RESUMO
This paper examines the concept and moral significance of "childhood interests." This concept is important in medical decision-making for children and more broadly in the field of pediatric ethics. The authors argue that childhood interests are identifiable components of childhood well-being that carry moral weight. Parents have a special role in protecting and promoting these interests and special obligations to do so. These parental obligations are grounded by the independent interests of the child, as well as the good of society more generally. Because parents have these child-rearing obligations, they must also have the authority and wide discretion necessary to fulfill them. However, while parental discretion is wide, it is not unlimited, for it must be used to safeguard and advance childhood interests.
Assuntos
Pais , Humanos , Criança , Pais/psicologia , Tomada de Decisões/ética , Proteção da Criança/ética , Obrigações Morais , Educação Infantil/psicologiaRESUMO
Despite apparent disagreement in the scholarly literature on standards of pediatric decision making, a recognition that similar norms underpin many of the dominant frameworks motivated a June 2022 symposium "Best Interests and Beyond: Standards of Decision Making in Pediatrics" in St Louis, MO. Over the course of this 3-day symposium, 17 expert scholars (see author list) deliberated on the question "In the context of US pediatric care, what moral precepts ought to guide parents and clinicians in medical decision making for children?" The symposium and subsequent discussion generated 6 consensus recommendations for pediatric decision making, constructed with the primary goals of accessibility, teachability, and feasibility for practicing clinicians, parents, and legal guardians. In this article, we summarize these recommendations, including their justification, limitations, and remaining concerns.
Assuntos
Tomada de Decisões , Pais , Criança , Humanos , Consenso , Dissidências e Disputas , Princípios MoraisRESUMO
The maxim "parents should do what is in the best interests of their child" seems like an unassailable truth, and yet, as I argue here, there are serious problems with it when it is taken seriously. One problem concerns the sort of demands such a principle places on parents; the other concerns its larger social implications when conceived as part of a national policy for the rearing of children. The theory of parenting that creates these problems I call "optimizing parentalism." To avoid them, I define and defend a new and more morally appealing theory, "satisficing parentalism."
Assuntos
Educação Infantil , Teoria Ética , Família , Obrigações Morais , Poder Familiar , Pais , Adulto , Criança , Proteção da Criança , Análise Ética , Humanos , Pais/psicologia , Estados UnidosAssuntos
Consciência , Pessoal de Saúde , Homossexualidade Feminina , Infertilidade/terapia , Direitos Sexuais e Reprodutivos , Técnicas de Reprodução Assistida/ética , California , Teoria Ética , Feminino , Pessoal de Saúde/ética , Acessibilidade aos Serviços de Saúde/ética , Humanos , Masculino , Preconceito , Recusa em Tratar , Direitos Sexuais e Reprodutivos/ética , Estados UnidosRESUMO
Ethics consultations have been shown to reduce the use of "nonbeneficial treatments," defined as life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, when treatment conflicts occurred in the adult intensive care unit (ICU). In this paper we estimated the costs of nonbeneficial treatment using the results from a randomized trial of ethics consultations. We found that ethics consultations were associated with reductions in hospital days and treatment costs among patients who did not survive to hospital discharge. We conclude that consultations resolved conflicts that would have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU instead of focusing on more appropriate comfort care.
Assuntos
Cuidados Críticos/economia , Consultoria Ética/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Unidades de Terapia Intensiva/economia , Cuidados para Prolongar a Vida/economia , Futilidade Médica , Adulto , Cuidados Críticos/ética , Cuidados Críticos/estatística & dados numéricos , Tomada de Decisões , Dissidências e Disputas , Feminino , Humanos , Unidades de Terapia Intensiva/ética , Tempo de Internação , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Análise de Sobrevida , Estados UnidosRESUMO
Urban bioethics is an area of inquiry within the discipline of bioethics that focuses on ethical issues, problems, and conflicts relating to medicine, science, health care, and the environment that typically arise in urban settings. Urban bioethics challenges traditional bioethics (1) to examine value concerns in a multicultural context, including issues related to equity and disparity, and public health concerns that may highlight conflict between individual rights and the public good, and (2) to broaden its primary focus on individual self-determination and respect for autonomy to include examination of the interests of family, community, and society. Three features associated with urban life-density, diversity, and disparity-affect the health of urban populations and provide the substrate for identifying ethical concerns and value conflicts and creating interventions to affect population health outcomes. The field of urban bioethics can be helpful in creating ethical foundations and principles for public health practice, developing strategies to respect diversity in health policy in a pluralistic society, and fostering collaborative work among educators, social scientists, and others to eliminate bias among health professionals and health care institutions to enhance patients' satisfaction with their care and ultimately affect health outcomes. Educational programs at all levels and encompassing all health professions are needed as a first step to address the perplexing and important problem of eliminating health disparities. Urban bioethics is both contributing to the social science literature in this area and helping educators to craft interventions to affect professional attitudes and behaviors.
Assuntos
Bioética , Sociologia Médica/ética , Saúde da População Urbana , Bioética/educação , Cidades/epidemiologia , Planejamento em Saúde Comunitária/ética , Diversidade Cultural , Política de Saúde , Humanos , Densidade Demográfica , Valores Sociais , Seguridade Social/ética , Fatores SocioeconômicosRESUMO
CONTEXT: Ethics consultations increasingly are being used to resolve conflicts about life-sustaining interventions, but few studies have reported their outcomes. OBJECTIVE: To investigate whether ethics consultations in the intensive care setting reduce the use of life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, as well as the reactions to the consultations of physicians, nurses, and patients/surrogates. DESIGN: Prospective, multicenter, randomized controlled trial from November 2000 to December 2002. SETTING: Adult intensive care units (ICUs) of 7 US hospitals representing a spectrum of institutional characteristics. PATIENTS: Five hundred fifty-one patients in whom value-related treatment conflicts arose during the course of treatment. INTERVENTIONS: Patients were randomly assigned either to an intervention (ethics consultation offered) (n = 278) or to usual care (n = 273). MAIN OUTCOME MEASURES: The primary outcomes were ICU days and life-sustaining treatments in those patients who did not survive to hospital discharge. We examined the same measures in those who did survive to discharge and also compared the overall mortality rates of the intervention and usual care groups. We also interviewed physicians and nurses and patients/surrogates about their views of the ethics consultation. RESULTS: The intervention and usual-care groups showed no difference in mortality. However, ethics consultations were associated with reductions in hospital (-2.95 days, P =.01) and ICU (-1.44 days, P =.03) days and life-sustaining treatments (-1.7 days with ventilation, P =.03) in those patients who ultimately did not survive to discharge. The majority (87%) of physicians, nurses, and patients/surrogates agreed that ethics consultations in the ICU were helpful in addressing treatment conflicts. CONCLUSION: Ethics consultations were useful in resolving conflicts that may have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU.
Assuntos
Cuidados Críticos/ética , Consultoria Ética , Planejamento de Assistência ao Paciente , Adulto , Ética Clínica , Humanos , Unidades de Terapia Intensiva/ética , Tempo de Internação , Futilidade Médica , Equipe de Assistência ao Paciente , Estudos Prospectivos , Estados UnidosAssuntos
Adolescente , Criança , Consentimento Livre e Esclarecido/ética , Relações Pais-Filho , Consentimento dos Pais/ética , Pais , Recusa do Paciente ao Tratamento/ética , Adulto , Fatores Etários , Beneficência , Tomada de Decisões , Família , Direitos Humanos , Humanos , Competência Mental , Autonomia Pessoal , Filosofia , Medição de RiscoAssuntos
Bioética , Diversidade Cultural , Justiça Social , Valores Sociais , Seguridade Social , Fatores Socioeconômicos , População Urbana , Temas Bioéticos , Comunicação , Consenso , Contratos , Tomada de Decisões , Teoria Ética , Ética , Feminismo , Liberdade , Geografia , Alocação de Recursos para a Atenção à Saúde , Humanos , Relações Interpessoais , Autonomia Pessoal , Saúde Pública , Política Pública , Alocação de Recursos , Predomínio Social , Responsabilidade Social , Estados Unidos , Saúde da População Urbana , Populações VulneráveisAssuntos
Adesão a Diretivas Antecipadas , Diretivas Antecipadas , Tomada de Decisões , Ética , Individualidade , Pessoalidade , Autoimagem , Consentimento do Representante Legal , Morte , Demência , Ética Médica , Família , Liberdade , Amigos , Humanos , Relações Interpessoais , Competência Mental , Narração , Assistência ao Paciente , Estado Vegetativo Persistente , Autonomia Pessoal , Filosofia , Padrões de Referência , Responsabilidade Social , Seguridade Social , Assistência Terminal , Fatores de TempoAssuntos
Planejamento Antecipado de Cuidados , Diretivas Antecipadas , Comunicação , Tomada de Decisões , Família , Médicos , Relações Profissional-Família , Consentimento do Representante Legal , Consenso , Diversidade Cultural , Diagnóstico , Revelação , Dissidências e Disputas , Ética , Ética Médica , Eutanásia Passiva , Relações Familiares , Amigos , Processos Grupais , Hospitais , Humanos , Relações Interpessoais , Jurisprudência , Cuidados para Prolongar a Vida , Testamentos Quanto à Vida , Prontuários Médicos , Modelos Teóricos , Narração , Negociação , Assistência ao Paciente , Educação de Pacientes como Assunto , Relações Médico-Paciente , Política , Prognóstico , Religião , Valores Sociais , Confiança , Estados Unidos , Suspensão de TratamentoAssuntos
Consentimento Livre e Esclarecido , Dor , Assistência ao Paciente , Placebos , Altruísmo , Beneficência , Doença Crônica , Enganação , Revelação , Teoria Ética , Ética , Liberdade , Humanos , Motivação , Participação do Paciente , Autonomia Pessoal , Relações Médico-Paciente , Psicologia , Resultado do Tratamento , ConfiançaRESUMO
No profession has undergone as much scrutiny in the past several decades as that of medicine. Indeed, one might well argue that no profession has ever undergone so much change in so short a time. An essential part of this change has been the growing insistence that competent, adult patients have the right to decide about the course of their own medical treatment. However, the familiar and widely accepted principle of patient self-determination entails a corollary that has received little attention in the growing literature on the ethics of physician-patient relations: if patients are to direct the course of their own medical treatment, then physicians are at least sometimes to be guided in their actions on behalf of patients by values that are not, and may even be incompatible with, their own values. Unless it is supposed that it would be best if physicians were simply to accommodate any and all patient requests, a possibility I consider and reject in this paper, there are bound to be numerous instances of legitimate moral conflict between the preferences of physicians and patients. In this paper, I examine the implications of this sort of moral conflict from the standpoint of the integrity of the physician....I have also considered the common practice of patient referral from the standpoint of physician integrity, and asked whether a physician who refuses to treat a patient as a matter of conscience can consistently refer the patient to another physician for the same treatment....