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2.
Clin J Oncol Nurs ; 25(1): 61-68, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33480884

RESUMEN

BACKGROUND: The disruption in the supply chain of resources and interruptions in cancer treatments caused by the pandemic presented tremendous challenges to the healthcare system. OBJECTIVES: This article describes the National Academy of Medicine-defined states of medical and nursing care delivery for which local plans should be drawn and the shifting and evolving systems framework that can guide decisions to optimize the crisis standards of care. METHODS: A case study is presented to describe the process of shifting the state of medical and nursing care delivery and bioethical nursing considerations during the pandemic and beyond. FINDINGS: An evolving and shifting systems framework for crises rooted in deontology, principlism, and the ethics of care model provide meaningful guidance for establishing priorities for patient care.


Asunto(s)
/enfermería , Toma de Decisiones/ética , Prestación de Atención de Salud/ética , Neoplasias/enfermería , Enfermería Oncológica/ética , Enfermería Oncológica/normas , Pandemias/ética , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Guías de Práctica Clínica como Asunto
4.
J Med Ethics ; 47(2): 108-112, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33335068

RESUMEN

One prominent view in recent literature on resource allocation is Persad, Emanuel and Wertheimer's complete lives framework for the rationing of lifesaving healthcare interventions (CLF). CLF states that we should prioritise the needs of individuals who have had less opportunity to experience the events that characterise a complete life. Persad et al argue that their system is the product of a successful process of reflective equilibrium-a philosophical methodology whereby theories, principles and considered judgements are balanced with each other and revised until we achieve an acceptable coherence between our various beliefs. Yet I argue that many of the principles and intuitions underpinning CLF conflict with each other, and that Persad et al have failed to achieve an acceptable coherence between them. I focus on three tensions in particular: the conflict between the youngest first principle and Persad et al's investment refinement; the conflict between current medical need and a concern for lifetime equality; and the tension between adopting an objective measure of complete lives and accommodating for differences in life narratives.


Asunto(s)
Toma de Decisiones/ética , Ética Clínica , Asignación de Recursos para la Atención de Salud/ética , Equidad en Salud/ética , Justicia Social , Triaje/ética , Prestación de Atención de Salud/ética , Análisis Ético , Prioridades en Salud/ética , Estado de Salud , Humanos , Principios Morales
6.
JAMA Netw Open ; 3(12): e2029650, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33320264

RESUMEN

Importance: Although considerable evidence exists on the association between negative health outcomes and daily experiences of discrimination, less is known about such experiences in the health care system at the national level. It is critically necessary to measure and address discrimination in the health care system to mitigate harm to patients and as part of the larger ongoing project of responding to health inequities. Objectives: To (1) identify the national prevalence of patient-reported experiences of discrimination in the health care system, the frequency with which they occur, and the main types of discrimination experienced and (2) examine differences in the prevalence of discrimination across demographic groups. Design, Setting, and Participants: This cross-sectional national survey fielded online in May 2019 used a general population sample from the National Opinion Research Center's AmeriSpeak Panel. Surveys were sent to 3253 US adults aged 21 years or older, including oversamples of African American respondents, Hispanic respondents, and respondents with annual household incomes below 200% of the federal poverty level. Main Outcomes and Measures: Analyses drew on 3 survey items measuring patient-reported experiences of discrimination, the primary types of discrimination experienced, the frequency with which they occurred, and the demographic and health-related characteristics of the respondents. Weighted bivariable and multivariable logistic regressions were conducted to assess associations between experiences of discrimination and several demographic and health-related characteristics. Results: Of 2137 US adult respondents who completed the survey (66.3% response rate; unweighted 51.0% female; mean [SD] age, 49.6 [16.3] years), 458 (21.4%) reported that they had experienced discrimination in the health care system. After applying weights to generate population-level estimates, most of those who had experienced discrimination (330 [72.0%]) reported experiencing it more than once. Of 458 reporting experiences of discrimination, racial/ethnic discrimination was the most common type (79 [17.3%]), followed by discrimination based on educational or income level (59 [12.9%]), weight (53 [11.6%]), sex (52 [11.4%]), and age (44 [9.6%]). In multivariable analysis, the odds of experiencing discrimination were higher for respondents who identified as female (odds ratio [OR], 1.88; 95% CI, 1.50-2.36) and lower for older respondents (OR, 0.98; 95% CI, 0.98-0.99), respondents earning at least $50 000 in annual household income (OR, 0.76; 95% CI, 0.60-0.95), and those reporting good (OR, 0.59; 95% CI, 0.46-0.75) or excellent (OR, 0.41; 95% CI, 0.31-0.56) health compared with poor or fair health. Conclusions and Relevance: The results of this study suggest that experiences of discrimination in the health care system appear more common than previously recognized and deserve considerable attention. These findings contribute to understanding of the scale at which interpersonal discrimination occurs in the US health care system and provide crucial evidence for next steps in assessing the risks and consequences of such discrimination. The findings also point to a need for further analysis of how interpersonal discrimination interacts with structural inequities and social determinants of health to build effective responses.


Asunto(s)
Prestación de Atención de Salud , Determinantes Sociales de la Salud , Discriminación Social , Estudios Transversales , Prestación de Atención de Salud/ética , Prestación de Atención de Salud/normas , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Prevalencia , Determinantes Sociales de la Salud/ética , Determinantes Sociales de la Salud/normas , Discriminación Social/clasificación , Discriminación Social/prevención & control , Discriminación Social/estadística & datos numéricos , Estados Unidos
13.
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.
Eur Urol ; 78(5): 731-742, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32893062

RESUMEN

CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid changes in medical practice. Many of these changes may add value to care, creating opportunities going forward. OBJECTIVE: To provide an evidence-informed, expert-derived review of genitourinary cancer care moving forward following the initial COVID-19 pandemic. EVIDENCE ACQUISITION: A collaborative narrative review was conducted using literature published through May 2020 (PubMed), which comprised three main topics: reduced in-person interactions arguing for increasing virtual and image-based care, optimisation of the delivery of care, and the effect of COVID-19 in health care facilities on decision-making by patients and their families. EVIDENCE SYNTHESIS: Patterns of care will evolve following the COVID-19 pandemic. Telemedicine, virtual care, and telemonitoring will increase and could offer broader access to multidisciplinary expertise without increasing costs. Comprehensive and integrative telehealth solutions will be necessary, and should consider patients' mental health and access differences due to socioeconomic status. Investigations and treatments will need to maximise efficiency and minimise health care interactions. Solutions such as one stop clinics, day case surgery, hypofractionated radiotherapy, and oral or less frequent drug dosing will be preferred. The pandemic necessitated a triage of those patients whose treatment should be expedited, delayed, or avoided, and may persist with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in circulation. Patients whose demographic characteristics are at the highest risk of complications from COVID-19 may re-evaluate the benefit of intervention for less aggressive cancers. Clinical research will need to accommodate virtual care and trial participation. Research dissemination and medical education will increasingly utilise virtual platforms, limiting in-person professional engagement; ensure data dissemination; and aim to enhance patient engagement. CONCLUSIONS: The COVID-19 pandemic will have lasting effects on the delivery of health care. These changes offer opportunities to improve access, delivery, and the value of care for patients with genitourinary cancers but raise concerns that physicians and health administrators must consider in order to ensure equitable access to care. PATIENT SUMMARY: The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward.


Asunto(s)
Infecciones por Coronavirus , Prestación de Atención de Salud , Pandemias , Neumonía Viral , Pautas de la Práctica en Medicina , Telemedicina/métodos , Neoplasias Urogenitales , Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Prestación de Atención de Salud/ética , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/tendencias , Humanos , Salud Mental/normas , Innovación Organizacional , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/tendencias , Neoplasias Urogenitales/psicología , Neoplasias Urogenitales/terapia
15.
Am J Public Health ; 110(10): 1523-1527, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32816541

RESUMEN

This article considers key ethical, legal, and medical dilemmas arising for people with disabilities in the COVID-19 pandemic. We highlight the limited application of existing frameworks of emergency planning with and for people with disabilities in the COVID-19 pandemic, explore key concerns and issues affecting the health care of people with disabilities (i.e., access to information and clinician-patient communication, nondiscrimination and reasonable accommodations, and rationing of medical goods), and indicate possible solutions. Finally, we suggest clinical and public health policy measures to ensure that people with disabilities are included in the planning of future pandemic-related efforts.The devastation evoked by the COVID-19 pandemic raises challenging dilemmas in bioethics. It also speaks to social justice issues that have plagued historically marginalized communities in the United States.Responses to the pandemic must be bound by legal standards, principles of distributive justice, and societal norms of protecting vulnerable populations-core commitments of public health-to ensure that inequities are not exacerbated, and should provide a pathway for improvements to ensure equitable access and treatment in the future.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/ética , Personas con Discapacidad , Política de Salud , Pandemias , Neumonía Viral/epidemiología , Betacoronavirus , Personas con Discapacidad/legislación & jurisprudencia , Servicios Médicos de Urgencia , Asignación de Recursos para la Atención de Salud , Planificación en Salud , Humanos , Estados Unidos/epidemiología , Poblaciones Vulnerables
16.
Cuad. bioét ; 31(102): 167-182, mayo-ago. 2020.
Artículo en Español | IBECS | ID: ibc-194276

RESUMEN

En este trabajo presento una reflexión sobre el modo de conciliar los esfuerzos por combatir la pandemia de la COVID-19 con la salvaguarda de los derechos humanos, desde una perspectiva bioética. Para ello desarrollo tres puntos: el marco normativo que justifica la restricción o suspensión de derechos ante amena-zas graves para la salud pública; las declaraciones de los comités internacionales de bioética sobre el modo en que se deben proteger los derechos humanos durante la crisis de salud pública que vivimos; y un repaso de los principales derechos amenazados tanto por la crisis de salud pública como por los medios adoptados para combatirla. Antes de entrar en cada uno de esos puntos, ofrezco una nota preliminar para esclarecer determinados conceptos jurídicos y subrayar la necesidad de superar los planteamientos disyuntivos en la consideración de los derechos humanos


In this paper present, from a bioethical perspective, a reflection on how to reconcile efforts to combat the COVID-19 pandemic with the safeguard of human rights. To do this, I develop three points. First, the regulatory framework that justifies the restriction or suspension of rights in the face of serious threats to public health. Second, the declarations of the international bioethics committees on the way in which human rights should be protected during public health crisis. And third, a review of the main rights threatened both by the public health crisis and by the means adopted to combat it. Before going into each of these points, I offer a preliminary note to clarify certain legal concepts and underline the need to overcome disjunctive approaches in considering human rights


Asunto(s)
Humanos , Bioética/tendencias , Derechos Humanos/legislación & jurisprudencia , Pandemias/ética , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/ética , Control de Enfermedades Transmisibles/legislación & jurisprudencia , Políticas Públicas de Salud
19.
Healthc Manage Forum ; 33(5): 239-242, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32638633

RESUMEN

Managing healthcare in the Coronavirus Disease 2019 (COVID-19) era should be guided by ethics, epidemiology, equity, and economics, not emotion. Ethical healthcare policies ensure equitable access to care for patients regardless of whether they have COVID-19 or another disease. Because healthcare resources are limited, a cost per Quality Life Year (QALY) approach to COVID-19 policy should also be considered. Policies that focus solely on mitigating COVID-19 are likely to be ethically or financially unsustainable. A cost/QALY approach could target resources to optimally improve QALYs. For example, most COVID-19 deaths occur in long-term care facilities, and this problem is likely better addressed by a focused long-term care reform than by a society-wide non-pharmacological intervention. Likewise, ramping up elective, non-COVID-19 care in low prevalence regions while expanding testing and case tracking in hot spots could reduce excess mortality from non-COVID-19 diseases and decrease adverse financial impacts while controlling the epidemic. Globally, only ∼0.1% of people have had a COVID-19 infection. Thus, ethical healthcare policy must address the needs of the 99.9%.


Asunto(s)
Infecciones por Coronavirus/terapia , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/ética , Equidad en Salud/economía , Equidad en Salud/ética , Política de Salud/economía , Neumonía Viral/terapia , Años de Vida Ajustados por Calidad de Vida , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Humanos , Pandemias , Neumonía Viral/epidemiología
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