ACLP Bioethics SIG Briefly Annotated Bibliography

Contributors: Cynthia Geppert, J. Celeste Peay, Brandon S. Hamm, and Kelly L. Hamilton
Formatting: Anita K. Chang
Reviewers: James L. Levenson and Marta D. Herschkopf
Appreciation for those who worked on previous iterations of this bibliography:
Cynthia Geppert, Kristin Beizai, Xavier Jimenez, James Kimball, Laura Weiss Roberts, Mary Ann Cohen, Richard C. Preisman, Maurice D. Steinberg, Teresa A. Rummons, Stuart J. Youngner, Cavin P. Leeman, Marguerite S. Lederberg, Owen S. Surman, and Joel A. Blum

A. General Bioethics Texts

Beauchamp TL, Childress JF: Principles of Biomedical Ethics (9th ed). New York: Oxford University Press 2026; 528 pp. A widely used and quoted textbook in academic ethics for its explanation of the principlism method of ethical analysis.

Jonsen AR, Siegler M, Winslade WJ: Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine (8th ed). New York: McGraw-Hill, 2015; 244 pp. A clinical ethics classic for its casuistic approach and analysis based on the four-box method this book made famous.

B. Psychiatric Ethics Texts

Bloch S, Green SA (Eds): Psychiatric Ethics (5th ed). Oxford; New York: Oxford University Press; 2021; 638 pp. Chapters from many of the most renowned scholars in psychiatric ethics that span the broad spectrum of psychiatric ethics from philosophy to practice.

Roberts LW: A Clinical Guide to Psychiatric Ethics. Washington, DC: APA Press, 2016; 382 pp. An updated overview of ethical dilemmas and approaches to clinical work with children and youth, veterans, patients from culturally distinct backgrounds, HIV/AIDS patients, those at the end of life, patients living with addictions, and more.

C. Topics in Clinical Psychiatric Ethics

1. Advance Care Directives/Surrogate Decision Making

Moye J, Sabatino CP, Brendel RW. Evaluation of the capacity to appoint a healthcare proxy. Am J Geriatr Psychiatry 2013; 21(4):326-336. Discussion of legal basis and a framework to approach the assessment (including suggested questions for clinical assessment). Useful resource.

Gloeckler S, Scholten M, et al. An international comparison of psychiatric advance directive policy: Across eleven jurisdictions and alongside advance directive policy. Int J Law Psychiatry 2025; 101. Comparative policy review of different international approaches to advance directives for psychiatric patients. Interesting article to understand the broad scope of different approaches.

Srebnik D, Appelbaum PS, Russo J. Assessing competence to complete psychiatric advance directives with the competence assessment tool for psychiatric advance directives. Compr Psychiatry 2004; 45(4):239-245. Classic paper outlining a competence assessment for ability to make and effectuate advance care directives or appoint a surrogate decision-maker.

Walaszek A: Clinical ethics issues in geriatric psychiatry. Psychiatr Clin North Am 2009; 32(2):343-359. Assessment of multiple capacities and issues specific to dementia. Excellent overview and resource.

2. Capacity/Informed Consent

Applebaum PS. Clinical practice. Assessment of patients’ competence to consent to treatment. N Engl J Med 2007; 357(18):1834-1840. Approaches to assessment, including relevant criteria and questions for clinical assessment. Excellent resource article for trainees.

Bourgeois JA, Cohen MA, Erickson JM, Brendel RW. Decisional and dispositional capacity determinations: Neuropsychiatric illness and an integrated clinical paradigm. Psychosomatics 2017; 58(6):565-573. Literature review of approaches taken to determine decisional capacity for patients with psychiatric illness or neuropsychiatric manifestations of medical illness.

Ganzini L, Volicer L, Nelson WA, Fox E, Derse AR. Ten myths about decision-making capacity. J Am Med Dir Assoc 2004; 5(4):263-267. Review of 10 common myths. Excellent article to lead a case-based discussion or organize presentations.

3. Clinical Ethics Consultation: The Role of the Psychiatrist

Bourgeois JA, Cohen MA, Geppert CM. The role of psychosomatic-medicine psychiatrists in bioethics: a survey study of members of the Academy of Psychosomatic Medicine. Psychosomatics 2006; 47(6):520-526. A survey of the wide and salient involvement of ACLP members in bioethics activities.

Geppert CM, Cohen MA. Consultation-liaison psychiatrists on bioethics committees: opportunities for academic leadership. Acad Psychiatry 2006; 30(5):416-421. Review of the significant part psychiatrists have played in ethics committees, consultations and professional organizations, and recommendations for promoting this leadership role through education.

4. Confidentiality/Privacy

Appelbaum PS. Privacy in psychiatric treatment: threats and responses. Am J Psychiatry 2002; 159(11):1809-1818. Review of ethical and legal basis for medical privacy, including technological changes. Excellent resource.

Baer W, Schwartz AC. Teaching professionalism in the digital age on the psychiatric consultation-liaison service. Psychosomatics 2011; 52(4):303-309. Review of professionalism, with examples of blunders. Good teaching points for issues with social media.

Mermelstein HT and Wallack JJ. Confidentiality in the age of HIPAA: a challenge for psychosomatic medicine. Psychosomatics 2008; 49(2):97-103. Review of the Standard and Ethics Committee of the Academy of Psychosomatic Medicine examines challenges for consultation-liaison psychiatrists to navigate federal and state laws pertaining to patient privacy while also providing good clinical care.

5. Code Status: DNR/DNI

Bernacki RE, Block SD, American College of Physicians High Value Care Task Force. Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med 2014; 174(12):1994-2003. Reviews best practices with practical advice, including a systematic approach and conversation guide. Useful for teaching communication strategies.

Kota KJ, Chen C, et al, Aligning patient values and code status: Choice of Diction’s Effect (CODE) study. J Am Geriatric Soc. 2024; 72(7): 2120-2125. Study exploring how changing terminology when discussing code status affects patients’ experience of code status discussions.

Martin RD, Cohen MA, Roberts LW, Batista SM, Hicks D, Bourgeois J. DNR versus DNT: clinical implications of a conceptual ambiguity: a case analysis. Psychosomatics 2007; 48(1):10-15. Case-based discussion of end-of-life issues. Useful in case-based ethics teaching.

Ryan RE, Connolly M, et al. Interventions for interpersonal communication about end of life care between health practitioners and affected people. Cochrane Database Syst Rev 2022; 7(7):CD013116. Cochrane review of different approaches taken to assess the effects of interventions designed to improve communication around end of life conversations.

6. DNR and Suicide

Cook R, Pan P, Silverman R, Soltys SM. Do-not-resuscitate orders in suicidal patients: clinical, ethical, and legal dilemmas. Psychosomatics 2010; 51(4):277-282. Case-based review of ethical, clinical, and legal issues with DNR orders and suicidal patients.

Nowland R, Steeg S, Quinlivan LM, et al. Management of patients with an advance decision and suicidal behavior: a systematic review BMJ Open, 2019; 9:e023978. This systematic review examines the management of advance decisions (including DNR orders) in patients presenting with suicidal behavior. The study identifies challenges in balancing patient autonomy with the duty to protect vulnerable individuals, highlighting the need for clear guidelines and support for clinicians facing these ethical dilemmas.

7. Eating Disorders

Tumba J, Smith M, Rodenbach KE. Clinical and ethical dilemmas in the involuntary treatment of anorexia nervosa. Harv Rev Psychiatry 2023; 31(1):14-21. Discusses the variability in pursuit of involuntary treatment for starvation in anorexia nervosa, highlighting differing perspectives on autonomy and thresholds, which contribute to the variability and complexity of capacity evaluation in these circumstances. Authors argue involuntary feeding is ethically justified when patients are incapacitated or when death is imminent.

Treem J, Yager J, Gaudiani JL. A Life-Affirming Palliative Care Model for Severe and Enduring Anorexia Nervosa. AMA J Ethics. 2023 Sep 1;25(9). Discusses the need for an alternative, palliative care model of treatment of severe and enduring anorexia nervosa. Rather than framing care as curative or futile, the model emphasizes harm reduction, patient-defined quality of life, and respect for autonomy while still addressing medical risk.

8. Ethics and Law

Brendel RW, Schouten R. Legal concerns in psychosomatic medicine. Psychiatr Clin North Am 2007; 30(4):663-676. Overview of relevant legal issues including treatment consent and refusal, malpractice, HIPAA, abuse and neglect. Excellent resource.

Haltaufderheide J, Gather J, Juckel G, et al. Types of ethical problems and expertise in clinical ethics consultation in psychiatry – insights from a qualitative empirical ethics study. Front Psychiatry 2021; 25:12:558795. Discussion of the role of “ethics consultant” that the consultation-liaison psychiatrist is asked to assume in some settings. Review of empirical data in identifying the types of issues most likely to require an ethics consultation.

Meisel A, Snyder L, Quill T, American College of Physicians–American Society of Internal Medicine End-of-Life Care Consensus Panel. Seven legal barriers to end-of-life care: myths, realities, and grains of truth. JAMA 2000; 284(19):2495-2501. Seven legal myths. Useful for teaching and a lead in discussing state laws.

9. Medically-Assisted Death

Bostwick JM, Pabst Battin M, Cohen L, Strouse TB. Words Matter: Why Distinguishing Medical Aid in Dying From Suicide Should Matter to a Consultation-Liaison Psychiatrist. J Acad Consult Liaison Psychiatry. 2024 Jul-Aug;65(4):388-395. Perspective on differentiating between medical aid in dying (MAiD), suicide and the role of the consult-liaison psychiatrist in helping remove the stigma of suicide from end-of-life decisions.

Cohen LM, Steinberg MD, Hails KC, Dobscha SK, Fischel SV. Psychiatric evaluation of death-hastening requests. Lessons from dialysis discontinuation. Psychosomatics 2000; 41(3):195-203. Complexities in assessments of death hastening requests, including diagnosing depression, evaluating adequacy of palliative care, and other factors.

Downar J, MacDonald S, Buchman S. Medical assistance in dying, palliative care, safety, and structural vulnerability. J Palliat Med 2023; 26(9):1175-1179. Discussion of some of the ethical considerations around assisted death with an emphasis on how socioeconomic deprivation and inadequate support services may influence individual choice to pursue different end-of-life options.

Ganzini L, Nelson HD, Lee MA, Kraemer DF, Schmidt TA, Delorit MA. Oregon physicians' attitudes about and experiences with end-of-life care since passage of the Oregon Death with Dignity Act. JAMA. 2001 May 9;285(18):2363-9. Self-administered questionnaire from 1999 following the passage of The Oregon Death with Dignity Act in 1997. This survey indicated that physicians over time aimed to improve their care to patients requesting MAiD.

Hanif H, McNiel DE, Weithorn L, Binder RL. Legal implications of psychiatric assessment for medical aid in dying. J Am Acad Psychiatry Law 2024; 52 (3): 347-357. This article examines existing statutory provisions for psychiatric assessments in medical aid in dying (MAiD) within the United States, analyzing the language used and its implications for psychiatric practice.

McCormack R, Fléchais R. The role of psychiatrists and mental disorder in assisted dying practices around the world: a review of the legislation and official reports. Psychosomatics 2012; 53(4):319-326. Assisted dying practices and the role of psychiatry. Useful for discussion of potential conflicts.

Moureau L, Verhofstadt M, Liégeois A. Mapping the ethical aspects in end-of-life care for persons with a severe and persistent mental illness: a scoping review of the literature. Front Psychiatry 2023; 14:1094038. Literature review of articles focused on the ethical considerations of providing end-of-life care to people with severe and persistent mental illness.

10. Palliative Care in Psychiatry

Edwards D, Anstey S, Coffey M, et al. End of life care for people with severe mental illness: mixed methods systematic review and thematic synthesis (the MENLOC study). Palliat Med 2021; 35(10): 1747-1760. Systematic review to synthesize international research and policy on the organization, provision, and receipt of end-of-life care for people with severe mental illness.

Geppert CM, Rabjohn P, Vlaskovits J. To treat or not to treat: psychosis, palliative care, and ethics at the end-of-life: a case analysis. Psychosomatics 2011; 52(2):178-184. Case-based discussion of end-of-life care from multiple perspectives. Useful for teaching about ethics at end-of-life.

Shalev D, Fields L, Shapiro P. End-of-life care in individuals with serious mental illness. Psychosomatics 2020; 61(5): 428-435. Review of existing data on end-of-life and palliative care for individuals with serious medical illness with co-morbid mental illness.

11. Professionalism (physician-patient relationship, boundaries)

Jain S, Roberts LW. Ethics in psychotherapy: a focus on professional boundaries and confidentiality practices. Psychiatr Clin North Am 2009; 32(2):299-314. Review of ethical principles, boundary issues with examples, and confidentiality/privacy.

John NJ, Shelton PG, Lang MC, Ingersoll J. Training psychiatry residents in professionalism in the digital world. Psychiatr Q 2017; 88(2):263-270. Discussion of the changes in the technology landscape and how this has impacted current trainees and their approach to professionalism. Excellent article to generate discussion for trainees.

Roberts LW, Hoop JG, Dunn LB, Geppert CMA. Essential ethical skills of mental health professionals. Focus 2009; 7(3):401-405. Discussion of six essential ethical skills and tensions/challenges that arise. https://psychiatryonline.org/doi/10.1176/foc.7.3.foc401

12. Treatment Over Objection

Pillai NR, Hulkower A, Gallagher S, Abraham C, Vaughn R. Consultation-Liaison Case Conference: Treatment Over Objection in the General Hospital. J Acad Consult Liaison Psychiatry. 2025 Nov-Dec;66(6):546-552. Case presentation that describes the management of a 65-year-old female with schizophrenia admitted to a general hospital for a urinary tract infection who refused both all medical treatments and required court ordered treatment over objection. The article provides multidisciplinary commentary from physicians and nursing staff, and directly addresses the ethical dilemmas inherent in TOO, the goals of such interventions, the logistical barriers hindering implementation, and the pivotal role of the C-L psychiatrist.

Rubin J, Prager KM. Guide to considering non-psychiatric medical intervention over objection for the patent without decisional capacity. Mayo Clin Proc 2018; 93(7):826-829. This very practical article articulates several questions that enable planning and decision making regarding involuntary care for incapacitated patients. Weighing these questions with the appropriate stakeholders can better enable a consensus path forward when considering involuntary procedures. The process also gives psychiatrists direction on the scope of their role in this care in contrast with the input authority of other stakeholders.

13. Refusing Medical Recommendations

Alfandre DJ. “I’m going home”: discharges against medical advice. Mayo Clin Proc 2009; 84(3):255-260. Review of contributors to the phenomena. Useful in expanding the trainee understanding of AMA discharges.

Clark MA, Abbott JT, Adyanthaya T. Ethics seminars: a best-practice approach to navigating the against-medical-advice discharge. Acad Emerg Med 2014; 21(9):1050-1057. Case based discussion of ethical and legal issues and a best practices approach. It is particularly useful in emergency departments.

Hendizadeh L, Goodman-Crews P, Martin J, Weber E. What do we owe to patients who leave against medical advice? the ethics of AMA discharges. Narrat Inq Bioeth. 2023; 13(2):139-145. Discussion of an ethical framework that can be applied for AMA discharges. Good article for starting a discussion with learners.

14. Withholding/Withdrawing Treatment

Note: For Pacemakers/ICD/LVAD and dialysis, please see Cardiology and Nephrology sections, respectively, under “D. Medical Specialty Ethics.”

Gaba A, Munjal S. “I don’t want to live like this anymore”: the role of psychiatry and clinical ethics in withdrawing life-sustaining treatment. Prim Care Companion CNS Disord. 2024; 26(4):24cr03715. Example case review for approaching consults for demoralization and decision-making capacity to stop treatment. Excellent article for trainee discussion and teaching as written in case format.

Gruenewald DA, Vandekieft G. Options of last resort: palliative sedation, physician aid in dying, and voluntary cessation of eating and drinking. Med Clin N Am 2020; 104:539–60. Description of practical clinical aspects and ethical considerations regarding hastened death in palliative sedation and voluntary cessation of eating and drinking. Also discusses an overview of medical assistance in dying.

Lissak IA, Young MJ. Limitation of life sustaining therapy in disorders of consciousness: ethics and practice. Brain 2024: 147(7): 2274-2288. Overview of clinical and ethical challenges that arise in withdrawing or withholding life sustaining care in individuals following brain injury.

Olsen ML, Swetz KM, Mueller PS. Ethical decision making with end-of-life care: palliative sedation and withholding or withdrawing life-sustaining treatments. Mayo Clin Proc 2010; 85(10):949-954. Review of palliative sedation, ethical basis, and comparison with withdrawing or withholding care. Good overview.

D. Medical-Specialty Ethics

1. Cardiologoy

Blumenthal-Barby JS, Kostick KM, Delgado ED, et al. Assessment of patients’ and caregivers’ informational and decisional needs for left ventricular assist device placement: implications for informed consent and shared decision-making. J Heart Lung Transplant 2015; 34(9):1182-1189. Detailed examination of engagement with LVAD decisions and what factors are relevant in capacitated informed consent. Also discusses caregiver experience and shared decision-making.

Zaidi D, Kirtkpatric JN, Fedson SE, Hull SC. Deactivation of left ventricular assist devices at the end of life: narrative review and ethical framework. JACC Heart Fail 2023; 11(11):1481-1490. Provides an ethical framework and clinical guidance regarding LVAD deactivation at the end of life. Discusses conflicts surrounding intention, consent, and communication in the setting of stakeholder moral distress.

2. Critical Care

Leland BD, Torke AM, Wocial LD, Helft PR. Futility disputes: a review of the literature and proposed model for dispute navigation through trust building. J Intensive Care Med 2017; 32(9): 523-527. Highlights the role of trust and relationship repair in navigating futility conflicts using empathic listening, validation, transparency, alliance-building.

Levin TT, Moreno B, Silvester W, Kissane D. End-of-life communication in the intensive care unit. Gen Hosp Psychiatry 2010; 32(4):433-442. Provides a variety of approaches to optimizing empathic communication to several end-of life patient experiences and also discusses conflicts that present barriers to optimal communication.

Kayser JB, Kaplan LJ. Conflict management in the ICU. Crit Care Med 2020; 48(9):1349-1357. This review is both descriptive and prescriptive regarding conflicts between different combinations of stakeholders in the ICU setting. Numerous tools are described to skill the reader with practical approaches to common conflicts.

Razzaq A, Prager KM, Garan AR, et al. Ethical considerations for mechanical support. Anesthesiol Clin 2025; 43(2):267–282. Updated version of a past comprehensive review on various mechanical support such as mechanical ventilator and ECMO discussing indications for initiation and withdrawal. Review touches on mechanically supported patients with “bridge to nowhere” contexts, mechanically supported patients with death criteria, and particular indications for unilateral decision-making regarding discontinuation.

3. Dermatology

Sun MD, Rieder EA. Psychosocial issues and body dysmorphic disorder in aesthetics: review and debate. Clin Dermatol 2022; 40(1):4–10. Reviews body dysmorphic disorder in elective aesthetic care settings. Provides practical approaches for screening and maintaining appropriate boundaries to prevent iatrogenic harm.

Fabbro S, Aultman JM, Mostow EN. Delusions of parasitosis: ethical and clinical considerations. J Am Acad Dermatol 2013;69(1):156-9. Reviews a variety of considerations for dermatologists navigating delusions of parasitosis, including biopsies and antiparasitic medication, therapeutic deception, informed consent for anti-psychotic medication.

4. Emergency Medicine

Hamm B. Ethical practice in emergency psychiatry: common dilemmas and virtue-informed navigation. Psychiatr Clin North Am 2021; 44(4):627-640. Review of common issues in emergency psychiatry context, such as agitation management, nonconsensual collateral, and duty to warn. Integrates virtue ethics layer of how to optimize ethical care in this setting.

Wilson MP, Hamrick E, Stiebel V, Nordstrom K. Contemporary practices for medical evaluation of the psychiatric patient in the emergency department. Focus 2023; 21(1):28-34. Acknowledges the 2017 AAEP consensus guidelines, while confronting conflicts in perspective and attempting to provide cross-sectional update with clear guidance and recommendations.

Yahyavi ST, Hoobehfekr S, Tabatabaee M. Exploring the hidden curriculum of professionalism and medical ethics in a psychiatric emergency department. Asian J Psychiatr 2021; 66:102885. Explores how informal norms can cultivate unprofessional behavior and institutional culture in the psychiatric emergency department setting. Provides insight into staff and patient dynamics in the high-stress environment.

5. Endocrinology

Mai Q, Holman CDJ, Sanfilippo FM, et al. Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study. BMC Med 2011; 9:118. This study demonstrates more diabetes complications but less diabetes care for patients with severe mental illness, suggesting a layer of diagnostic overshadowing may lead to disparities in diabetes care for patients with mental illness.

Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgender Health 2022;23(sup1):S1-S259. Chapters 6 and 12, “Adolescents” and “Hormone Therapy,” provide an overview of assent and consent, proportionality of risk and reversibility, as well as fertility preservation considerations. It also contrasts of medical necessity, optimizing well-being, and minimizing harm.

Skriver LKL, Nielsen MW, Walther S, et al. Factors associated with adherence or nonadherence to insulin therapy among adults with type 2 diabetes mellitus: A scoping review. J Diabetes Complications 2023; 37(10):108596. Nonadherence with chronic conditions, such as diabetes, can prompt requests for decision making capacity. This article provides a recent overview of factors that may contribute to diabetes treatment nonadherence for patients who are capacitated.

6. Gastroenterology: Artificial Nutrition and Hydration

Geppert CM, Andrews MR, Druyan ME. Ethical issues in artificial nutrition and hydration: a review. JPEN J Parenter Enteral Nutr 2010; 34(1):79-88. Framework of clinical practices, ethical principles, legal precedents and professional guidelines, with the contexts of terminal illness, advanced dementia and persistent vegetative state. Useful for teaching and ethics consultations.

Schwartz DB, Barrocas A, Wesley JR, et al. Gastrostomy tube placement in patients with advanced dementia or near end of life. Nutr Clin Pract 2014; 29(6):829-840. Recommendations for changes to clinical practice and care strategy, including algorithm for decision-making and a checklist to use prior to placement of G-tubes. Useful for teaching end-of-life issues.

7. Geriatrics

Cimino-Fiallos N, Rosen T. Elder abuse: a guide to diagnosis and management in the emergency department. Emerg Med Clin North Am 2021; 39(2):405–417. Practical framework for identifying and managing elder abuse and neglect. The article highlights patient vulnerabilities as well as clinical intersection with capacity, autonomy, and duty to protect.

Sun W, Matsuoka T, Kato Y, et al. The financial capacity of individuals with dementia: A narrative review. Psychogeriatrics 2025; 25(4):e70052. Narrative review of financial capacity in dementia, covering clinical features, assessment tools, and neuroimaging correlates. Authors note addressing patient vulnerability commonly requires surrogate decision-making to safeguard autonomy and prevent exploitation.

8. Hematology

Anderson D, Lien K, Agwu C, et al. The bias of medicine in sickle cell disease. J Gen Intern Med 2023; 38(14):3247-3251. Concise article regarding highlighting research evidencing clinical bias in sickle cell disease care, as well as racial bias in medicine, stigmatization in medical care, and systemic inequity.

Bergman EJ, Diamond NJ. Sickle cell disease and the “difficult patient” conundrum. Amer J Bioethics 2013; 13(4): 3–10. Target article for a 2013 issue of American Journal of Bioethics regarding portrayal of patients with sickle cell anemia as “difficult patients.” Discusses contributing factors, such as racialized history, pain management, addiction concerns, and mistrust. Consider reading the commentaries for diverse perspectives and additional facets of the topic.

Sween LK, West JM. Ethical issues in the care of patients whose personal, religious, or cultural beliefs impact clinical management strategies. Anesthesiol Clin 2024; 42:515–28. Reviews common Jehovah’s Witness beliefs/choices regarding blood products and discusses several implications in clinical management (informed consent, treatment alternatives, capacity, and surrogate decision making). Also covers other religious/cultural groups’ unique considerations in care management.

9. Infectious Disease

Lee ASD, Cody SL. The stigma of sexually transmitted infections. Nurs Clin North Am 2020; 55:295-305. Explores the ethical implications of STI-related stigma, partner notification, including criminalization of nondisclosure of HIV status before sexual activity.

Kopar PK, Kramer JB, Brown DE, Bochicchio GV. Critical ethics: how to balance patient autonomy with fairness when patients refuse coronavirus disease 2019 testing. Crit Care Explor 2021; 3(1):e0326. Deconstructs different perspectives regarding ethical and operational challenges when COVID-19 testing is refused in acute care settings. Discusses institutional and public health obligations, as well as clinical response options.

10. Nephrology

Chen JHC, Lim WH, Howson P. Changing landscape of dialysis withdrawal in patients with kidney failure: implications for clinical practice. Nephrology 2022; 27:551-565. Provides a breakdown of key components of dialysis withdrawal decisions, including preferences, beliefs, and ethical and legal issues. Provides guidance on navigation, including kidney supportive care, shared decision making, and end-of-life planning.

Golsorkhi M, Ebrahimi N, Vakhshoori M, et al. Patient-physician communication in advanced kidney disease: a narrative review. J Nephrology 2025; 38(3):827-843. Narrative review of patient-clinician communication techniques in advanced kidney disease, advocating for optimized communication as an ethical imperative. Emphasizes empathy, attention to patient values, transparent prognosis, and shared decision-making.

Janosevic D, Wang AX, Wish JB. Difficult patient behavior in dialysis facilities. Blood Purif 2019; 47(1-3):254-258. Provides analysis and guidance regarding challenging behavior by patients needing hemodialysis including aggression and nonadherence. The article discusses management of these behaviors, with inclusion of criteria for involuntary discharge.

11. Neurology

Kagan A, Shumway E, MacDonald S. Assumptions about decision-making capacity and aphasia: ethical implications and impact. Semin Speech Lang 2020; 41(3):221-231. Very practical overview of dilemmas and adapted communication strategies to optimize autonomy in aphasia contexts when capacity is evaluated. Advocates that language impairment can lead to misinterpretation regarding cognitive abilities for capacitated decision-making.

Mcloughlin C, Lee WH, Carson A, Stone J. Iatrogenic harm in functional neurological disorder. Brain 2025; 148(1):27-38. Synthesizes fragmented literature into a practical presentation of iatrogenic harm potential in functional neurological disorder care. Areas highlighted include diagnosis delivery and misdiagnosis, dismissive language, treatment planning, stigma, and distrust.

Mcloughlin C, Hoeritzauer I, Cabreira V, et al. Functional neurological disorder is a feminist issue. J Neurol Neurosurg Psychiatry 2023; 94(10):855-862. Connects dilemmas in functional neurological disorder diagnosis and management to gendered history and systemic bias. Notes the female predominance in functional neurological disorder and potential influence of gender on diagnostic skepticism and symptom misattribution.

12. Obstetrics and Gynecology

Miller LJ. Ethical issues in perinatal mental health. Psychiatr Clin North Am 2009; 32(2):259–270. Describes a variety of ethical dilemmas in the context of pregnancy and severe mental illness: nonadherence with care due to depression or delusions, delusions to harm fetus, predicted parenting risks. Offers frameworks for conceptualizing the dilemmas.

Kaufman JS, Yonkers KA, Maltz C, et al. Reporting perinatal substance use to child protective services: obstetric provider perspectives on the impact on care. J Women’s Health 2024; 33(11):1501-1508. Surveys obstetricians on the ethical tensions of mandated reporting of perinatal substance abuse. Responses included perception of a trade-off that can undermine trust and engagement, as well as concern about systemic bias.

Ross NE, Webster TG, Tastenhoye CA, et al. Reproductive decision-making capacity in women with psychiatric illness: a systematic review. J Acad Consult Liaison Psychiatry 2022; 63(1):61-70. Systematic review of the case literature on decision making dilemmas in the setting of severe mental illness: termination, delivery, contraception, and in vitro fertilization.

12. Obstetrics and Gynecology

13. Pulmonology

AlMutairi HJ, Mussa CC, Lambert CT, et al. Perspectives from COPD subjects on portable long-term oxygen therapy devices. Respir Care 2018; 63(11):1321-1330. Qualitative study that provides clinicians with perspective on negative impacts of oxygen therapy that can influence nonadherence. Major areas including mobility, freedom from external restrictions, perception of exclusion from community, and overall concerns about quality of life.

Courtwright AM, Rubin E, Robinson EM, et al. An ethical framework for the care of patients with prolonged hospitalization following lung transplantation. HEC Forum 2019; 31(1):49–62. Thoughtful discourse dissecting areas of ethical dilemma in prolonged hospitalization after lung transplantation. Areas include communication for informed consent and prognosis, tension in the ambiguity between demoralized passive death wish and comfort care preference, impact of performance metrics, and obligations to donors.

Nolley E, Fleck J, Kavalieratos D, et al. Lung transplant pulmonologists’ views of specialty palliative care for lung transplant recipients. J Palliative Med 2020; 23(5):619-626. Qualitative study that demonstrates a diversity of transplant pulmonologist perspectives on palliative care utility in patients with lung transplants, with a section discussing first year survival metrics as a barrier to referral.

14. Oncology/Cancer Pain

Cherny NI, Ziff-Werman B. Ethical considerations in the relief of cancer pain. Support Care Cancer 2023; 31(7):414. Reviews a variety of concepts. Focuses on clinician duties in the setting of pain/misuse/dependence. Discusses “pseudoaddiction,” chemical coping, diversion, and practical clinical approach.

Hetzler III PT, Dugdale LS. How do medicalization and rescue fantasy prevent healthy dying?. AMA J Ethics 2018; 20(8):e766-773. Discusses the dilemma of medicalized dying process, despite majority preference for nonmedicalized dying. The article notes the potential role of physician rescue fantasy in cultivating this context.

Howard LM, Barley EA, Davies E, et al. Cancer diagnosis in people with severe mental illness: practical and ethical issues. Lancet Oncol 2010; 11(8):797-804. Reviews aspects of disparities in cancer care and outcomes for patients with severe mental illness. Concerns are raised regarding diagnostic overshadowing, consent, and equity.

Laryionava K, Winkler EC. Dealing with family conflicts in decision‑making in end‑of‑life care of advanced cancer patients. Curr Oncol Rep 2021; 23(11):124. Provides strategies for empathic mediation approach in emotionally charged family dynamics surrounding end of life care.

Marron JM, Kyi K, Appelbaum PS, Magnuson A. Medical decision-making in oncology for patients lacking capacity. Am Soc Clin Oncol Educ Book 2020:40:1-11. Evaluates decision making in oncological care for patients who lack capacity, with attention to patient vulnerabilities, surrogate involvement, and pediatric and adult cancer contexts.

15. Pediatrics

Bursch B, Emerson ND, Sanders MJ. Evaluation and management of factitious disorder imposed on another. J Clin Psychol Med Settings 2021; 28(1):67–77. Comprehensive review of phenomenon in factious disorder imposed on another, with guidance on approach to suspected cases. Features discussion of the tension of obligation to protect children with possibility of false accusation and compromised parental rights.

Navin MC, Wasserman JA, Diekema DS, Pope TM. Limits on parental discretion in medical decision-making: pediatric intervention principles converge. Perspect Biol Med 2024; 67(2):277-289. This article articulates the role of parents in decision-making, as well as limits on what they can decide. Limitations described include abuse and neglect, nonbeneficial interventions, refusal of beneficial interventions and state interventions.

Sawyer K, Rosenberg AR. How should adolescent health decision-making authority be shared? AMA J Ethics 2020; 22(5):e372-379. Describes the balance of protection obligations of adults and emerging autonomy of adolescents. Provides guidance on contexts for increased autonomy and how to incorporate adolescents into shared decision-making.

Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgender Health 2022;23(sup1):S1-S259. Chapters 6 and 7, “Adolescents” and “Children,” outline transitioning, puberty suppression, and hormone initiation relative to developmental stage. Ethics discussion centers around shared decision making and assent/consent, risk and benefit relative to reversibility, fertility considerations, and long-term uncertainties.

16. Surgery

Note: For “Code Status” and “Treatment Over Objection,” please see their subsections under Section C, “Topics in Clinical Psychiatric Ethics” above. For Transplantation, please see the “Transplantation” subsection below.

Sur MD, Angelos P. Ethical issues in surgical critical care: the complexity of interpersonal relationships in the surgical intensive care unit. J Intensive Care Med 2016; 31(7):442-450. Discusses the distinct relational dynamics with surgeons, patients, and other stakeholders that influence culture and ethics in the surgical ICU setting, including surgical ownership, as well as prognosis transparency and increased resistance to withdrawal care. Relevant for hierarchical navigation of goals of care, capacity contexts, and moral distress.

Convie LT, Carson E, McCusker, et al. The patient and the clinician experience of informed consent for surgery: A systematic review. BMC Medical Ethics 2020;21:58. Synthesizes key areas in surgical informed consent including communication and trust, trust, decisional burden and relational considerations, as well as contributors to informed consent success and failure.

Agledahl KM, Pedersen R. Ethics in the operating room: A systematic review. BMC Med Ethics 2024;25(1):128. Review provides a window into ethical tensions in the operation stage of hospital care, covering topics such as responsibility in team contexts, patient vulnerability under anesthesia, ethical challenges with innovation and education, and intraoperative decision-making.

17. Transplantation

Chin HP. Case vignettes in transplant psychiatry ethics. Camb Q Healthc Ethics 2022; 31(3):386-394. Uses cases vignettes and commentaries to explore dilemmas in transplant care involving suicide attempts, incapacitation from hepatic encephalopathy, treatable psychiatric episodes, and hostile behavior impacting candidacy.

Maldonado JR. Why it is important to consider social support when assessing organ transplant candidates? Am J Bioeth 2019; 19(11):1-8. This article critiques the validity of social support as a criterion for transplant candidacy, noting reinforcement of disparities, inconsistency in utilization of social support in decisions, and low clinician confidence in assessments.

Martinelli V, Lumer ELL, Chiappedi M, et al. Ethical issues in living donor kidney transplantation: an update from a psychosocial perspective. Healthcare 2024; 12(18):1832. Comprehensive review of topics related to ethics of living donor kidney transplantation, such as informed consent, relational obligation pressure, and post-surgical psychological sequelae.

Caplan A, Purves D. A quiet revolution in organ transplant ethics. J Med Ethics 2017; 43(11):797-800. Comprehensive review of emerging area of transplant medicine focused on improving transplant recipients’ quality of life and the ethical implications inherent in this.