Fiester, Autumn

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  • Publication
    Creating Fido's Twin: Can Pet Cloning be Ethically Justified
    (2005-08-01) Fiester, Autumn
    Taken at face value, pet cloning may seem at best a frivolous practice, costly both to the cloned pet's health and its owner's pocket. At worst, its critics say, it is misguided and unhealthy - way of exploiting grief to the detriment of the animal, its owner, and perhaps even animal welfare in general. But if the great pains we are willing to take to clone Fido raise the status of companion animals in the public eye, then the practice might be defensible.
  • Publication
    What Mediators Can Teach Physicians about Managing 'Difficult' Patients
    (2015-03-01) Fiester, Autumn
    Between 10% and 12% of patients are considered difficult by their treating physicians,1 indicating a widespread problem. Many physicians report feeling at a loss to know how to effectively manage challenging patient interactions.2 In extreme cases, physicians resort to refusing to treat hostile patients or dismissing them from their clinical practice.
  • Publication
    Mediation and Advocacy
    (2012-01-01) Fiester, Autumn
  • Publication
    The Principlist Paradigm and the Problem of the False Negative: Why the Clinical Ethics We Teach Fails Patients
    (2007-07-01) Fiester, Autumn
    The clinical ethics framework that is typically taught to medical students and residents is deeply flawed, and the result of using this framework exclusively to resolve ethical conflicts at the bedside is compromised patient care. The author calls this framework the principlist paradigm and maintains that it blinds clinicians from seeing the full set of moral obligations they have to the patient and limits the range of options they see as available to navigate through ethical conflicts. Although it is important for the moral obligations it does recognize (e.g., those based on the principles of autonomy, beneficence, nonmaleficence, and justice), the principlist paradigm should not be used as the only moral template for case analysis. The author illustrates the paradigm’s limitations with a clinical case study, in which the treating clinicians failed to recognize three important moral obligations to the patient: the obligation to express regret, the obligation to apologize, and the obligation to make amends. The failure to recognize these widely accepted moral obligations can have tragic consequences. The principlist paradigm undertrains clinicians for the complex ethical dilemmas they face in practice, and medical ethics educators need to rethink the tools they offer student clinicians to guide their ethical analysis. The author advocates a reexamination of this standard approach to teaching clinical ethics.
  • Publication
    Teaching Nonauthoritarian Clinical Ethics: Using an Inventory of Values and Positions
    (2014-08-29) Fiester, Autumn
    One area of bioethics education with direct impact on the lives of patients, families, and providers is the training of clinical ethics consultants who practice in hospital-based settings. There is a universal call for increased skills and knowledge among practicing consultants, broad recognition that many are woefully undertrained, and a clear consensus that CECs must avoid an “authoritarian approach” to consultation—an approach, that is, in which the consultant imposes his or her values, ethical priorities, or religious convictions on the stakeholders in an ethics conflict. Yet little work has been done on how to teach CECs not to impose their values in an ethics consultation, or even on the dimensions of this problem. In this essay, I propose a tool for bioethical instruction that targets this question: how can CECs be taught a nonauthoritarian mode of ethical analysis and consultation that can avert the problem of values imposition?
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  • Publication
    The "Difficult" Patient Reconceived: An Expanded Moral Mandate for Clinical Ethics
    (2012-05-01) Fiester, Autumn
    Between 15%-60% of patients are considered “difficult” by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed “difficult.” But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as responses to problematic interactions related to healthcare delivery. If there are grounds to reconceive the “difficult” patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.
  • Publication
    Respondent Burden in Clinical Research: When Are We Asking Too Much of Subjects?
    (2005-08-01) Ulrich, Connie M; Fiester, Autumn; Wallen, Gwyneth R; Grady, Christine
  • Publication
    The Queering of HIV Testing Practices and the Reinforcement of Stigma
    (2010-12-28) Wahlert, Lance; Fiester, Autumn
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