The relationship between body privacy and anxiety in women having gynecological examination.

Protection of privacy during gynecological examination is one of the important ethical principles and invasion of body privacy can cause anxiety. This study was conducted in order to determine the relationship between the level of importance women attach to privacy and the level of anxiety. This descriptive-correlational study consisted of 349 women who applied to the obstetrics outpatient clinic of a university hospital to have gynecological examination. Data were collected using Body Privacy Scale for Gynecology and Obstetrics and State Anxiety Inventory. Before the gynecological examination, the high importance women attach to privacy in rights and all of them experienced anxiety. A positive relationship was found between the importance women attach to privacy and their anxiety levels. It was determined that the importance women attach to body privacy in these areas explained 16.3% of the total variance at the level of anxiety.IMPACT STATEMENTWhat is already known on this subject? Gynecological examination is one of the basic examination methods in the protection of women's health. Protection of body privacy during gynecological examination is one of the most important ethical principles. Failure to exercise due care to ensure body privacy during gynecological examination causes anxiety in women.What do the results of this study add? In our study, it was found that women having gynecological examination place a high degree of emphasis on body privacy. It was determined that all women experienced anxiety before gynecological examination. It was determined that the importance women attach to body privacy was an important determinant in the increasing level of anxiety.What are the implications of these findings for clinical practice and/or further research? Not giving importance to body privacy, increases the level of anxiety before gynecological examination.

Ethical challenges for women's healthcare highlighted by the COVID-19 pandemic.

Healthcare policies developed during the COVID-19 pandemic to safeguard community health have the potential to disadvantage women in three areas. First, protocols for deferral of elective surgery may assign a lower priority to important reproductive outcomes. Second, policies regarding the prevention and treatment of COVID-19 may not capture the complexity of the considerations related to pregnancy. Third, policies formulated to reduce infectious exposure inadvertently may increase disparities in maternal health outcomes and rates of violence towards women. In this commentary, we outline these challenges unique to women's healthcare in a pandemic, provide preliminary recommendations and identify areas for further exploration and refinement of policy.

The Birkenhead drill suggests 'women and children first': government and society's reversal of the drill during the COVID-19 pandemic, left children last and cannot be allowed to continue.

The Birkenhead drill states that in the time of crisis, the correct action is to prioritise the weakest and most vulnerable, in that example, women and children. Ethically this has been well analysed in terms of the intrinsic value of the human versus any utilitarian calculus of worth to society's function. We do not attempt to re-analyse this but do note that standard pandemic planning often disadvantages the weak and vulnerable in terms of allocation of resources to those with a greater chance of functional survival. We more argue from a debt that society owes its children in terms of the sacrifices they have made in terms of school, social life, healthcare and overall welfare during the pandemic from which they were at markedly less risk than adults. Society owes a debt to its young, and this on top of pre-existing commitments to the them that most nations fail to realise, calls for prioritisation of children and young people's issues as society rebuilds. The effects of poverty and systemic racism on many children must be tackled; so too the existential threats of climate change and pollution. COVID-19 provides a once in a generation opportunity to create a kinder, fairer society. Early signs are not good: Pub re-opening prioritised over school re-opening; no significant investment in children's services or women's health, a significant determinant of children's welfare. We highlight the way COVID-19 has, and continues, to harm children and argue that the contemporary erosion of the Birkenhead principle is simply amoral.

Divulgação não autorizada de imagem íntima: danos à saúde das mulheres e produção de cuidados / Divulgación no autorizada de imagen íntima: daños a la salud de la mujeres y producción de cuidados / Unauthorized disclosure of intimate image: damage to women's health and the production of care

Objetivou-se analisar os danos à saúde das mulheres que tiveram imagens íntimas divulgadas sem autorização, bem como os cuidados em saúde necessários nessas situações. Partiu-se do debate sobre violência contra as mulheres em sua interface com a Saúde Coletiva. Foram realizadas entrevistas em profundidade com 17 mulheres com idade entre 17 e 50 anos que tiveram imagens íntimas divulgadas sem autorização e com dez profissionais da saúde e da assistência que atenderam mulheres nessa situação. Foram observados diversos danos à Saúde Mental, como agravamento de transtorno alimentar e uso abusivo de álcool, automutilação, desenvolvimento de fobias, depressão e tentativa de autoextermínio. A exposição da intimidade tem se mostrado uma forma recorrente de violência que requer cuidados peculiares, a serem apropriados pelo campo da saúde na produção de cuidados com vistas à promoção da saúde integral das mulheres. (AU)

El objetivo fue analizar los daños a la salud de las mujeres que tuvieron imágenes íntimas divulgadas sin autorización, así como los cuidados de salud necesarios en esas situaciones. Se partió del debate sobre la violencia contra las mujeres en su interfaz con la Salud Colectiva. Se realizaron entrevistas en profundidad con 17 mujeres con edades entre los diecisiete y cincuenta años que tuvieron imágenes íntimas divulgadas sin autorización y con diez profesionales de la salud y de la asistencia que atendieron a mujeres en esa situación. Se observaron diversos daños a la salud mental, tales como agravación de trastorno alimentario y uso abusivo de alcohol, automutilación, desarrollo de fobias, depresión e intento de auto-exterminio. La exposición de la intimidad se ha mostrado como una forma recurrente de violencia que requiere cuidados propios que deben ser apropiados por el campo de la salud en la producción de cuidados con el objetivo de la promoción de la salud integral de las mujeres. (AU)

The objective was to analyze the damage to the health of women who had intimate images released without authorization, as well as the necessary health care in these situations. The starting point was the debate on violence against women in its interface with Public Health. In-depth interviews were conducted with 17 women aged between 17 and 50 years old, who had intimate images released without authorization; and with ten health and care professionals who attended women in this situation. Several damages to mental health were observed, such as aggravation of eating disorders and alcohol abuse, self-mutilation, development of phobias, depression and attempted self-extermination. The exposure of intimacy has been shown to be a recurrent violence that requires proper care, to be appropriated by the health field in the production of care in order to promote women's comprehensive health. (AU)

Integration of Catholic Values and Professional Obligations in the Provision of Family Planning Services: A Qualitative Study.

Importance: Religious leaders of the Catholic church created guidelines for practicing medicine, that involve reproductive care restrictions that may conflict with professional obligations. Objective: To explore how Catholic obstetrician-gynecologists integrate their religious values and professional obligations related to family planning services. Design, Setting, and Participants: In this qualitative investigation, in 2018, US-based obstetrician-gynecologists were recruited through an online survey and were invited to participate in audio-recorded telephone interviews using a semistructured interview guide. Participants were obstetrician-gynecologists who self-identified as Catholic and reported providing reproductive health care as follows: (1) provide natural family planning only (low practitioners), (2) provide additional contraceptive methods (moderate practitioners), and (3) provide family planning services including abortion (high practitioners). The study purposively sampled those with higher self-reported religiosity. Data were analyzed from November 2018 to February 2019. Main Outcomes and Measures: The primary outcome was understanding how participants describe integration of Catholic values with family planning service provision. The telephone interviews explored their integration of Catholic values and professional obligations, and 3 coders analyzed the responses using grounded theory. Results: Among the 34 Catholic obstetrician-gynecologists interviewed (27 women [79.4%]), there were 10 low, 15 moderate, and 9 high practitioners from 19 states. Participants' description of morality was consistent with Albert Bandura's Social-Cognitive Theory of Moral Thought and Action. The findings were used to create a modified framework. Within each group of physicians, 3 themes demonstrating their reconciliations between Catholic values and professional obligations emerged; each of these themes reflected one of the medical ethical principles of autonomy, beneficence, nonmaleficence, or justice. All 10 low practitioners primarily promoted natural family planning approaches to avoid iatrogenic risks and none provided abortion, reflecting nonmaleficence. Alternatively, moderate practitioners focused on nonmaleficence by offering contraception to prevent abortions. High practitioners primarily promoted patient autonomy by separating religious doctrine from medical practice. All had concerns for beneficence. In each group, 1 of the 4 medical ethical principles was underrepresented. Conclusions and Relevance: In this qualitative analysis, Catholic obstetrician-gynecologists establish their family planning care provision practices by emphasizing certain moral and/or ethical principles over others. These findings highlight how physician morality in the realm of family planning service provision often involves certain religious and/or professional reconciliations. Understanding the dilemmas Catholic obstetrician-gynecologists face can guide professional development efforts and inform ongoing discussions about conscientious objection and provision.

Epistemic Injustice: A Philosophical Analysis of Women's Reproductive Health Care in a Somali-American Community.

Epistemology is the study of the grounds of knowledge. We illustrate through case studies how epistemic injustice is manifested in the delivery of reproductive health care services for women from Somalia, even though it may not be intended or recognized as injustice. Testimonial injustice occurs when women are not believed or are discredited in their aim to receive care. Hermeneutic injustice occurs when a significant area of one's social experience is obscured from understanding owing to flaws in group knowledge resources for understanding. For example, women from Somalia may not receive full disclosure about the diagnostic or treatment services that are recommended in the reproductive health care setting. We explore how the many intersections in a person's identity can give rise to epistemic injustice and we suggest more expansive ways of evaluating the validity of diverse epistemologies in patient-centered care. Structural competency is recommended as a way nurses and other health care providers can mitigate the social determinants of health, which contribute to epistemic injustice.

Prioritizing Women's Health in Germline Editing Research.

Although women are inextricably involved in the study of germline editing, their interests have not been significantly represented in debates about the evolution of genome editing technology. Discussions have taken place about effects of germline editing on women as parents and members of families, but key discussions about women's health and well-being as patients and subjects are lacking. This neglect is due in part to restrictions on uterine transfer of modified human embryos, a boundary that has now been crossed. As a result, only scant discussion has taken place about safeguards needed to ensure that women who participate in germline modification research are not exposed to disproportionate risk in exchange for benefits they might expect for future offspring. This omission sets the stage for serious ethical implications for women and their families.

Not Sick: Liberal, Trans, and Crip Feminist Critiques of Medicalization.

Medicalization occurs when an aspect of embodied humanity is scrutinized by the medical industry, claimed as pathological, and subsumed under medical intervention. Numerous critiques of medicalization appear in academic literature, often put forth by bioethicists who use a variety of "lenses" to make their case. Feminist critiques of medicalization raise the concerns of the politically disenfranchised, thus seeking to protect women-particularly natal sex women-from medical exploitation. This article will focus on three feminist critiques of medicalization, which offer an alternative narrative of sickness and health. I will first briefly describe the philosophical origins of medicalization. Then, I will present three feminist critiques of medicalization. Liberal feminism, trans feminism, and crip feminism tend to regard Western medicine with a hermeneutics of suspicion and draw out potential harms of medicalization of reproductive sexuality, gender, and disability, respectively. While neither these branches of feminism-nor their critiques-are homogenous, they provide much-needed commentaries on phallocentric medicine. I will conclude the paper by arguing for the continual need for feminist critiques of medicalization, using uterus transplantation as a relevant case study.

Analysing the ethics of breast cancer overdiagnosis: a pathogenic vulnerability.

Breast cancer screening aims to help women by early identification and treatment of cancers that might otherwise be life-threatening. However, breast cancer screening also leads to the detection of some cancers that, if left undetected and untreated, would not have damaged the health of the women concerned. At the time of diagnosis, harmless cancers cannot be identified as non-threatening, therefore women are offered invasive breast cancer treatment. This phenomenon of identifying (and treating) non-harmful cancers is called overdiagnosis. Overdiagnosis is morally problematic as it leads to overall patient harm rather than benefit. Further, breast cancer screening is offered in a context that exaggerates cancer risk and screening benefit, minimises risk of harm and impedes informed choice. These factors combine to create pathogenic vulnerability. That is, breast cancer screening exacerbates rather than reduces women's vulnerability and undermines women's agency. This paper provides an original way of conceptualising agency-supporting responses to the harms of breast cancer overdiagnosis through application of the concept of pathogenic vulnerability.

Regret, shame, and denials of women's voluntary sterilization.

Women face extraordinary difficulty in seeking sterilization as physicians routinely deny them the procedure. Physicians defend such denials by citing the possibility of future regret, a well-studied phenomenon in women's sterilization literature. Regret is, however, a problematic emotion upon which to deny reproductive freedom as regret is neither satisfactorily defined and measured, nor is it centered in analogous cases regarding men's decision to undergo sterilization or the decision of women to undergo fertility treatment. Why then is regret such a concern in the voluntary sterilization of women? I argue that regret is centered in women's voluntary sterilization due to pronatalism or expectations that womanhood means motherhood. Women seeking voluntary sterilization are regarded as a deviant identity that rejects what is taken to be their essential role of motherhood and they are thus seen as vulnerable to regret.

Catholic Health Care and Women's Health.

Catholic health care facilities account for approximately one sixth of the U.S. health care market, have recently demonstrated successful growth, and serve as the only local hospital in certain remote locations. The Ethical and Religious Directives for Catholic Health Care Services is a set of guidelines created and revised by church leaders that applies the church's teaching, particularly as it relates to concern for human dignity, to modern-day medical practice; all Catholic health care facilities and providers within these facilities are required to abide. Strict interpretation of these directives limits family planning and most infertility services. Many women, however, do not anticipate differences to reproductive health care based on Catholic affiliation, and recent patient reports and legal enactments have highlighted the tension that arises when women are unable to receive medically indicated family planning services. In this article, I demonstrate that reproductive health care services are not consistently prohibited and that clinics often do not inform patients when scheduling appointments when restrictions exist. I highlight ethical concerns about patient autonomy as it relates to modern-day practice and recommend solutions including greater transparency and efforts to improve uniformity of practice at Catholic health care facilities.

Necesidad de autocuidado en la mujer: un reto para la prevención de la enfermedad cardiovascular / Need for women self-care: a challenged for the prevention of cardiovascular disease

Introducción: la agencia del autocuidado es la capacidad que tiene el individuo de cuidarse a sí mismo, donde pueden influir diversos factores propios o factores condicionantes que afecten las características de la salud de la persona. Objetivo: evaluar la capacidad de agencia de autocuidado en la mujer para la prevención de la enfermedad cardiovascular. Métodos: revisión bibliográfica en libros, información oficial registrada en bases de datos de metabuscadores reconocidos internacionalmente durante el periodo 2000-2013 tendiendo en consideración criterios óptimos de inclusión y exclusión referente al tema investigado. Conclusiones: los programas de salud pública en atención primaria cumplen con la planeación en prevención y promoción hacia la salud cardiovascular, pero la evidencia científica no logra demostrar disminución de indicadores sobre morbi-mortalidad en la población femenina, por lo que se recomienda el fomento de investigaciones evaluativas del proceso educativo para realizar un diagnóstico detallado sobre estrategias de enseñanza, aprendizaje y dominio conceptual que conlleven a retroalimentar de manera contextualizada la eficacia de los programas de promoción de la salud y prevención de la enfermedad(AU)

Introduction: Self-care management is the individual capacity to care for himself or herself, in which different factor both individually-inherent or conditioning may have in influence as they affect the person's health characteristics. Objective: Assess the women's capacity for self-care management for the prevention of the cardiovascular disease. Methods: Bibliography review in books, official information records in databases of internationally renowned meta-browsers, during the period from 2000 to 2013, considering optimal inclusion and exclusion criteria referring to the investigated topic. Conclusions: Public health programs in primary health care fulfill the planning for prevention and promotion regarding cardiovascular health, but the scientific evidence does not show the decrease of morbidity and mortality in the female population, a reason why it is recommended fostering research assessing the educational process to diagnose in details the teaching, learning and conceptual management strategies leading to a contextualized feedback in the efficiency of the health promotion and diseases prevention programs(AU)

Committee Opinion No. 646: Ethical Considerations for Including Women as Research Participants.

Inclusion of women in research studies is necessary for valid inferences about health and disease in women. The generalization of results from trials conducted in men may yield erroneous conclusions that fail to account for the biologic differences between men and women. Although significant changes in research design and practice have led to an increase in the proportion of women included in research trials, knowledge gaps remain because of a continued lack of inclusion of women, especially those who are pregnant, in premarketing research trials. This document provides a historical overview of issues surrounding women as participants in research trials, followed by an ethical framework and discussion of the issues of informed consent, contraception requirements, intimate partner consent, and the appropriate inclusion of pregnant women in research studies.