt (AEM 2019). Beratungsmethoden im engeren Sinne bleiben dagegen unberücksichtigt oder werden nur allgemein benannt (Orr und Shelton 2009;Simon 2021;Vollmann 2021). ...

... While the field of clinical ethics consultation is almost 30 years old and has achieved some maturity, there is by no means an accepted consensus about a number of aspects of the process or those individuals who engage in ethics consultation. Unlike other areas of medical specialization that have established fields of praxis and expertise, such as cardiology and oncology, in which standards of knowledge and practical application are accepted and for which measurements of professional accomplishment have been established (such as specialty board examinations), a similar foundation does not yet exist for the practice of ethics consultation (Kodish et al. 2013;Bruce et al. 2015;Tarzian, Wocial, and Committee 2015). There are ongoing attempts to regulate and professionalize the practice by setting both individual and institutional standards, but these efforts have not yet achieved fruition and there remains a large degree of inter-institutional variability (Fins et al. 2016;Prince et al. 2017). ...

... While most discussion of accommodation focuses on time after determination and declaration (so families have an opportunity to gather and say goodbye), hospitals also offer accommodations before determination. 98 Among other evidence, court cases in the USA indicate that clinicians regularly offer brief accommodations of 24-72 hr. 12 Several Canadian court cases indicate that Canadian clinicians also delay testing to accommodate family wishes. 99,100 For example, in the above-referenced (cf. ...

... Hier wird in der Literatur allerdings eine oft unzureichende Aufklärung mit ungenügender Transparenz einerseits und mangelhaftem Verständnis patientenseitig beklagt, zumal die ursprüngliche Indikationsgruppe "brigde to transplant" und die ohnehin seltene "bridge to recovery" zahlenmäßig immer kleiner werden in Relation zu "destination therapy" und der in letzter Zeit häufiger genutzten "brigde to decision" [189]. Mit der verbesserten notfall-und intensivmedizinischen Versorgung mehren sich in kardiologischen Zentren jedoch auch die Fälle, in denen Patienten zum fraglichen Zeitpunkt ihre Entscheidung nicht kommunizieren können, sodass "Ersatzentscheider" (Familienangehörige, durch Patientenverfügung oder behördlich bestellte Personen) befragt werden, die allerdings mindestens in 1/3 der Fälle anders entscheiden, als es der Betroffene getan hätte [190,191]. ...