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2.
JAMA ; 325(21): 2214, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34061153
4.
Int J Pediatr Otorhinolaryngol ; 147: 110787, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34120028

RESUMO

OBJECTIVES: This paper proposes that there is a specific pediatric otolaryngology ethic. METHODS: In support of this contention, traditional ethical frameworks are considered, before ethical issues specific to pediatric otolaryngology are addressed. RESULTS: First, there is a difference between child flourishing and family flourishing, parents have parental virtue (as parents), and where autonomy as a moral agent is vested, is contested. Parents act as both proxy decision-makers and as autonomous decision-makers for our patients. We are aware of the open future of a child. We worry about unvoiced and unvoicable concerns and distress in children. Second, we treat the not-yet-born and the recently born, so we need a philosophical understanding of what is a person, and when we become one. Third, traditional approaches to decision-making in medical ethics in Western settings are based upon the frameworks of duty and rules, or of consequences and outcomes, or are virtue-based. In our contemporary era, characterized by pronounced value pluralism, these ethical approaches no longer provide sufficient guidance in the complex milieu of our pediatric otolaryngology practice. In contemporary pediatric otolaryngology, a moral philosophical approach is needed to add meaning and normativity (a sense of oughtness or shouldness) to decision-making amongst the stakeholders in the clinical consultation. CONCLUSION: Determining the virtuous balance between a priori rules and empirical consequences is a possible solution. This is put into clinical practice via the process of dialogic consensus - an inclusive, non-coercive and reflective dialogue, aimed at reaching a consensual decision as how to maximize the good of our young patients and their family. Based upon differing ethical and moral considerations, and specific issues around children and their families, there is a particular pediatric otolaryngology ethic.


Assuntos
Princípios Morais , Otolaringologia , Criança , Ética Médica , Família , Humanos , Pais
6.
Bull Cancer ; 108(7-8): 677-685, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34175111

RESUMO

Clinical practice and medical research can expose to several situations with risks of conflicts of interests. Such situations can induce attenuations of their primary professional interest in favor of, so-called, secondary interests, and leading to bias in their judgement and actions. In this area, if financial conflicts of interests are consistent and frequently dominant, intellectual conflicts of interests have to be analyzed and considered, like those amplified and even induced by the current tremendous competition for scientific publication. In this article, after a contextual review of conflicts of interests in medicine, we will document and discuss more specifically those frequently induced by leaks of financial interests and those linked by evolutions of the current scientific expansion and competition.


Assuntos
Pesquisa Biomédica/ética , Conflito de Interesses/economia , Ética Médica , Editoração/ética , Viés , Pesquisa Biomédica/economia , Raciocínio Clínico , Comunicação , Competição Econômica , Empoderamento , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/ética , Humanos , Poder Psicológico , Má Conduta Científica/ética
9.
Psychiatr Danub ; 33(Suppl 3): S292-S298, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34010254

RESUMO

The aim of this paper is to draw on John Gregory's (1724-1773) professional ethics in medicine to provide guidance to physicians for the responsible management of the potentially contested boundary between medicine and religion. The paper provides a philosophical and clinical interpretation of Gregory's method of argument by persuasion: setting out complementary considerations that together invite agreement. The cumulative effect of this argument by persuasion is that a contested boundary between medicine and religion is not required by the commitment to the evidence-based, scientific practice of medicine. Gregory's legacy to us is the concept of the profession of medicine as secular, in two senses. As scientific, medicine draws on evidence and not on divinity, transcendent reality, or sacred texts and practices. There is no necessary hostility of evidence-based medicine toward religion and faith communities.


Assuntos
Ética Médica , Médicos , Humanos , Religião , Religião e Medicina
10.
Can Vet J ; 62(5): 445-446, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33967282
12.
Am J Bioeth ; 21(5): 36-38, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33945424
15.
BMC Med Educ ; 21(1): 273, 2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980240

RESUMO

BACKGROUND: Encouraging professional integrity is vital for providing a standard of excellence in quality medical care and education and in promoting a culture of respect and responsibility. The primary objective of this work consisted of studying the relationship of medical students to the right to patient privacy in Spain, specifically by analysing the conditions for accessing patient clinical histories (CHs). METHODS: A cross-sectional study was conducted based on a questionnaire sent by e-mail to final-year students at 41 Spanish universities. It had 14 multiple choice and closed questions framed in 3 large blocks. The first question addressed basic general knowledge issues on the right to privacy and the obligation for confidentiality. The two remaining blocks were made up of questions directed towards evaluating the frequency with which certain requirements and action steps related to students attending patients were performed and regarding the guarantees associated with accessing and handling patient CHs both on paper and in the Electronic Medical Record. RESULTS: A total of 245 valid replies were considered. A total of 67.8 % of participants were women, with an average age of 24.05 ± 3.49 years. Up to 90.6 % were aware that confidentiality affected the data in CHs, although 43.3 % possessed non-anonymized photocopies of patient clinical reports outside the healthcare context, and only 49.8 % of the students were always adequately identified. A total of 59.2 % accessed patient CHs on some occasions by using passwords belonging to healthcare professionals, 77.2 % of them did not have the patients' express consent, and 71.9 % accessed a CH that was not anonymised. CONCLUSIONS: The role of healthcare institutions and universities is considered to be fundamental in implementing educational measures regarding the risks and ethical and legal problems arising from the use of CHs among professionals and students. A thorough study of medical ethics is needed through the analysis of clinical cases and direct exposure to situations in which the patient's confidentiality is questioned.


Assuntos
Estudantes de Medicina , Adulto , Confidencialidade , Estudos Transversais , Ética Médica , Feminino , Humanos , Masculino , Espanha , Adulto Jovem
17.
J Am Coll Surg ; 233(1): 64-72.e2, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34015451

RESUMO

BACKGROUND: The disruption by the COVID-19 pandemic on undergraduate medical education allowed for assessment of virtual curricular innovations. One of the difficulties encountered in the virtual curriculum is the teaching of clinical competencies that would traditionally require students to undergo in-person simulations and patient encounters. We implemented a novel informed consent activity module, with standardized patients, to improve self-efficacy in communication within our core surgery clerkship. STUDY DESIGN: All medical students who participated in the virtual surgery clerkship were recruited to participate in a retrospective survey study regarding the novel informed consent module. These questions evaluated their perceived competence in 4 domains relating to informed consent: identifying the key elements, describing common challenges, applying the New Mexico Clinical Communication Scale (NMCCS), and documenting. RESULTS: Thirty-four of 90 students participated in the study (38% of the cohort). Respondents to the survey reported that their self-efficacy in communication skills related to informed consent improved as a result of their participation in the activity in each of the 4 domains surveyed (p < 0.01), with the majority of students identifying as satisfactory or above in each domain post-module. Students generally viewed the virtual informed consent activity positively, but noted that it was not the same as an in-person clinical experience. CONCLUSIONS: A virtual module of communication skills training, using standardized patients and faculty, improved students' belief in their self-efficacy in obtaining informed consent. This communication module can be useful in a virtual or mixed curricular structure for both current and future medical students.


Assuntos
Estágio Clínico , Educação de Graduação em Medicina/métodos , Ética Médica/educação , Cirurgia Geral/educação , Consentimento Livre e Esclarecido/ética , Relações Médico-Paciente , COVID-19/epidemiologia , Competência Clínica , Instrução por Computador , Currículo , Feminino , Humanos , Masculino , Pandemias , SARS-CoV-2 , Estados Unidos , Adulto Jovem
20.
Health Res Policy Syst ; 19(1): 47, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789671

RESUMO

BACKGROUND: At the height of the COVID-19 pandemic, Thailand had almost depleted its critical care resources, particularly intensive care unit (ICU) beds and ventilators. This prompted the necessity to develop a national guideline for resource allocation. This paper describes the development process of a national guideline for critical resource allocation in Thailand during the COVID-19 pandemic. METHODS: The guideline development process consisted of three steps: (1) rapid review of existing rationing guidelines and literature; (2) interviews of Thai clinicians experienced in caring for COVID-19 cases; and (3) multi-stakeholder consultations. At steps 1 and 2, data was synthesized and categorized using a thematic and content analysis approach, and this guided the formulation of the draft guideline. Within step 3, the draft Thai critical care allocation guideline was debated and finalized before entering the policy-decision stage. RESULTS: Three-order prioritization criteria consisting of (1) clinical prognosis using four tools (Charlson Comorbidity Index, Sequential Organ Failure Assessment, frailty assessment and cognitive impairment assessment), (2) number of life-years saved and (3) social usefulness were proposed by the research team based on literature reviews and interviews. At consultations, stakeholders rejected using life-years as a criterion due to potential age and gender discrimination, as well as social utility due to a concern it would foster public distrust, as this judgement can be arbitrary. It was agreed that the attending physician is required to be the decision-maker in the Thai medico-legal context, while a patient review committee would play an advisory role. Allocation decisions are to be documented for transparency, and no appealing mechanism is to be applied. This guideline will be triggered only when demand exceeds supply after the utmost efforts to mobilize surge capacity. Once implemented, it is applicable to all patients, COVID-19 and non-COVID-19, requiring critical care resources prior to ICU admission and during ICU stay. CONCLUSIONS: The guideline development process for the allocation of critical care resources in the context of the COVID-19 outbreak in Thailand was informed by scientific evidence, medico-legal context, existing norms and societal values to reduce risk of public distrust given the sensitive nature of the issue and ethical dilemmas of the guiding principle, though it was conducted at record speed. Our lessons can provide an insight for the development of similar prioritization guidelines, especially in other low- and middle-income countries.


Assuntos
COVID-19 , Cuidados Críticos , Estado Terminal , Alocação de Recursos para a Atenção à Saúde , Acesso aos Serviços de Saúde , Pandemias , Guias de Prática Clínica como Assunto , Tomada de Decisões , Revelação , Ética Médica , Recursos em Saúde , Hospitalização , Humanos , Unidades de Terapia Intensiva , Prognóstico , SARS-CoV-2 , Discriminação Social , Valores Sociais , Participação dos Interessados , Tailândia , Confiança
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