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OBJECTIVES To comprehensively assess the effect of a living will on end-of-life care. Included studies were conducted in adults with and without living wills.

From an ethical perspective, the value of trustworthiness is a prerequisite of successful risk management. This value is connected to safety culture since it refers to physical safety, psychological safety, and cultural safety.

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Furthermore, it is important for the managers to encourage multidisciplinary collaboration to facilitate transparent reporting In this case, the apparent reason was that the incubator door was left open by someone or was not correctly closed. Questions raised in this context include the following: Was the nurse occupied with other emergency and essential actions?

Was the incubator door latch broken? Why would the nurse forget to accurately examine the door? Is it possible that lack of guidelines for patient safety led to this incident?

Bioethics in Health Policy (excerpt)

The most important step to reduce the possibility of such events in clinical settings is to establish policies and procedures that work best for each ward. Furthermore, the continuous training of the personnel in patient safety, steady supervision, and controlling the efficacy level of the performed actions are some other steps that can be taken in this regard. For instance, in this case, frequent checking of the incubator door, the use of two locks, and explanation of safety tips regarding the incubator to the staff are also important.

Furthermore, evaluation and constant controlling of compliance with patient safety rules, and feedback are also necessary. The quantity of human resources is also noteworthy in the field of patient safety. In other words, quality assurance depends on the quantity of manpower. Therefore, in order to prevent similar incidents, providing an adequate number of staff at the bedside is essential Professional ethics and patient safety are intertwined fundamental concepts in medicine.

Patient safety is grounded in ethical principles which are considered as care quality indicators The realization of patient safety requires the provision and implementation of a professional code of ethics. Based on the Iranian healthcare professional code of conduct, it is expected that all patients be treated with dignity and be protected from any possible harm Accordingly, adherence to ethical principles requires healthcare providers to identify potential safety failures to prevent falling incidents The establishment of patient safety has different individual, professional, and organizational aspects with a special focus on ethics.

It seems in case of any error made by the care team, the event must be announced to the parents honestly without blaming the care providers. Under circumstances in which errors were caused by inappropriate pattern of providing hospital services, parents should be reassured that all services will be paid for by the hospital.

It would be better if the parents were informed by the chief physician or the head nurse and given enough time to express their concern or anger. It should be considered that knowing the truth is one of the basic rights of patients and their family members. Furthermore, it should be noticed that primary conversations usually take place when there is not accurate and comprehensive information about the event, so recognizing, understanding, and explaining all the details in complicated clinical situations is not possible.

Thus, it is suggested that in such situations, information be given in several stages and by providing psychological support for the patient. Furthermore, while they may need supportive interventions, the patient's family can be considered as an important source of information in the process of root cause analysis RCA of similar incidents 17 - In addition, regarding the presented case, the father should be ensured that hospitalizing the newborn was necessary and the mother should not be blamed.

In fact, he should be ensured that the incident was entirely due to system error and not by the mother.

Basically, maintaining the integrity of the family is essential and medical staff must consider family support at all stages, especially in such circumstances. Indeed, an important ethical point in this case is the necessity of offering an honest apology. Laws and regulations related to patient safety, which may vary based on the legislation system of each country, should encourage the disclosure of medical errors while supporting the implementation of the ethical imperatives of patient safety. In general, based on the medical law, the patient who is a victim of negligence is supposed to be fairly compensated.

In addition, these rules provide possibilities for promotion of transparency and open communications in all levels. Reaching this goal requires regarding all stakeholders in the healthcare system In the mentioned case, some questions could be raised. Either the falling was in the presence of the mother or not.

If it was in her presence, the hypothesis is that she dropped the baby intentionally. Accordingly, it should be considered that maternal postpartum sleepiness is one of the major risk factors for falling of newborns.


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Half of all newborn falling incidents in hospitals have occurred while the mother was holding the infant in a hospital bed. Therefore, recognizing the risks of neonatal falling during mother—baby care situations and teaching the mothers is a major nursing responsibility If the mother is incapable of taking care of the hospitalized baby, she should be under supervision of the care team and should be educated. Furthermore, notifying the father is an appropriate act if the complaint was raised by the father.

The main task of the physician or nurse after a detailed examination and treatment is the detailed registration and description of all events without any assumptions.

Illuminating the Art of Medicine

If the examinations found evidence of neglect, it would be a completely different discussion and calling the social services would be absolutely necessary. There is an obligation to inform the patient or the family about every unwanted event in healthcare settings. The idea that there is no need to disclose errors which did not affect the patient is based on the traditional stance of the law. Despite increased attention toward the quality of health care services, there are still numerous threats to patient safety in healthcare settings.

Reaching the ultimate goal of the healthcare system, which is to ensure quality and safety of the services, requires structured policies and processes to foster the safety settings based on mutual trust. This can be facilitated by encouraging multidisciplinary collaboration for the transparent reporting of medical errors and also active participation of the patients and their families in detecting medical errors.

Furthermore, the provision of emotional support and legal protection of the staffs by the organization is essential to encourage voluntary reporting of incidents. Moreover, training and emphasizing on the professional code of ethics can be effective on deepening the understanding of and belief in the moral foundations of patient safety. National Center for Biotechnology Information , U. J Med Ethics Hist Med. Many of the workers and their family members present to the clinic with signs of malnutrition.

A number of them also report respiratory complaints and skin and eye problems, which they associate with their handling of pesticides on the large farm. Skip to content 14 Jun June 14, The deadline for submissions is 1 October La date limite pour les soumissions est le 1er octobre Are Injections Better Than Pills? Post to Cancel. This body of work includes materials as diverse as adaptations of existing scripts e. Jack Kevorkian; organ transplantation; medical and research decision-making; and environmental justice. These works have been developed and used in the classroom, as medical grand rounds, in public humanities projects, as educational materials in public health research, as radio readings, and in conference settings.

The PCS model is in some respects a laboratory, in others a workshop. Case development is accomplished during a single 12—week semester in three phases of roughly equal length, described in the course syllabus as follows:. Phase One: Discussion and Analysis. This is approximately five class sessions. We will discuss and analyze the contextual and background material, and the perspectives represented by stakeholders, scholars, and reporters.

Phase Two: Targeted Research. This is approximately three class sessions.

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Each student will do research specifically intended to inform and advance the work of constructing the case, present their research and analysis to the rest of the class, and field questions regarding the research itself and its applicability to the bioethics framework. Additional presentation time may be necessary, depending upon the final class size.


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It is intended that this Phase take place entirely during class sessions, and will cover the remainder of the semester. At this juncture, characters have been revealed via the framing of bioethics issues. The engagement of characters with each other and their circumstances e. The class will divide into writing teams, according to which characters interact in a given setting, in a given class period. These interactions will be facilitated by the faculty instructor.

The writing process, which begins approximately two-thirds of the way into the semester, is facilitated via the intra- and inter-group dynamics of as many as four writing teams, whose memberships change according to the scene, dialog, and character interactions of a given writing session.

Circulating between writing teams during class sessions, the faculty instructor is able to work with each team, providing on-the-spot monitoring, prompting, and editorial suggestions, both to ensure narrative continuity and to maintain a proper balance between character, narrative, and issues. Scripts are crafted to highlight questions and tensions, in order to promote lively and nuanced post-performance discussion. The class prepares lists of audience discussion questions and drafts framing materials event introduction, and guidelines for discussion facilitators to ensure that all participants understand the necessary complementarity of performance and discussion.

Every aspect of every reading thus points toward discussion. Moreover, discussion is designed in the course and managed in each presentation not only to build on the case presented, but also to incorporate the experiences and perceptions of diverse audiences, whose insights have the capacity to greatly enrich the interpretation and discussion of the issues.

An MSII class, for example, will necessarily represent strong backgrounds in the life sciences, even if some might have had a humanities or social science discipline as their major undergraduate course of study. The Graduate Program in Bioethics at Wake Forest University, however, not only shows a similar breadth of disciplinary backgrounds, but also has a student population that includes fully credentialled physicians, nurses, physician assistants, and practicing attorneys, as well as current and future medical, law, and divinity students, and others with undergraduate backgrounds in STEM disciplines as well as the humanities and social sciences.

Although there are often significant differences in disciplinary background and career experience within a given class, or from one class to another, the learning objectives for students are consistent, regardless of topic or issue area. The PCS syllabus states these objectives as: 1 Careful and thorough research.

Furthermore, it is not required that the case itself represent the homogenization of the perspectives and analyses that emerge as the semester unfolds. Rather, it is understood that divergences of opinion and interpretation will enrich not only the process but also the end result. This pedagogical method works equally well with all student cohorts, not only because of the scholarly imperatives that attend bioethics inquiry regardless of method, but also because this particular method, as mentioned previously, allows even demands a recognition that complex ethical issues are not binary, but multifaceted.

Professor Robeson and his students have researched and written 13 original case studies to date. Each of those created by bioethics graduate students has been presented, with discussion, as a campus-wide event sponsored by the Wake Forest University Center for Bioethics, Health, and Society. The case that formed the basis of the work of the class was a family controversy that arose when the wife of a retired physician with dementia allegedly consulted Dr.

Cases in Medical Ethics: Student-Led Discussions - Markkula Center for Applied Ethics

The class was provided by Richard Robeson with newspaper clippings detailing the court proceedings and interviews with family members. Nancy King compiled resources about end-of-life decisions, capacity to consent, surrogate decision-making, and the distinctions between withholding treatment, physician-assisted suicide, and euthanasia.

The case study, while short, is vivid and surprisingly nuanced. This is attributable in no small measure to the aforementioned tri-phasic process. By the time that the case construction is begun, the students, having spent two-thirds of a semester identifying and discussing the salient ethical issues, have also identified or imagined stakeholders who represent those issues.

From this point, the essential writing task is to engage the issue or circumstance as the stakeholder. Given that most of the students who have taken this course over the years expect to work in clinical ethics or biomedical caregiving settings, the ability to identify with a challenging or unfamiliar ethical position has both immediate and enduring value. The writing teams vary from one class session to another, depending upon which elements of the narrative arc are being developed.

It is also critically important that the lines of dialogue be spoken aloud as they are written. Having the dialogue develop as spoken language helps to ensure that it is conversational, and embodying the character can sometimes result in exchanges that are completely unplanned. Taking care of your father has become so difficult. Have you heard of him? I think the time has come to make a decision. The dialogue here emerged from the positions that the students determined were held by these two stakeholders, based on their research, discussion, and writing work. In the classroom, where other writing teams are working at the same time, similar exchanges are taking place.

The perceived ethical imperatives among family members are sufficiently distinct that the moral high ground, as it were, is difficult to discern. And this, of course, is the reason that a case study in this form has such power, both as narrative, and as stimulus to multiple lines of bioethical inquiry. I just got done talking to him and he seems suicidal! Why are you surprised? I just told you your husband wants to kill himself and I think you should be doing more. HANK: And you support his taking his own life? HANK: Hard? Hard for you?

What about him? What about us? Rubenstein and have him put Dad out of your misery? HANK: To kill himself?!! Or should I say, to have you kill him?