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3.
Cuad Bioet ; 31(102): 183-202, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32910671

RESUMO

The article deals with the analysis of the criteria for the allocation of scarce health resources during the pandemic produced by the COVID 19 virus in Spain. It critically analyses the absence of a legal-constitutional perspective in the elaboration of such criteria and suggests the incorporation of the criterion of equity as a guarantee of the effective exercise of the constitutional right to health protection by vulnerable persons.


Assuntos
Betacoronavirus , Recursos em Saúde/ética , Pandemias/ética , Alocação de Recursos/ética , Constituição e Estatutos , Infecções por Coronavirus/prevenção & controle , Teoria Ética , Órgãos Governamentais , Prioridades em Saúde , Recursos em Saúde/legislação & jurisprudência , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/legislação & jurisprudência , Direitos Humanos/legislação & jurisprudência , Humanos , Grupos Minoritários , Pandemias/legislação & jurisprudência , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Publicações , Alocação de Recursos/legislação & jurisprudência , Papel (figurativo) , Justiça Social , Sociedades Médicas , Espanha/epidemiologia , Triagem/ética , Populações Vulneráveis
10.
Pediatrics ; 146(Suppl 1): S25-S32, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737229

RESUMO

In this article, I examine the role of minors' competence for medical decision-making in modern American law. The doctrine of parental consent remains the default legal and bioethical framework for health care decisions on behalf of children, complemented by a complex array of exceptions. Some of those exceptions vest decisional authority in the minors themselves. Yet, in American law, judgments of minors' competence do not typically trigger shifts in decision-making authority from adults to minors. Rather, minors' decisional capacity becomes relevant only after legislatures or courts determine that the default of parental discretion does not achieve important policy goals or protect implicated constitutional rights in a particular health care context and that those goals can best be achieved or rights best protected by authorizing capable minors to choose for themselves. It is at that point that psychological and neuroscientific evidence plays an important role in informing the legal inquiry as to whether minors whose health is at issue are legally competent to decide.


Assuntos
Tomada de Decisão Clínica , Competência Mental/legislação & jurisprudência , Menores de Idade/legislação & jurisprudência , Consentimento dos Pais/legislação & jurisprudência , Adolescente , Desenvolvimento do Adolescente , Criança , Desenvolvimento Infantil , Serviços de Saúde da Criança/legislação & jurisprudência , Educação Infantil , Bem-Estar da Criança/legislação & jurisprudência , Direitos Civis , Tomada de Decisão Clínica/ética , Família , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Consentimento Informado por Menores/ética , Consentimento Informado por Menores/legislação & jurisprudência , Competência Mental/normas , Menores de Idade/psicologia , Relações Pais-Filho , Consentimento dos Pais/ética , Patient Self-Determination Act , Autonomia Pessoal , Procurador/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Estados Unidos
11.
PLoS One ; 15(8): e0237776, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822404

RESUMO

While medical advocacy is mandated as a core professional commitment in a growing number of ethical codes and medical training programs, medical advocacy and social justice engagement are regularly subordinated to traditional clinical responsibilities. This study aims to provide insight into factors that motivate clinician engagement and perseverance with medical advocacy, so as to inform attempts by policymakers, leaders and educators to promote advocacy practices in medicine. Furthermore, this study aims to provide an analysis of the role of medical advocates in systems where patients' rights are perceived to be infringed and consider how we might best support and protect these medical advocates as a profession, by exploring the experiences and perspectives of Australian clinicians defending the health of detained asylum seekers. In this qualitative study thirty-two medical and health professionals advocating on asylum seeker health in immigration detention were interviewed. Transcripts were coded both inductively and deductively from interview question domains and thematically analysed. Findings suggested that respondents' motivations for advocacy stemmed from deeply intertwined professional and personal ethics. Overall, advocacy responses originated from the union of three integral stimuli: personal ethics, proximity and readiness. We conclude that each of these three integral factors must be addressed in any attempt to foster advocacy within the medical profession. In light of current global trends of increasingly protectionist immigration practices, promoting effective physician advocacy may become essential in ensuring patients' universal right to health.


Assuntos
Acesso aos Serviços de Saúde , Defesa do Paciente , Refugiados , Austrália , Feminino , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Masculino , Defesa do Paciente/ética , Defesa do Paciente/legislação & jurisprudência , Assistência Centrada no Paciente/ética , Assistência Centrada no Paciente/legislação & jurisprudência , Refugiados/legislação & jurisprudência
15.
Tex Med ; 116(5): 43-45, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32649772

RESUMO

The Child Psychiatric Access Network (CPAN) plans to start operations in May, giving pediatricians and family physicians across Texas free telemedicine-based consultation and training on community psychiatry. CPAN is a key part of a much larger mental health initiative created by the 2019 Texas Legislature called the Texas Child Mental Health Care Consortium. Aside from CPAN, the consortium also will help public schools respond to mental health needs among students; expand the psychiatric workforce by paying for psychiatric positions and fellowships; and provide money for research on mental health in Texas.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde Mental , Saúde Mental/estatística & dados numéricos , Criança , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Colaboração Intersetorial , Pediatria , Atenção Primária à Saúde , Encaminhamento e Consulta , Texas
16.
BMJ Glob Health ; 5(6)2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-601766

RESUMO

The COVID-19 pandemic is a reminder that insufficient income security in periods of ill health leads to economic hardship for individuals and hampers disease control efforts as people struggle to stay home when sick or advised to observe quarantine. Evidence on income security during periods of ill health is growing but has not previously been reviewed as a full body of work concerning low-income and middle-income countries (LMICs). We performed a scoping review to map the range, features, coverage, protective effects and equity of policies that aim to provide income security for adults whose ill health prevents them from participating in gainful work. A total of 134 studies were included, providing data from 95% of LMICs. However, data across the majority of these countries were severely limited. Collectively the included studies demonstrate that coverage of contributory income-security schemes is low, especially for informal and low-income workers. Meanwhile, non-contributory schemes targeting low-income groups are often not explicitly designed to provide income support in periods of ill health, they can be difficult to access and rarely provide sufficient income support to cover the needs of eligible recipients. While identifying an urgent need for more research on illness-related income security in LMICs, this review concludes that scaling up and diversifying the range of income security interventions is crucial for improving coverage and equity. To achieve these outcomes, illness-related income protection must receive greater recognition in health policy and health financing circles, expanding our understanding of financial hardship beyond direct medical costs.


Assuntos
Acesso aos Serviços de Saúde , Renda , Pobreza , Previdência Social , Adulto , Betacoronavirus , Infecções por Coronavirus , Países em Desenvolvimento , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Pandemias , Pneumonia Viral , Licença Médica , Previdência Social/economia , Previdência Social/legislação & jurisprudência
17.
Psychiatr Serv ; 71(10): 1078-1081, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487009

RESUMO

People with serious mental illness are at disproportionate risk of COVID-19 morbidity and mortality because of high rates of risk factors that directly parallel those related to poor coronavirus outcomes, including smoking, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes, along with housing instability, homelessness, food insecurity, and poverty. Community-based behavioral health organizations are also at risk of adverse outcomes because of dramatic declines in revenues and a diminished workforce. The State of Massachusetts has responded to this crisis by rapidly implementing a variety of policy, regulatory, and payment reforms. This column describes some of these reforms, which are designed to enhance remote telehealth delivery of care, ensure access to needed medications and residential care staff, and support the financial livelihood of community-based behavioral health services.


Assuntos
Betacoronavirus , Serviços de Saúde Comunitária/legislação & jurisprudência , Serviços de Saúde Comunitária/métodos , Infecções por Coronavirus/terapia , Política de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Transtornos Mentais/terapia , Pneumonia Viral/terapia , Infecções por Coronavirus/complicações , Humanos , Massachusetts , Transtornos Mentais/complicações , Pandemias , Pneumonia Viral/complicações
18.
Medicine (Baltimore) ; 99(22): e20033, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481373

RESUMO

Though overall death from opioid overdose are increasing in the United States, the death rate in some states and population groups is stabilizing or even decreasing. Several states have enacted a Naloxone Accessibility Laws to increase naloxone availability as an opioid antidote. The extent to which these laws permit layperson distribution and possession varies. The aim of this study is to investigate differences in provisions of Naloxone Accessibility Laws by states mainly in the Northeast and West regions, and the impact of naloxone availability on the rates of drug overdose deaths.This cross-sectional study was based on the National Vital Statistics System multiple cause-of-death mortality files. The average changes in drug overdose death rates between 2013 and 2017 in relevant states of the Northeast and West regions were compared according to availability of naloxone to laypersons.Seven states in the Northeast region and 10 states in the Western region allowed layperson distribution of naloxone. Layperson possession of naloxone was allowed in 3 states each in the Northeast and the Western regions. The average drug overdose death rates increased in many states in the both regions regardless of legalization of layperson naloxone distribution. The average death rates of 3 states that legalized layperson possession in the West region decreased (-0.33 per 100,000 person); however, in states in the West region that did not allow layperson possession and states in the Northeast region regardless of layperson possession increased between 2013 and 2017.The provision to legalize layperson possession of naloxone was associated with decreased average opioid overdose death rates in 3 states of the West region.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/mortalidade , Acesso aos Serviços de Saúde/legislação & jurisprudência , Naloxona/provisão & distribução , Antagonistas de Entorpecentes/provisão & distribução , Estudos Transversais , Overdose de Drogas/tratamento farmacológico , Acesso aos Serviços de Saúde/tendências , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Estudos Retrospectivos , Governo Estadual , Estados Unidos
19.
BMJ Glob Health ; 5(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32540963

RESUMO

The COVID-19 pandemic is a reminder that insufficient income security in periods of ill health leads to economic hardship for individuals and hampers disease control efforts as people struggle to stay home when sick or advised to observe quarantine. Evidence on income security during periods of ill health is growing but has not previously been reviewed as a full body of work concerning low-income and middle-income countries (LMICs). We performed a scoping review to map the range, features, coverage, protective effects and equity of policies that aim to provide income security for adults whose ill health prevents them from participating in gainful work. A total of 134 studies were included, providing data from 95% of LMICs. However, data across the majority of these countries were severely limited. Collectively the included studies demonstrate that coverage of contributory income-security schemes is low, especially for informal and low-income workers. Meanwhile, non-contributory schemes targeting low-income groups are often not explicitly designed to provide income support in periods of ill health, they can be difficult to access and rarely provide sufficient income support to cover the needs of eligible recipients. While identifying an urgent need for more research on illness-related income security in LMICs, this review concludes that scaling up and diversifying the range of income security interventions is crucial for improving coverage and equity. To achieve these outcomes, illness-related income protection must receive greater recognition in health policy and health financing circles, expanding our understanding of financial hardship beyond direct medical costs.


Assuntos
Acesso aos Serviços de Saúde , Renda , Pobreza , Previdência Social , Adulto , Betacoronavirus , Infecções por Coronavirus , Países em Desenvolvimento , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Pandemias , Pneumonia Viral , Licença Médica , Previdência Social/economia , Previdência Social/legislação & jurisprudência
20.
J Pain Symptom Manage ; 60(2): e48-e51, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32387575

RESUMO

Section 2 of the 2019 World Health Organization Model List of Essential Medicines includes opioid analgesics formulations commonly used for the control of pain and respiratory distress, as well as sedative and anxiolytic substances such as midazolam and diazepam. These medicines, essential to palliative care, are regulated under the international drug control conventions overseen by United Nations specialized agencies and treaty bodies and under national drug control laws. Those national laws and regulations directly affect bedside availability of Internationally Controlled Essential Medicines (ICEMs). The complex interaction between national regulatory systems and global supply chains (now impacted by COVID-19 pandemic) directly affects bedside availability of ICEMs and patient care. Despite decades of global civil society advocacy in the United Nations system, ICEMs have remained chronically unavailable, inaccessible, and unaffordable in low- and-middle-income countries, and there are recent reports of shortages in high-income countries as well. The most prevalent symptoms in COVID-19 are breathlessness, cough, drowsiness, anxiety, agitation, and delirium. Frequently used medicines include opioids such as morphine or fentanyl and midazolam, all of them listed as ICEMs. This paper describes the issues related to the lack of availability and limited access to ICEMs during the COVID-19 pandemic in both intensive and palliative care patients in countries of all income levels and makes recommendations for improving access.


Assuntos
Infecções por Coronavirus , Acesso aos Serviços de Saúde , Pandemias , Pneumonia Viral , Analgésicos/uso terapêutico , Infecções por Coronavirus/terapia , Cuidados Críticos/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Internacionalidade , Legislação de Medicamentos , Cuidados Paliativos/legislação & jurisprudência , Pneumonia Viral/terapia , Nações Unidas
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