Characteristics and Outcomes of Safe Discharge Planning Bioethics Consultations of a Single Ethics Service at a Large Medical Center.

Unlabelled: AbstractBackground: Clinical ethics consults are sometimes requested for patients who lack capacity and do not assent to discharge recommendations, particularly those with neurocognitive or psychiatric disorders desiring home discharge. Balancing the risks and benefits of overriding patient preferences involves considering dignity, values, clinical information, and available resources. Outcomes of such consultations lack characterization in the literature.

An Open Discussion of the Impact of OpenNotes on Clinical Ethics: A Justification for Harm-Based Exclusions from Clinical Ethics Documentation.

The OpenNotes (ON) mandate in the 21st Century Cures Act requires that patients or their legally authorized representatives be able to access their medical information in their electronic medical record (EMR) in real time. Ethics notes fall under the domain of this policy. We argue that ethics notes are unique from other clinical documentation in a number of ways: they lack best-practice guidelines, are written in the context of common misconceptions surrounding the purpose of ethics consultation, and often answer questions of a different nature than other documentation.

A Place of His Own: Applying Dignity of Risk to Bioethics Consultation.

Hospitals have both a regulatory and an ethical mandate to craft a safe discharge plan for all patients. These plans can become a source of conflict between clinicians and patients when they have differing conceptions of safety and best interests. In bioethics principles this conflict can be characterized as the tension between the patient's right to make medical decisions in accordance with their values, or autonomy, and the clinician's obligation to provide best care to their patients, or beneficence.

Learning from Covid.

Mrs. Clark's case was an ordinary consult in an extraordinary time. She was refusing dialysis, but the psychiatric unit had concluded that she lacked capacity for such decision-making.

Should Dialysis Be Stopped for an Unrepresented Patient With Metastatic Cancer?

Unrepresented patients (also referred to as unbefriended, patients alone, patients without proxy, or isolated patients) are among the most vulnerable persons entering the health care system. Legislation concerning these patients varies across the United States, resulting in disparities in care. For example, the statutory definition of who is unrepresented varies.

It's All Relative.

In this issue of the Hastings Center Report, Daniel Brudney suggests that clinicians have an overly deferential attitude toward their patients' surrogate decision-makers that is rooted in a wrongful investment of moral authority. He maintains that surrogate decision-makers have no moral right to decide for their loved ones and that their value in the decision-making process is limited to their knowledge of their loved one's preferences. If operationalized, Brudney's framework would ease the way for clinicians to remove a surrogate who cannot provide information relevant to the patient's preferences and to resort to a paternalistic model of decision-making.

Empty Spaces.

"I'm Jewish, you know, and my mother said, 'Always trust the rabbis.'" I never heard Mr. Weisman's refrain from his own lips.

A Good Death.

A good death is hard to find. Family members tell us that loved ones die in the wrong place-the hospital-and do not receive high-quality care at the end of life. This issue of the Hastings Center Report offers two articles from authors who strive to provide good end-of-life care and to prevent needless suffering.