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1.
AMA J Ethics ; 21(3): E223-231, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30893035

RESUMEN

In the case scenario, RJ is a resettled refugee teenager who presents to his physician with vitamin B12 deficiency, anemia, and symptoms of mental illness. This commentary considers social determinants of refugee health and the moral importance of freedom to achieve well-being. The capabilities framework is used to analyze this case because it offers an ethical framework for understanding and evaluating social determinants of refugee health that either promote or diminish freedom to achieve well-being. By using this framework to consider social isolation as a negative social determinant of refugee health, clinicians and institutions can be caregivers as well as advocates for social justice, fulfilling 2 core ethical obligations to refugee communities.

2.
Psychiatr Serv ; 68(2): 105, 2017 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-28142393
3.
Acad Med ; 92(3): 312-317, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-27580436

RESUMEN

Recent attention to racial disparities in law enforcement, highlighted by the death of Freddie Gray, raises questions about whether medical education adequately prepares physicians to care for persons particularly affected by societal inequities and injustice who present to clinics, hospitals, and emergency rooms. In this Perspective, the authors propose that medical school curricula should address such concerns through an explicit pedagogical orientation. The authors detail two specific approaches-antiracist pedagogy and the concept of structural competency-to construct a curriculum oriented toward appropriate care for patients who are victimized by extremely challenging social and economic disadvantages and who present with health concerns that arise from these disadvantages. In memory of Freddie Gray, the authors describe a curriculum, outlining specific strategies for engaging learners and naming specific resources that can be brought to bear on these strategies. The fundamental aim of such a curriculum is to help trainees and faculty understand how equitable access to skilled and respectful health care is often denied; how we and the institutions where we learn, teach, and work can be complicit in this reality; and how we can work toward eliminating the societal injustices that interfere with the delivery of appropriate health care.


Asunto(s)
Curriculum , Educación Médica/organización & administración , Docentes/psicología , Disparidades en Atención de Salud , Médicos/psicología , Prejuicio , Justicia Social/educación , Justicia Social/legislación & jurisprudencia , Adulto , Femenino , Humanos , Masculino , Maryland , Persona de Mediana Edad
4.
AMA J Ethics ; 18(6): 579-86, 2016 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-27322991

RESUMEN

In this case and commentary, a patient's request to be treated for depression without a stigmatizing diagnostic label of bipolar II disorder challenges a clinician's obligation to provide a clinically and ethically appropriate diagnosis and safe treatment consistent with the patient's family medical history. Sensitively recognizing and responding to patients' concerns and values, even when they might conflict with the delivery of reasonable psychiatric care, is essential when gauging the appropriateness of such therapeutic practices. Furthermore, developing honest and open communication; recognizing that patients, like some psychiatric diagnoses, do not fit into discrete boundaries or cannot be categorized by a single label; and placing the patient at the center of care can all serve to resolve value conflicts, protect patient privacy, and promote accurate diagnostic and treatment practices.


Asunto(s)
Trastorno Bipolar/diagnóstico , Toma de Decisiones Clínicas/ética , Depresión/diagnóstico , Ética Médica , Atención Dirigida al Paciente , Estigma Social , Incertidumbre , Adolescente , Trastorno Bipolar/terapia , Comunicación , Depresión/terapia , Femenino , Humanos , Privacidad , Responsabilidad Social
5.
J Clin Ethics ; 25(1): 50-64, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24779319

RESUMEN

In this mixed methods study we identify and assess ethical and pragmatic issues and dilemmas surrounding e-health technologies in the context of primary care, including what is already in the literature. We describe how primary healthcare professionals can access reliable and accurate data, improve the quality of care for patients, and lower costs while following institutional guidelines to protect patients. Using qualitative and quantitative methodologies we identify several underlying ethical and pragmatic burdens and benefits of e-health technologies.The 41 study participants reported more burdens than benefits, and were generally ambivalent about their level of satisfaction with their institutions' e-health technologies, their general knowledge about the technologies, and whether e-health can improve team-based communication and collaboration. Participants provided recommendations to improve e-health technologies in primary care settings.


Asunto(s)
Comunicación , Confidencialidad , Conducta Cooperativa , Registros Electrónicos de Salud , Personal de Salud , Grupo de Atención al Paciente , Pacientes , Atención Primaria de Salud , Privacidad , Registros Electrónicos de Salud/ética , Registros Electrónicos de Salud/normas , Registros Electrónicos de Salud/tendencias , Humanos , Internet , Ohio , Grupo de Atención al Paciente/ética , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/normas , Grupo de Atención al Paciente/tendencias , Seguridad del Paciente , Atención Primaria de Salud/ética , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/normas , Atención Primaria de Salud/tendencias
6.
Nurs Ethics ; 21(1): 53-63, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23702895

RESUMEN

Our objective was to better understand the values and ethical dilemmas surrounding advance care planning through stories told by registered nurses and licensed social workers, who were employed as care managers within Area Agencies on Aging. We conducted eight focus groups in which care managers were invited to tell their stories and answer open-ended questions focusing on their interactions with consumers receiving home-based long-term care. Using narrative analysis to understand how our participants thought through particular experiences and what they valued, we identified seven themes representative of their work with consumers and families: humility, respect, responsibilities, boundaries, empowerment, courage, and veracity.


Asunto(s)
Planificación Anticipada de Atención/ética , Toma de Decisiones/ética , Cuidados a Largo Plazo , Enfermeras y Enfermeros/psicología , Manejo de Atención al Paciente/ética , Grupos Focales , Humanos
8.
J Law Med Ethics ; 41(1): 353-68, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23581677

RESUMEN

This paper explores the vulnerability of Latin American human subjects, and how their vulnerability is ignored due to the complexities and inconsistencies of oversight committees and institutional policies. Secondly, the concept of apology is examined and its meaning to victims of past research abuses.


Asunto(s)
Experimentación Humana/ética , Violaciones de los Derechos Humanos/prevención & control , Cooperación Internacional , Responsabilidad Social , Humanos , América Latina , Estados Unidos , Poblaciones Vulnerables
9.
Med Health Care Philos ; 16(3): 417-27, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22422134

RESUMEN

Although bedbug infestation is not a new public health problem, it is one that is becoming more alarming among healthcare professionals, public health officials, and ethicists given the magnitude of patients who may be denied treatment, or who are unable to access treatment, especially those underserved populations living in low income housing. Efforts to quarantine and eradicate Cimicidae have been and should be made, but such efforts require costly interventions. The alternative, however, can further exacerbate the already growing problems of injustice, i.e., unfair treatment of patients, inaccessibility of needed resources. In the following paper, I examine the ramifications of denying access to medical care, among other healthcare justice dilemmas surrounding bedbug infestations. I also explore the value of health, and how healthcare professionals and public officials often feel as though bedbugs are not a priority because they, themselves, are not diseases, regardless of the fact they cause physical and mental problems that affect a person's health. I propose recommendations for improving the health and well-being of those vulnerable populations who are facing a difficult and growing public health problem that is currently being ignored in medical and public health ethics literature, regardless of increased media attention and unusual habitats of localized infestations, e.g., Statue of Liberty, New York City.


Asunto(s)
Chinches , Disparidades en Atención de Salud , Justicia Social , Animales , Prestación de Atención de Salud/ética , Infestaciones Ectoparasitarias/prevención & control , Accesibilidad a los Servicios de Salud/ética , Disparidades en Atención de Salud/ética , Control de Insectos , Asignación de Recursos/ética , Poblaciones Vulnerables
10.
HEC Forum ; 24(2): 99-114, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22302457

RESUMEN

CONTEXT: Established in 1997, Summa Health System's Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been unclear. OBJECTIVES: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. METHODS: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. RESULTS: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133-62); (2) changes in top two reasons for EC consult requests from 'Family opposed to withdrawing life-sustaining treatment (LST)' and 'Patient capacity in question' to 'Futility' and 'Physician opposed to providing LST'; (3) changes in top two recommendations given by the EC from 'Emotional Support for Patient/Family' and 'Initiate DNR Order' to 'Comfort Care' and 'Withdraw Treatment.' Overall, 88% of recommendations were followed. CONCLUSION: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined.


Asunto(s)
Comités de Ética Clínica , Ética Médica , Derivación y Consulta/ética , Anciano , Comités de Ética Clínica/organización & administración , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/ética , Derivación y Consulta/estadística & datos numéricos , Cuidado Terminal
12.
Med Teach ; 33(1): e43-9, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21182373

RESUMEN

AIM: We sought to understand current medical students' levels of training and knowledge, and their attitudes regarding universal precautions practices and underlying professional and ethical issues. METHOD: A total of 54 US medical students at two schools were interviewed to determine the level of understanding and training students receive about universal precautions, their feelings about the effectiveness (or ineffectiveness) of universal precautions, the frequency and kinds of universal precautions used by healthcare professionals as observed by medical students, and students' perspectives about the lack of or inconsistent use of universal precautions. RESULTS: Pre-clinical students focused on safe-sex practices among students and professionals, as well as simple, important acts to protect oneself against infection and disease, such as hand-washing. Clinical students, on the other hand, had more exposure to observing and practicing universal precautions, thus presented us with more, in-depth responses pertaining to inconsistent and ineffective use of universal precautions among peers and role models. Several themes were noted from students' responses. CONCLUSION: This study confirms previously acquired data that universal precautions are not consistently or appropriately used by healthcare professionals, it is a significant and novel study in that it reveals a hidden, ethical, and clinical problem in medical education.


Asunto(s)
Ética Profesional , Conocimientos, Actitudes y Práctica en Salud , Modelos Organizacionales , Precauciones Universales , Adolescente , Femenino , Grupos Focales , Humanos , Masculino , Estudiantes de Medicina/psicología , Estados Unidos , Adulto Joven
13.
Med Teach ; 33(1): e50-6, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21182374

RESUMEN

AIM: This study examined future medical professionals' attitudes and beliefs regarding mandatory human immunodeficiency virus (HIV) testing and disclosure. METHOD: A total of 54 US medical students were interviewed regarding mandatory testing and disclosure of HIV status for both patient and health care professional populations. Interviews were qualitatively analyzed using thematic analysis by the first author and verified by the second author. RESULTS: Medical students considered a variety of perspectives, even placing themselves in the shoes of their patients or imagining themselves as a healthcare professional with HIV. Mixed opinions were presented regarding the importance of HIV testing for students coupled with a fear about school administration regarding HIV positive test results and the outcome of a student's career. Third- and fourth-year medical students felt that there should be no obligation to disclose one's HIV status to patients, colleagues, or employers. However, most of these students did feel that patients had an obligation to disclose their HIV status to healthcare professionals. CONCLUSION: This study gives medical educators a glimpse into what our future doctors think about HIV testing and disclosure, and how difficult it is for them to recognize that they can be patients too, as they are conflicted by professional and personal values.


Asunto(s)
Revelación/ética , Seropositividad para VIH/diagnóstico , Estudiantes de Medicina/psicología , Adolescente , Adulto , Pruebas Anónimas/ética , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Adulto Joven
15.
Med Health Care Philos ; 13(4): 321-32, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-20411339

RESUMEN

Without a better understanding of mental disease, patients diagnosed with a mental disease may be mistreated clinically and/or socially, and caregivers and families may be wrongfully blamed for causing the disease and/or for not effectively helping and developing meaningful relationships with the patient as person. In trying to understand mental disease and why its various dimensions raise difficulties for our systems of classification and our medical models of diagnosis and treatment, a framework is required. This framework will connect metaphysical, epistemological, and ethical considerations in ways that are mutually supportive and illuminating. This, in turn, will benefit those who are diseased and those persons who study, classify, diagnose, and treat disease.


Asunto(s)
Trastornos Mentales , Relaciones Metafisicas Mente-Cuerpo , Personeidad , Filosofía Médica , Psiquiatría/ética , Trastorno Autístico , Humanos , Trastornos Mentales/clasificación
19.
Med Educ ; 43(1): 34-41, 2009 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19148979

RESUMEN

CONTEXT: A study of medical students' perspectives on derogatory and cynical humour was published in 2006. The current study examines residents' and attending doctors' perspectives on the same phenomenon in three clinical departments of psychiatry, internal medicine and surgery. METHODS: Two focus groups were conducted in each of the three clinical departments, one with residents and one with attending doctors,during the 2006-07 academic year. Seventy doctors participated, including 49 residents and 21 attendings. The same semi-structured format was used in each group. Questions focused on characterisations of derogatory and cynical humour along with motives and rules for its use.All focus groups were audiotaped and the tapes transcribed. Each transcript was read independently by each researcher as part of an inductive process to discover the categories that describe and explain the uses, motives and effects of such humour. RESULTS: Three categories that appeared in the first study with medical students - locations for humour, the humour game, and not-funny humour - emerged as virtually identical,whereas two others--objects of humour and motives for humour - were more fully elaborated. DISCUSSION: Discussions of derogatory and cynical humour should occur in any department where teaching and role modelling are priorities. In addition, the tenets of appreciative inquiry and the complex responsive process,particularly as they are used at the Indiana University School of Medicine, offer medical educators valuable tools for addressing this phenomenon.


Asunto(s)
Actitud del Personal de Salud , Cuerpo Médico de Hospitales/psicología , Identificación Social , Ingenio y Humor como Asunto , Cultura , Educación Médica/métodos , Humanos , Relaciones Médico-Paciente , Percepción Social , Estudiantes de Medicina/psicología
20.
Perspect Biol Med ; 50(3): 348-62, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17660630

RESUMEN

In this essay we link the rationale for the medical humanities with radical hermeneutics, a move that infuses the medical humanities with incredulity and suspicion. This orientation is particularly important at this historical moment, when the evidence-based and competency blanket is threatening to overpower all aspects of medical education, including the medical humanities discourse itself. Radical hermeneutics works relentlessly against the final word on anything, and as such, it provides a critically provocative way of thinking about doctors, patients, illness, health, families, death--in short, the experience of being human. We use three literary examples to illustrate the complex, contradictory, perplexing, and disturbing questions related to a life in medicine: Rafael Campo's "Like a Prayer," Irvin Yalom's "Fat Lady," and Richard Selzer's "Brute."


Asunto(s)
Ética Médica , Humanidades/ética , Filosofía Médica/historia , Curriculum , Historia del Siglo XX , Humanos , Modelos Educacionales , Narración
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