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Indian J Med Ethics ; VI(2): 1-6, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33908351


The WHO Ad Hoc Expert Group on the Next Steps for Covid-19 Vaccine Evaluation makes recommendations on the use of placebo controlled trials in ongoing and future Covid-19 vaccine research. These recommendations unequivocally prioritise data quality over participants' rights and safety. Participants in trials of vaccines which have received emergency use listing or authorisation would be refused available vaccines. Placebo-controlled trials that would be impossible to conduct in rich countries would be permitted in poor countries. If these suggestions are implemented, the major beneficiary will be the vaccine industry.

/normas , Ética Médica , Derechos del Paciente/ética , Derechos del Paciente/normas , Placebos/normas , Adulto , Anciano , Anciano de 80 o más Años , Investigación Biomédica , Exactitud de los Datos , Femenino , Guías como Asunto , Humanos , Masculino , Persona de Mediana Edad , Pandemias
Indian J Med Ethics ; VI(2): 1-10, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33908352


This article compares the current debate over the use of placebos in developing country clinical trials of second generation Covid-19 vaccines with the debates over previous paradigmatic cases raising similar issues. Compared to the earlier zidovudine and Surfaxin trials, Covid-19 vaccine trials are likely to confer lower risk to placebo groups and to offer a greater number and variety of alternative study designs. However, turning to the developing world to conduct studies that would be unacceptable in developed countries, simply on the ground that Covid-19 vaccines are generally unavailable in developing countries, is not ethically justifiable. This is so whether the justification is rooted in total absence of vaccine in a given country or in developing country vaccine prioritisation practices, because at root both derive from economic, not scientific conditions. However, the advent of variants that may create genuine uncertainty as to comparator vaccine effectiveness could justify a placebo control, depending on vaccine characteristics, variant prevalence, the degree of variant resistance, and the acceptability of immune-bridging studies. These factors must be considered together in the necessary case-by-case assessment of the ethical justification for any proposed trial.

/normas , Ensayos Clínicos como Asunto/ética , Ensayos Clínicos como Asunto/normas , Ética Médica , Derechos del Paciente/normas , Placebos/normas , Adulto , Anciano , Anciano de 80 o más Años , Países en Desarrollo , Femenino , Guías como Asunto , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Factores de Riesgo
Clin Ter ; 172(2): 119-122, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33763685


ABSTRACT: In 2020 the World Health Organization declared the Covid-19 to be a pandemic. Governments around the world are facing a tough challenge that could jeopardise the national healthcare systems. Safeguarding the rights of Covid patients and all citizens - especially those who are now even more vulnerable than they were before - is part of this challenge. This work aims to examine the issues arising from the current emergency in terms of how individuals' constitutional rights have been balanced and how much people at the highest risk amid this pandemic - the homeless, the inmates in prison, geriatric and psychiatric patients, and doctors on the Covid frontline - have been protected. This analysis focuses mostly on one of the worst-hit countries by the SARS-CoV-2: Italy.

Prestación de Atención de Salud/organización & administración , Derechos del Paciente , Anciano , Humanos , Italia , Pandemias , Prisioneros
Soins Psychiatr ; 42(332): 36-39, 2021 Feb.
Artículo en Francés | MEDLINE | ID: mdl-33602457


The subjective recognition by those involved in care, of people with psychiatric disorders, is not self-evident. Caregivers, in the general sense of the term, often find it difficult to recognise the personal freedom and dignity of psychiatric patients. Care is, however, inseparable from the relationship of trust and the mobilisation of the patient's ability to freely express choices and to participate in decisions concerning him; a central ability in the caregiver-patient relationship. Although the objectives of access to care and protection of the patient's rights are clearly stated, the question of the mental patient's freedom of choice, as well as his inner moral freedom, remains open to question, as does the questioning of these same freedoms among care providers.

Trastornos Mentales , Relaciones Enfermero-Paciente , Enfermería Psiquiátrica , Libertad , Humanos , Trastornos Mentales/enfermería , Derechos del Paciente
Rev. Esc. Enferm. USP ; 55: e03678, 2021. tab, graf
Artículo en Inglés | LILACS, BDENF - Enfermería | ID: biblio-1180883


ABSTRACT Objective: To synthesize current evidence on nurses' attitudes and/or knowledge on the entire spectrum of patient rights. Method: A systematic search of the literature was performed in Web of Science, PubMed, Scopus and CINAHL. Studies were selected according to pre-defined inclusion/exclusion criteria. The Cochrane and PRISMA guidelines, including templates for systematic reviews, were applied. For rigor assessment, the Critical Appraisal Skills Program Qualitative Research Checklist, and the Center for Evidence-Based Management tool were employed. Results: Thirteen studies were included, that exhibited important methodological limitations, such as convenience sampling, mediocre response rates and inadequate instrument validity. Findings indicated: a) low level of awareness regarding patient rights among nurses, b) knowledge discrepancies on specific aspects of patient rights, c) low priority ascribed to a patient's right to access information, and d) insufficient evidence on formal educational sources of knowledge on the topic of patient rights. Conclusion: Narrow geographical localization, heterogeneity and methodological limitations render generalizability of the conclusions difficult. Further research based on robust methodology is proposed.

RESUMO Objetivo: Sintetizar as evidências atuais sobre as atitudes e/ou conhecimentos dos enfermeiros sobre todo o espectro dos direitos do paciente. Método: Uma busca sistemática da literatura foi realizada na Web of Science, PubMed, Scopus e CINAHL. Os estudos foram selecionados de acordo com critérios de inclusão/exclusão pré-definidos. As diretrizes Cochrane e PRISMA, incluindo modelos para revisões sistemáticas, foram aplicadas. Para uma avaliação rigorosa, foram utilizados o Critical Appraisal Skills Program Qualitative Research Checklist e a ferramenta do Center for Evidence-Based Management. Resultados: Foram incluídos 13 estudos que exibiram limitações metodológicas importantes, como amostragem por conveniência, taxas de resposta medíocres e validade inadequada do instrumento. Os resultados indicaram: a) baixo nível de consciência sobre os direitos do paciente entre os enfermeiros, b) discrepâncias de conhecimento sobre aspectos específicos dos direitos do paciente, c) baixa prioridade atribuída ao direito do paciente de acessar informações, e d) evidências insuficientes sobre fontes de conhecimento educacionais formais sobre o tema dos direitos do paciente. Conclusão: A localização geográfica estreita, a heterogeneidade e as limitações metodológicas dificultam a generalização das conclusões. Outras pesquisas baseadas em metodologia robusta são propostas.

RESUMEN Objetivo: Sintetizar la evidencia actual sobre las actitudes y/o conocimientos de las enfermeras sobre todo el espectro de los derechos del paciente. Método: Se realizó una búsqueda sistemática de la literatura en Web of Science, PubMed, Scopus y CINAHL. Los estudios se seleccionaron de acuerdo con criterios de inclusión/exclusión predefinidos. Se aplicaron las guías Cochrane y PRISMA, incluidas las plantillas para revisiones sistemáticas. Para una evaluación más rigurosa, se emplearon el Critical Appraisal Skills Program Qualitative Research Checklist y la herramienta del Center for Evidence-Based Management. Resultados: Se incluyeron trece estudios, que exhibieron importantes limitaciones metodológicas, como muestreo por conveniencia, tasas de respuesta mediocres y validez inadecuada del instrumento. Los hallazgos indicaron: a) bajo nivel de conciencia sobre los derechos del paciente entre las enfermeras, b) discrepancias de conocimiento sobre aspectos específicos de los derechos del paciente, c) baja prioridad atribuida al derecho del paciente a acceder a la información, y d) evidencia insuficiente sobre fuentes formales de conocimiento educativo sobre el tema de los derechos del paciente. Conclusión: La estrecha localización geográfica, la heterogeneidad y las limitaciones metodológicas dificultan la generalización de las conclusiones. Se propone más investigación basada en una metodología robusta.

Conocimientos, Actitudes y Práctica en Salud , Derechos del Paciente , Práctica Profesional , Conocimiento , Ética en Enfermería , Revisión Sistemática
Cuad. bioét ; 31(103): 309-317, sept.-dic. 2020. tab
Artículo en Español | IBECS | ID: ibc-200023


En los últimos años el número de divorcios ha ido aumentando, siendo en ocasiones, para el paciente pediátrico, el divorcio de sus padres un elemento traumático. Nuestro objetivo fue analizar los conflictos éticos que se producen en la relación sanitaria médico-padres-hijo y de forma más específica en niños procedentes de separación/divorcio. Se realizó un estudio descriptivo mediante una encuesta compuesta de 39 items. Previamente se realizó un análisis bibliográfico exhaustivo de artículos relacionados. Nuestros resultados muestran que solo el 35% de los pediatras ha recibido formación en bioética pese a su importancia en la práctica diaria. Sobre otras cuestiones, la mayoría (57,5%) no retiraría el tratamiento de un paciente enfermo pese a que aumentara su calidad de vida, y actuaría ante una decisión equivocada de los padres (82,5%). Dan poco valor a las decisiones del menor (6,05%), raramente informados exclusivamente (5%). En cambio, se les informa primero en un 20% de los casos y en el 90% se les implica. Respecto a los progenitores, el 17,5% de las madres son informadas en exclusiva, nunca los padres. La ética tiene un valor intrínseco muy importante en las decisiones clínicas habituales, respetándose generalmente las normas y adaptándose a la situación particular de cada niño/a. En los casos en los que hay un conflicto importante, como divorcios, es importante conocer a quién se debe informar, y qué derecho tiene cada uno a decidir. Aún resulta difícil para algunos pediatras aplicar la ley 41/2002 de Autonomía del Paciente

Lately, number of divorces is increasing, nevertheless, a parents' divorce can become a traumatic problem for paediatric patients. Consequently, the aim of this study was to analyze the ethical conflicts that appear in the relationship between physician/parents/son/daughter, and more specifically those that a divorce generates. A descriptive study was developed through a survey composed by 39 items. Previously, an exhaustive bibliographic analysis was carried out. Our results show that only 35% of paediatricians interviewed have been educated in bioethics although this issue is important in daily practice. Other items show that 57,5% would not cancel a pharmacological treatment in order to improve quality of life. Also, they would react against a wrong parents' decision (82,5%). They give low value to the minor`s decision (6,05%), and rarely inform exclusively to adolescents (5%). In contrast, paediatricians sometimes ask to adolescents (20%) in first place and involved them to decide in 90% of cases. Besides, there are differences in the relation with fathers and mothers, 17,5% of mothers are informed exclusively, a fact that never hap-pens with fathers. Ethics has an intrinsic value very important in daily clinical decisions in order to respect the rules and to adapt them to the situation of every paediatric patient. When an important ethical conflict become, as a divorce is, it is essential to know who must be informed and the rights everyone has to make a decision. It is complicated to the paediatricians yet to develop 41/2002 law for Patient's autonomy

Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Relaciones Médico-Paciente/ética , Menores , Divorcio/ética , Custodia del Niño/ética , Relaciones Padres-Hijo , Pediatras/ética , Autonomía Personal , Derechos del Paciente/ética , Encuestas y Cuestionarios , Conocimientos, Actitudes y Práctica en Salud , Pautas de la Práctica en Medicina
Medicina (Kaunas) ; 56(12)2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33322462


Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Italy has proven to be one of the countries with the highest coronavirus-linked death rate. To reduce the impact of SARS-CoV-2 coronavirus, the Italian Government decision-makers issued a series of law decrees that imposed measures limiting social contacts, stopped non-essential production activities, and restructured public health care in order to privilege assistance to patients infected with SARS-CoV-2. Health care services were substantially limited including planned hospitalization and elective surgeries. These substantial measures were criticized due to their impact on individual rights including freedom and autonomy, but were justified by the awareness that hospitals would have been unable to cope with the surge of infected people who needed treatment for COVID-19. The imbalance between the need to guarantee ordinary care and to deal with the pandemic, in a context of limited health resources, raises ethical concerns as well as clinical management issues. The emergency scenario caused by the COVID-19 pandemic, especially in the lockdown phase, led the Government and health care decision-makers to prioritize community safety above the individuals' rights. This new community-centered approach to clinical care has created tension among the practitioners and exposed health workers to malpractice claims. Reducing the morbidity and mortality rates of the COVID-19 pandemic is the priority of every government, but the legitimate question remains whether the policy that supports this measure could be less harmful for the health care system.

/prevención & control , Política de Salud , Derechos del Paciente , Administración en Salud Pública/ética , Cuarentena/ética , /mortalidad , Urgencias Médicas , Humanos , Italia/epidemiología , Administración en Salud Pública/legislación & jurisprudencia , Cuarentena/legislación & jurisprudencia
Bull World Health Organ ; 98(11): 801-808, 2020 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-33177777


Four decades after the Declaration of Alma-Ata, its vision of health for all and strategy of primary health care are still an inspiration to many people. In this article we evaluate the current status of primary health care in the era of the Declaration of Astana, the sustainable development goals, universal health coverage and the coronavirus disease 2019 pandemic. We consider how best to guide greater application of the primary health care strategy, reflecting on tensions that remain between the political vision of primary health care and its implementation in countries. We also consider what is required to support countries to realize the aspirations of primary health care, arguing that national needs and action must dominate over global preoccupations. Changing contexts and realities need to be accommodated. A clear distinction is needed between primary health care as an inspirational vision and set of values for health development, and primary health care as policy and implementation space. To achieve this vision, political action is required. Stakeholders beyond the health sector will often need to lead, which is challenging because the concept of primary health care is poorly understood by other sectors. Efforts on primary health care as policy and implementation space might focus explicitly on primary care and the frontline of service delivery with clear links and support to complementary work on social determinants and building healthy societies. Such efforts can be partial but important implementation solutions to contribute to the much bigger political vision of primary health care.

Infecciones por Coronavirus/epidemiología , Salud Global , Política de Salud , Neumonía Viral/epidemiología , Atención Primaria de Salud/organización & administración , Atención de Salud Universal , Betacoronavirus , Sector de Atención de Salud/organización & administración , Prioridades en Salud/organización & administración , Humanos , Sistemas de Información , Pandemias , Derechos del Paciente/normas , Política , Desarrollo Sostenible
Rev. bioét. derecho ; (50): 1133-131, nov. 2020.
Artículo en Español | IBECS | ID: ibc-191349


Han sucedido tantas cosas, y en tan poco tiempo, que no resulta fácil seleccionar alguna temática sin dejarnos fuera otras igualmente relevantes. Probablemente nos pasaremos los próximos años debatiendo sobre lo acontecido, entre otros motivos, por la escasa información que aun hoy tenemos sobre la apisonadora que ha triturado nuestro estilo de vida. Pues bien, he seleccionado, de entre las innumerables que podríamos estudiar, cuatro narrativas. En concreto, la pandemia como refriega entre neokantianos y utilitaristas; como datificación de rebaño; como ajuste de cuentas epistemológico y como singularidad española. Con este análisis podremos interrelacionar, aunque sea de forma breve, las implicaciones éticas, jurídicas, políticas y científicas de una historia que recién ha comenzado

So many things have happened, and in such a short time, that it is not easy to select some topic without leaving out other equally relevant ones. We will probably spend the next few years debating what happened, among other things, due to the scant information that we still have today about the steamroller that has crushed our lifestyle. Well, I have selected, from the innumerable ones that remain to be studied, four narratives. Specifically, the pandemic as a fray between neo-Kantians and utilitarians; as herd dating; as an epistemological reckoning and as a Spanish singularity. With this analysis we will be able to interrelate, albeit briefly, the ethical, legal, political and scientific implications of a history that has just begun

Han passat tantes coses, I en tan poc temps, que no resulta fàcil seleccionar alguna temàtica sense deixar-nos fora d'altres igualment rellevants. Probablement ens passarem els propers anys debatent sobre els fets, entre altres motius, per l'escassa informació que encara avui tenim sobre la piconadora que ha triturat el nostre estil de vida. Doncs bé, he seleccionat, d'entre els innombrables que podríem estudiar, quatre narratives. En concret, la pandèmia com la batalla entre neokantians I utilitaristes; com datificació de ramat; com venjança epistemològica I com a singularitat espanyola. Amb aquest anàlisi podrem interrelacionar, encara que sigui de forma breu, les implicacions ètiques, jurídiques, polítiques I científiques d'una història que just acaba de començar

Humanos , Triaje , Biotecnología , Derechos del Paciente , Toma de Decisiones , Infecciones por Coronavirus , Neumonía Viral , Pandemias
Cien Saude Colet ; 25(suppl 2): 4197-4200, 2020 Oct.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-33027356


Coronavirus disease 2019 made us question daily practices, such as the simple handshake. It also raised some ethical and legal issues. Are the ethical principles, that should guide the provision of individualized care, being fulfilled? Will we, as health professionals, be able to provide patients with instruments so that they can fully exercise their autonomy? The guarantee of necessary security solutions, to reduce the risk of contagion in the provision of care, safeguards the principle of non-maleficence. However, the risk of contagion is impossible to completely eliminate, and there is a residual risk associated with the use of physical facilities in healthcare services. But, shouldn't the decision to take that risk be the subject of the patient's free and informed will? The incorporation of telemedicine platforms is ideal for managing several challenges posed by COVID-19, such as the decrease in face-to-face health care assistance. Can the patient really decide how he prefers to be consulted, or are we imposing the consultation model? There have been profound changes in healthcare systems. However, one must remember that there are ethical principles of biomedicine, that should always prevail?

Infecciones por Coronavirus/epidemiología , Derechos del Paciente , Autonomía Personal , Neumonía Viral/epidemiología , Betacoronavirus , Confidencialidad , Humanos , Tamizaje Masivo , Pandemias , Prioridad del Paciente , Portugal , Telemedicina
Obstet Gynecol ; 136(5): 1036-1039, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33030860


The population of women within carceral systems is growing rapidly. A portion of these individuals are pregnant and will deliver while incarcerated. Although shackling laws for pregnant persons have improved, incarcerated patients are forced to labor without the support of anyone but a carceral officer and their medical staff. We believe access to continuous labor support is critical for all pregnant persons. Carceral systems and their affiliated hospitals have the opportunity to change policies to reflect that continuous labor support is a basic human right and should be permitted for incarcerated pregnant persons in labor, either through a doula program or a selected person of choice.

Parto Obstétrico/ética , Trabajo de Parto/psicología , Derechos del Paciente/legislación & jurisprudencia , Atención Perinatal/ética , Prisioneros/psicología , Entorno del Parto , Parto Obstétrico/legislación & jurisprudencia , Femenino , Humanos , Atención Perinatal/legislación & jurisprudencia , Embarazo , Prisioneros/legislación & jurisprudencia
Soins Psychiatr ; 41(328): 19-22, 2020.
Artículo en Francés | MEDLINE | ID: mdl-33039086


The act of 5 July 2011 pertaining to the rights and the protection of persons under psychiatric care presents the possibility for compulsory care, without the need for full hospitalisation. Patients can be cared for through partial hospitalisation (day hospital and part-time therapeutic clinic) or in a medical-psychological centre. Treatments and all care are detailed in a care programme. This programme is sent, like all certificates, to the regional health agency and the prefecture in the case of psychiatric care by decision of the State representative, or to the hospital director for psychiatric care at the request of a third party. We propose two clinical vignettes.

Atención Ambulatoria , Trastornos Mentales/terapia , Centros de Día , Humanos , Derechos del Paciente/legislación & jurisprudencia
Soins Psychiatr ; 41(328): 23-25, 2020.
Artículo en Francés | MEDLINE | ID: mdl-33039087


Psychiatric compulsory community treatment programmes are widely and heterogeneously used measures of coercion. The recovery oriented mental health service 59G21 used them to minimize violating the rights of persons under compulsory care. Based on a clinical situation of failing this objective, we discuss their place in the health system and the reasons why we chose to move towards a "zero recourse" objective.

Servicios Comunitarios de Salud Mental , Trastornos Mentales/terapia , Humanos , Derechos del Paciente
Soins Psychiatr ; 41(328): 26-29, 2020.
Artículo en Francés | MEDLINE | ID: mdl-33039088


The care programmes are medical-legal and therapeutic systems that showcase different spaces, the law, the patient's clinic, their freedom and their rights. In this context, the patient preserves their freedom to come and go. In applying the care programme, the doctor must acquire their approval, not to say consent. Outside hospitalisation, the care programmes bring patients and teams together within the city. The matter of social and community psychiatry, a vector of catchment-area psychiatry, then makes full sense.

Trastornos Mentales/terapia , Psiquiatría Comunitaria , Libertad , Humanos , Derechos del Paciente