Principios bioéticos y actitudes en la atención de pacientes con VIH, del Hopital Clínico Viedma, 2021 / Bioethical principles and attitudes in the care of patients with HIV, Hospital Clínico Viedma, 2021

La infección por el Virus de la inmunodeficiencia humana, el estigma y la discriminación, así como su interrelación con los derechos humanos, se han transformado en los ejes centrales de las campañas contra el SIDA y a favor de los derechos de las personas viviendo con el VIH/SIDA, constituyéndose en uno de los problemas más frecuentes en el área hospitalaria. El presente estudio se realizó para identificar los principios bioéticos y actitudes del personal de enfermería, elementos de valoración y cuidados que implementan el personal para la prevención de las mismas; con el enfoque cualitativo - cuantitativo de tipo descriptivo y transversal, en el servicio de Infectología del HCV, gestión II/2021. Los resultados más significativos del personal de enfermería son: discriminación con el 20%; rechazo, 20%; actitudes negativas, 20% un 27% percibe una mala atención y 13% trato inadecuado, por tanto 100% de la población ha recibido algún tipo de maltrato del personal de enfermería. Pese a que estos conocen los principios bioéticos de autonomía, beneficencia, no maleficencia y equidad con los pacientes, solo en la parte teórica, ya que en la práctica no las aplican. (AU)

COVID-19 and its intersect with ethics and human rights in Sub-Saharan Africa.

Confirmed new cases of Coronavirus disease 2019 (COVID-19) have accelerated in Sub-Saharan Africa against a backdrop of fragile health systems, a high burden of comorbidities and socioeconomic instability. The context makes the region particularly vulnerable to the virus and its impact. As cases escalate, the need to tailor-make COVID-19-related response strategies to the African context is imperative. This paper aims to discuss key considerations on the public health response to the pandemic and its intersection with ethics and human rights. With this perspective, we bring attention to the conflict between healthcare workers' obligations and patient rights under the unclear policy and regulatory frameworks and the application of restrictive measures in the context of poverty. The indirect effects of the pandemic on already existing health problems are also highlighted. We appeal to the African States to establish appropriate systems which integrate human rights-based approaches to COVID-19 response. These systems should be ethically sound systems and ensure no-one is left behind in terms of testing, access to therapeutics and vaccination, and social protection; based on lessons learned over the past 12 months of the pandemic's presence in SSA, and patterns emerging across the globe.

Post-traumatic stress disorder, human rights and access to healthcare: an analysis of judgments of the European Court of Human Rights from an ethical perspective.

Background: Human rights violations such as torture are associated with a high risk of post-traumatic stress disorder (PTSD). The judgements of the European Court of Human Rights (ECtHR) include a normative perspective on PTSD and address central ethical questions. Objective: To help bridge the gap between the psycho-medical and the legal discourse on human rights violations and to illustrate their medico-ethical implications by systematically assessing and categorizing all judgements by the ECtHR dealing with PTSD. Method: The ECtHR database was searched for 'post-traumatic stress disorder'. A descriptive statistic was performed on the Articles of the European Convention on Human Rights involved and violations to these articles. In a qualitative analysis, the judgements were thematically grouped. Results: The search yielded n = 103 judgements, of which n = 90 were included. There were mostly violations of Article 3 (prohibition of torture), Article 8 (Right to respect for private and family life) and Article 6 (Right to a fair trial). PTSD in these judgements is normatively discussed with regards to ethical, social and political themes such as inadequate access to healthcare, especially in prison, matters of asylum, expulsion and extradition, protection of minorities and minors, as well as rights and duties of traumatized witnesses. Conclusion: PTSD plays a central role in a large number of ECtHR judgements. Our results show that PTSD as a medical diagnosis also encompasses legal, ethical, social, and political dimensions. This knowledge is essential for healthcare professionals working with traumatized persons, but can also be relevant for political decision-makers.

Antecedentes: las violaciones de derechos humanos como la tortura están asociadas con un alto riesgo de trastorno de estrés postraumático (TEPT). Las sentencias del Tribunal Europeo de Derechos Humanos (TEDH) incluyen una perspectiva normativa sobre el trastorno de estrés postraumático y abordan cuestiones éticas fundamentales.Objetivo: ayudar a cerrar la brecha entre el discurso psico-médico y legal sobre las violaciones de los derechos humanos e ilustrar sus implicaciones médico-éticas evaluando y categorizando sistemáticamente todas las sentencias del TEDH relacionados con el trastorno de estrés postraumático.Método: Se buscó en la base de datos del TEDH para 'trastorno por estrés postraumático'. Se realizó una estadística descriptiva sobre los artículos del Convenio Europeo de Derechos Humanos involucrados y las violaciones a estos artículos. En un análisis cualitativo, las sentencias se agruparon temáticamente.Resultados: La búsqueda arrojó n = 103 sentencias, de las cuales se incluyeron n = 90. En su mayoría fueron violaciones del artículo 3 (prohibición de la tortura), artículo 8 (derecho al respeto de la vida privada y familiar) y artículo 6 (derecho a un juicio justo). El TEPT en estas sentencias se discute normativamente con respecto a temas éticos, sociales y políticos como el acceso inadecuado a la atención médica, especialmente en prisión, asuntos de asilo, expulsión y extradición, protección de minorías y menores, así como derechos y deberes de testigos traumatizados.Conclusión: TEPT juega un papel central en un gran número de sentencias del TEDH. Nuestros resultados muestran que el TEPT como diagnóstico médico también abarca dimensiones legales, éticas, sociales y políticas. Este conocimiento es esencial para que los profesionales sanitarios trabajen con personas traumatizadas, pero también puede ser relevante para los responsables de la toma de decisiones políticas.

Health: bioecological analysis of subjective well-being in teaching

Reflect on the concepts that go through the history of people with disabilities, in the context of their rights, as the processes involving their education is an emerging theme. The objective of this work was to understand the conceptions about health of university professors based on the Bioecological Theory of Human development. This is an exploratory case study research with a mixed approach carried out with professors from a public university in the State of Rio Grande do Sul. The method of data collection was the interview and the self-administered questionnaire. 73 professors and 6 interview participants from different fields of knowledge, selected at random participated answering to the questionnaire. It was observed that the systems that constitute the organizational basis of the participants' lives were similar and that their life stories, their culture, the media and the relationships they establish at work are factors that influence their conceptions about health and about the relationship established with people with disabilities in Higher Education. The participants' conception of health, however, still runs through the biomedical model, but has been undergoing a progressive change. It is concluded that the conceptions about health are linked to life history, when then one starts to subjectivity. Combined with the contextual issues of a particular place, the concept of health has been progressively detaching itself from the concept of disease.

Japanese insurers' attitudes toward adverse selection and genetic discrimination: a questionnaire survey and interviews with employees about using genetic test results.

Since the 1990s, insurance has been the primary field focused on the social disadvantages of using genetic test results because of the concerns related to adverse selection. Although life insurance is popular in Japan, Japan does not currently have any regulations on the use of genetic information and insurers have largely kept silent for decades. To reveal insurers' attitudes on the topic, we conducted an anonymous questionnaire survey with 100 insurance company employees and recruited nine interviewees from the survey respondents. We found that genetic discrimination is not generally considered as a topic of human rights. We also found that insurers have uncertain fears and concerns about adverse selection in terms of actuarial fairness but not regarding profits. When it comes to preparing guidelines on the use of genetic information by Japanese insurers, we believe that public dialog and consultation are necessary to gain understanding of the people.

Back to WHAT? The role of research ethics in pandemic times.

The Covid-19 pandemic creates an unprecedented threatening situation worldwide with an urgent need for critical reflection and new knowledge production, but also a need for imminent action despite prevailing knowledge gaps and multilevel uncertainty. With regard to the role of research ethics in these pandemic times some argue in favor of exceptionalism, others, including the authors of this paper, emphasize the urgent need to remain committed to core ethical principles and fundamental human rights obligations all reflected in research regulations and guidelines carefully crafted over time. In this paper we disentangle some of the arguments put forward in the ongoing debate about Covid-19 human challenge studies (CHIs) and the concomitant role of health-related research ethics in pandemic times. We suggest it might be helpful to think through a lens differentiating between risk, strict uncertainty and ignorance. We provide some examples of lessons learned by harm done in the name of research in the past and discuss the relevance of this legacy in the current situation.

The COVID-19 pandemic and the human rights of persons with mental and cognitive impairments subject to coercive powers in Australia.

The purpose of this paper is to explore the effect of the COVID-19 pandemic on the human rights of persons with mental and cognitive impairments subject to coercive powers in Australia. It sets out the relevant human rights in the Convention on the Rights of Persons with Disabilities which have been engaged by the COVID-19 pandemic and the government's response to it. It examines the effect of emergency legislation on the relaxation of human rights safeguards in mental health laws, with a focus on mental health tribunals (although it is limited by a lack of published decisions and gaps in publicly available information). However, some of the issues created for persons with disabilities during the COVID-19 pandemic are evident in some decisions published by the New South Wales Guardianship Tribunal. The paper critically analyses two guardianship decisions UZX [2020] NSWCATGD 3 (3 April, 2020) and GZK [2020] NSWCATGD 5 (23 April, 2020) and some emergency South Australian legislation COVID-19 Emergency Response Act, 2020 (SA) Schedule 1 to demonstrate the ways in which the human rights of persons with mental and cognitive impairments can be more at risk than those of the general population, even when the general population is itself in "lockdown."

Mental health, mental capacity, ethics, and the law in the context of COVID-19 (coronavirus).

The emergence of the COVID-19 (coronavirus) pandemic in late 2019 and early 2020 presented new and urgent challenges to mental health services and legislators around the world. This special issue of the International Journal of Law and Psychiatry explores mental health law, mental capacity law, and medical and legal ethics in the context of COVID-19. Papers are drawn from India, Australia, the United Kingdom, Ireland, Germany, Portugal, and the United States. Together, these articles demonstrate the complexity of psychiatric and legal issues prompted by COVID-19 in terms of providing mental health care, protecting rights, exercising decision-making capacity, and a range of other topics. While further work is needed in many of these areas, these papers provide a strong framework for addressing key issues and meeting the challenges that COVID-19 and, possibly, other outbreaks are likely to present in the future.

The ethics and value of contact tracing apps: International insights and implications for Scotland's COVID-19 response.

The COVID-19 pandemic has put health systems, economies and societies under unprecedented strain, calling for innovative approaches. Scotland's government, like those elsewhere, is facing difficult decisions about how to deploy digital technologies and data to help contain, control and manage the disease, while also respecting citizens' rights. This paper explores the ethical challenges presented by these methods, with particular emphasis on mobile apps associated with contact tracing. Drawing on UK and international experiences, it examines issues such as public trust, data privacy and technology design; how changing disease threats and contextual factors can affect the balance between public benefits and risks; and the importance of transparency, accountability and stakeholder participation for the trustworthiness and good-governance of digital systems and strategies. Analysis of recent technology debates, controversial programmes and emerging outcomes in comparable countries implementing contact tracing apps, reveals sociotechnical complexities and unexpected paradoxes that warrant further study and underlines the need for holistic, inclusive and adaptive strategies. The paper also considers the potential role of these apps as Scotland transitions to the 'new normal', outlines challenges and opportunities for public engagement, and poses a set of ethical questions to inform decision-making at multiple levels, from software design to institutional governance.