RESUMO
COVID-19 presents many challenges, both clinical and philosophical. In this paper we discuss a major lacuna that COVID-19 revealed in our philosophy and understanding of medicine. Whereas we have some understanding of how physician-scientists interrogate the world to learn more about medicine, we do not understand the epistemological costs and benefits of the various ways clinicians acquire new knowledge in their fields. We will also identify reasons this topic is important both when the world is facing a pandemic and when it is not.
Assuntos
COVID-19/epidemiologia , Filosofia Médica , Pesquisa Biomédica , COVID-19/prevenção & controle , COVID-19/terapia , Vacinas contra COVID-19/administração & dosagem , Estudos Transversais , Humanos , Conhecimento , Papel do MédicoRESUMO
Futility often serves as a proposed reason for withholding or withdrawing medical treatment, even in the face of patient and family requests. Although there is substantial literature describing the meaning and use of futility, little of it is specific to emergency medicine. Furthermore, the literature does not provide a widely accepted definition of futility, and thus is difficult if not impossible to apply. Some argue that even a clear concept of futility would be inappropriate to use. This article will review the origins of and meanings suggested for futility, specific challenges such cases create in the emergency department (ED), and the relevant legal background. It will then propose an approach to cases of perceived futility that is applicable in the ED and does not rely on unilateral decisions to withhold treatment, but rather on avoiding and resolving the conflicts that lead to physicians' believing that patients are asking them to provide "futile" care.
Assuntos
Tomada de Decisão Clínica/ética , Medicina de Emergência/ética , Medicina de Emergência/legislação & jurisprudência , Ética Médica , Futilidade Médica/ética , Futilidade Médica/legislação & jurisprudência , Idoso , Serviço Hospitalar de Emergência/ética , Serviço Hospitalar de Emergência/legislação & jurisprudência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos , Guias de Prática Clínica como Assunto/normas , Assistência Terminal/ética , Assistência Terminal/legislação & jurisprudência , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudênciaRESUMO
This article provides a brief review of moral and legal duties to respect confidentiality in emergency medicine. The article considers current challenges to confidentiality in emergency departments and proposes strategies to address them. It is offered as an update of the two-part review of confidentiality in emergency medicine in 2005 by Moskop et al published in 2005 in Annals of Emergency Medicine.
RESUMO
In the course of legal investigations, law enforcement officers may enlist emergency department (ED) personnel to gather information or forensic evidence, often with the intent of building cases against a patient. These situations create ethical conflicts between the emergency physician's obligations to the patient and society. This paper provides an overview of the ethical and legal considerations in ED forensic evidence collection and the general principles that emergency physicians should apply in these situations.
RESUMO
On 7 May 2020, Columbia University Global Centers hosted an online international symposium on ethical dilemmas during the COVID-19 pandemic. This interdisciplinary engagement between philosophers and Covid medical professionals reports the challenges as well as the discrepancies between ethical guidelines and reality. This collection of presentations identifies four key ethical dilemmas regarding responsibility, fairness, dignity and honouring death. In looking into accountability and consistency in medical humanities, it examines whether the contextuality of coronavirus across countries and cultures affected the ethical decision-making processes. This work aims to provide a seminal resource for the development of a high-quality roadmap in medical ethics for future health crises.
Assuntos
COVID-19 , Ética Médica , Pandemias , Morte , Humanos , Respeito , Responsabilidade SocialRESUMO
Problems of refusal of care, among the most common ethical dilemmas in the emergency department, are also often the most difficult to resolve, pitting 2 conflicting duties, that of helping patients and that of respecting their autonomy, against each other. Using a case presentation as a backdrop, this article offers a practical approach to patients who refuse treatment, including assessment of decisionmaking capacity but emphasizing the role of trust, communication, and compromise in these cases.
Assuntos
Competência Mental , Relações Médico-Paciente , Recusa do Paciente ao Tratamento , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/cirurgia , Comunicação , Tomada de Decisões , Humanos , Masculino , Autonomia Pessoal , Relações Médico-Paciente/ética , Recusa do Paciente ao Tratamento/éticaRESUMO
Organ donation after cardiac death (DCD) is increasingly considered as an option to address the shortage of organs available for transplantation, both in the United States and worldwide. The procedures for DCD differ from procedures for donation after brain death and are likely less familiar to emergency physicians (EPs), even as this process is increasingly involving emergency departments (EDs). This article explores the ED operational and ethical issues surrounding this procedure.
Assuntos
Morte , Serviço Hospitalar de Emergência/ética , Obtenção de Tecidos e Órgãos/ética , Humanos , Estados UnidosRESUMO
RATIONALE: One's understanding of medical progress - what it is, how it is pursued and how it is assessed - may be deeply dependent on one's understanding of the metaphysics of medicine, and of diseases in particular. AIMS AND OBJECTIVES: In this paper I present a new account of the nature of diseases, neither realist nor constructivist, and describe what progress in medicine looks like if we understand diseases in this way. CONCLUSIONS: This new account, Constructive Realism, may provide a better account of medicine than either realism or constructivism.
Assuntos
Pesquisa Biomédica/organização & administração , Filosofia Médica , Fibrose Cística/fisiopatologia , HumanosRESUMO
The ontology of medicine--the question of whether disease entities are real or not--is an underdeveloped area of philosophical inquiry. This essay explains the primary question at issue in medical ontology, discusses why answering this question is important from both a philosophical and a practical perspective, and argues that the problem of medical ontology is unique, i.e., distinct, from the ontological problems raised by other sciences and therefore requires its own analysis.
Assuntos
Doença , Metafísica , Filosofia Médica , Animais , HumanosAssuntos
Filosofia Médica , Comorbidade , Ensaios Clínicos Controlados como Assunto/ética , Ensaios Clínicos Controlados como Assunto/métodos , Ensaios Clínicos Controlados como Assunto/normas , Diagnóstico Diferencial , Saúde , História da Medicina , Homeostase , Humanos , Cooperação Internacional , Transtornos Mentais/diagnóstico , Projetos de PesquisaRESUMO
BACKGROUND AND OBJECTIVE: Culturally competent medical care for the dying patient by families and health care professionals is a challenging task especially when religious values, practices, and beliefs influence treatment decisions for patients at the end of life. This article describes end-of-life guidelines for hospital health care professionals caring for Orthodox Jewish patients and their families. Religious perspectives on advance directives, comfort care and pain control, nutrition and hydration, do not resuscitate/do not intubate (DNR/DNI), and extubation are often unfamiliar to the American medical community. DESIGN: The guidelines for the care of the dying Orthodox Jewish patient were mutually agreed upon by the authors, recognized authorities in medicine, ethics, and Jewish law, who presented their perspectives during a 1-day symposium and who participated in an active working-group session. CONCLUSIONS: Care of the religious patient close to death is enormously complex especially when balancing religious obligations, the role of the rabbi, medical procedures, and personal preferences. These guidelines address from a religious perspective profound issues such as the definition of death, organ donation, and caring for the patient at life's end. The guidelines can be useful for any hospital that serves an Orthodox Jewish population.
Assuntos
Judaísmo , Assistência Terminal , Diretivas Antecipadas , Atitude Frente a Morte , Competência Cultural , Tomada de Decisões , Hidratação , Humanos , Apoio Nutricional , Dor/prevenção & controle , Obtenção de Tecidos e ÓrgãosRESUMO
Metaphysics is an essential part of philosophy of medicine, providing the background for further methodological work. Current accounts of the ontology of particular diseases may be classified as realist or anti-realist. Because strong arguments can be marshaled by both of these positions, an approach to medical ontology that draws support from both sides of this divide would be desirable. Abstract models, as described by Ronald Giere, provide such an approach. After a review of Giere's account of mechanics, I show how abstract models can provide an account of the ontology of diseases.
Assuntos
Doença , Metafísica , Modelos Teóricos , Filosofia Médica , Fibrose Cística , Humanos , Conhecimento , Teste de RealidadeRESUMO
Properly assigning authorship of academic papers is often an ethical challenge. Through a hypothetical case study, the authors examine some of the potential ethical issues involved in determining who should and should not be listed as an author: the problems of honorary authorship, coerced authorship, and ghost authorship, as well as the question of how to order authors. Guidelines for avoiding and negotiating these issues are also discussed.