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1.
J Bioeth Inq ; 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33942206

RESUMO

This article poses a response to one argument supporting the force feeding of political prisoners. This argument assumes that prisoners have moral autonomy and thus cannot be force fed in the early stages of their hunger strike. However, as their fasting progresses, their cognitive competence declines, and they are no longer autonomous. Since they are no longer autonomous, force feeding becomes justified. This article questions the recurrent citation of a paper in empirical support of the claim that hunger strike causes mental disorders or cognitive impairments. The paper, written by Daniel Fessler, partially relies on the Minnesota Starvation Experiment conducted in 1944 to 1945 for scientific support. Using widely accepted criteria for assessing the ethical acceptability of clinical research, we argue that the Minnesota Starvation Experiment had significant scientific shortcomings and is a case of unethical research. From this, we question the appropriateness of citing the Minnesota Starvation Experiment and consequently Fessler's paper. If Citing Fessler's paper becomes problematic, this particular argument for the force feeding of prisoners loses much of its strength.

2.
Bioethics ; 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33829525

RESUMO

This article poses an invitation for bioethicists to engage with loneliness as a bioethics and public health concern. I argue that loneliness is a relevant issue for bioethicists for three main reasons: it causes ill-health; particularly in the age of Covid-19, it is becoming prominent on the clinical and public health agenda, affecting millions worldwide; and it engenders several ethical and philosophical questions as a social determinant of health with a rich conceptual background. In what follows I first review the link between loneliness and ill-health and argue that it should concern bioethicists because of this link. I also demonstrate how pertinent the issue of loneliness is being considered nowadays, and mark this as another reason for bioethicists to become engaged. I then move on to define loneliness and its various forms, drawing from modern and contemporary philosophers. The way we choose to cope with the pandemic of loneliness depends in part on its theoretical underpinnings, as well as its empirical scope. Theory thus combines with empirical data in order to devise and implement a rational public health policy, necessitating the kind of interdisciplinary approach that is the bedrock of bioethics. I conclude by suggesting future areas of research and recommendations.

4.
Public Health Ethics ; 13(2): 133-142, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33294029

RESUMO

This article argues that outbreak preparedness and response should implement a 'family presence' policy for infected patients in isolation that includes the option of physical visits and care within the isolation facility under some conditions. While such a 'physical family presence' (PFP) policy could increase infections during an outbreak and may raise moral dilemmas, we argue that it is ethically justified based on the least infringement principle and the need to minimize the harms and burdens of isolation as a restrictive measure. Categorical prohibition of PFP during the course of an outbreak or epidemic is likely to result in unnecessary harms to patients and families, and violate values such as the moral commitments of families to care for each other. Supporting the option of PFP under particular circumstances, on the other hand, will least infringe these moral considerations. An additional reason for a family presence policy is that it may facilitate voluntary cooperation with isolation and other restrictive measures. We provide an analysis of these considerations for supporting modes of family presence during an outbreak emergency, before defending the riskier option of PFP in the isolation facility from plausible objections and concerns.

5.
Dev World Bioeth ; 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32573955

RESUMO

This essay discusses and weaves together three interrelated topics: loneliness as a neglected bioethics problem, solidarity as one potential solution to loneliness, and the Israeli-Palestinian Conflict as a neglected bioethics problem in which loneliness is stark. I first present and define various kinds of loneliness, focusing on ethical loneliness, defined as suffering injustice without a proper repair process. I next discuss current health conditions in Gaza, focusing on healthcare providers who, according to the UN, are being intentionally targeted by Israel. I explain how the various kinds of loneliness are reflected among people in Gaza. I lastly relate together the notions of solidarity, responsibility and personal autonomy, arguing that bioethicists and healthcare providers have a duty to support the people in Gaza, stemming from solidarity and an extended responsibility perspective.

7.
Monash Bioeth Rev ; 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32285336

RESUMO

Active surveillance cultures and contact precautions is a strategy to control the transmission of methicillin-resistant Staphylococcus aureus (MRSA) within healthcare facilities. Whether to implement this strategy to routinely screen and isolate inpatients with MRSA in non-outbreak (endemic) settings, or to remove it and use standard infection control precautions only is scientifically and ethically controversial, in view of the potential adverse effects of contact precautions on patients. To support the use of standard precautions only, it has been argued that active surveillance to identify patients who are asymptomatically colonised with MRSA to place them in contact precautions is unjust or unfair to these patients in various ways. This paper will unpack and examine four distinct arguments, which are advanced from a medical ethics or quality improvement ethical framework, for why this is so. Our analysis shows that while these arguments highlight the injustice of current practices, they do not provide strong ethical reasons for justifying the removal of active surveillance and contact precautions to control MRSA transmission and infection. An implication of our arguments is that the ethical frame for evaluating prevention and control strategies for MRSA, a multi-drug resistant bacteria, should shift from healthcare to primarily public health. From a public health ethics perspective, whether a strategy is unjust, or how ethically significant its lack of fairness is, depends on assessing the evidence for its public health effectiveness and necessity in a given setting, and the extent of the harms and burdens patients with MRSA bear when they are on contact precautions, which remain matters of scientific debate or uncertainty. As an ethical consideration in the debate, the chief normative implication of justice is to provide us further reasons to revise current active surveillance-contact precautions practices, and for the need for research and interventions to minimise their potential adverse effects on patients.

8.
J Med Ethics ; 46(9): 632-633, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32075867

RESUMO

Johnson and Degeling have recently enquired whether one health (OH) requires a comprehensive normative framework, concluding that such a framework, while not necessary, may be helpful. In this commentary, we provide a context for this debate, and describe how pragmatism has been predominant in the OH literature. We nevertheless argue that articulating a comprehensive normative theory to ground OH practice might clear existing vagueness and provide stronger guidance in relevant health dilemmas. A comprehensive theory will also be needed eventually to ground notions such as universal good. We, thus, call for the systematic articulation of a comprehensive, metaethical theory, concomitantly with already ongoing normative work.

10.
J Emerg Med ; 58(3): e129-e132, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31806433

RESUMO

BACKGROUND: One Health is a biomedical approach that aims to optimize the health of humans, animals, and the environment through interdisciplinary collaboration. Cellulitis is an infection of the dermis and subcutaneous fat that may be caused by zoonotic streptococci species. CASE REPORT: We report a case of cellulitis caused by Streptococcus canis in a woman who was taking Etanercept. We frame the presentation within a One Health approach and urge emergency physicians to collaborate with veterinarians in the management of patients with zoonotic diseases who are discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pets are a source for zoonotic diseases, including resistant bacteria, that pose particular risk to immunocompromised patients. Emergency physicians often discharge patients with potential zoonotic infections such as cellulitis home without a long-term, holistic care plan, according to a One Health approach. Physicians should then collaborate with veterinarians in caring for humans and animals.

11.
J Clin Ethics ; 30(4): 347-355, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31851626

RESUMO

Most professional guidelines advocate family presence during resuscitation (FPDR). Many clinicians, however, are still reluctant to implement this recommendation. In this article I present the most comprehensive case for FPDR to date. I review the little that has been written about the ethics of FPDR, as well as the available empirical evidence. More importantly, I present and defend three arguments for FPDR: adherence to professional guidelines, benefit to patients and relatives, and patients' autonomy. I conclude with suggestions for future research.


Assuntos
Reanimação Cardiopulmonar/ética , Cuidados Críticos/ética , Família , Relações Profissional-Família/ética , Atitude do Pessoal de Saúde , Reanimação Cardiopulmonar/psicologia , Cuidados Críticos/psicologia , Família/psicologia , Humanos , Guias de Prática Clínica como Assunto
14.
Dev World Bioeth ; 19(2): 116-122, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30993853

RESUMO

Using Madison Powers and Ruth Faden's definition of 'well-being,' the authors argue that Israel, the international community and public health practitioners have a justice-based obligation to assist the Palestinian people in the Occupied Palestinian Territories. Focusing on Palestinians in Gaza, the authors first outline a normative framework of justice, as articulated by Powers and Faden. Following Powers and Faden's assumption that empirical assessments of justice can be made using the six dimensions of well-being, the authors next present current data on the living conditions in Gaza and describe how these conditions prevent residents from achieving sufficient levels of well-being. Using these indicators to demonstrate that Palestinians living in Gaza suffer deficiencies in these dimensions of well-being, the authors present a strong argument from justice to assist the residents of Gaza. The medical, public health, and bioethics community cannot sit idle while injustice continues.


Assuntos
Direitos Humanos/ética , Justiça Social/ética , Adaptação Psicológica , Inquéritos Epidemiológicos , Humanos , Israel
15.
J R Army Med Corps ; 165(4): 266-269, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30127066

RESUMO

Whether injured terrorists should receive equal consideration in medical triage as their victims is a morally and emotionally challenging issue for healthcare providers. Against the conventional approach, some commentators have argued for a 'victims-first' principle in which severely injured victims should always be prioritised over an injured terrorist even if the terrorist is worse off based on justice ideas. This paper argues that supporters of 'victims-first' fail to sufficiently justify the subversion of the equal rights of terrorists to treatment and the role and professional ethics of healthcare providers in the allocation of scarce medical resources. Accordingly, they fail to substantiate an exceptional approach for emergency medical triage during terror or terror-like attack situations.


Assuntos
Medicina Militar/ética , Terrorismo/ética , Triagem/ética , Humanos , Militares
17.
Theor Med Bioeth ; 39(4): 321-334, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29948503

RESUMO

Several bioethicists have recently advocated the force-feeding of prisoners, based on the assumption that prisoners have reduced or no autonomy. This assumed lack of autonomy follows from a decrease in cognitive competence, which, in turn, supposedly derives from imprisonment and/or being on hunger strike. In brief, causal links are made between imprisonment or voluntary total fasting (VTF) and mental disorders and between mental disorders and lack of cognitive competence. I engage the bioethicists that support force-feeding by severing both of these causal links. Specifically, I refute the claims that VTF automatically and necessarily causes mental disorders such as depression, and that these mental disorders necessarily or commonly entail cognitive impairment. Instead, I critically review more nuanced approaches to assessing mental competence in hunger strikes, urging that a diagnosis of incompetence be made on a case-by-case basis-a position that is widely shared by the medical community.


Assuntos
Nutrição Enteral/efeitos adversos , Nutrição Enteral/ética , Jejum/efeitos adversos , Competência Mental/normas , Prisioneiros/psicologia , Nutrição Enteral/métodos , Jejum/psicologia , Humanos , Autonomia Pessoal
18.
Lancet ; 391(10120): 539, 2018 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-29617243
19.
Monash Bioeth Rev ; 34(3-4): 158-188, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28812253

RESUMO

In 2015, the Israeli Knesset passed the force-feeding act that permits the director of the Israeli prison authority to appeal to the district court with a request to force-feed a prisoner against his expressed will. A recent position paper by top Israeli clinicians and bioethicists, published in Hebrew, advocates for force-feeding by medical professionals and presents several arguments that this would be appropriate. Here, we first posit three interrelated questions: 1. Do prisoners have a right to hunger-strike? 2. Should governing institutions force-feed prisoners and/or is it ethical to force-feed prisoners? 3. Should healthcare professionals force-feed prisoners? We then focus on the first and third questions. We first briefly provide several arguments to support the right of prisoners to refuse treatment. Next, we critically review the arguments presented in the Israeli position paper, demonstrating that they are all misguided at best. Lastly, we briefly present arguments against force-feeding by medical professionals. We conclude that healthcare providers should not participate in the force-feeding of prisoners.


Assuntos
Nutrição Enteral/ética , Ética Médica , Jejum , Pessoal de Saúde/ética , Direitos Humanos , Prisões/ética , Temas Bioéticos , Dissidências e Disputas , Humanos , Israel , Prisioneiros
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