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"Disorders of Consciousness (DOCs) identify a diverse group of dysfunctions affecting individuals who have survived severe brain damage. Although the clinical evaluation of patients with DOC normally depends on their residual ability to create a connection with the outside world through motor behavior, in the last ten years neuroscientists have made a great effort to better characterize the patient's consciousness even in the case of reduced or no motor reactivity. Often, in fact, patients with DOCs are not able to perform any type of movement or adequately understand the command required but they might be still conscious or at least minimally conscious. The gap between patients' motor capability and their residual brain complexity raises important moral issues, especially about appropriateness and proportionality of interventions and treatments. We argue that Clinical Ethics Consultation may be crucial in addressing these clinical scenarios, which assume aspects of further drama when the DOC derives from a sudden and unexpected acute event such as a trauma or a cerebrovascular accident in healthy patients. In these situations, given the particular vulnerability of the patients and the unpredictability of the diseases, Ethics Consultants should be involved in the therapeutic process in order to improve the standard of care, ensuring compliance with the inclinations and desires of the patients. Moreover, Ethics Consultants should monitor that the procedures are rigorously managed in the context of fully understood consent of those who are legally entitled to make decision. "

Ethical issues facing anesthesiologists are more far-reaching than those involving virtually any other medical specialty. In this clinical ethics textbook, authors from across the USA, Canada and Europe draw on ethical principles and practical knowledge to provide a realistic understanding of ethical anesthetic practice. The result is a compilation of expert opinion and international perspectives from clinical leaders in anesthesiology. Building on real-life, case-based problems, each chapter is clinically focused and addresses both practical and theoretical issues. Topics include general operating room care, pediatric and obstetrical patient care, the intensive care unit, pain practice, research and publication, as well as discussions of lethal injection, disclosure of errors, expert witness testimony, triage in disaster and conflicts of interest with industry. An important reference tool for any anesthesiologist, whether clinical or research-oriented, this book is especially valuable for physicians involved in teaching residents and students about the ethical aspects of anesthesia practice

Examines health ethics, focusing on the need to broaden the scope beyond the just distribution of clinical care within health care systems, to include public health interventions and justice across national borders; role of individual autonomy in medical ethics.

Most work in medical ethics across the last twenty-five years has centered on the ethics of clinical medicine. Even work on health and justice has, in the main, been concerned with the just distribution of (access to) clinical care for individual patients. By contrast, the ethics of public health has been widely neglected. This neglect is surprising, given that public health interventions are often the most effective (and most cost-effective) means of improving health in rich and poor societies alike.In this essay I explore two sources of contemporary neglect of public health ethics. One source of neglect is that contemporary medical ethics has been preoccupied—in my view damagingly preoccupied—with the autonomy of individual patients. Yet individual autonomy can hardly be a guiding ethical principle for public health measures, since many of them must be uniform and compulsory if they are to be effective. A second source of neglect is that contemporary political philosophy has been preoccupied—in my view damagingly preoccupied—with the requirements for justice within states or societies, and (until very recently) has hardly discussed justice across borders. Yet public health problems often cross borders, and public health interventions have to measure up to the problems they address.

"Conducting ethical case discussions is a core aspect of any clinical ethics support service or work as an ethical consultant in a hospital. Numerous case discussion methods can be used to do this, many of which are based on Beauchamp and Childress' four biomedical principles. Other commonly used types are the 'moral case deliberations' by prominent authors such as Widdershoven, Molewijk et al. However, based on our practical work as clinical ethicists, and doctoral students in the field of clinical ethics, we would like to hypothesize that most of the methods seem to be in need of philosophical supplementation, especially on the blind spots regarding the is-ought fallacy, i.e. how to relate empirical data to normative conclusions. A further weakness may be found in the inadequate handling of power structures, which may lead to an unjust handling of opinions. In our talk, we will therefore present Miranda Fricker's conceptual idea of 'epistemic injustice' and we will apply these insights to clinical cases of our everyday practice. Epistemic injustice is injustice related to knowledge. The concept focuses on exclusion and silencing people in public discourse. This silencing leads to a systematic distortion or misrepresentation of one's meanings or contributions and/or to an undervaluing of someone's status in communicative practices. We think that this concept has not been considered in clinical ethics thus far, and we would like to discuss whether ethical case discussions should not help to avoid epistemic injustice. If so, then the case discussion methods of our discipline should be adapted accordingly. "

Background Rationing and allocation decisions at the clinical level – bedside rationing – entail complex dilemmas that clinicians and managers often find difficult to handle. There is a lack of mechanisms and aids for promoting fair decisions, especially in hard cases. Reports indicate that clinical ethics committees (CECs) sometimes handle cases that involve bedside rationing dilemmas. Can CECs have a legitimate role to play in bedside rationing? Main text Aided by two frameworks for legitimate priority setting, we discuss how CECs can contribute to enhanced epistemic, procedural and political legitimacy in bedside rationing decisions. Drawing on previous work we present brief case vignettes and outline several potential roles that CECs may play, and then discuss whether these might contribute to rationing decisions becoming legitimate. In the process, key prerequisites for such legitimacy are identified. Legitimacy places demands on aspects such as the CEC's deliberation process, the involvement of stakeholders, transparency of process, the opportunity to appeal decisions, and the competence of CEC members. On these conditions, CECs can help strengthen the legitimacy of some of the rationing decisions clinicians and managers have to make. Conclusions On specified conditions, CECs can have a well-justified advisory role to play in order to enhance the legitimacy of bedside rationing decisions. ; publishedVersion