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2.
Br J Nurs ; 29(5): 314-317, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32167808

RESUMO

Person-first thinking makes it a virtue to 'see the person, not the disability', overlooking, or making an effort to overlook, a person's impairment in order to see 'the person within'. This might seem a caring and compassionate approach in everyday nursing practice, but on closer examination it can be seen as unhelpful and even discriminatory. This article considers why this should be the case and introduces the affirmation model as a basis for a different way of thinking about the issue.


Assuntos
Pessoas com Deficiência , Empatia , Filosofia em Enfermagem , Humanos , Princípios Morais , Ética Baseada em Princípios
3.
Am J Emerg Med ; 38(1): 138-142, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31378410

RESUMO

There is considerable diversity in compensation models in the specialty of Emergency Medicine (EM). We review different compensation models and examine moral consequences possibly associated with the use of various models. The article will consider how different models may promote or undermine health care's quadruple aim of providing quality care, improving population health, reducing health care costs, and improving the work-life balance of health care professionals. It will also assess how different models may promote or undermine the basic bioethical principles of beneficence, non-maleficence, respect for autonomy, and justice.


Assuntos
Temas Bioéticos , Compensação e Reparação/ética , Medicina de Emergência/economia , Medicina de Emergência/ética , Modelos Econômicos , Medicina de Emergência/normas , Custos de Cuidados de Saúde , Humanos , Satisfação no Emprego , Ética Baseada em Princípios , Qualidade da Assistência à Saúde , Sociedades Médicas
4.
Eur J Haematol ; 103(5): 478-482, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31418923

RESUMO

PURPOSE OF THE STUDY: To discuss the ethical challenges for the therapeutic team when dealing with a young savior sibling as a potential tissue donor. BASIC PROCEDURES: Savior siblings are children that are created to serve a sibling as a donor of umbilical cord blood, bone marrow, or peripheral blood from which hematopoietic stem cells are derived. These cells are used for hematopoietic stem cell therapy, which is the only curative treatment for certain hemoglobinopathies. We used a case including a 19-year-old thalassemia patient and his two and a half year old sister from our practice as ethics consultants. Our methodological basis is the principlism approach by Beauchamp and Childress, consisting of four principles: autonomy, non-maleficence, beneficence, and justice. MAIN FINDINGS: We found that the main conflict arises between the autonomy of the savior sibling as well as the non-maleficence regarding her and the beneficence of the thalassemia patient. PRINCIPAL CONCLUSIONS: Decision-making is complex when decisions within the family are concerned, especially when non-competent young children are involved. The therapeutic team does not only have to recognize the principal vulnerability of children but also the different scales of vulnerability depending on their age.


Assuntos
Temas Bioéticos , Tomada de Decisão Clínica/ética , Ética Baseada em Princípios , Irmãos , Obtenção de Tecidos e Órgãos/ética , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Adulto Jovem
5.
J Bioeth Inq ; 16(3): 405-414, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31418161

RESUMO

Preimplantation genetic diagnosis (PGD) allows the detection of genetic abnormalities in embryos produced through in vitro fertilization (IVF). Current funding models in Australia provide governmental subsidies for couples undergoing IVF, but do not extend to PGD. There are strong reasons for publicly funding PGD that follow from the moral principles of autonomy, beneficence and justice for both parents and children. We examine the objections to our proposal, specifically concerns regarding designer babies and the harm of disabled individuals, and show why these are substantially outweighed by arguments for subsidizing PGD. We argue that an acceptance of PGD is aligned with present attitudes towards procreative decision making and IVF use, and that it should therefore receive government funding.


Assuntos
Financiamento Governamental/ética , Custos de Cuidados de Saúde/ética , Pais/psicologia , Diagnóstico Pré-Implantação/economia , Diagnóstico Pré-Implantação/ética , Ética Baseada em Princípios , Austrália , Beneficência , Tomada de Decisões/ética , Feminino , Humanos , Masculino , Autonomia Pessoal , Gravidez , Seleção Genética , Justiça Social
6.
N Z Med J ; 132(1499): 64-71, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31352476

RESUMO

After five decades of restrictive laws, New Zealand is on the cusp of law reform that may result in abortion being treated as a health, rather than a criminal, matter. Given this possible liberalisation, a pressing issue is the way in which 'conscientious objection' (CO) will be accommodated within the new legislative landscape. In this context, CO constitutes a health provider refusing, on the grounds of personal conscience, to provide care that, although legal and potentially clinically appropriate, conflicts with their personal moral views. Currently, New Zealand law permits significant concessions for conscientious objectors. This paper argues that in the light of current reform, the justification for permitting CO should be revisited. It claims that even if it is conceded that some form of CO should be respected, a pragmatic compromise must be adopted so that both provider's and women's rights are sufficiently protected. We argue that the current legal situation in New Zealand is unbalanced, favouring the rights of providers at the expense of women's timely access to abortion care. At a minimum, providers with a CO should be required to ensure an indirect referral to another provider who is willing to refer the woman to abortion services.


Assuntos
Aborto Induzido , Atitude do Pessoal de Saúde , Médicos , Encaminhamento e Consulta , Direitos da Mulher , Feminino , Humanos , Nova Zelândia , Médicos/ética , Médicos/psicologia , Ética Baseada em Princípios , Profissionalismo/ética
7.
Bioethics ; 33(4): 431-438, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31016740

RESUMO

Working as clinical ethicists in an academic hospital, we find that practitioners tend to take a principle-based approach to moral dilemmas when it comes to (not) treating patients who feel like a burden, in which respect for autonomy tends to trump other principles. We argue that this approach insufficiently deals with the moral doubts of professionals with regard to feeling that you are a burden as a motive to decline or withdraw from treatment. Neither does it take into adequately account the specific needs of the patient that might underlie their feeling of being a burden to others. We propose a care ethics approach as an alternative. It focuses on being attentive and responsive to the caring needs of those involved in the care process-which can be much more specific than either receiving or withdrawing from treatment. This approach considers these needs in the context of the patient's identity, biography and relationships, and regards autonomy as relational rather than as individual. We illustrate the difference between these two approaches by means of the case of Mrs K. Furthermore, we show that a care ethics approach is in line with interventions that are found to alleviate feeling a burden and maintain that facilitating moral case deliberation among practitioners can supports them in taking a care ethics approach to moral dilemmas in (not) treating patients who feel like a burden.


Assuntos
Atitude Frente a Morte , Tomada de Decisões/ética , Emoções , Relações Familiares , Assistência ao Paciente/ética , Autonomia Pessoal , Recusa do Paciente ao Tratamento/psicologia , Morte , Ética Médica , Pessoal de Saúde/ética , Humanos , Motivação , Assistência ao Paciente/psicologia , Ética Baseada em Princípios , Autoimagem , Estresse Psicológico
8.
Curr Opin Anaesthesiol ; 32(2): 169-173, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30817390

RESUMO

PURPOSE OF REVIEW: Many medical professionals receive requests from family and friends asking for medical advice and treatment. But should medics treat their family? Ethically can we treat, or refuse to treat, family members? This is a common ethical challenge that most doctors face during their career and there is limited evidence available. By examining ethical principles, we aim to answer these questions and provide a framework that will guide decision making in this area. RECENT FINDINGS: There is a paucity of evidence available. Many ethical systems exist and have been discussed since ancient Greece but in recent years, bioethics has become more prominent in medical thinking and debate. SUMMARY: We examine ethical systems such as virtue ethics, utilitarianism, deontology and principlism and how they relate to treating family members. We then look at cases in different contexts and describe a system for approaching such cases, allowing doctors to conform to moral standards, and consider ethical arguments, prior to embarking upon any treatment course with a relative.


Assuntos
Temas Bioéticos , Tomada de Decisões , Ética Médica , Família/psicologia , Médicos/ética , Teoria Ética , Humanos , Médicos/psicologia , Ética Baseada em Princípios
9.
BMC Med Ethics ; 20(1): 14, 2019 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-30777063

RESUMO

BACKGROUND: Animal-derived constituents are frequently used in anaesthesia and surgery, and patients are seldom informed of this. This is problematic for a growing minority of patients who may have religious or secular concerns about their use in their care. It is not currently common practice to inform patients about the use of animal-derived constituents, yet what little empirical data does exist indicates that many patients want the opportunity to give their informed consent. DISCUSSION: First we review the nature and scale of the problem by looking at the groups who may have concerns about the use of animal-derived constituents in their care. We then summarise some of the products used in anaesthesia and surgery that can contain such constituents, such as anaesthetic drugs, surgical implants and dressings. Finally, we explore the problem of animal-derived constituents and consent using Beauchamp and Childress' four principles approach, examining issues of autonomy, beneficence, nonmaleficence and justice. Disclosing the use of animal-derived constituents in anaesthesia and surgery is warranted under Beauchamp and Childress' four principles approach to the problem. Although there exist systemic and practical challenges to implementing this in practice, the ethical case for doing so is strong. The Montgomery ruling presents additional legal reason for disclosure because it entails that patients must be made aware of risks associated with their treatment that they attach significance to.


Assuntos
Anestesia/ética , Anestesia/métodos , Revelação/ética , Consentimento Livre e Esclarecido/ética , Bem-Estar do Animal/ética , Animais , Beneficência , Materiais Biocompatíveis/química , Dieta Vegana/ética , Teoria Ética , Humanos , Autonomia Pessoal , Preparações Farmacêuticas , Ética Baseada em Princípios , Religião e Medicina , Vegetarianos
10.
Indian J Med Ethics ; 4(1): 26-29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30473498

RESUMO

Medical ethics is invoked for immunisation of children as it involves an interaction between a healthcare professional and the child. Immunisation under the national immunisation programme is a public health intervention and the common belief is that ethics is not relevant. Two vaccines with contrasting safety and efficacy profiles were available against polio before the national immunisation programme was launched: the inactivated poliovirus vaccine (IPV) and the live attenuated oral poliovirus vaccine (OPV). India chose OPV and excluded IPV. We carried out an ethical appraisal of that choice. Principles of medical ethics comprising four elements-non-maleficence, beneficence, autonomy and justice-was already in vogue at the time. Applying each of them, a head-to-head comparison between IPV and OPV is made. The results clearly show that the choice of vaccine was made without using ethical principles, resulting in serious adverse effects in hundreds of thousands of children. We recommend that medical ethics must be applied to all choices of public health interventions.


Assuntos
Comportamento de Escolha/ética , Programas de Imunização/ética , Poliomielite/prevenção & controle , Vacina Antipólio de Vírus Inativado , Vacina Antipólio Oral/efeitos adversos , Prática de Saúde Pública/ética , Vacinação/ética , Criança , Pré-Escolar , Análise Ética , Ética Médica , Humanos , Índia , Ética Baseada em Princípios
11.
Sci Eng Ethics ; 25(2): 477-517, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29299754

RESUMO

Researchers of the Northeast Ethics Education Partnership (NEEP) at Brown University sought to improve an understanding of the ethical challenges of field researchers with place-based communities in environmental studies/sciences and environmental health by disseminating a questionnaire which requested information about their ethical approaches to these researched communities. NEEP faculty sought to gain actual field guidance to improve research ethics and cultural competence training for graduate students and faculty in environmental sciences/studies. Some aspects of the ethical challenges in field studies are not well-covered in the literature. More training and information resources are needed on the bioethical challenges in environmental field research relating to maximizing benefits/reducing risks to local inhabitants and ecosystems from research; appropriate and effective group consent and individual consent processes for many diverse communities in the United States and abroad; and justice considerations of ensuring fair benefits and protections against exploitation through community-based approaches, and cultural appropriateness and competence in researcher relationships.


Assuntos
Competência Cultural , Ecologia/ética , Meio Ambiente , Saúde Ambiental/ética , Ética em Pesquisa , Características de Residência , Justiça Social , Temas Bioéticos , Relações Comunidade-Instituição , Ecossistema , Humanos , Consentimento Livre e Esclarecido , Ética Baseada em Princípios , Projetos de Pesquisa , Pesquisadores , Rhode Island , Inquéritos e Questionários , Universidades
13.
Indian J Med Ethics ; 3(4): 315-320, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30121562

RESUMO

Right to privacy of health-related information is a foundational bioethical principle. In India, the importance of protecting privacy is included in law and ethical guidelines. Institutional Ethics Committees (IECs) are entrusted with the responsibility of protecting fundamental ethical principles, including privacy and confidentiality. The present qualitative study was designed to understand IECs' privacy-related obligations and the members' experience in implementing ethical guidelines and privacy protections in their institutions. An interview guide was prepared regarding knowledge of ethical guidelines. Interviews of nineteen IEC members were recorded, transcribed, and translated. Interviews were analysed using thematic analysis. Themes related to these issues were extracted after analysis: awareness, understanding, and implementation of ethical guidelines; understanding of privacy-related obligations and their implementation; and juridical risks to privacy of patients and research participants. The results suggest that training programmes and awareness workshops should be organised for IEC members to protect the rights of research participants, especially in confidentiality issues.


Assuntos
Confidencialidade/ética , Comitês de Ética em Pesquisa , Ética em Pesquisa , Guias como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Privacidade , Pesquisadores/ética , Conscientização , Membro de Comitê , Compreensão , Confidencialidade/legislação & jurisprudência , Fidelidade a Diretrizes , Direitos Humanos , Humanos , Índia , Ética Baseada em Princípios , Privacidade/legislação & jurisprudência , Pesquisa Qualitativa , Pesquisa/legislação & jurisprudência , Inquéritos e Questionários
14.
Sci Eng Ethics ; 24(5): 1645-1652, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30143956

RESUMO

The Ethics of Technology: A Geometric Analysis of Five Moral Principles proposes five moral principles for analyzing ethical issues related to engineering and technology. The objections raised by several authors to the multidimensional scaling technique used in the book reveal a lack of familiarity with this widely used technique.


Assuntos
Engenharia/ética , Análise Ética/métodos , Ética Baseada em Princípios , Tecnologia/ética , Temas Bioéticos , Humanos , Princípios Morais
15.
New Bioeth ; 24(3): 258-267, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30015576

RESUMO

In this paper, I will examine how the role of hope can inform our interpretation of the classical principles of medical ethics. Defining hope as a future-oriented expectation for the good, I will look at how it can shape our understanding of justice, beneficence, respect for autonomy and non-maleficence. I will suggest that ethically engaging with these principles in medical practice requires placing value on the patient-practitioner relation as a mode of hope. Engaging the writings of Emmanuel Lévinas and Søren Kierkegaard, I will show how hope reveals itself through responsible and expectant relationship, even in the midst of suffering.


Assuntos
Ética Médica , Esperança , Obrigações Morais , Relações Médico-Paciente , Ética Baseada em Princípios , Beneficência , Bioética , Humanos , Autonomia Pessoal , Justiça Social
16.
BMC Med Ethics ; 19(1): 52, 2018 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-29866194

RESUMO

BACKGROUND: Health care organization is entering a new age. Focus is increasingly shifting from individual health care institutions to interorganizational collaboration and health care networks. Much hope is set on such networks which have been argued to improve economic efficiency and quality of care. However, this does not automatically mean they are always ethically justified. A relevant question that remains is what ethical obligations or duties one can ascribe to these networks especially because networks involve many risks. Due to their often amorphous and complex structure, collective responsibility and accountability may increase while individual responsibility goes down. MAIN BODY: We argue that a business ethics approach to ethical obligations for health care networks, is problematic and we propose to opt for a patient perspective. Using the classic four principles of biomedical ethics (justice, nonmaleficence, beneficence and autonomy) it is possible to identify specific ethical duties. Based on the principle of justice, health care networks have an ethical duty to provide just and fair access for all patients and to be transparent to patients about how access is regulated. The principle of nonmaleficence implies an obligation to guarantee patient safety, whereas the principle of beneficence implies an obligation for health care networks to guarantee continuity of care in all its dimensions. Finally, the principle of autonomy is translated into a specific obligation to promote and respect patient choice. Networks that fail to meet any of these conditions are suspect and cannot be justified ethically. CONCLUSIONS: Faced with daunting challenges, the health care system is changing rapidly. Currently many hopes ride on integrated care and broad health care networks. Such networks are the topic of empirical debate, but more attention should be given to the ethical aspects. Health care networks raise new and pressing ethical issues and we are in need of a framework for assessing how and when such networks are justified.


Assuntos
Bioética , Continuidade da Assistência ao Paciente , Assistência à Saúde/ética , Acesso aos Serviços de Saúde , Segurança do Paciente , Autonomia Pessoal , Ética Baseada em Princípios , Temas Bioéticos , Assistência à Saúde/organização & administração , Ética Médica , Humanos , Obrigações Morais
17.
BMC Med Ethics ; 19(1): 25, 2018 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-29636102

RESUMO

BACKGROUND: Forensic psychiatry is a particular subspecialty within psychiatry, dedicated in applying psychiatric knowledge and psychiatric training for particular legal purposes. Given that within the scope of forensic psychiatry, a third party usually intervenes in the patient-doctor relationship, an amendment of the traditional ethical principles seems justified. RESULTS: Thus, 47 articles, two book chapters and the guidelines produced by the World Psychiatric Association, the American Association of Psychiatry and the Law, as well as by the Royal Australian and New Zealand College of psychiatrists, were analyzed. The review revealed that the ethics of correctional forensic psychiatry and those of legal forensic psychiatry do not markedly differ from each other, but they are incongruent in terms of implementation. METHODS: In an effort to better understand which ethical principles apply to forensic psychiatry, a chronological review of the literature published from 1950 to 2015 was carried out. CONCLUSION: The ethics of correctional forensic psychiatry are primarily deontological. The principle of justice translates into the principle of health care equivalence, the principle of beneficence into providing the best possible care to patients, and the principle of respect of autonomy into ensuring confidentiality and informed consent. The ethics of legal forensic psychiatry are rather consequentialist. In this latter setting, the principle of justice is mainly characterized by professionalism, the principle of beneficence by objectivity and impartiality, and the principle of respect of autonomy by informed consent. However, these two distinct fields of forensic psychiatry share in common the principle of non maleficence, defined as the non collaboration of the psychiatrist in any activity leading to inhuman and degrading treatment or to the death penalty.


Assuntos
Beneficência , Ética Médica , Psiquiatria Legal/ética , Jurisprudência , Obrigações Morais , Autonomia Pessoal , Justiça Social , Pena de Morte , Teoria Ética , Consentimento Livre e Esclarecido , Relações Médico-Paciente , Ética Baseada em Princípios , Profissionalismo , Tortura
18.
Arch Iran Med ; 21(1): 19-25, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29664666

RESUMO

BACKGROUND: Considering that medical ethics is an applied subject providing systematic solutions to help physicians with moral issues, this research aimed to evaluate adherence to the principles of medical ethics among physicians on the basis of attitude of physicians of Mazandaran province. METHODS: This cross-sectional study was conducted in Mazandaran province, Iran during 2015. A researcher-made questionnaire was used for data collection. The questionnaire was first completed by 40 physicians and its reliability was confirmed by obtaining a Cronbach's alpha coefficient equal to 0.818. Its validity was confirmed by medical ethics experts. Therefore, the questionnaire was reliable and valid. Analytical and descriptive analysis were performed. RESULTS: According to our findings, there is a significant correlation between some of variables of medical ethics principles. The results show that adherence to indicators of beneficence, non-maleficence and justice has been almost good; however, physicians' ethical behaviors which pertain towards the principle of autonomy have not been acceptable. There was not any significant difference in adherence to the principles of autonomy, beneficence and non-maleficence, and justice on the basis of sex, residency, education and occupation. CONCLUSION: According to the present study, more training is required to improve physicians' adherence to the principles of medical ethics .


Assuntos
Assistência à Saúde/ética , Ética Médica , Médicos/ética , Ética Baseada em Princípios , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Masculino
19.
New Bioeth ; 24(1): 44-56, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29529983

RESUMO

This essay considers one argument used to defend parents who use preimplantation genetic diagnosis (PGD) to select for deafness and other disabilities. Some bioethicists have argued that a distinction should be drawn between genetically modifying embryos to possess disabilities and using PGD to select embryos that already present markers of them, and that the former is unethical because it inflicts avoidable harms onto the resulting children, whereas the latter is permissible because it allows children with potentially impaired abilities to exist. This essay raises doubts about whether a meaningful moral distinction can be drawn between modification and selection. Arguments which distinguish modification from selection can be understood in two ways. One is to read them as presenting a No Harm, No Foul argument. Another is to read them as presenting a Harming Versus Letting Be argument. Neither succeeds, however, either in establishing a meaningful moral distinction between modification and selection, or in showing that the second is morally permissible in contradistinction to the first.


Assuntos
Surdez , Crianças com Deficiência , Engenharia Genética/ética , Pais , Diagnóstico Pré-Implantação/ética , Adulto , Criança , Surdez/genética , Eugenia (Ciência) , Humanos , Vida , Princípios Morais , Ética Baseada em Princípios
20.
BMC Med Ethics ; 19(1): 16, 2018 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-29499693

RESUMO

BACKGROUND: With a large number of forcibly displaced people seeking safety, the EU is facing a challenge in maintaining solidarity. Europe has seen millions of asylum seekers crossing European borders, the largest number of asylum seekers since the second world war. Endemic diseases and often failing health systems in their countries of origin, and arduous conditions during transit, raise questions around how to meet the health needs of this vulnerable population on arrival in terms of screening, vaccination, and access to timely and appropriate statutory health services. This paper explores the potential role of the principle of reciprocity, defined as the disposition 'to return good in proportion to the good we receive, and to make reparations for the harm we have done', as a mid-level principle in infectious disease screening policies. MAIN TEXT: More than half of the European countries implemented screening programmes for newly arrived asylum seekers. Screening may serve to avoid potential infectious disease risks in the receiving countries as well as help identify health needs of asylum seekers. But screening may infringe upon basic rights of those screened, thus creating an ethical dilemma. The use of the principle of reciprocity can contribute to the identification of potential improvements for current screening programmes and emphasizes the importance of certain rights into guidelines for screening. It may create a two way moral obligation, upon asylum seekers to actively participate in the programme, and upon authorities to reciprocate the asylum seekers' participation and the benefits for the control of public health. CONCLUSION: The authors argue that the reciprocity principle leads to a stronger ethical justification of screening programmes and help achieve a balance between justifiable rights claims of the host population and the asylum seekers. The principle deserves a further and more thorough exploration of its potential use in the field of screening, migration and infectious diseases.


Assuntos
Assistência à Saúde/ética , Emigrantes e Imigrantes , Acesso aos Serviços de Saúde/ética , Infecções , Programas de Rastreamento/ética , Refugiados , Vacinação/ética , Controle de Doenças Transmissíveis , Europa (Continente) , União Europeia , Direitos Humanos , Humanos , Obrigações Morais , Aceitação pelo Paciente de Cuidados de Saúde , Ética Baseada em Princípios , Saúde Pública , Populações Vulneráveis
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