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2.
Cuad. bioét ; 29(97): 221-231, sept.-dic. 2018.
Artículo en Inglés | IBECS | ID: ibc-175374

RESUMEN

In 2017, the Italian National Bioethics Committee (INBC) released an opinion paper titled "Clinical ethics committees". Said document advocates for the creation of "clinical bioethics committees" in every suitable setting and lays out a set of guidelines aimed at regulating such committees' functions. The recommendations deal primarily with the independence, requirements for counselling, structures, composition, tasks, placement, coordination, requisite competences, regulations. In the opinion's contents there are: a) the need to entrust counselling and training on ethical issues within clinical practice to different committees than those that deal with ethical assessments of scientific trials and experimentation; b) the laying out of all the various functions and related competencies required of the ethics committees' members; c) the necessity that all counselling practices be carried out by each committee as a whole, rather than by a single expert member; d) Committee's independence. The authors elaborate on each one of the above mentioned aspects and highlight the importance of INBC's recommendations in order to improve the quality standards of care delivered "to each patient's bed"


En el 2017, el Comité Nacional Italiano de Bioética (CNIB) publicó un artículo de opinión titulado "Comités de Ética Clínica". Dicho documento aboga por la creación de "comités clínicos de bioética" en cada entorno adecuado, y establece un conjunto de directrices destinadas a regular las funciones de tales comités. Las recomendaciones se refieren principalmente a la independencia, los requisitos para el asesoramiento, las estructuras, la composición, las tareas, la ubicación, la coordinación, las competencias requeridas, las regulaciones. En los contenidos de la opinión se plantean: a) la necesidad de confiar el asesoramiento y la capacitación en cuestiones éticas dentro de la práctica clínica a diferentes comités que aquellos que se ocupan de las evaluaciones éticas de los ensayos científicos y la experimentación; b) la presentación de las diversas funciones y competencias requeridas por los miembros de los comités de ética; c) la necesidad de que todas las prácticas de asesoramiento sean llevadas a cabo por cada comité como un todo, y no por un solo miembro experto; d) independencia del comité. Los autores detallan cada uno de los aspectos mencionados anteriormente y resaltan la importancia de las recomendaciones de CNIB para mejorar los estándares de calidad de la atención brindada "a la cabecera de la cama de cada paciente"


Asunto(s)
Humanos , Comités de Ética Clínica/organización & administración , Ética Clínica , Miembro de Comité , Comités de Ética Clínica/normas , Comités de Ética Clínica/tendencias , Italia
3.
Cuad Bioet ; 29(97): 221-231, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30380897

RESUMEN

In 2017, the Italian National Bioethics Committee (INBC) released an opinion paper titled ″Clinical ethics committees″. Said document advocates for the creation of ″clinical bioethics committees″ in every suitable setting and lays out a set of guidelines aimed at regulating such committees' functions. The recommendations deal primarily with the independence, requirements for counselling, structures, composition, tasks, placement, coordination, requisite competences, regulations. In the opinion's contents there are: a) the need to entrust counselling and training on ethical issues within clinical practice to different committees than those that deal with ethical assessments of scientific trials and experimentation; b) the laying out of all the various functions and related competencies required of the ethics committees' members; c) the necessity that all counselling practices be carried out by each committee as a whole, rather than by a single expert member; d) Committee's independence. The authors elaborate on each one of the above mentioned aspects and highlight the importance of INBC's recommendations in order to improve the quality standards of care delivered ″to each patient's bed″.


Asunto(s)
Comités de Ética Clínica/organización & administración , Comités de Ética Clínica/tendencias , Bioética , Italia
4.
Rev. clín. esp. (Ed. impr.) ; 218(3): 142-148, abr. 2018.
Artículo en Español | IBECS | ID: ibc-174246

RESUMEN

El desarrollo de la ética clínica hospitalaria en España depende casi exclusivamente de los comités de ética asistencial. Estos han sido criticados por su falta de cercanía a la cabecera del paciente en los conflictos éticos cotidianos y por su escasa operatividad práctica, que se refleja en el escaso número de consultas que reciben. En el presente trabajo reflexionamos sobre la necesidad de modificar el modelo actual de atención en ética clínica para reactivarlo y llamar la atención sobre el papel primordial del internista como motor de dicho cambio. Para ello proponemos un modelo en que los comités de ética asistencial incorporen consultores de ética, mejor posicionados para la discusión de casos a la cabecera del enfermo. Seguidamente analizamos las características que dichos consultores deberían poseer


The development of hospital clinical ethics in Spain depends almost exclusively on the healthcare ethics committees, which have been criticized for a lack of proximity to the patient's bedside in day-to-day ethical conflicts and for their scarce practical operation, reflected in the low number of consultations they receive. In this study, we reflect on the need to change the current healthcare model in clinical ethics so as to reactivate it and call attention to the essential role of internists as the engine for this change. To this end, we propose a model in which the healthcare ethics committees incorporate ethics consultants, who are better positioned to discuss cases at the patient's bedside. We then analyse the characteristics that these consultants should have


Asunto(s)
Humanos , Administración de la Práctica Médica/ética , Prácticas Clínicas/ética , Medicina Interna/ética , Medicina Interna , Comités de Ética Clínica/organización & administración , Comités de Ética Clínica/normas , Consultores , Prestación de Atención de Salud/ética
8.
Hastings Cent Rep ; 47(5): 3-4, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28940348

RESUMEN

"I'm Jewish, you know, and my mother said, 'Always trust the rabbis.'" I never heard Mr. Weisman's refrain from his own lips. I never heard him say any words all. By the time I met him he was in a vegetative state, a man on the precipice of invisibility-white hair, thin pale limbs, melting into sheets of the same color. When I think about Mr. Weisman, I see empty spaces-the absence of his voice, the too-large bed for his shrinking frame, the always-empty chair by his bedside, and most of all, the myriad gaps in his life story. He was what in hospitals is often called a "patient alone": someone who lacks decisional capacity and has no surrogate to make medical decisions for him. Mr. Weisman's aloneness prompted his primary team to consult our bioethics service in order to formulate goals of care for him, including the possibility of hospice care.


Asunto(s)
Toma de Decisiones , Comités de Ética Clínica/organización & administración , Privación de Tratamiento/ética , Humanos
10.
Hastings Cent Rep ; 47 Suppl 1: S31-S34, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28543651

RESUMEN

The establishment of Mexico's National Bioethics Commission (Comisión Nacional de Bioética), in 1992, was conceived within the context of a global movement aimed at raising awareness of the ethical implications of technological and scientific development, especially in biomedicine. In 2005, a new decree put the commission under the scope of the Secretariat of Health and granted it technical and operational autonomy, allowing it to become a regulatory agency aimed at promoting a culture of bioethics, encouraging reflection on human health, and developing guidelines for health care, research, and education, through a global, secular, and democratic perspective. The commission became the leading actor in the strategy for institutionalizing bioethics in Mexico after reforms to the country's General Health Act in 2011, which required that public, social assistance, or private health care facilities establish a hospital bioethics committee to address bioethical dilemmas or issues and, when relevant, a research ethics committee to address research with human subjects. This assignment has shifted the focus of the activities and goals of the National Bioethics Commission toward establishing these committees in line with current regulations and developing mechanisms to ensure that they operate with the highest standards of ethical conduct, performance, and accountability.


Asunto(s)
Discusiones Bioéticas , Bioética , Comités de Ética/organización & administración , Comités de Ética Clínica/organización & administración , Comités de Ética en Investigación/organización & administración , Humanos , Capacitación en Servicio , Relaciones Interinstitucionales , Internacionalidad , México , Objetivos Organizacionales , Política Pública
12.
J Clin Ethics ; 27(4): 322-340, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-28001139

RESUMEN

During the 1970s and 1980s, legal precedent, governmental recommendations, and professional society guidelines drove the formation of hospital ethics committees (HECs). The Joint Commission on Accreditation of Health Care Organization's requirements in the early 1990s solidified the role of HECs as the primary mechanism to address ethical issues in patient care. Because external factors drove the rapid growth of HECs on an institution-by-institution basis, however, no initial consensus formed around the structure and function of these committees. There are now almost 40 years of empirical studies on the composition, administration, and activities of HECs in the United States. We conducted a systematic review of the available empirical literature on HECs to describe their evolution. As HECs changed over time, they increased their total number of members and percentage of members from nursing and the community. Although physicians increasingly chaired these committees, their presence as a percentage of overall members declined. The percentage of administrative members remained steady, although committees became increasingly likely to have at least one administrative member. HECs were also increasingly likely to report to an administrative body or to the board of trustees or directors rather than to the medical staff. Finally, consultation volume increased steadily over time. There has not, however, been a national survey of the composition of ethics committees, their administration, or volume of consultation in more than 10 years, despite increasing calls for professional standards and quality improvement assessments among HECs.


Asunto(s)
Comités de Ética Clínica/organización & administración , Consultoría Ética/estadística & datos numéricos , Hospitales , Humanos
13.
J Soc Work End Life Palliat Care ; 12(3): 277-88, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27462956

RESUMEN

Hospital ethics committees (HECs) are typically charged with addressing ethical disputes, conflicts, and dilemmas that arise in the course of patient care. HECs are not widely viewed as having a therapeutic role for health care professionals who experience psychological distress or anticipatory grief in the course of discharging professional duties. A case is presented in which an ethics consultation was requested, chiefly, to secure emotional support for health care professionals who had been asked by a patient to discontinue life-sustaining treatments. As the case demonstrates, HECs may be called upon to provide emotional support and reassurance to health care professionals who willingly carry out psychologically difficult actions, even though these actions may be ethically uncontroversial. In providing this service, the HEC may not necessarily engage in its customary activity of deliberating an ethics issue and resolving a conflict but may still provide valuable assistance, as in the case presented.


Asunto(s)
Comités de Ética Clínica/organización & administración , Pesar , Personal de Salud/psicología , Privación de Tratamiento , Humanos , Masculino , Persona de Mediana Edad , Cuadriplejía/enfermería , Cuadriplejía/psicología , Respiración Artificial
14.
J Clin Ethics ; 27(2): 111-6, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27333061

RESUMEN

Although leaders in the field of ethics have for many years pointed to the crucial role that organizations play in shaping healthcare ethics, organizational ethics remains a relatively undeveloped area of ethics activity. Clinical ethics committees are an important source of potential expertise, but new skills will be required. Clinical ethics committees seeking to extend their purview to organizational issues will have to respond to three challenges-how to gain sanction and support for addressing controversial and sensitive issues, how to develop an acceptable process, and how to make a difference on the ground. The article presents practical suggestions for how clinical ethics committees meet these challenges.


Asunto(s)
Toma de Decisiones en la Organización , Comités de Ética Clínica , Consultoría Ética , Ética Institucional , Comités de Ética Clínica/organización & administración , Comités de Ética Clínica/normas , Comités de Ética Clínica/tendencias , Humanos , Estados Unidos
15.
HEC Forum ; 28(3): 261-72, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26922945

RESUMEN

With disagreement, doubts, or ambiguous grounds in end-of-life decisions, doctors are advised to involve a clinical ethics committee (CEC). However, little has been published on doctors' experiences with discussing an end-of-life decision in a CEC. As part of the quality assurance of this work, we wanted to find out if clinicians have benefited from discussing end-of-life decisions in CECs and why. We will disseminate some Norwegian doctors' experiences when discussing end-of-life decisions in CECs, based on semi-structured interviews with fifteen Norwegian physicians who had brought an end-of-life decision case to a CEC. Almost half of the cases involved conflicts with the patients' relatives. In a majority of the cases, there was uncertainty about what would be the ethically preferable solution. Reasons for referring the case to the CEC were to get broader illumination of the case, to get perspective from people outside the team, to get advice, or to get moral backing on a decision already made. A great majority of the clinicians reported an overall positive experience with the CECs' discussions. In cases where there was conflict, the clinicians reported less satisfaction with the CECs' discussions. The study shows that most doctors who have used a CEC in an end-of-life decision find it useful to have ethical and/or legal aspects illuminated, and to have the dilemma scrutinized from a new perspective. A systematic discussion seems to be significant to the clinicians.


Asunto(s)
Toma de Decisiones/ética , Comités de Ética Clínica/organización & administración , Médicos/psicología , Cuidado Terminal/ética , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Negociación/métodos , Noruega , Médicos/ética , Investigación Cualitativa
16.
Cuad Bioet ; 26(87): 292-301, 2015.
Artículo en Español | MEDLINE | ID: mdl-26378601

RESUMEN

The next project was based on the design on the creation of a medical ethical Committee at a hospital. It was developed at the San Miguel Arcangel Hospital, District of San Miguelito, Province of Panama, in 2013. Insomuch as the creation of social projects requires unified international parameters, format is taken from the Unesco's guides for the establishing and working of bioethics committees; adapted to the socio-economic, political and cultural context of the San Miguelito District, Panama Province. Furthermore to adapting to socio-ecological aspect where the research project is carried out, the theoretical aspect includes from the ontological personalistic bioethics, where the cornerstone is the dignity of the human person. A study of perceptions of medical staff and nursing was developed on the management of the most common ethical dilemmas in the Hospital San Miguel Arcángel. The instrument used was a previously validated perception survey through a pilot test. Reliability was measured using Cronbach's alpha coefficient, and validity was obtained from the content. Satisfactory statistical results, that verify the working hypotheses on the recognition of the importance of autonomy, confidentiality, protection of vulnerable population, occupational health staff welfare and integration of bioethics at the institutional agenda, were obtained. However, there were particular aspects that indicate some doubt as to the management of some realities that are presented in the context of health care.


Asunto(s)
Comités de Ética Clínica/organización & administración , Comités de Ética en Investigación/organización & administración , Hospitales Públicos/organización & administración , Hospitales Urbanos/organización & administración , Actitud del Personal de Salud , Discusiones Bioéticas , Estudios Transversales , Humanos , Modelos Teóricos , Negociación , Panamá , Derechos del Paciente , Personal de Hospital/psicología , Áreas de Pobreza , Factores Socioeconómicos , Encuestas y Cuestionarios , Poblaciones Vulnerables
17.
Therapie ; 70(1): 21-36, 2015.
Artículo en Inglés, Francés | MEDLINE | ID: mdl-25679191

RESUMEN

In May 2014, the European Union Parliament and Council published a new regulation on clinical trials on medicinal products for human use, which is designed to replace Directive 2001/20/EC. It will not come into effect until 2016. Nevertheless, it is essential to examine its relationship with national legislation, i.e. the Jardé Act, whose implementation has been delayed pending publication of the European regulation. The Giens workshop identified and examined the various issues that this relationship is bound to raise. In particular, it looked at trial methodology assessment procedures, the working relationship between the French National Agency of Drug Safety and Health Products (Agence Nationale de Sécurité du Médicament et des Produits de Santé, ANSM) and ethics committees during the authorization application evaluation phase, review of post-authorization/registration studies on medicinal products and medical devices, and data transparency.


Asunto(s)
Ensayos Clínicos como Asunto/legislación & jurisprudencia , Acceso a la Información/legislación & jurisprudencia , Ensayos Clínicos como Asunto/normas , Seguridad Computacional/legislación & jurisprudencia , Comités de Ética Clínica/legislación & jurisprudencia , Comités de Ética Clínica/organización & administración , Comités de Ética Clínica/normas , Comités de Ética en Investigación/legislación & jurisprudencia , Comités de Ética en Investigación/organización & administración , Comités de Ética en Investigación/normas , Unión Europea , Francia , Agencias Gubernamentales , Experimentación Humana/legislación & jurisprudencia , Humanos , Lenguaje , Legislación de Dispositivos Médicos , Estudios Observacionales como Asunto/legislación & jurisprudencia , Proyectos de Investigación/normas
18.
Adv Neonatal Care ; 14(6): 398-402, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25422925

RESUMEN

This article discusses all aspects of the hospital ethics committee. The nurse's use of the committee and participation on the committee are delineated. Neonatal examples are given.


Asunto(s)
Comités de Ética Clínica/organización & administración , Ética en Enfermería , Cuidado Intensivo Neonatal/ética , Ética en Enfermería/educación , Hospitales , Humanos , Relaciones Interprofesionales , Joint Commission on Accreditation of Healthcare Organizations , Enfermeras y Enfermeros , Cuidados Paliativos/ética , Médicos , Estados Unidos
19.
Dtsch Med Wochenschr ; 139(43): 2178-83, 2014 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-25317647

RESUMEN

BACKGROUND: There have been different initiatives for the implementation of clinical ethics consultation during the past years. The present study surveys current data. METHODS: A structured questionnaire was used. Of the 1,858 contacted hospitals throughout Germany 550 answered to that questionnaire (return rate 29,6 %). The survey took place between September 2013 and January 2014. RESULTS: The clinical ethics committee is the mostly implemented structure of clinical ethics consultation. Recommendations to implement those structures (ZEKO 2006, AEM 2010) show less influence than the legally binding standard (HKHG 2011). Structures of clinical ethics consultation are respected as instrument to solving ethical conflicts in clinical routines. CONCLUSIONS: Establishing ethics consultation should be promoted. Preferably appropriate legal rules for the implementation of clinical ethics consultation should be developed further as well as their structural framing.


Asunto(s)
Comités de Ética Clínica/organización & administración , Comités de Ética Clínica/estadística & datos numéricos , Comités de Ética Clínica/legislación & jurisprudencia , Alemania , Implementación de Plan de Salud/legislación & jurisprudencia , Implementación de Plan de Salud/organización & administración , Implementación de Plan de Salud/estadística & datos numéricos , Humanos , Encuestas y Cuestionarios , Revisión de Utilización de Recursos/estadística & datos numéricos
20.
Aust Health Rev ; 38(3): 295-300, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24870355

RESUMEN

OBJECTIVE: The processes of research ethics and research governance are core to the conduct of research in health. Each aims to facilitate research that is both ethical and practical in order to produce new knowledge about the health system and improve the lives of those who use it. However, our experience has demonstrated that the process of obtaining ethical approval for a low-risk and low-resource research project was severely confounded by the multiple layers of research governance in operation at hospitals in Queensland (Qld) and New South Wales (NSW). METHODS: We analysed our own experience of gaining research governance approval with the aim of improving governance processes for multicentre research projects. Our project aimed to interview and survey one person at each of 57 hospitals in NSW and 18 in Qld. We recorded and compared the steps, documents and time-frame related to research governance approval at each of these research sites. RESULTS: We found that the progress of our project was significantly impeded by the multiple steps related to research governance processes in hospitals. Research governance approval took an average of 160 days in NSW and 316 in Qld. There was inconsistency between hospitals regarding documentation and significant duplication of documentation already approved through ethical review processes. The necessity for separate research contracts for all Qld research sites also added to research delays. CONCLUSION: Based on our experiences we make recommendations about changes to research governance including clarification of responsibility, reform of areas of duplication and inconsistency, time limitations for approval and, in Qld, reform of financial and legal oversight.


Asunto(s)
Investigación Biomédica/ética , Comités de Ética Clínica/organización & administración , Financiación Gubernamental , Investigación Biomédica/organización & administración , Eficiencia Organizacional , Nueva Gales del Sur , Estudios de Casos Organizacionales , Investigación Cualitativa , Queensland , Factores de Tiempo
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