Complex Considerations: 'Right to Try' Laws Raise Ethical Concerns
March-April 2018, Health Progress
Nicholas J. Kockler, Ph.D., M.S.

In 2015, the Oregon legislature passed a "Right to Try" law allowing a qualified patient to use an investigational product, meaning one that has not been approved by the U.S. Food and Drug Administration, when the product is offered by a lawfully authorized health care practitioner for the purposes of treating a terminal illness.1 To date, 38 states have passed Right to Try laws, and in 2017 the U.S. Senate...Read the full article

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Caring for Patients with a History of Illicit Intravenous Drug Use: Ethical Obligations from Bedside to Boardroom
Winter 2017, Health Care Ethics USA
Nicholas J. Kockler

A few years ago, Infection Control in one of our ministries asked for an ethicist’s perspective of whether it was ethically permissible to unilaterally remove a peripherally-inserted central catheter (PICC) from a person who tampered with it and who had a history of illicit intravenous drug use. The tampering concern was precipitated by regulations on... Read full article

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Competencies Required for Clinical Ethics
Consultation as Coaching
2015 Fall, Health Care Ethics USA
Nicholas J. Kockler, Ph.D, M.S. and Kevin M. Dirksen, M.Div, MSC

Editors note: A version of this paper was presented by the authors at the International Conference on Clinical Ethics Consultation in May 2015.

Elsewhere we have described our philosophy and practice of clinical ethics consultation as coaching; 1 here, we wish to describe the competencies required for performing ethics consultation in this manner. We define coaching as a set of activities performed by one person (or more) to assist and support another individual or group striving to achieve excellence in a given field or discipline. 2 This coaching modality3 may be distinguished from other.

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Physicians’ Perspectives on Ethically Challenging Situations: Early Identification and Action
2015 July-September, AJOB Empirical Bioethics
Carol Pavlish, Katherine Brown-Saltzman, Kevin M. Dirksen and Alyssa Fine

Even though much has been written about ethical dilemmas and conflicts, little is known about situational factors that increase the risk for these difficult experiences to develop....Identifying risk factors for ethical conflicts shifts the gaze from downstream, rescue efforts on a case-by-case basis toward more proactive, integrated, and system-wide approaches (Foglia et al. 2012)....

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Incorporating Balanced Accountability in a Clinical
Ethics Fellowship Program
2014 June, The American Journal of Bioethics
Kevin M. Dirksen

As the emerging profession of clinical ethics continues to reflect on important questions such as attestation, certification, and accreditation (Magill 2013),Weise and Daly (2014) provide the opportunity to consider the degree to which clinical ethics consultants should accept accountability for the advice rendered in an ethics consult....

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Capacity: About Autonomy or Authorization?
2013, October-December, AJOB Neuroscience
James A. Hynds and Kevin M. Dirksen

Among other things, the authors of this interesting article remind us of a basic truth in clinical ethics, namely, that the mere possession of consciousness (i.e., being awake and aware) is not sufficient cognitive endowment to enjoy the right to make and have respected one’s decisions regarding medical care. It is necessary, in addition, that a patient possess a further endowment that clinicians and ethicists have come almost universally to call...

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The Existential Question in Palliative Sedation: Reply to Putman et al.
2013 May, Journal of Pain and Symptom Management
Kevin M. Dirksen, MDiv, MSc, James A. Hynds, LLB, PhD, Ayesha R. Bhavsar, PhD and Katherine Brown-Saltzman, MA, RN

To the Editor: Putman et al.1 provide an important contribution to the palliative sedation literature in evidencing that physicians see a critical difference between intending unconsciousness and merely tolerating it as a foreseen, although unintended consequence. They further examine whether physicians believe that a patient has the right to decide to hasten one’s death... Read full letter

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Dissenting on the Matter of Assent
2013, January-March, AJOB Neuroscience
Kevin M. Dirksen and Katherine Brown-Saltzman

Sheer vulnerability marks the patient in a minimally conscious state (MCS) who was previously diagnosed persistently vegetative: retaining a certain level of awareness but otherwise being profoundly impeded from engaging with the outside world (Posner et al. 2007, 360). That it is even a question of, as Wilkinson and Savulescu (2012) recently inquire in their title, “Is it better to be minimally conscious than vegetative?” is evidence enough...

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Uncovering the Real Work Behind Policy Development
2012 November, The American Journal of Bioethics
Kevin M. Dirksen and Katherine Brown-Saltzman

Clinical ethicists should appreciate that there must be a greater quality focus within their profession, especially in an area such as ethics policy work with its lasting influence on patients and providers. As Frolic and colleagues (2012) show, there is a dearth of scholarly literature addressing this activity; they call for practice standards and quality review to address this deficiency. Unfortunately, the development of practice standards and lessons from quality review will....

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Ethics Education Enhances Skills of Doctors in Training
2012 May-June, Health Progress               
John Tuohey, Ph.D. and Nicholas J. Kockler, Ph.D., MS

Samuel is a 36-year-old gentleman who was building a home with his girlfriend of six years. One day she drove out to the construction site and found him on the ground, not breathing, and pulseless. She dialed 911 and initiated CPR as best she could. When the EMTs arrived, they took over, managed to get a heartbeat and maintained his breathing on the way to the hospital. Upon admission he was… Read the full article

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The Historical Roots of Personalism
2012 by Bijdragen: International Journal for Philosophy and Theology
Kevin M. Dirksen and Paul T. Schotsmans

In line with Johan De Tavernier's recently produced historical survey of various articulations of personalism, detailing the origination and contribution of four European voices1, a further examination of the Boston personalist corpus is provided in this investigation. Indeed, De Tavernier claims to include 'American personalism', however, the article provides only a minimal treatment of personalism in the United Stated in favour of....

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Care Across Cultures: Does Every Patient Need to Know? 
2012 March-April, Health Progress
Marian Hodges, M.D., MPH and Barbara A. Segal, MA, MS

An 85-year-old Russian man is admitted to the hospital complaining of increasing back pain. In the ER, an abdominal CAT scan indicates evidence of new metastatic disease to his spine. The patient has limited English skills. When the admitting hospitalist and an interpreter enter the room, they see the patient surrounded by his daughter and other relatives talking in Russian... Read the full article

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End of Life: POLST Reflects Patient Wishes, Clinical Reality
2011 March-April, Health Progress
Rev. John Tuohey, Ph.D. and Marian O. Hodges, M.D.

The case of Sarah is a good starting point: Sarah is a 95-year-old, frail woman living in a retirement home. She has hypertension and osteoporosis, and she has been slowly losing weight. She has discussed code status with her doctor and has asked for “Do Not Attempt Resuscitation” (DNAR), which is marked in her chart. One afternoon, the staff finds her down, unresponsive and cyanotic in the hallway… Read the full article

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A Fatal Conflict: Can Catholic Hospitals Refuse to Save Lives?
2011 Jan., Commonweal
John F. Tuohey, Ph.D.

It is commonly accepted that any entity that is part of the Catholic health-care ministry must offer its services in a manner consistent with the Ethical and Religious Directives for Catholic Health Care Services (ERDs), a publication of the United States Conference of Catholic Bishops (USCCB). The ERDs help distinguish Catholic health care from other systems, in part by… Read the full article

Ethical Considerations in the Risk-Benefit Analysis for Patients with Diminished Capacity
2009 Winter, Journal of Hospital Ethics
John Tuohey, Ph.D. and Jeffery T. Young, M.D.

Ms. Y is a 64-year-old woman who presented to the Emergency Department (ED) with chest pain, shortness of breath and a history of fainting. She consented to admission to a medical unit. She was diagnosed with aortic stenosis, presumably severe. The clinician recommended that Ms. Y receive cardiac catheterization…Ms. Y told the clinician she was not interested, but would take her vitamins… Download a PDF of the article

Redefining Death as a Way to Procure More Vital Organs: A Response
2009 Spring, Health Care Ethics USA
Rev. John Tuohey, Ph.D.

Recent ethical literature on organ donation in the United States focuses on the reality that there are far more patients on a waiting list for a transplant than there are donors. It is estimated that there are approximately 170,000 people living today in the United States who are recipients of an organ donation, yet as many as 7,000 patients die annually because there are not enough organs… Read the full article

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A Matrix for Ethical Decision Making in a Pandemic: The Oregon Tool for Emergency Preparedness
2007 November, Health Progress
Fr. John F. Tuohey, Ph.D.

In recent years, there has been a great deal of interest in emergency preparedness. This is especially true in light of concerns about a pandemic of the H5N1 virus, the “bird flu.” Ethical concerns include ensuring access to basic resources such as health care, and the duties of professionals to perform their task in the face of such events. Like other states, Oregon set out to establish an… Read the full article

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Screening for Aneuploidy: A Complex Ethical Issue
2007 Spring, Health Care Ethics USA
Rev. John Tuohey, Ph.D.

People often use the terms ‘risk’ and ‘chance’ interchangeably. We might hear before cardiac surgery, “There is a risk/chance of stroke with this procedure.” Greater care is found in research; an institutional review board (IRB) will generally look askance at language in a consent form suggesting there is a ‘chance’ of some effect. An IRB will insist that a consent form clearly state the ‘risks’ involved… Read the full article

Making Access A Priority
2007 March-April, Health Progress
Rev. John Tuohey, Ph.D.

In 2004, the Portland, Ore., Oregonian published a letter to the editor from the directors of the various ethics programs of the state's health care systems. I was among the signers, representing Seattle-based Providence Health & Services in Oregon. In the letter, we said that we planned to bring together the Portland area's top health care leaders and ethicists to discuss how we might better coordinate... Read the full article

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The Five People You Meet in a Pandemic—and What They Need from You Today
2006 Sept., The Hastings Center Bioethics Backgrounder
Nancy Berlinger and Jacob Moses in collaboration with Providence Center for Health Care Ethics

In April 2007, all state public health directors submitted their pandemic influenza preparedness plans to the Centers for Disease Control (CDC), in response to an assignment and template from the National Strategy for Pandemic Influenza, coordinated by the Departments of Health and Human Services (HHS) and Homeland Security. Officials were required to describe how they will deploy public… Read the full article

Ethics Consultation in Portland
2006 March-April, Health Progress
Fr. John Tuohey, Ph.D.
The Portland Service Area (PSA) of Providence Health System, Oregon Region, where I work, comprises three hospitals: Providence St. Vincent Medical Center and Providence Portland Medical Center, both of which have internal residency programs, and Providence Milwaukie Hospital, which has a family practice residency program. Each has an ethics committee. Historically, one responsibility of an ethics committee has been to provide a resource or forum for ethics consultations. Six years ago, the PSA committees… Read the full article

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