The American Journal of Bioethics, 15(1): 62, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 1526-5161 print / 1536-0075 online DOI: 10.1080/15265161.2015.975590
Introduction
Clinical Ethics: Case Reports, Consultations, Commentaries Jeffrey P. Spike, University of Texas, Houston This recurring feature highlights challenging cases in clinical ethics, with commentaries by ethical, clinical, and legal experts. The two cases in this issue come from two of the dozen hospitals in the Texas Medical Center in Houston. Each case is about an issue that, in some respects, is familiar to the field of bioethics. One case concerns whether to give a blood transfusion to a Jehovah’s Witness and the other is about whether to allow a patient to refuse an amputation. At first glance, both seem simple, and the issues settled. Yet they are both challenging, one because of the nature of the surgery (a heart transplant) being undertaken at a center that prides itself on its “bloodless surgery” program, and the other because of the age of the patient (only 18 years). In the end, these cases provide evidence that it is important to have a functional ethics consult service, recognized and respected within the institution, even for cases that might sound like they should be routine. It is very easy to imagine hospitals that may lack an ethics consult service trying to improvise, or simply asking a respected senior surgeon for a second opinion in a hallway. Such shortcuts still occur in some institutions far too often. However, decisions that involve a potential life at risk deserve gathering input from all stakeholders, awareness of all the relevant laws, regulations, and policies, and careful reflection by trained and experienced ethicists with a fiduciary responsibility.
Every six months we plan to present two cases, each with a few commentaries by ethical, clinical, and legal experts who include ethics consultation activities in their work. The clinical cases are brief, and the commentaries are modeled on consult notes which are expected (within very constrained time limits) to recommend a resolution, a course of action with strong ethical justifications. While two commentators might arrive at different conclusions, readers will have the grounds needed for comparing recommendations and judging which conclusion has the best support. I hope many readers of these cases will thus find that the cases provide them a chance to exercise their own clinical ethics skills. The goal is to help the ethics consultation community to be better prepared for the types of cases they encounter in practice. As such, cases will include both the ordinary and the extraordinary, the medically challenging and the ethically challenging, medical and surgical, adult and pediatric. Readers with interesting cases should send them to the editor of the series at the address below. One may submit cases anonymously, if preferred to maximize confidentiality. Authors may submit a case without a commentary, or a case with a commentary, or volunteer to write additional commentaries. Cases should be 500–600 words, and commentaries roughly 1000–2000 words. (For a more detailed description of the series, see American Journal of Bioethics 14(1), January 2014, pp. 36–37.) &
Address correspondence to Jeffrey P. Spike, University of Texas, Houston, 6431 Fannin, JJL Suite 410, Houston, TX 77030, USA. E-mail: [email protected]
62 ajob
Copyright of American Journal of Bioethics is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Introduction
Clinical Ethics: Case Reports, Consultations, Commentaries Jeffrey P. Spike, University of Texas, Houston This recurring feature highlights challenging cases in clinical ethics, with commentaries by ethical, clinical, and legal experts. The two cases in this issue come from two of the dozen hospitals in the Texas Medical Center in Houston. Each case is about an issue that, in some respects, is familiar to the field of bioethics. One case concerns whether to give a blood transfusion to a Jehovah’s Witness and the other is about whether to allow a patient to refuse an amputation. At first glance, both seem simple, and the issues settled. Yet they are both challenging, one because of the nature of the surgery (a heart transplant) being undertaken at a center that prides itself on its “bloodless surgery” program, and the other because of the age of the patient (only 18 years). In the end, these cases provide evidence that it is important to have a functional ethics consult service, recognized and respected within the institution, even for cases that might sound like they should be routine. It is very easy to imagine hospitals that may lack an ethics consult service trying to improvise, or simply asking a respected senior surgeon for a second opinion in a hallway. Such shortcuts still occur in some institutions far too often. However, decisions that involve a potential life at risk deserve gathering input from all stakeholders, awareness of all the relevant laws, regulations, and policies, and careful reflection by trained and experienced ethicists with a fiduciary responsibility.
Every six months we plan to present two cases, each with a few commentaries by ethical, clinical, and legal experts who include ethics consultation activities in their work. The clinical cases are brief, and the commentaries are modeled on consult notes which are expected (within very constrained time limits) to recommend a resolution, a course of action with strong ethical justifications. While two commentators might arrive at different conclusions, readers will have the grounds needed for comparing recommendations and judging which conclusion has the best support. I hope many readers of these cases will thus find that the cases provide them a chance to exercise their own clinical ethics skills. The goal is to help the ethics consultation community to be better prepared for the types of cases they encounter in practice. As such, cases will include both the ordinary and the extraordinary, the medically challenging and the ethically challenging, medical and surgical, adult and pediatric. Readers with interesting cases should send them to the editor of the series at the address below. One may submit cases anonymously, if preferred to maximize confidentiality. Authors may submit a case without a commentary, or a case with a commentary, or volunteer to write additional commentaries. Cases should be 500–600 words, and commentaries roughly 1000–2000 words. (For a more detailed description of the series, see American Journal of Bioethics 14(1), January 2014, pp. 36–37.) &
Address correspondence to Jeffrey P. Spike, University of Texas, Houston, 6431 Fannin, JJL Suite 410, Houston, TX 77030, USA. E-mail: [email protected]
62 ajob
Copyright of American Journal of Bioethics is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
