Integrating one health: exploring the global dialogue on bioethics.

Unesco's World Bioethics Day, whose theme this year is the protection of future generations, reveals the centrality of the concept of one-health, as the main way to guarantee a future for the planet seen as the common home of all living beings. The recent pandemic has sufficiently shown how animal health is linked to human health and how only the balance of the entire planet guarantees both. Living on earth as human beings, no longer blinded by the Anthropocene's arrogance, but conscious of having a fundamental responsibility for the health care and well-being of every species is the imperative that should guide scientific research, education and social life. Thus, a renovating of the education system is essential to break down rigid boundaries between disciplines and promote complex and critical thinking.

The value of nurse bioethicists.

BACKGROUND: The field of nursing has long been concerned with ethical issues. The history of the nursing profession has a rich legacy of attention to social justice and to societal questions regarding issues of fairness, access, equity, and equality. Some nurses have found that their clinical experiences spur an interest in ethical patient care, and many are now nurse bioethicists, having pursued additional training in bioethics and related fields (e.g., psychology, sociology). PURPOSE: The authors describe how the clinical and research experiences of nurses give them a unique voice in the field of bioethics. RESULTS: Authors present reasons for the relative invisibility of nurse bioethicists, compared with physician, theologian, or philosopher bioethicists, as well as current efforts to increase the visibility of nurse bioethicists. They also describe four specific areas where nurse bioethicists have made and continue to make important contributions: as ethics consultants to colleagues in hospitals and other settings; as bioethics researchers or as advisers to researchers conducting trials with human subjects; as educators of trainees, patients and families, healthcare providers, and the public; and in helping to draft humane and ethical policies for the care of vulnerable patients and underserved populations. CONCLUSION: Nurse bioethicists are central to the future goals of healthcare bringing a unique perspective to the day-to-day ethical challenges of both clinical care and research, as well as to the education of health professionals and the public.

If Not Now, Then When? Taking Disability Seriously in Bioethics.

The impression of bioethicists as "dangerous," as articulated in Mouth Magazine in 1994, has continued to be a theme in the disability movement. We respond to three common responses by bioethicists to this impression-namely, this is from the past, and bioethicists are different now; this is an angry and extremist position; and the Americans with Disabilities Act and other disability rights and justice efforts have solved historical inequities. We draw on the historical record and on our collective experiences as bioethicists engaged in clinical consultation and education and as the founding, former, and current directors of a program focused on disability and rehabilitation ethics to argue that ableism and unexamined assumptions about people with disabilities have persisted in bioethics despite decades of counternarratives, research, and divergent perspectives. Ableism and such assumptions can lead to health care decisions that are prone to bias, mistreatment, and a lack of consideration of viable options for living with disability. As the field of bioethics moves toward certification examinations and as new generations join the field's ranks, these problems need to be rectified with solutions at the individual, interpersonal, and structural levels. It is past time to take disability seriously.

Beyond the hype of big data and artificial intelligence: building foundations for knowledge and wisdom.

Big data, coupled with the use of advanced analytical approaches, such as artificial intelligence (AI), have the potential to improve medical outcomes and population health. Data that are routinely generated from, for example, electronic medical records and smart devices have become progressively easier and cheaper to collect, process, and analyze. In recent decades, this has prompted a substantial increase in biomedical research efforts outside traditional clinical trial settings. Despite the apparent enthusiasm of researchers, funders, and the media, evidence is scarce for successful implementation of products, algorithms, and services arising that make a real difference to clinical care. This article collection provides concrete examples of how "big data" can be used to advance healthcare and discusses some of the limitations and challenges encountered with this type of research. It primarily focuses on real-world data, such as electronic medical records and genomic medicine, considers new developments in AI and digital health, and discusses ethical considerations and issues related to data sharing. Overall, we remain positive that big data studies and associated new technologies will continue to guide novel, exciting research that will ultimately improve healthcare and medicine-but we are also realistic that concerns remain about privacy, equity, security, and benefit to all.

Why the history of nursing ethics matters.

Modern American nursing has an extensive ethical heritage literature that extends from the 1870s to 1965 when the American Nurses Association issued a policy paper that called for moving nursing education out of hospital diploma programs and into colleges and universities. One consequence of this move was the dispersion of nursing libraries and the loss of nursing ethics textbooks, as they were largely not brought over into the college libraries. In addition to approximately 100 nursing ethics textbooks, the nursing ethics heritage literature also includes hundreds of journal articles that are often made less accessible in modern databases that concentrate on the past 20 or 30 years. A second consequence of nursing's movement into colleges and universities is that ethics was no longer taught by nursing faculty, but becomes separated and placed as a discrete ethics (later bioethics) course in departments of philosophy or theology. These courses were medically identified and rarely incorporated authentic nursing content. This shift in nursing education occurs contemporaneously with the rise of the field of bioethics. Bioethics is rapidly embraced by nursing, and as it develops within nursing, it fails to incorporate the rich ethical heritage, history, and literature of nursing prior to the development of the field of bioethics. This creates a radical disjunction in nursing's ethics; a failure to more adequately explore the moral identity of nursing; the development of an ethics with a lack of fit with nursing's ethical history, literature, and theory; a neglect of nursing's ideal of service; a diminution of the scope and richness of nursing ethics as social ethics; and a loss of nursing ethical heritage of social justice activism and education. We must reclaim nursing's rich and capacious ethics heritage literature; the history of nursing ethics matters profoundly.

Survey of practices around pharmaceutical company funding for continuing professional development among medical oncologists and trainees in Australia.

BACKGROUND: The completion of continuing professional development (CPD) is mandatory for medical oncologists and trainees (MO&T). Pharmaceutical companies may fund some CPD activities, but there is increasing debate about the potential for conflicts of interest (COI). AIM: To assess current practices around funding to attend CPD activities. METHODS: An electronic survey was distributed to Australian MO&T. The survey asked questions about current practices, institutional policies and perceptions about attending CPD funded by pharmaceutical companies. The design looked at comparing responses between MO&T as well as their understanding of and training around institutional and ethical process. RESULTS: A total of 157 of 653 (24%) responses was received, the majority from MO (76%). Most CPD activities attended by MO&T were self-funded (53%), followed by funding from institutions (19%), pharmaceutical companies (16%) and salary award (16%). Most institutions allowed MO&T to receive CPD funding from professional organisations (104/157, 66%) or pharmaceutical companies (90/157, 57%). A minority of respondents (13/157, 8%) reported that the process to use pharmaceutical funds had been considered by an ethics committee. Although 103/157 (66%) had received pharmaceutical funding for CPD, most (109/157, 69%) reported never receiving training about potential COI. The lack of education was more noticeable among trainees (odds ratio (OR) 8.61, P = 0.02). MO&T acknowledged the potential bias towards a pharmaceutical product (P = 0.05) but believed there was adequate separation between themselves and pharmaceutical companies (P < 0.01). CONCLUSION: Majority of CPD attended by MO&T is self-funded. There is lack of clarity in institutional policies regarding external funding support for CPD activities. Formal education about potential COI is lacking.

Medical Students' Assessment of Eduard Pernkopf's Atlas: Topographical Anatomy of Man.

INTRODUCTION: To date, there has been no study examining the perceptions of first-year medical students regarding Eduard Pernkopf's atlas, particularly during their study of gross anatomy and prior to coursework in medical ethics. We present a discussion of Pernkopf's Atlas: Topographical Anatomy of Man from the perspective of U.S. medical students, and sought to determine whether medical students view Pernkopf's Topographical Anatomy of Man as a resource of greater accuracy, detail, and potential educational utility as compared to Netter's Atlas of Human Anatomy. METHODS: The entire first-year class at Drexel University College of Medicine (265 students) was surveyed at approximately the midpoint of their gross anatomy course and 192 responses were collected (72% response rate). RESULTS: Of these, 176 (95%) were unaware of the existence of Pernkopf's atlas. Another 71% of students found the Pernkopf atlas more likely complete and accurate, whereas 76% thought the Netter atlas more useful for learning (p<.001). When presented with a hypothetical scenario in which the subjects used in creating Pernkopf's atlas were donated, or unclaimed, but with knowledge that Pernkopf was an active member of the Nazi party, 133 students (72%) retained their original position (p=.001). About 94% desired discussion of Pernkopf within a medical school bioethics course. The relationship between level of self-reported knowledge and whether or not students would advocate removal of the atlas was statistically significant (p=.013). CONCLUSION: Discussing ethical violations in medical history, especially the Pernkopf atlas, must attain a secure place in medical school curricula, and more specifically, within a bioethics course.

La relación médico paciente: el desarrollo para una nueva cultura médica / Doctor-patient relationship: the development of a new medical culture

La relación entre el médico paciente se ha modificado y se requiere realizar una reflexión crítica en torno a los procesos de salud y enfermedad en los diversos escenarios en que éstos se producen para desarrollar una nueva cultura sanitaria. En este contexto, la Bioética y sus principios favorece una manera diferente de entender la relación entre el médico y el paciente, en donde se privilegia el derecho que tiene el paciente como persona con autonomía en la toma de decisiones sobre su salud y se reconoce una responsabilidad compartida que considera el impacto de factores biológicos, sociales, culturales, económicos, psicológicos y éticos sobre la atención médica y el cuidado de la salud. Se hace necesario el aporte de la Filosofía, la Bioética y Ética Médica para investigar y estudiar la relación médico paciente en sus diferentes dimensiones: ética, médica, social y moral; fortalecer las bases éticas y legales de los médicos, lograr que sean capaces de analizar y hacer propuestas que lleven a la solución de los conflictos y dilemas que se generan con el desarrollo, la innovación del conocimiento y la aplicación de la tecnología en los seres humanos, y en todos los seres vivos (AU).

The doctor-patient relationship has changed and it is necessary to carry out a critical reflection on the health-disease processes in the different sets where they take place to develop a new sanitary culture. In this context, Bioethics and its principles favor a different way of understanding the doctor-patient relationship, where the right the patient has as a person with autonomy in taking decisions about his health is privileged, and it is recognized the a shared responsibility that takes into consideration the strike of ethic, psychological, economic, cultural, social and biological factors on medical and health care. The contribution of Philosophy, Bioethics, and Medical Ethics is necessary to investigate and study the doctor-patient relationship in its different dimensions: ethic, medical, social and moral; strengthening the physicians' ethic and legal bases, achieving them to be able of analyzing making propositions leading to the solution of conflicts and dilemmas generated with the development, knowledge innovation and the application of technology in human people and all the rest of living beings (AU).

Networking Ethics: A Survey of Bioethics Networks Across the U.S.

Ethics networks have emerged over the last few decades as a mechanism for individuals and institutions over various regions, cities and states to converge on healthcare-related ethical issues. However, little is known about the development and nature of such networks. In an effort to fill the gap in the knowledge about such networks, a survey was conducted that evaluated the organizational structure, missions and functions, as well as the outcomes/products of ethics networks across the country. Eighteen established bioethics networks were identified via consensus of three search processes and were approached for participation. The participants completed a survey developed for the purposes of this study and distributed via SurveyMonkey. Responses were obtained from 10 of the 18 identified and approached networks regarding topic areas of: Network Composition and Catchment Areas; Network Funding and Expenses; Personnel; Services; and Missions and Accomplishments. Bioethics networks are designed primarily to bring ethics education and support to professionals and hospitals. They do so over specifically defined areas-states, regions, or communities-and each is concerned about how to stay financially healthy. At the same time, the networks work off different organizational models, either as stand-alone organizations or as entities within existing organizational structures.

La violencia contra la mujer: abordaje en profesionales de la Atención Primaria desde una perspectiva bioética / Violence against Women: Approach to Primary Care Professionals from A Bioethical Perspective

Introducción: la violencia contra la mujer es considerada por organizaciones internacionales y gobiernos como un problema de salud pública de primer orden, que requiere de una voluntad política para establecer objetivos y estrategias eficaces en función de la prevención y un seguimiento constante. Objetivo: reflexionar sobre la necesidad de que los profesionales de la atención primaria en su accionar, tanto en consulta como en visita a terreno, utilicen los principios de la bioética como un instrumento esencial para la obtención de un diagnóstico integral y la imperiosa solución preventiva de los conflictos de valores morales que se puedan presentar o de transgresión de principios éticos en el abordaje de tal problemática. Métodos: revisión bibliográfica sobre aspectos éticos y bioéticos necesarios para el abordaje del problema de la violencia contra la mujer por parte de los profesionales de la Atención Primaria de Salud. Conclusiones: los conocimientos sobre violencia contra la mujer en los profesionales de la atención primaria tienen un limitado alcance para afrontar las disímiles manifestaciones de este fenómeno en función de un accionar comunitario transformador, a partir de la realización de acciones de prevención y promoción de salud que permitan análisis y comprensión de actividades de prevención con una visión intersectorial(AU)

Introduction: Violence against women is considered a public health problem of the first order by international organizations and governments. This problem requires political will establish effective goals and strategies in terms of prevention and constant monitoring. Objective: Reflect on the need for primary care professionals in their actions, both in consultation and field visits, using the bioethics principles as an essential tool for obtaining comprehensive diagnosis and urgent preventive solution on moral values conflicts that may arise and / or violation of ethical principles in addressing such issues. Methods: A literature review was conducted on ethical and bioethical aspects needed to address the problem of violence against women by the professionals of Primary Health Care. Conclusions: Knowledge on violence against women of primary care professionals are limited in scope to address the disparate manifestations of this phenomenon in terms of transforming community action, from performing prevention and health promotion, which allow analysis and understanding of prevention activities with a cross-cutting vision(AU)

Teaching Bioethics at Historically Black Colleges and Universities (HBCUs).

This article describes a two-pronged, pilot bioethics education program implemented at a historically Black college/university to determine the interest in bioethics education and begin increasing the program's visibility. The pilot program included a Train-the-Trainer (TtT) component for selected faculty members and a simultaneously-running film- and-speaker series for the entire campus.

Expanding ELSI to all areas of innovative science and technology.

New curricula in the study of the ethical, legal and social implications of scientific research aims to further the conversation among all stakeholders in the interactions between science, technology and society.

Finding A Seat at the Table Together: Recommendations for Improving Collaboration between Social Work and Bioethics.

Social work and bioethics are fields deeply committed to cross-disciplinary collaboration to do their respective work. While scholars and practitioners from both fields share a commitment to social justice and to respecting the dignity, integrity and the worth of all persons, the overlap between the fields, including shared values, has received little attention. The purpose of this article is to describe the ways in which greater collaboration between the two fields can broaden their scope, enrich their scholarship, and better ground their practice. We describe the potential for realizing such benefits in two areas - health care ethics consultation and social inequalities in health - arguing that the fields both complement and challenge one another, making them ideal partners for the interdisciplinary inquiry and problem-solving so often called for today in health and health care.

Privacidade e confidencialidade em saúde na vigilância epidemiológica: relato de experiência sob o olhar bioético / Privacy and confidentiality in health in epidemiological surveillance: experience report on bioethical look

Durante experiência de trabalho em vigilância epidemiológica, na Bahia, entre as atividades desenvolvidas, destaca-se a notificação compulsória de agravos e doenças. O estudo da disciplina Bioética em Ciência da Saúde, do Programa de Pós Graduação em Enfermagem e Saúde, nível de Mestrado, mobilizou-nos à retomada de vivências cotidianas nos serviços de saúde que envolve questões bioéticas e que merece reflexão crítica. O presente estudo teve como objetivo desenvolver uma reflexão, segundo a perspectiva bioética, sobre a experiência vivenciada, envolvendo privacidade e confidencialidade em saúde, no contexto da vigilânciaepidemiológica. Trata-se de estudo descritivo da vivência em atividade de notificação compulsória no serviço de vigilância epidemiológica da Secretaria Municipal de Saúde de município da Bahia, no período de novembro de 2011 a março de 2013. Permitiu-nos perceber que a negligência na aplicação de princípios bioéticos no âmbito da notificação compulsória pode interferir na saúde do usuário, pois não garante a integridade de seus direitos e reflete a inadequação da ambiência para os atendimentos e o despreparo dos profissionais, no que se refere ao conhecimento teórico-prático de bioética

During work experience in epidemiological surveillance, Bahia, between the activities, there is mandatory reporting of injuries and Illnesses. The study of the discipline of Health Scienc and in Bioethics, the Graduate Program in Nursing and Health, Master level, mobilized us to the resumption of daily experiences in health services Involving bioethical issues que deserve critical reflection. The present study Aimed to develop the reflection, According to bioethical perspective on the lived experience Involving privacy and confidentiality in health, in the context of epidemiological surveillance. This is a descriptive study of the experience of Mandator y reporting on activity in the epidemiological surveillance service of the Municipal Health Secretariat of the state of Bahia, in the period november 2011 to march 2013.Allowed us to perform que negligence in the application of bioethical principles under compulsory notification may interfere with the health of the user, it does not guarantee the integrity of Their Rights and Reflects the inadequacy of ambience for consultations and the unpreparedness of professionals, with regard to the theoretical and practical knowledge of bioethics.

Nurse attitudes in relation to health care ethics and legal regulations for nursing / Actitudes de las enfermeras en relación con la ética de la salud y las regulaciones legales de enfermería / Atitudes das enfermeiras com relação à ética em saúde e às regulamentações legais de enfermagem

The nursing environment is full of situations under ethical and legal constraints. Therefore this study focused on the knowledge, position and attitudes of nurses in relation to healthcare ethics and nursing legal regulations. We conducted a pretest and posttest study using a specific questionnaire administered to a convenience sample of nurses who worked in a healthcare system in Principado de Asturias, a northern state of Spain and were enrolled in a continuing nursing education program about ethical and legal aspects in the nursing profession. The main findings suggest that nurses are very concerned about situations that create ethical and legal conflicts but do not feel sufficiently trained. In general, they demonstrated sufficient knowledge to address the most frequent ethical and moral situations of nursing work, and the training received during a postgraduate course in ethics and legislation provided them with greater knowledge and tools to solve the dilemmas. In conclusion, although the nurses have university-level education about professional deontology, bioethics and nursing legislation, they require periodic continuing education.

El ámbito de la enfermería está llena de situaciones clínicas que comportan limitaciones éticas y legales. Por ello, este estudio se centró en demostrar el conocimiento, posicionamiento y actitudes de las enfermeras en relación con la las regulaciones ético legales inherentes a la práctica de enfermería. Se realizó un estudio pretest y posttest, mediante un cuestionario específico administrado a una muestra de conveniencia de las enfermeras que trabajaban en un sistema de salud en el Principado de Asturias de España, y que se habían inscrito en un curso de educación continua sobre los aspectos éticos y legales en la de enfermería profesional. Las principales conclusiones indican que las enfermeras están muy preocupadas por las situaciones que generan conflictos éticos y legales, pero no se sienten suficientemente capacitadas para resolverlas. En general, demostraron conocimientos suficientes para hacer frente a las situaciones ético-morales más frecuentes del trabajo enfermero, y la formación recibida durante un curso de posgrado en la ética y la legislación les proporcionó un mayor conocimiento y herramientas para resolver otros dilemas éticos. En conclusión, aunque las enfermeras tienen conocimientos aprendidos en la universidad sobre deontología profesional, bioética y legislación en enfermería, se requiere de una educación continua en el ámbito ético-legal en enfermería.

O âmbito da enfermagem está cheio de situações clínicas que comportam limitações éticas e legais. Por isso, este estudo se centrou em demonstrar o conhecimento, posicionamento e atitudes das enfermeiras com relação às regulamentações ético-legais inerentes à prática de enfermagem. Realizou-se um estudo pré-teste e pós-teste, mediante um questionário específico administrado a uma amostra de conveniência das enfermeiras que trabalhavam num sistema de saúde no Principado de Astúrias, Espanha, e que se inscreveram num curso de educação continuada sobre os aspectos éticos e legais da enfermagem profissional. As principais conclusões indicam que as enfermeiras estão muito preocupadas com situações que geram conflitos éticos e legais, porém não se sentem suficientemente capacitadas para resolvê-las. Em geral, demonstraram conhecimentos suficientes para fazer frente às situações ético-morais mais frequentes do trabalho de enfermagem, e a formação recebida durante um curso de pós-graduação em ética e legislação lhes proporcionou um maior conhecimento e ferramentas para resolver outros dilemas éticos. Em conclusão, ainda que as enfermeiras tenham conhecimentos aprendidos na universidade sobre deontologia profissional, bioética e legislação em enfermagem, se requer uma educação continuada no âmbito ético-legal em enfermagem.

Ethiopian medical schools' rapid scale-up to support the government's goal of universal coverage.

In 2003, Ethiopia declared it would pursue the goal of universal primary health coverage. In response to the critical shortage of human resources for health care, the government decided to rapidly increase the training of health workers to provide basic services, including health education, disease prevention, and family health services primarily to rural areas. This approach, which became known as the "flooding strategy," was extended in 2005 to include medical doctors. Between 2003 and 2009, the number of universities and health science colleges grew from 5 to 23, and the original 5 medical schools were given a mandate to increase their annual enrollment by three to four times. This article describes how the "flooding strategy" strained and threatened the quality of the Ethiopian medical education system and how Addis Ababa University responded by leveraging a timely grant through the Medical Education Partnership Initiative (MEPI) to support the establishment of a consortium of four Ethiopian medical schools (MEPI-E). The consortium goals are to address the new demands by (1) maintaining and improving the quality of education through innovation and efficient use of resources, (2) developing and implementing new strategies to build human capacity and promote faculty retention, and (3) increasing locally relevant research and bioethics capacity. Implementation of program began in May 2011. Although it is still under way, MEPI-E has already catalyzed the development of a national network of medical schools, enabling unprecedented collaboration to respond to the increased demands on the Ethiopian medical education system.

Teaching and assessment of ethics and professionalism: a survey of pediatric program directors.

OBJECTIVE: The Accreditation Council for Graduate Medical Education requires residency programs to provide instruction in and evaluation of competency in ethics and professionalism. We examined current practices and policies in ethics and professionalism in pediatric training programs, utilization of newly available resources on these topics, and recent concerns about professional behavior raised by social media. METHODS: From May to August 2012, members of the Association of Pediatric Program Directors identified as categorical program directors in the APPD database were surveyed regarding ethics and professionalism practices in their programs, including structure of their curricula, methods of trainee assessment, use of nationally available resources, and policies regarding social media. RESULTS: The response rate was 61% (122 of 200). Most pediatric programs continue to teach ethics and professionalism in an unstructured manner. Many pediatric program directors are unaware of available ethics and professionalism resources. Although most programs lack rigorous evaluation of trainee competency in ethics and professionalism, 30% (35 of 116) of program directors stated they had not allowed a trainee to graduate or sit for an examination because of unethical or unprofessional conduct. Most programs do not have formal policies regarding social media use by trainees, and expectations vary widely. CONCLUSIONS: Pediatric training programs are slowly adopting the educational mandates for ethics and professionalism instruction. Resources now exist that can facilitate curriculum development in both traditional content areas such as informed consent and privacy as well as newer content areas such as social media use.