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1.
J Clin Ethics ; 32(1): 35-37, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656455

RESUMEN

The excellent article by Daniel J. Benedetti, Mithya Lewis-Newby, Joan S. Roberts, and Douglas S. Diekema draws strength by dealing both with micro ethical (personal) and macro ethical (institutional policies and structures) considerations. One should further note that often, the macro factors are even stronger than the article implies, although individuals can affect the macro context. A particularly important macro factor for all matters concerning healthcare, indeed all human services, is the tension between the profit motive and ethical decisions.


Asunto(s)
Enfermedades Transmisibles/terapia , Ética Institucional , Ética Profesional , Pandemias/ética , Personal de Salud/ética , Humanos , Obligaciones Morales
2.
PLoS One ; 16(2): e0246320, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33529237

RESUMEN

Emerging infectious diseases such as Ebola Virus Disease (EVD), Nipah Virus Encephalitis and Lassa fever pose significant epidemic threats. Responses to emerging infectious disease outbreaks frequently occur in resource-constrained regions and under high pressure to quickly contain the outbreak prior to potential spread. As seen in the 2020 EVD outbreaks in the Democratic Republic of Congo and the current COVID-19 pandemic, there is a continued need to evaluate and address the ethical challenges that arise in the high stakes environment of an emerging infectious disease outbreak response. The research presented here provides analysis of the ethical challenges with regard to allocation of limited resources, particularly experimental therapeutics, using the 2013-2016 EVD outbreak in West Africa as a case study. In-depth semi-structured interviews were conducted with senior healthcare personnel (n = 16) from international humanitarian aid organizations intimately engaged in the 2013-2016 EVD outbreak response in West Africa. Interviews were recorded in private setting, transcribed, and iteratively coded using grounded theory methodology. A majority of respondents indicated a clear propensity to adopt an ethical framework of guiding principles for international responses to emerging infectious disease outbreaks. Respondents agreed that prioritization of frontline workers' access to experimental therapeutics was warranted based on a principle of reciprocity. There was widespread acceptance of adaptive trial designs and greater trial transparency in providing access to experimental therapeutics. Many respondents also emphasized the importance of community engagement in limited resource allocation scheme design and culturally appropriate informed consent procedures. The study results inform a potential ethical framework of guiding principles based on the interview participants' insights to be adopted by international response organizations and their healthcare workers in the face of allocating limited resources such as experimental therapeutics in future emerging infectious disease outbreaks to ease the moral burden of individual healthcare providers.


Asunto(s)
Enfermedades Transmisibles Emergentes/terapia , Brotes de Enfermedades/ética , Asignación de Recursos para la Atención de Salud/ética , Fiebre Hemorrágica Ebola/terapia , Ensayos Clínicos Adaptativos como Asunto/ética , Adulto , África Occidental/epidemiología , Femenino , Personal de Salud/ética , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Terapias en Investigación/ética
3.
Ethics Hum Res ; 43(2): 19-27, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33565280

RESUMEN

Employees are often considered a vulnerable research population due to concerns about consent and confidentiality, but there is insufficient guidance regarding their ethical inclusion in research. In the context of Covid-19, frontline health care workers comprise a particularly relevant research population in light of their risks of viral exposure and psychological strain, among other factors. They may therefore be targeted for research conducted at their place of employment and benefit from participating in such research. Beyond Covid-19, there are other circumstances in which health care workers may be considered for inclusion in research conducted by or with the involvement of their colleagues and employers. As investigators, sponsors, institutional review boards, and others assess the ethical permissibility of these scenarios, as well as relevant protections, we recommend systematic consideration of social and scientific value, validity, fairness, risks and benefits, voluntary consent, respect, and independent review. There is often good reason to specifically target health care workers for inclusion in Covid-19 research (beyond convenience), and they should not be excluded from research offering the prospect of direct benefit. However, additional safeguards may be necessary in employer-based research to avoid scientific bias, promote voluntariness, and solicit stakeholder input. Research personnel should be permitted to enroll in their own Covid-19 studies only when participation offers them the prospect of unique benefits.


Asunto(s)
Comités de Ética en Investigación , Personal de Salud/ética , Investigadores , Investigación , Personal de Salud/organización & administración , Humanos
4.
Hastings Cent Rep ; 51(1): 22-27, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33630324

RESUMEN

The Covid-19 crisis has accelerated a trend toward burnout in health care workers, making starkly clear that burnout is especially likely when providing health care is not only stressful and sad but emotionally alienating; in such situations, there is no mental space for clinicians to experience authentic clinical empathy. Engaged curiosity toward each patient is a source of meaning and connection for health care providers, and it protects against sympathetic distress and burnout. In a prolonged crisis like Covid-19, clinicians provide care out of a sense of duty, especially the duty of nonabandonment. We argue that when duty alone is relied on too heavily, with fear and frustration continually suppressed, the risk of burnout is dramatically increased. Even before Covid-19, clinicians often worked under dehumanizing and unjust conditions, and rates of burnout were 50 percent for physicians and 33 percent for nurses. The Covid-19 intensification of burnout can serve as a wake-up call that the structure of health care needs to be improved if we are to prevent the loss of a whole generation of empathic clinicians.


Asunto(s)
Agotamiento Profesional/epidemiología , Empatía , Obligaciones Morales , Estrés Laboral/epidemiología , Agotamiento Profesional/psicología , Personal de Salud/ética , Personal de Salud/psicología , Humanos , Estrés Laboral/psicología , Estados Unidos
9.
Bioethics ; 35(2): 125-134, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33325536

RESUMEN

In March 2020, the rapid increase in severe COVID-19 cases overwhelmed the healthcare systems in several European countries. The capacities for artificial ventilation in intensive care units were too scarce to care for patients with acute respiratory disorder connected to the disease. Several professional associations published COVID-19 triage recommendations in an extremely short time: in 21 days between March 6 and March 27. In this article, we compare recommendations from five European countries, which combine medical and ethical reflections on this situation in some detail. Our aim is to provide a detailed overview on the ethical elements of the recommendations, the differences between them and their coherence. In more general terms we want to identify shortcomings in regard to a common European response to the current situation.


Asunto(s)
/terapia , Asignación de Recursos para la Atención de Salud , Nivel de Atención/ética , Triaje/ética , Factores de Edad , Europa (Continente)/epidemiología , Personal de Salud/ética , Personal de Salud/psicología , Prioridades en Salud , Hospitalización , Derechos Humanos , Humanos , Unidades de Cuidados Intensivos/ética , Guías de Práctica Clínica como Asunto , Resultado del Tratamiento , Ventiladores Mecánicos/provisión & distribución , Privación de Tratamiento/ética
10.
J Infect Dev Ctries ; 14(9): 968-970, 2020 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-33031082

RESUMEN

The COVID-19 pandemic has created new challenges on multiple fronts including a few ethical concerns. Timely and appropriate access to health services and the need to protect vulnerable people are some of them. An important aspect to consider, at the global level, is the frailty of health systems in many developing countries and the constant threat of these collapsing due to shortage of resources and medical supply. Special attention should be placed towards protecting the health of care workers who are highly exposed to SARS-CoV-2 infection. Research and clinical trials involving COVID-19 patients and healthy human volunteers must be done in strict adherence to the fundamental principles of bioethics, even if finding a solution is an urgent need. Shared responsibility must be assumed as we collectively face a common problem and ethical conflicts must be resolved using, as reference, the guidelines developed by the World Health Organization and other relevant international and national organizations. This would allow responsible action in the face of the pandemic without harming human rights, the individual and collective well-being.


Asunto(s)
Betacoronavirus , Salud Global/ética , Pandemias/ética , Ensayos Clínicos como Asunto/ética , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Países en Desarrollo , Personal de Salud/ética , Disparidades en Atención de Salud/ética , Derechos Humanos/ética , Humanos , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Triaje/ética
11.
S Afr Med J ; 110(6): 450-452, 2020 05 14.
Artículo en Inglés | MEDLINE | ID: mdl-32880548

RESUMEN

It is likely that the SARS-CoV-2 pandemic will affect a large part of the world's population and will last for several years. Many critical ethical issues have arisen in the healthcare context. While response from healthcare professionals to participating in the care of patients in the era of COVID-19 has generally been positive, there have also been disturbing experiences on the ground. The practice of medicine is a social contract with humanity. Challenges have arisen because the patient is both a victim and a vector of the coronavirus. All humans should have a natural instinct to care for those in need. Ethically and legally, healthcare professionals cannot be expected to assume a significant and unreasonable risk of harm. While fear is understandable, altruism and interest in serving the sick exemplify the value of solidarity. Social harms like stigmatisation and discrimination can occur. Concerns have been raised regarding protection of privacy and respect for rights of infected individuals. In the era of COVID-19, fear, misinformation and a detachment from one's calling put professionalism strongly to the test.


Asunto(s)
Infecciones por Coronavirus/terapia , Prestación de Atención de Salud/organización & administración , Personal de Salud/organización & administración , Neumonía Viral/terapia , Altruismo , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/ética , Personal de Salud/ética , Humanos , Pandemias/ética , Neumonía Viral/epidemiología , Profesionalismo
14.
PLoS One ; 15(7): e0235509, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32663206

RESUMEN

BACKGROUND: Healthcare professionals (HCPs), patients and families are often faced with ethical dilemmas. The role of healthcare ethics committees (HECs) is to offer support in these situations. AIM: The primary objective was to study how often HCPs encounter ethical dilemmas. The secondary objective was to identify the main types of ethical dilemmas encountered and how HCPs solve them. SUBJECTS AND METHODS: We conducted a cross-sectional, survey-based study among HCPs in 14 Slovenian hospitals. A questionnaire was designed and validated by HCPs who were selected by proportional stratified sampling. Data collection took place between April 2015 and April 2016. RESULTS: The final sample size was n = 485 (385 or 79.4%, female). The response rates for HCPs working in secondary and tertiary level institutions were 45% and 51%, respectively. Three hundred and forty (70.4%) of 485 HCPs (very) frequently encountered ethical dilemmas. Frequent ethical dilemmas were waiting periods for diagnostics or treatment, suboptimal working conditions due to poor interpersonal relations on the ward, preserving patients' dignity, and relations between HCPs and patients. Physicians and nurses working in secondary level institutions, compared to their colleagues working in tertiary level institutions, more frequently encountered ethical dilemmas with respect to preserving patients' dignity, protecting patients' information, and relations between HCPs and patients. In terms of solutions, all HCPs most frequently discussed ethical dilemmas with co-workers (colleagues), and with the head of the department. According to HCPs, the most important role of HECs is staff education, followed by improving communication, and reviewing difficult ethical cases. CONCLUSIONS: Waiting periods for diagnostics and treatment and suboptimal working conditions due to poor interpersonal relations are considered to be among the most important ethical issues by HCPs in Slovenian hospitals. The most important role of HECs is staff education, improving communication, and reviewing difficult ethical cases.


Asunto(s)
Personal de Salud/ética , Encuestas y Cuestionarios , Adulto , Estudios Transversales , Femenino , Hospitales/estadística & datos numéricos , Humanos , Masculino , Eslovenia
17.
BMC Med Ethics ; 21(1): 60, 2020 07 15.
Artículo en Inglés | MEDLINE | ID: mdl-32664908

RESUMEN

BACKGROUND: As the COVID-19 (coronavirus) pandemic develops, healthcare professionals are looking for support with, and guidance to inform, the difficult decisions they face. In the (current) absence of an authoritative national steer in England, professional bodies and local organisations have been developing and disseminating their own ethical guidance. Questions inevitably arise, some of which are particularly pressing during the pandemic, as events are unfolding quickly and the field is becoming crowded. My central question here is: which professional ethical guidance should the professional follow? MAIN BODY: Adopting a working definition of "professional ethical guidance", I offer three domains for a healthcare professional to consider, and some associated questions to ask, when determining whether - in relation to any guidance document - they should "bin it or pin it". First, the professional should consider the source of the guidance: is the issuing body authoritative or, if not, at least sufficiently influential that its guidance should be followed? Second, the professional should consider the applicability of the guidance, ascertaining whether the guidance is available and, if so, whether it is pertinent. Pertinence has various dimensions, including whether the guidance applies to this professional, this patient and/or this setting, whether it is up-to-date, and whether the guidance addresses the situation the professional is facing. Third, the professional should consider the methodology and methods by which the guidance was produced. Although the substantive quality of the guidance is important, so too are the methods by which it was produced. Here, the professional should ask whether the guidance is sufficiently inclusive - in terms of who has prepared it and who contributed to its development - and whether it was rigorously developed, and thus utilised appropriate processes, principles and evidence. CONCLUSION: Asking and answering such questions may be challenging, particularly during a pandemic. Furthermore, guidance will not do all the work: professionals will still need to exercise their judgment in deciding what is best in the individual case, whether or not this concerns COVID-19. But such judgments can and should be informed (and constrained) by guidance, and hopefully these preliminary observations will provide some useful pointers for time-pressed professionals.


Asunto(s)
Infecciones por Coronavirus , Ética Médica , Personal de Salud/ética , Pandemias , Neumonía Viral , Guías de Práctica Clínica como Asunto , Betacoronavirus , Códigos de Ética , Investigación sobre Servicios de Salud , Humanos , Pandemias/ética
18.
Rev. bioét. derecho ; (49): 125-139, jul. 2020.
Artículo en Inglés | IBECS | ID: ibc-192098

RESUMEN

Promoting measures that aim to mitigate discrepancies in the decision-making process, ensuring adequate training of physicians in the ethical aspect of care, and incrementing the wellbeing of patients and their families are becoming the principal objectives for high-quality care, especially in the Intensive Medicine Unit (ICU). In this paper, we're going to deal with the implementation of a specific ethics support for the ICU health care professionals, and considering the advanced Spanish experience on this matter, it deals with the current potentialities and limits of CEC's role to improve the quality of health care assistance


Promover medidas que tengan como objetivo mitigar las discrepancias en el proceso de toma de decisiones, garantizar la capacitación adecuada de los médicos en el aspecto ético de la atención e incrementar el bienestar de los pacientes y sus familias se están convirtiendo en los objetivos principales para una atención de alta calidad, especialmente en Medicina Intensiva. En este artículo abordaremos la implementación de un apoyo ético específico para los profesionales de la salud de la UCI. Teniendo en cuenta la amplia experiencia española en este tema, nos centraremos en el potencial y los límites actuales del rol del CEA para mejorar la calidad de asistencia sanitaria


Promoure mesures que tinguin com a objectiu mitigar els discrepàncies en el procés de presa de decisions, garantir la capacitació adequada dels metges respecte a l'aspecte ètic de l'atenció I incrementar el benestar dels pacients I els seves families s'estan convertint en els objectius principals per a una atenció de qualitat, especialment a Medicina Intensiva. En aquest article abordarem la implementació d'un soport ètic específic per a professionals de la salut de l'UCI. Tenint en compte l'àmplia experiència espanyola en aquest tema, ens centrarem en el potencial I els límits actuals del rol del CEA per a millorar la qualitat de l'assistència sanitària


Asunto(s)
Humanos , Personal de Salud/ética , Cuidados Críticos/ética , Comité de Profesionales/ética , Toma de Decisiones/ética , Directivas Anticipadas/ética , Unidades de Cuidados Intensivos/ética , Directivas Anticipadas/legislación & jurisprudencia
19.
Otolaryngol Head Neck Surg ; 163(4): 621-622, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32513064

RESUMEN

The widespread, tragic loss of life and the dedication of health care professionals have characterized the severe acute respiratory syndrome coronavirus 2 pandemic. While we mourn the loss of so many Americans to this novel virus, we also much acknowledge the positive effects to our profession, which are not insignificant. We have witnessed our larger community of otolaryngologist-head and neck surgeons pulling together in a manner not heretofore observed by this author. From the local level of practitioners to our national societies, there has been an amazing effort of collegial unity to develop the most clinically relevant guidelines for providing patient care with maximal safety, in the face of little scientific knowledge or experience with this virus. In addition, we as a specialty and individual otolaryngologists have, through our shared experiences, raised the bar for empathy, ethics, and professional interaction during these difficult times. We must reflect upon our professional growth and capture this renewal of altruism that lives at the heart of our calling.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Empatía , Personal de Salud/ética , Pandemias , Atención al Paciente/ética , Neumonía Viral/epidemiología , Humanos
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