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4.
Med Health Care Philos ; 22(1): 53-58, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29946900

RESUMO

Thirty years of debate have passed since the term "Rule of Rescue" has been introduced into medical ethics. Its main focus was on whether or why medical treatment for acute conditions should have priority over preventive measures irrespective of opportunity costs. Recent contributions, taking account of the widespread reluctance to accept purely efficiency-oriented prioritization approaches, advance another objection: Prioritizing treatment, they hold, discriminates against statistical lives. The reference to opportunity costs has also been renewed in a distinctly ethical fashion: It has been stipulated that favoring help for identifiable lives amounts to a lack of benevolence for one's fellow creatures. The present article argues against both objections. It suggests that the debate's focus on consequences (deaths or severe ill health) should be reoriented by asking which aspects of such states of affairs are actually attributable to a decision maker who judges within a specific situation of choice.


Assuntos
Beneficência , Financiamento Governamental/economia , Prioridades em Saúde/economia , Recursos em Saúde/economia , Trabalho de Resgate/economia , Alocação de Recursos/economia , Tomada de Decisões , Ética Médica , Financiamento Governamental/ética , Prioridades em Saúde/ética , Recursos em Saúde/ética , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/ética , Humanos , Programas Nacionais de Saúde/economia , Trabalho de Resgate/ética , Alocação de Recursos/ética
5.
Cardiol Young ; 29(1): 36-39, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30334497

RESUMO

BACKGROUND: In countries with ample resources, no debate exists as to whether heart surgery should be provided. However, where funding is limited, what responsibility exists to care for children with congenital heart defects? If children have a "right" to surgical treatment, to whom is the "duty" to provide it assigned? These questions are subjected to ethical analysis. METHODS: Examination is initially based on the four principles of medical ethics: autonomy, beneficence, non-maleficence, and justice. Consideration of beneficence and justice is expanded using a consequentialist approach. RESULTS: Social structures, including governments, exist to foster the common good. Society, whether by means of government funding or otherwise, has the responsibility, according to the means available, to assure health care for all based on the principles of beneficence, non-maleficence, and justice. In wealthy countries, adequate resources exist to fund appropriate treatment; hence it should be provided to all based on distributive justice. In resource-limited countries, however, decisions regarding provision of care for expensive or complex health problems must be made with consideration for broader effects on the general public. Preliminary data from cost-effectiveness analysis indicate that many surgical interventions, including cardiac surgery, may be resource-efficient. Given that information, utilitarian ethical analysis supports dedication of resources to congenital heart surgery in many low-income countries. In the poorest countries, where access to drinking water and basic nutrition is problematic, it will often be more appropriate to focus on these issues first. CONCLUSION: Ethical analysis supports dedication of resources to congenital heart surgery in all but the poorest countries.


Assuntos
Altruísmo , Procedimentos Cirúrgicos Cardíacos , Tomada de Decisões/ética , Recursos em Saúde/ética , Criança , Cardiopatias Congênitas/cirurgia , Humanos
6.
Hastings Cent Rep ; 47(5): 17-24, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28940341

RESUMO

When Dr. Hortense screens her patients in Chicago for cervical dysplasia and cancer, she conducts a pelvic exam, takes a sample of cervical cells, and sends them for Pap cytology and human papilloma virus DNA co-testing. But when she conducts cervical cancer screening in Botswana, she employs a much simpler diagnostic strategy. She applies acetic acid to highlight precancerous lesions and visually inspects the cervix-a technique known as the VIA (visual inspection with acetic acid) method. She treats suspicious lesions with cryotherapy. There are multiple reasons that Dr. Hortense uses VIA in developing countries. It requires no specialized laboratory facilities or highly trained personnel. With immediate results, there is no delay in diagnosis and treatment, ensuring that patients are not lost to follow-up. Most importantly, VIA is considerably cheaper than Pap and HPV co-testing. This difference in care between Chicago and Botswana presents an ethical dilemma in global health: is it ethically acceptable to provide some patients cheaper treatments that are less effective or more toxic than the treatments other patients receive? We argue that it is ethical to consider local resource constraints when deciding what interventions to provide. The provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.


Assuntos
Países em Desenvolvimento , Saúde Global , Recursos em Saúde/economia , Recursos em Saúde/ética , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/ética , Humanos , Justiça Social , Organização Mundial da Saúde
7.
Gesundheitswesen ; 79(10): 877-882, 2017 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-27144711

RESUMO

State of the debate: The "Rule of Rescue" refers to the practice that, in order to save people from immediate peril, societies incur high costs largely irrespective of the fact that many more lives could be saved under alternative uses of the resources. The practice has been found difficult to explain, let alone justify, and has often been criticized. In the early literature in the context of the Oregon rationing experiment, the irrationality objection dominated in view of the obvious lack to consider opportunity costs. More recent contributions, taking account of the declining support for purely efficiency-oriented prioritization approaches, advance an equity objection: The practice discriminates against statistical lives. Intent of the present contribution: This article provides a critical assessment of both objections. Results: The following contentions result from the analysis: 1. The equity objection is unfounded; 2. Following the rule of rescue is (in a certain sense) inefficient, but it is not irrational; 3. The criticized judgments result from deep-seated shortcomings in the action-theoretical concepts used (or rather, omitted) in the literature. These shortcomings are inherent in the consequentialist framework dominating the debate and deserve more attention.


Assuntos
Financiamento Governamental/economia , Prioridades em Saúde/economia , Recursos em Saúde/economia , Programas Nacionais de Saúde/economia , Trabalho de Resgate/economia , Alocação de Recursos/economia , Discriminação Social , Análise Custo-Benefício , Ética Médica , Financiamento Governamental/ética , Alemanha , Prioridades em Saúde/ética , Recursos em Saúde/ética , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/ética , Humanos , Trabalho de Resgate/ética , Alocação de Recursos/ética , Discriminação Social/ética
8.
AMA J Ethics ; 18(8): 764-70, 2016 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-27550559

RESUMO

This case of platelet transfusion in palliative care illustrates a common dilemma in transfusion medicine: approval of the use of a scarce, yet potentially life-saving, resource. As in this case, these decisions often involve seriously ill patients with acute needs and evolving goals of care. The use of resources to treat the patient at hand must be balanced against maintaining adequate resources to treat future patients. In this setting, the ethical principles of beneficence and social justice are in conflict.


Assuntos
Tomada de Decisões/ética , Ética Médica , Alocação de Recursos para a Atenção à Saúde/ética , Recursos em Saúde/ética , Cuidados Paliativos/ética , Transfusão de Plaquetas/ética , Assistência Terminal/ética , Beneficência , Pré-Escolar , Feminino , Humanos , Justiça Social
11.
World J Surg ; 38(7): 1574-80, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24789014

RESUMO

Global surgery, while historically a small niche, is becoming a larger part of the global health enterprise. This article discusses the burden of global surgery, emphasizing the importance of addressing surgical needs in low- and middle-income countries. It describes the barriers to surgical care in the developing world, the ethical challenges that these barriers create, and strategies to overcome these barriers. It emphasizes the crucial role of preparation for global surgical interventions as a way to maximize benefits as well as minimize harms and ethical challenges. It ends with the cautionary statement that preparation does not eliminate ethical problems, so surgical volunteers must be prepared not only for the technical challenges of global surgery but also for the ethical challenges.


Assuntos
Países em Desenvolvimento , Cirurgia Geral/ética , Saúde Global/ética , Acessibilidade aos Serviços de Saúde/ética , Missões Médicas/ética , Fortalecimento Institucional/ética , Barreiras de Comunicação , Efeitos Psicossociais da Doença , Recursos em Saúde/ética , Humanos , Relações Médico-Paciente/ética , Estados Unidos , Voluntários
12.
J Med Ethics ; 39(1): 51-4, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23001919

RESUMO

Within the context of global health development approaches, surgical missions to provide care for underserved populations remain the least studied interventions with regard to their methodology. Because of the unique logistical needs of delivering operative care, surgical missions are often described solely in terms of cases performed, with a paucity of discourse on medical ethics. Within surgery, subspecialties that serve patients on a non-elective basis should, it could be argued, create mission strategies that involve a didactic approach and the propagation of sustainable surgical care. The ethical considerations have yet to be described for paediatric neurosurgical outreach missions. We present here the perspectives of neurosurgeons who have participated in surgical outreach missions in Central America, South America, Eastern Europe and sub-Saharan Africa from the vantage point of both the visiting mission team and the host team that accommodates the mission efforts.


Assuntos
Países Desenvolvidos , Países em Desenvolvimento , Missões Médicas/ética , Neurocirurgia/ética , Pediatria/ética , Adolescente , África Subsaariana , América Central , Criança , Pré-Escolar , Conflito de Interesses , Europa Oriental , Recursos em Saúde/ética , Recursos em Saúde/estatística & dados numéricos , Humanos , Consentimento Livre e Esclarecido , Internet , Procedimentos Neurocirúrgicos/ética , América do Sul , Equipamentos Cirúrgicos
14.
Gesundheitswesen ; 73(10): 688-95, 2011 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-21259190

RESUMO

Empirical studies have shown that QALY-maximization leads to results that are perceived as unfair. Health economists have attempted to integrate fairness aspects in Cost-Utility Analysis by means of equity weighting. A well-known example is Cost-Value Analysis (Nord et al.). Over and above the value of individual health related utilities, it tries to capture the value of distributing resources fairly. The debate has shown, however, that these approaches face several problems. The present contribution argues that the difficulties are of a more fundamental nature than most contributors to the debate have hitherto assumed. Cost-utility analysis, we believe, cannot consistently be adjusted to meet fairness objections by means of weighting schemes.


Assuntos
Alocação de Recursos para a Atenção à Saúde/economia , Programas Nacionais de Saúde/economia , Anos de Vida Ajustados por Qualidade de Vida , Bioética , Doença Crônica/economia , Análise Custo-Benefício/ética , Pessoas com Deficiência , Alemanha , Alocação de Recursos para a Atenção à Saúde/ética , Recursos em Saúde/economia , Recursos em Saúde/ética , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/ética , Humanos , Programas Nacionais de Saúde/ética
15.
Z Rheumatol ; 69(10): 860-2, 2010 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-21088968

RESUMO

Disease biomarkers would aim at a more specific definition of diagnosis or subtype of a certain disease, as well as prognosis definition, including efficacy and side effects of certain therapeutics. Biomarkers could lead to a prognostically optimized definition of remission in the individual patient and thus to a more objective definition of therapeutic efficacy. Is this possible and does it make sense? Or would an extensive analysis of biomarkers to date lead to a costly overestimation of as yet not well established biologic parameters? Although we are currently unable to answer this question, many colleagues argue in favour of more in depth research for a better evaluation of biomarkers in many diseases. This could save money if we were able to predict the efficacy of expensive drugs such as immunobiologics. Biomarkers comprise cytometric information, data on protein expression and secretion, mRNA, microRNA or DNA, including epigenetic variants. Although much of these data already exist in the scientific literature, it is associated with problems in terms of feasibility (for cytometry and RNA analysis only on-site analysis is possible, while for DNA analysis central testing is also possible), costs and reproducibility (ethnic variability!). To date all biomarkers have only limited value in terms of the above-mentioned aims. The present review compiles "PROs and CONs" in a subjective way in order to provoke a discussion on the meaningfulness of biomarkers, while at the same time supporting and encouraging further research in this field.


Assuntos
Biomarcadores/sangue , Marcadores Genéticos/genética , Recursos em Saúde/economia , Programas Nacionais de Saúde/economia , Reumatologia/economia , Artrite Reumatoide/sangue , Artrite Reumatoide/genética , Artrite Reumatoide/terapia , Análise Custo-Benefício/tendências , Diagnóstico Diferencial , Previsões , Marcadores Genéticos/ética , Alemanha , Recursos em Saúde/ética , Recursos em Saúde/tendências , Humanos , Prognóstico , Reumatologia/ética , Reumatologia/tendências , Resultado do Tratamento
16.
Rev. bioét. (Impr.) ; 18(2)maio-ago. 2010.
Artigo em Português, Inglês | LILACS | ID: lil-577716

RESUMO

Estudo exploratório qualitativo objetivou conhecer e analisar critérios levantados por bioeticistas sobre o estabelecimento de prioridades para o sistema de saúde brasileiro em face da escassez de recursos. Os dados foram obtidos no período de julho de 2007 a fevereiro de 2009 mediante entrevistas semiestruturadas com 21 professores universitários de bioética, diretores e ex-diretores da Sociedade Brasileira de Bioética (SBB) e de suas diretorias regionais. A maior parte dos discursos apontou a validade de se limitar recursos em situação de escassez e contrariedadeà utilização dos recursos voltados para ações que se enquadram na denominação de medicina de desejo. Também demonstram posicionamentos, ora orientados pela equidade, priorizando os mais desfavorecidos, ora orientados pela maximização dos benefícios. Conclui-se nesta análise parcial pela existência de um pluralismo moral que traz dificuldades para decidir-se sobre o que seria um sistema de saúde justo, do que se pode depreender ser necessário exaustivo diálogo para se chegar aos consensos possíveis.


Assuntos
Humanos , Alocação de Recursos para a Atenção à Saúde/tendências , Eticistas , Recursos Financeiros em Saúde , Políticas, Planejamento e Administração em Saúde , Sistemas de Saúde , Política de Saúde , Recursos em Saúde/ética , Pesquisa Qualitativa , Inquéritos e Questionários
17.
Artigo em Alemão | MEDLINE | ID: mdl-20354669

RESUMO

The German health care system will face major challenges in the near future. Progress in medicine as well as demographic change will combine to drastically exacerbate the scarcity of resources in the health care system. The word scarcity in this case not only refers to the availability of funds. Other resources, e.g., staff, attention, time, and organs for transplantation, are also becoming scarce. It is conceivable that, in the future, it will no longer be possible to provide medical services for all patients to the same extent as in the past. If the necessary resources are not available in the health care system, if the potential for saving resources has been more or less exhausted, and if rationing shall not be an option, the only option to resort to will be prioritization. Prioritization in the health care sector denotes a supply of services according to specific, predetermined criteria. A broad and open public debate, which would have to be accompanied as well as moderated by the Health Council ("Gesundheitsrat"), is essential for determining such criteria.


Assuntos
Prioridades em Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Programas Nacionais de Saúde/tendências , Dinâmica Populacional , Sociedades Médicas , Idoso , Ética Médica , Alemanha , Custos de Cuidados de Saúde/ética , Custos de Cuidados de Saúde/tendências , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/tendências , Prioridades em Saúde/ética , Recursos em Saúde/ética , Recursos em Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/ética , Humanos , Morbidade/tendências , Programas Nacionais de Saúde/ética , Sociedades Médicas/ética
19.
Rev. chil. reumatol ; 24(2): 111-114, 2008.
Artigo em Espanhol | LILACS | ID: lil-504087

RESUMO

Siempre la distribución de recursos económicos tiene un componente ético. Como ética aplicada hay que situarla en su circunstancia. Por lo tanto, varía según su época histórica. En este trabajo se hace un brevísimo recorrido histórico para situarse en el hoy, en que este tema es más candente. Tema siempre abierto a la deliberación y a la racionalidad prudente y responsable.


The distribution of economic resources always has an ethical element. As applied ethics, the same must be placed according to its circumstances, which varies according to its moment in history. We present a brief historical look in order to position ourselves in the present, where the issue has taken on unsuspected importance. Ethics is always open to deliberation, as well as prudent and responsible rationality.


Assuntos
Recursos em Saúde/ética , Recursos em Saúde/provisão & distribuição , Justiça Social
20.
Postgrad Med J ; 81(959): 608-12, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16143694

RESUMO

Challenging issues confront emergency physicians routinely when performing cardiopulmonary resuscitation. Ethical issues surrounding resuscitation may include issues of futility, withholding or withdrawing interventions, advance directives, family presence, practising procedures on the newly dead, palliative care, and communication. Principles of bioethics can be valuable in assessing and debating ethical dilemmas. In many cases where curative care is not possible or is not desired, the goal of medical care at the end of life is to provide comfort to the patient and family, rather than initiating technological interventions that are unlikely to benefit the patient.


Assuntos
Reanimação Cardiopulmonar/ética , Diretivas Antecipadas/ética , Comunicação , Tratamento de Emergência/ética , Ética Médica , Eutanásia/ética , Família , Educação em Saúde/normas , Recursos em Saúde/ética , Recursos em Saúde/estatística & dados numéricos , Humanos , Futilidade Médica , Cuidados Paliativos/ética , Papel do Médico , Relações Médico-Paciente , Suicídio Assistido/ética , Estados Unidos
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