Teaching Ethics Consultation Using a Tabletop Exercise.

Drawing on pedagogical tools utilized in clinical scenario simulation and emergency preparedness training, the authors describe an innovative method for teaching clinical ethics consultation skills, which they call a "tabletop" exercise. Implemented at the end of a clinical ethics intensive course, the tabletop enables learners to implement the knowledge and practice the skills they gained during the course. The authors highlight the pedagogical tools on which the tabletop exercise draws, describe the tabletop exercise itself, offer how to best operationalize such an exercise, reflect on the method's strengths and weaknesses, and provide insights for others who may want to implement their own tabletop for ethics consultation education.

Letting Go of the Status Quo: One Program's Experience Discontinuing Ethics Committees and Creating Alternative Structures for Engagement.

AbstractThe authors describe their Ethics Program's transition from utilizing ethics committees to instead implementing a three-initiative structure consisting of Ethics Grand Rounds, an Ethics Liaison Network, and an Ethics Advisory Group. They first outline the history of ethics committees. Then, they discuss the history of their Ethics Program and the challenges that ethics committees posed.

Transgender women's perspectives on mental health care related to vaginoplasty for gender affirmation.

Purpose: This study aimed to describe patient experiences and attitudes about the role of the mental health professional as it relates to pursuing gender affirmation surgery.

Methods: This was a mixed-models study with semi-structured interviews. Participants who presented for gender affirming vaginoplasty and had completed pre-surgical requirements but had not yet had the procedure were invited to participate in the study.

State-Mandated Ethics Oversight Is Inappropriate for Gender-Affirming Care.

A proposed state administrative rule would have required medical ethicists to approve certain aspects of gender-affirming care. The authors argue the proposed rule lacked appropriate justification compared to other instances of state-mandated ethics oversight and would undermine trust, raise practical challenges, and send harmful messages to society, patients, and providers.

Reimagining Thriving Ethics Programs without Ethics Committees.

With the increasing professionalization of clinical ethics, some hospitals and health systems utilize both ethics committees and professional clinical ethicists to address their ethics needs. Drawing upon historical critiques of ethics committees and their own experiences, the authors argue that, in ethics programs with one or more professional clinical ethicists, ethics committees should be dissolved when they fail to meet minimum standards of effectiveness. The authors outline several criteria for assessing effectiveness, describe the benefits of a model that places primary responsibility for ethics work with professional clinical ethicists-the , and offer suggestions for alternative ethics program structures that empower healthcare professionals to contribute to ethics work in ways more tailored to their strengths and skills while minimizing the shortcomings of ethics committees.