33 found
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  1. Vaccine ethics: an ethical framework for global distribution of COVID-19 vaccines.Nancy S. Jecker, Aaron G. Wightman & Douglas S. Diekema - forthcoming - Journal of Medical Ethics.
    This paper addresses the just distribution of vaccines against the SARS-CoV-2 virus and sets forth an ethical framework that prioritises frontline and essential workers, people at high risk of severe disease or death, and people at high risk of infection. Section I makes the case that vaccine distribution should occur at a global level in order to accelerate development and fair, efficient vaccine allocation. Section II puts forth ethical values to guide vaccine distribution including helping people with the greatest need, (...)
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  2.  74
    Revisiting the Best Interest Standard: Uses and Misuses.Douglas S. Diekema - 2011 - Journal of Clinical Ethics 22 (2):128-133.
    The best interest standard is the threshold most frequently employed by physicians and ethics consultants in challenging a parent’s refusal to provide consent for a child’s medical care. In this article, I will argue that the best interest standard has evolved to serve two different functions, and that these functions differ sufficiently that they require separate standards. While the best interest standard is appropriate for choosing among alternative treatment options for children, making recommendations to parents, and making decisions on behalf (...)
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  3.  40
    Prioritizing Frontline Workers during the COVID-19 Pandemic.Nancy S. Jecker, Aaron G. Wightman & Douglas S. Diekema - 2020 - American Journal of Bioethics 20 (7):128-132.
    Volume 20, Issue 7, July 2020, Page 128-132.
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  4.  64
    Ashley Revisited: A Response to the Critics.Douglas S. Diekema & Norman Fost - 2010 - American Journal of Bioethics 10 (1):30-44.
    The case of Ashley X involved a young girl with profound and permanent developmental disability who underwent growth attenuation using high-dose estrogen, a hysterectomy, and surgical removal of her breast buds. Many individuals and groups have been critical of the decisions made by Ashley's parents, physicians, and the hospital ethics committee that supported the decision. While some of the opposition has been grounded in distorted facts and misunderstandings, others have raised important concerns. The purpose of this paper is to provide (...)
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  5.  33
    Ethical Guidance for Selecting Clinical Trials to Receive Limited Space in an Immunotherapy Production Facility.Nancy S. Jecker, Aaron G. Wightman, Abby R. Rosenberg & Douglas S. Diekema - 2018 - American Journal of Bioethics 18 (4):58-67.
    Our aims are to set forth a multiprinciple system for selecting among clinical trials competing for limited space in an immunotherapy production facility that supplies products under investigation by scientific investigators; defend this system by appealing to justice principles; and illustrate our proposal by showing how it might be implemented. Our overarching aim is to assist manufacturers of immunotherapeutic products and other potentially breakthrough experimental therapies with the ethical task of prioritizing requests from scientific investigators when production capacity is limited.
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  6.  18
    Competencies and Milestones for Bioethics Trainees: Beyond ASBH’s Healthcare Ethics Consultant Certification and Core Competencies.Douglas S. Diekema, Anna Snyder, Nicolas Dundas & Kimberly E. Sawyer - 2021 - Journal of Clinical Ethics 32 (2):127-148.
    Clinical ethics training programs are responsible for preparing their trainees to be competent ethics consultants worthy of the trust of patients, families, surrogates, and healthcare professionals. While the American Society for Bioethics and Humanities (ASBH) offers a certification examination for healthcare ethics consultants, no tools exist for the formal evaluation of ethics trainees to assess their progress toward competency. Medical specialties accredited by the Accreditation Council for Graduate Medical Education (ACGME) use milestones to report trainees’ progress along a continuum of (...)
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  7.  27
    From protection to entitlement: selecting research subjects for early phase clinical trials involving breakthrough therapies.Nancy S. Jecker, Aaron G. Wightman, Abby R. Rosenberg & Douglas S. Diekema - 2017 - Journal of Medical Ethics 43 (6):391-400.
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  8.  32
    Taking children seriously: What's so important about assent?Douglas S. Diekema - 2003 - American Journal of Bioethics 3 (4):25 – 26.
  9.  6
    Do Clinical Ethics Fellowships Prepare Trainees for Their First Jobs? A National Survey of Former Clinical Ethics Fellows.Kathryn L. Weise, Sabahat Hizlan, Douglas S. Diekema & Robert M. Guerin - 2020 - Journal of Clinical Ethics 31 (4):372-382.
    Clinical ethics consultants provide a range of services in hospital settings and in teaching environments. Training to achieve the skills needed to meet the expectations of employers comes in various forms, ranging from on-the-job training to formal fellowship training programs. We surveyed graduates of clinical ethics fellowships to evaluate their self-reported preparedness for their first job after fellowship training. The results indicated several areas of need, including greater exposure to program-building skills, quality improvement skills, and approaches to working with members (...)
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  10.  44
    Physician Dismissal of Families Who Refuse Vaccination: An Ethical Assessment.Douglas S. Diekema - 2015 - Journal of Law, Medicine and Ethics 43 (3):654-660.
    Thousands of U.S. parents choose to refuse or delay the administration of selected vaccines to their children each year, and some choose not to vaccinate their children at all. While most physicians continue to provide care to these families over time, using each visit as an opportunity to educate and encourage vaccination, an increasing number of physicians are choosing to dismiss these families from their practice unless they agree to vaccinate their children. This paper will examine this emerging trend along (...)
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  11.  17
    Rhetoric, Persuasion, Compulsion, and the Stubborn Problem of Vaccine Hesitancy.Douglas S. Diekema - 2022 - Perspectives in Biology and Medicine 65 (1):106-123.
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  12.  29
    Agreed: The Harm Principle Cannot Replace the Best Interest Standard … but the Best Interest Standard Cannot Replace The Harm Principle Either.D. Micah Hester, Kellie R. Lang, Nanibaa' A. Garrison & Douglas S. Diekema - 2018 - American Journal of Bioethics 18 (8):38-40.
    In Bester’s article (2018) challenging the use of the harm principle and advocating sole reliance on the use of a best interest standard (BIS) in pediatric decision-making, we believe that the auth...
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  13.  35
    Navigating Growth Attenuation in Children with Profound Disabilities.Benjamin S. Wilfond, Paul Steven Miller, Carolyn Korfiatis, Douglas S. Diekema, Denise M. Dudzinski & Sara Goering - 2010 - Hastings Center Report 40 (6):27-40.
    A twenty‐person working group convened to discuss the ethical and policy considerations of the controversial intervention called “growth attenuation,” and if possible to develop practical guidance for health professionals. A consensus proved elusive, but most of the members did reach a compromise.
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  14.  10
    Pandemics and Beyond: Considerations When Personal Risk and Professional Obligations Converge.Douglas S. Diekema, Joan S. Roberts, Mithya Lewis-Newby & Daniel J. Benedetti - 2021 - Journal of Clinical Ethics 32 (1):20-34.
    With each novel infectious disease outbreak, there is scholarly attention to healthcare providers’ obligation to assume personal risk while they care for infected patients. While most agree that healthcare providers have a duty to assume some degree of risk, the extent of this obligation remains uncertain. Furthermore, these analyses rarely examine healthcare institutions’ obligations during these outbreaks. As a result, there is little practical guidance for healthcare institutions that are forced to weigh whether or when to exclude healthcare providers from (...)
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  15.  10
    Integrating Ethics and Patient Safety: The Role of Clinical Ethics Consultants in Quality Improvement.Robert A. Pearlman, Benjamin S. Wilfond, Douglas S. Diekema, Dena Brownstein & Douglas J. Opel - 2009 - Journal of Clinical Ethics 20 (3):221-227.
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  16.  56
    Navigating Growth Attenuation in Children with Profound Disabilities.Benjamin S. Wilfond, Paul Steven Miller, Carolyn Korfiatis, Douglas S. Diekema, Denise M. Dudzinski, Sara Goering & The Seattle Growth Attenuation and Ethics Working Group - 2010 - Hastings Center Report 40 (6):27-40.
    A twenty‐person working group convened to discuss the ethical and policy considerations of the controversial intervention called “growth attenuation,” and if possible to develop practical guidance for health professionals. A consensus proved elusive, but most of the members did reach a compromise.
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  17.  8
    Limits on Parental Discretion in Medical Decision-Making: pediatric intervention principles converge.Mark Christopher Navin, Jason Adam Wasserman, Douglas S. Diekema & Thaddeus M. Pope - 2024 - Perspectives in Biology and Medicine 67 (2):277-289.
    Pediatric intervention principles help clinicians and health-care institutions determine appropriate responses when parents’ medical decisions place children at risk. Several intervention principles have been proposed and defended in the pediatric ethics literature. These principles may appear to provide conflicting guidance, but much of that conflict is superficial. First, seemingly different pediatric intervention principles sometimes converge on the same guidance. Second, these principles often aim to solve different problems in pediatrics or to operate in different background conditions. The potential for convergence (...)
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  18.  11
    Decision Making on Behalf of Children: Understanding the Role of the Harm Principle.Douglas S. Diekema - 2019 - Journal of Clinical Ethics 30 (3):207-212.
    Thirty years ago, Buchanan and Brock distinguished between guidance principles and interference principles in the setting of surrogate decision making on behalf of children and incompetent adult patients. They suggested that the best interest standard could serve as a guidance principle, but was insufficient as an interference principle. In this issue of The Journal of Clinical Ethics, Ross argues that the best interest standard can serve as neither a guidance nor interference principle for decision making on behalf of children, but (...)
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  19.  21
    Integrating Ethics and Patient Safety: The Role of Clinical Ethics in Quality Improvment (vol 20, pg 220, 2009).Douglas J. Opel, Dena Brownstein, Douglas S. Diekema, Benjamin S. Wilfond & Robert A. Pearlman - 2009 - Journal of Clinical Ethics 20 (4):370-370.
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  20.  23
    Parental Refusals of Blood Transfusions from COVID-19 Vaccinated Donors for Children Needing Cardiac Surgery.Daniel H. Kim, Emily Berkman, Jonna D. Clark, Nabiha H. Saifee, Douglas S. Diekema & Mithya Lewis-Newby - forthcoming - Narrative Inquiry in Bioethics.
    There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...)
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  21.  33
    The role of family liaisons in research ethics consultations.Halle Showalter Salas, Zuraya Aziz & Douglas S. Diekema - 2008 - American Journal of Bioethics 8 (3):27 – 28.
  22.  5
    Parental Refusals of Blood Transfusions from COVID-19 Vaccinated Donors for Children Needing Cardiac Surgery.Daniel H. Kim, Emily Berkman, Jonna D. Clark, Nabiha H. Saifee, Douglas S. Diekema & Mithya Lewis-Newby - 2023 - Narrative Inquiry in Bioethics 13 (3):215-226.
    There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID-19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...)
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  23.  26
    The Case of A.R.: The Ethics of Sibling Donor Bone Marrow Transplantation Revisited.Douglas J. Opel & Douglas S. Diekema - 2006 - Journal of Clinical Ethics 17 (3):207-219.
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  24.  29
    DNAR in the Schools: Watch Your Language!Douglas S. Diekema - 2005 - American Journal of Bioethics 5 (1):76-78.
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  25.  15
    A Quality of Life Quandary: A Framework for Navigating Parental Refusal of Treatment for Co-Morbidities in Infants with Underlying Medical Conditions.Douglas J. Opel, Douglas S. Diekema, Ryan M. McAdams & Sarah N. Kunz - 2015 - Journal of Clinical Ethics 26 (1):16-23.
    Parental refusal of a recommended treatment is not an uncommon scenario in the neonatal intensive care unit. These refusals may be based upon the parents’ perceptions of their child’s projected quality of life. The inherent subjectivity of quality of life assessments, however, can exacerbate disagreement between parents and healthcare providers. We present a case of parental refusal of surgical intervention for necrotizing enterocolitis in an infant with Bartter syndrome and develop an ethical framework in which to consider the appropriateness of (...)
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  26.  11
    Staffing crisis capacity: a different approach to healthcare resource allocation for a different type of scarce resource.Catherine R. Butler, Laura B. Webster & Douglas S. Diekema - forthcoming - Journal of Medical Ethics.
    Severe staffing shortages have emerged as a prominent threat to maintaining usual standards of care during the COVID-2019 pandemic. In dire settings of crisis capacity, healthcare systems assume the ethical duty to maximise aggregate population-level benefit of existing resources. To this end, existing plans for rationing mechanical ventilators and intensive care unit beds in crisis capacity focus on selecting individual patients who are most likely to survive and prioritising these patients to receive scarce resources. However, staffing capacity is conceptually different (...)
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  27.  13
    Boldt v. Boldt: A Pediatric Ethics Perspective.Douglas S. Diekema - 2009 - Journal of Clinical Ethics 20 (3):251-257.
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  28.  14
    Decision-Making for Children with Disabilities: Parental Discretion and Moral Ambiguity.Douglas S. Diekema & Benjamin S. Wilfond - 2015 - Perspectives in Biology and Medicine 58 (3):328-331.
    The case presented here is tragic, not just in the sense of being a sad story, but in the dramatic meaning of tragedy. It presents us with a situation where there is no clear path, where moral ambiguity exists, and where no possible solution could unequivocally be declared the right or good one. Ethical deliberation can help here, but only as a way of clarifying the issues and offering reasonable solutions. It cannot show us the one right way.Baby G has (...)
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  29.  17
    Hans Jonas and the Ethics of Human Subjects Research.Douglas S. Diekema - 2020 - Hastings Center Report 50 (1):8-9.
    In the 1960s, human experimentation and public funding of research increased significantly, and with the rise of the modern teaching hospital, the distinction between clinical care and experimentation became more and more blurred. Yet little in the way of meaningful government regulation existed in the United States prior to 1970. In 1966, Paul Freund, the president of the American Academy of Arts and Sciences, appointed an interdisciplinary working group to consult on the issues being raised by human experimentation. Contributions from (...)
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  30.  15
    The armchair ethicist: it's all about location.Douglas S. Diekema - 2007 - Journal of Clinical Ethics 18 (3):227.
  31.  14
    A Quality Improvement Approach to Improving Informed Consent Practices in Pediatric Research.Mary Beth Foglia, Halle Showalter Salas & Douglas S. Diekema - 2009 - Journal of Clinical Ethics 20 (4):343-352.
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  32.  15
    Fairly Allocating Space in an Immunotherapy Production Facility: Reply to Critics.Nancy S. Jecker, Aaron G. Wightman, Abby R. Rosenberg & Douglas S. Diekema - 2018 - American Journal of Bioethics 18 (5):W9-W12.
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  33.  9
    Heroics at the End of Life in Pediatric Cardiac Intensive Care: The Role of the Intensivist in Supporting Ethical Decisions around Innovative Surgical Interventions.Mithya Lewis-Newby, Emily Berkman, Douglas S. Diekema & Jonna D. Clark - 2021 - Ethics in Biology, Engineering and Medicine 12 (1):1-13.
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