RESUMEN
AbstractInformed consent is a necessary component of the ethical practice of surgery. Ideally, consent is performed in a setting conducive to a robust patient-provider conversation, with careful consideration of risks, benefits, and outcomes. For patients with medical or surgical emergencies, navigating the consent process can be complicated and requires both careful and expedited assessment of decision-making capacity. We present a recent case in which a patient in need of emergency care refused intervention, requiring urgent capacity assessment and a modification to usual care.
Asunto(s)
Tratamiento de Urgencia , Consentimiento Informado , Procedimientos Quirúrgicos Operativos , Humanos , Procedimientos Quirúrgicos Operativos/ética , Tratamiento de Urgencia/éticaRESUMEN
In 2018, approximately 2.8 million passengers flew in and out of U.S. airports per day. Twenty-four to 130 in-flight medical emergencies are estimated to occur per 1 million passengers; however, there is no internationally agreed-upon recording or classification system. Up to 70% of in-flight emergencies are managed by the cabin crew without additional assistance. If a health care volunteer is requested, medical professionals should consider if they are in an appropriate condition to render aid, and then identify themselves to cabin crew, perform a history and physical examination, and inform the cabin crew of clinical impressions and recommendations. An aircraft in flight is a physically constrained and resource-limited environment. When needed, an emergency medical kit and automated external defibrillator are available on all U.S. aircraft with at least one flight attendant and a capacity for 30 or more passengers. Coordinated communication with the pilot, any available ground-based medical resources, and flight dispatch is needed if aircraft diversion is recommended. In the United States, medical volunteers are generally protected by the Aviation Medical Assistance Act of 1998. There is no equivalent law governing international travel, and legal jurisdiction depends on the patient's and medical professional's countries of citizenship and the country in which the aircraft is registered.
Asunto(s)
Medicina Aeroespacial , Aeronaves , Urgencias Médicas/epidemiología , Tratamiento de Urgencia , Voluntarios , Medicina Aeroespacial/ética , Medicina Aeroespacial/legislación & jurisprudencia , Medicina Aeroespacial/métodos , Desfibriladores/provisión & distribución , Tratamiento de Urgencia/ética , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/psicología , Humanos , Internacionalidad , Viaje , Estados Unidos/epidemiología , Voluntarios/legislación & jurisprudencia , Voluntarios/psicologíaRESUMEN
Whether COVID-19 patients in need of extended care in an intensive care unit qualify for 'emergency medical treatment' is answered by considering the Constitution, the meaning of emergency medical treatment, and whether such patients are in an incurable chronic condition. Considering ethical guidelines for the withholding and withdrawal of treatment may assist a court in determining whether a healthcare practitioner has acted with the degree of skill and care required of a reasonably competent practitioner in his or her branch of the profession.
Asunto(s)
COVID-19/terapia , Constitución y Estatutos , Cuidados Críticos/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Privación de Tratamiento/legislación & jurisprudencia , Enfermedad Crónica/legislación & jurisprudencia , Cuidados Críticos/ética , Tratamiento de Urgencia/ética , Accesibilidad a los Servicios de Salud/ética , Humanos , Unidades de Cuidados Intensivos , Jurisprudencia , Respiración Artificial , SARS-CoV-2 , Sudáfrica , Privación de Tratamiento/éticaRESUMEN
OBJECTIVE: Migration has increased globally. Emergency departments (EDs) may be the first and only contact some migrants have with healthcare. Emergency care providers' (ECPs) views concerning migrant patients were examined to identify potential health disparities and enable recommendations for ED policy and practice. DESIGN: Systematic review and meta-synthesis of published findings from qualitative studies. DATA SOURCES: Electronic databases (Ovid Medline, Embase (via Ovid), PsycINFO (via OVID), CINAHL, Web of Science and PubMed), specialist websites and journals were searched. ELIGIBILITY CRITERIA: Studies employing qualitative methods published in English. SETTINGS: EDs in high-income countries. PARTICIPANTS: ECPs included doctors, nurses and paramedics. TOPIC OF ENQUIRY: Staff views on migrant care in ED settings. DATA EXTRACTION AND SYNTHESIS: Data that fit the overarching themes of 'beliefs' and 'challenges' were extracted and coded into an evolving framework. Lines of argument were drawn from the main themes identified in order to infer implications for UK policy and practice. RESULTS: Eleven qualitative studies from Europe and the USA were included. Three analytical themes were found: challenges in cultural competence; weak system organisation that did not sufficiently support emergency care delivery; and ethical dilemmas over decisions on the rationing of healthcare and reporting of undocumented migrants. CONCLUSION: ECPs made cultural and organisational adjustments for migrant patients, however, willingness was dependent on the individual's clinical autonomy. ECPs did not allow legal status to obstruct delivery of emergency care to migrant patients. Reported decisions to inform the authorities were mixed; potentially leading to uncertainty of outcome for undocumented migrants and deterring those in need of healthcare from seeking treatment. If a charging policy for emergency care in the UK was introduced, it is possible that ECPs would resist this through fears of widening healthcare disparities. Further recommendations for service delivery involve training and organisational support.
Asunto(s)
Actitud del Personal de Salud , Tratamiento de Urgencia , Cuerpo Médico de Hospitales/psicología , Personal de Enfermería en Hospital/psicología , Migrantes , Actitud del Personal de Salud/etnología , Barreras de Comunicación , Competencia Cultural , Servicio de Urgencia en Hospital , Tratamiento de Urgencia/ética , Humanos , Internacionalidad , Lenguaje , Cuerpo Médico de Hospitales/ética , Personal de Enfermería en Hospital/ética , Estereotipo , Reino UnidoRESUMEN
The AMA Code of Medical Ethics offers guidance on decision making for unrepresented patients in Opinion 5.2, "Advance Directives." This opinion discusses situations in which a surrogate is needed because the patient is unable to make his or her own health care decisions, but none is available.
Asunto(s)
American Medical Association , Códigos de Ética , Toma de Decisiones/ética , Competencia Mental , Médicos/ética , Poblaciones Vulnerables , Tratamiento de Urgencia/ética , Humanos , Cuidado Terminal/ética , Estados UnidosRESUMEN
We review some of the recent literature on consent for surgical procedures and suggest a scheme for obtaining surgical consent.
Asunto(s)
Consentimiento Informado , Procedimientos Quirúrgicos Operativos/ética , Tratamiento de Urgencia/ética , Formularios como Asunto , Humanos , Procedimientos Quirúrgicos Operativos/métodosRESUMEN
We describe below the pressures of running a small private hospital in an underserved rural area, while providing emergency healthcare for victims of poisonous stings, accidents, and other acute health conditions. Both ethics and law demand that payment is not asked for upfront in emergency cases. Yet patients and their families often fail to pay normal dues for months or even years. It is disturbing to encounter such behaviour even in villages; and doctors in small communities are easy prey. In these conditions can one be true to ethical principles and ensure one's own survival?
Asunto(s)
Servicios Médicos de Urgencia/ética , Tratamiento de Urgencia/ética , Ética Médica , Gastos en Salud , Remuneración , Servicios de Salud Rural/ética , Población Rural , Enfermedad Aguda , Servicios Médicos de Urgencia/economía , Tratamiento de Urgencia/economía , Hospitales , Humanos , India , Médicos , Sector Privado , Servicios de Salud Rural/economíaRESUMEN
The precipitous and unexpected nature of trauma requires training health care practitioners to think and act quickly, according to the best medical interest of the patient. The urgency of treatment for trauma patients, who frequently have temporary alterations in their abilities to make autonomous and competent decisions, often results in presumed consent for medically necessary treatment. Academic trauma centers use protocol-based management of injuries to facilitate their simultaneous evaluation by multiple clinicians and to avoid delays in treatment, ensuring that trauma patients receive the best possible care. In this article, we will discuss the issues of deferred informed consent and surgical education as they relate to trainees' graduated responsibility in the trauma bay.
Asunto(s)
Medicina de Emergencia/ética , Tratamiento de Urgencia/ética , Consentimiento Informado/ética , Consenso , Humanos , Competencia MentalRESUMEN
Zika virus was recognised in 2016 as an important vector-borne cause of congenital malformations and Guillain-Barré syndrome, during a major epidemic in Latin America, centred in Northeastern Brazil. The WHO and Pan American Health Organisation (PAHO), with partner agencies, initiated a coordinated global response including public health intervention and urgent scientific research, as well as ethical analysis as a vital element of policy design. In this paper, we summarise the major ethical issues raised during the Zika epidemic, highlighting the PAHO ethics guidance and the role of ethics in emergency responses, before turning to ethical issues that are yet to be resolved. Zika raises traditional bioethical issues related to reproduction, prenatal diagnosis of serious malformations and unjust disparities in health outcomes. But the epidemic has also highlighted important issues of growing interest in public health ethics, such as the international spread of infectious disease; the central importance of reproductive healthcare in preventing maternal and neonatal morbidity and mortality; diagnostic and reporting biases; vector control and the links between vectors, climate change, and disparities in the global burden of disease. Finally, there are controversies regarding Zika vaccine research and eventual deployment. Zika virus was a neglected disease for over 50 years before the outbreak in Brazil. As it continues to spread, public health agencies should promote gender equity and disease control efforts in Latin America, while preparing for the possibility of a global epidemic.
Asunto(s)
Brotes de Enfermedades/ética , Salud Global/ética , Complicaciones Infecciosas del Embarazo/epidemiología , Infección por el Virus Zika/epidemiología , Aborto Inducido/ética , Brotes de Enfermedades/prevención & control , Urgencias Médicas , Tratamiento de Urgencia/ética , Ética Clínica , Femenino , Síndrome de Guillain-Barré/epidemiología , Síndrome de Guillain-Barré/prevención & control , Política de Salud , Humanos , Microcefalia/epidemiología , Microcefalia/prevención & control , Mosquitos Vectores , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Factores de Riesgo , Vacunas Virales , Infección por el Virus Zika/prevención & controlAsunto(s)
Tratamiento de Urgencia/ética , Radiología/ética , Ética , Humanos , Mala Praxis , MedicinaAsunto(s)
Aeronaves , Tratamiento de Urgencia/ética , Rol del Médico , Responsabilidad Social , Voluntarios , Humanos , ViajeRESUMEN
State laws are awash with discord concerning whether a police officer's request or court order necessarily obligates physicians to perform a body fluid analysis of an arrested, conscious, nonconsenting suspect. Police typically bring arrestees directly to the emergency department (ED), and federal courts have begun to wrestle with the implications of the Emergency Medical Treatment and Labor Act (EMTALA), which requires that anyone presenting to the ED be screened for treatment. Some state laws require health care providers to comply with any police request for lab analysis, while other states offer more leeway to physicians. Recent trends in federal case law interpreting EMTALA suggest that a medical screening exam is not required for patients brought by police specifically for a blood or urine sample unless either the arrestee requests medical care or a prudent observer would believe medical care was indicated. This article answers two questions: What happens when a police officer presents to the ED requesting service on behalf of an arrestee? What does EMTLA require of physicians in response? We survey current state statutes, review recent state and federal case law, describe example policies from various hospitals, and conclude with recommendations for hospital risk managers.
Asunto(s)
Servicios Médicos de Urgencia/ética , Servicios Médicos de Urgencia/legislación & jurisprudencia , Tratamiento de Urgencia/ética , Tratamiento de Urgencia/psicología , Aplicación de la Ley/ética , Médicos/psicología , Policia/psicología , Adulto , Actitud del Personal de Salud , Actitud Frente a la Salud , Derecho Penal , Femenino , Política de Salud , Humanos , Masculino , Persona de Mediana Edad , Estados UnidosRESUMEN
No disponible
Asunto(s)
Humanos , Auxiliares de Urgencia/legislación & jurisprudencia , Tratamiento de Urgencia/ética , Competencia Clínica/normas , Servicios Médicos de Urgencia , Socorristas/legislación & jurisprudenciaAsunto(s)
Reanimación Cardiopulmonar/ética , Toma de Decisiones en la Organización , Tratamiento de Urgencia/ética , Órdenes de Resucitación/ética , Reanimación Cardiopulmonar/psicología , Reanimación Cardiopulmonar/normas , Formularios de Consentimiento , Tratamiento de Urgencia/normas , Humanos , Defensa del Paciente/legislación & jurisprudencia , Resucitación , Órdenes de Resucitación/psicología , Tasa de Supervivencia , Cuidado Terminal/ética , Cuidado Terminal/psicología , Cuidado Terminal/normasAsunto(s)
Tratamiento de Urgencia , Accesibilidad a los Servicios de Salud/organización & administración , Trastornos Mentales/terapia , Médicos , Refugiados , Actitud del Personal de Salud , Tratamiento de Urgencia/ética , Alemania/epidemiología , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Trastornos Mentales/epidemiología , Refugiados/psicología , Responsabilidad SocialRESUMEN
Venturing into the mountains, doctors have accompanied expeditions to provide routine care to the teams, undertake research and occasionally take on a rescue role. The role of doctors practicing mountain medicine is evolving. Public health issues involving concepts of health and safety have become necessary with the coming of commercial and youth expeditions. Increasingly individuals with a disability or a medical diagnosis choose to ascend to high altitudes. Doctors become involved in assessment of risk and providing advice for such individuals. The field of mountain medicine is perhaps unique in that acceptance of risk is part of the ethos of climbing and adventure. The pursuit of mountaineering goals may represent the ultimate conquest of a disability. Knowledge of mountain environment is essential in facilitating mountain ascents for those who choose to undertake them, in spite of a disability or medical condition.