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1.
Emerg Med Clin North Am ; 39(1): 217-225, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218659

RESUMO

The emergency department is where the patient and potential ethical challenges are first encountered. Patients with acute neurologic illness introduce a unique set of dilemmas related to the pressure for ultra-early prognosis in the wake of rapidly advancing treatments. Many with neurologic injury are unable to provide autonomous consent, further complicating the picture, potentially asking uncertain surrogates to make quick decisions that may result in significant disability. The emergency department physician must take these ethical quandaries into account to provide standard of care treatment.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Assistência Terminal/ética , Manuseio das Vias Aéreas/ética , Manuseio das Vias Aéreas/métodos , Beneficência , Morte Encefálica/diagnóstico , Lesões Encefálicas Traumáticas/diagnóstico , Serviço Hospitalar de Emergência/ética , Procedimentos Endovasculares/ética , Ética Médica , Humanos , Consentimento Livre e Esclarecido/ética , Prognóstico , Acidente Vascular Cerebral/terapia , Obtenção de Tecidos e Órgãos/ética
5.
Cuad Bioet ; 31(102): 203-222, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32910672

RESUMO

The crisis in the health system caused by COVID-19 has left some important humanitarian deficits on how to care for the sick in their last days of life. The humanization of the dying process has been affected in three fundamental aspects, each of which constitutes a medical and ethical duty necessary. In this study, I analyze why dying accompanied, with the possibility of saying goodbye and receiving spiritual assistance, constitutes a specific triad of care and natural obligations that should not be overlooked - even in times of health crisis - if we do not want to see human dignity violated and violated some fundamental rights derived from it.


Assuntos
Atitude Frente a Morte , Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Espiritualidade , Assistência Terminal/ética , Desumanização , Emoções , Humanos , Relações Interpessoais , Obrigações Morais , Cuidados Paliativos , Conforto do Paciente , Isolamento de Pacientes/ética , Direitos do Paciente , Pessoalidade , Papel do Médico , Religião , Assistência Terminal/métodos , Assistência Terminal/psicologia , Visitas a Pacientes
6.
Pediatrics ; 146(Suppl 1): S3-S8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737225

RESUMO

One of the earliest controversies in the modern history of bioethics was known at the time as "the Hopkins Mongol case," involving an infant with Trisomy 21 and duodenal atresia whose parents declined to consent to surgery. Fluids and feeding were withheld, and the infant died of dehydration after 15 days. The child's short life had a profound impact on the author's career and that of several others and ultimately led to changes in the care of children and adults with disabilities and the way difficult end-of-life decisions are made in US hospitals today. It also contributed to the growth of the modern bioethics movement and scholarship focused on pediatric bioethics issues.


Assuntos
Temas Bioéticos , Tomada de Decisão Clínica/ética , Síndrome de Down/terapia , Pediatria/ética , Suspensão de Tratamento/ética , Comitês Consultivos/ética , Temas Bioéticos/história , Temas Bioéticos/legislação & jurisprudência , Crianças com Deficiência/legislação & jurisprudência , Síndrome de Down/história , Atresia Esofágica/história , Atresia Esofágica/terapia , Fundações , História do Século XX , Humanos , Recém-Nascido , Consentimento dos Pais/ética , Consentimento dos Pais/legislação & jurisprudência , Pais , Pediatria/legislação & jurisprudência , Assistência Terminal/ética , Suspensão de Tratamento/legislação & jurisprudência
8.
Hastings Cent Rep ; 50(3): 58-60, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596896

RESUMO

In recent months, Covid-19 has devastated African American communities across the nation, and a Minneapolis police officer murdered George Floyd. The agents of death may be novel, but the phenomena of long-standing epidemics of premature black death and of police violence are not. This essay argues that racial health and health care disparities, rooted as they are in systemic injustice, ought to carry far more weight in clinical ethics than they generally do. In particular, this essay examines palliative and end-of-life care for African Americans, highlighting the ways in which American medicine, like American society, has breached trust. In the experience of many African American patients struggling against terminal illness, health care providers have denied them a say in their own medical decision-making. In the midst of the Covid-19 pandemic, African Americans have once again been denied a say with regard to the rationing of scarce medical resources such as ventilators, in that dominant and ostensibly race-neutral algorithms sacrifice black lives. Is there such thing as a "good" or "dignified" death when African Americans are dying not merely of Covid-19 but of structural racism?


Assuntos
Afro-Americanos , Infecções por Coronavirus/epidemiologia , Disparidades em Assistência à Saúde/etnologia , Cuidados Paliativos/organização & administração , Pneumonia Viral/epidemiologia , Assistência Terminal/organização & administração , Betacoronavirus , Alocação de Recursos para a Atenção à Saúde/ética , Disparidades em Assistência à Saúde/ética , Humanos , Cuidados Paliativos/ética , Pandemias , Racismo , Determinantes Sociais da Saúde/ética , Determinantes Sociais da Saúde/etnologia , Justiça Social , Assistência Terminal/ética , Confiança , Estados Unidos/epidemiologia
9.
Hastings Cent Rep ; 50(3): 71-72, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596902

RESUMO

Ethicists and physicians all over the world have been working on triage protocols to plan for the possibility that the Covid-19 pandemic will result in shortages of intensive care unit beds, ventilators, blood products, or medications. In reflecting on those protocols, many health care workers have noticed that, outside the pandemic shortage situation, we routinely supply patients in the ICU with invasive and painful care that will not help the patients survive even their hospitalization. This is the kind of pointless care that even the most basic protocol would triage against. Perhaps this widespread reflection on triage standards will draw our attention to our ongoing custom of supplying burdensome and inefficacious care to those near the end of life-care that most health care providers would not want for themselves. This essay argues that reflecting on triage could help us improve end-of-life care.


Assuntos
Infecções por Coronavirus/epidemiologia , Alocação de Recursos para a Atenção à Saúde/ética , Unidades de Terapia Intensiva/ética , Pneumonia Viral/epidemiologia , Assistência Terminal/ética , Triagem/ética , Betacoronavirus , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva/organização & administração , Pandemias , Assistência Terminal/organização & administração , Triagem/organização & administração
11.
Psychol Trauma ; 12(S1): S146-S147, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32538660

RESUMO

The COVID-19 pandemic has changed the way doctors approach palliative and end-of-life care, which has undoubtedly affected the mental health of patients, families, and health care professionals. Given these circumstances, doctors working on the front line are vulnerable to moral injury and compassion fatigue. This is a reflection of 2 junior doctors experiencing firsthand demands of caring for patients during the outbreak. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Fadiga por Compaixão , Infecções por Coronavirus/terapia , Corpo Clínico Hospitalar , Cuidados Paliativos , Pandemias , Pneumonia Viral/terapia , Relações Profissional-Família , Trauma Psicológico , Assistência Terminal , Adulto , Fadiga por Compaixão/etiologia , Fadiga por Compaixão/psicologia , Inglaterra , Humanos , Corpo Clínico Hospitalar/ética , Corpo Clínico Hospitalar/psicologia , Princípios Morais , Cuidados Paliativos/ética , Cuidados Paliativos/psicologia , Relações Profissional-Família/ética , Trauma Psicológico/etiologia , Trauma Psicológico/psicologia , Assistência Terminal/ética , Assistência Terminal/psicologia
12.
J Clin Ethics ; 31(2): 191-193, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32585665

RESUMO

Public health strategies recommend isolating patients with SARS-CoV-2 infection. But compassionate care in the intensive care unit (ICU) is an ethical obligation of modern medicine that cannot be justified by the risk of infection or the lack of personal protective equipment. This article describes the experiences of clinicians in ICUs in the south of Spain promoted by the Andalusian Society of Intensive Care SAMIUC, in the hope it will serve to improve the conditions in which these patients die, and to help their families who suffer when they cannot say good-bye to their loved ones. In the south of Spain, healthcare professionals use daily videoconferencing to improve communication between clinicians, patients, and their relatives who cannot visit them in the ICU. This close communication allows families to see their loved ones and extends communication between healthcare professionals, patients, and their relatives. To allow family members to accompany patients at the end of life, it is possible to adapt public health rules to the epidemic situation.


Assuntos
Infecções por Coronavirus/terapia , Estado Terminal , Pneumonia Viral/terapia , Assistência Terminal/ética , Betacoronavirus , Comunicação , Empatia , Família , Humanos , Unidades de Terapia Intensiva/organização & administração , Pandemias/ética , Espanha
13.
J Med Ethics ; 46(8): 514-525, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32561660

RESUMO

BACKGROUND: Humanitarian crises and emergencies, events often marked by high mortality, have until recently excluded palliative care-a specialty focusing on supporting people with serious or terminal illness or those nearing death. In the COVID-19 pandemic, palliative care has received unprecedented levels of societal attention. Unfortunately, this has not been enough to prevent patients dying alone, relatives not being able to say goodbye and palliative care being used instead of intensive care due to resource limitations. Yet global guidance was available. In 2018, the WHO released a guide on 'Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises'-the first guidance on the topic by an international body. AIMS: This paper argues that while a landmark document, the WHO guide took a narrowly clinical bioethics perspective and missed crucial moral dilemmas. We argue for adding a population-level bioethics lens, which draws forth complex moral dilemmas arising from the fact that groups having differential innate and acquired resources in the context of social and historical determinants of health. We discuss dilemmas concerning: limitations of material and human resources; patient prioritisation; euthanasia; and legacy inequalities, discrimination and power imbalances. IMPLICATIONS: In parts of the world where opportunity for preparation still exists, and as countries emerge from COVID-19, planners must consider care for the dying. Immediate steps to support better resolutions to ethical dilemmas of the provision of palliative care in humanitarian and emergency contexts will require honest debate; concerted research effort; and international, national and local ethical guidance.


Assuntos
Temas Bioéticos , Assistência à Saúde/ética , Planejamento em Desastres , Cuidados Paliativos/ética , Pandemias/ética , Assistência Terminal/ética , Altruísmo , Betacoronavirus , Bioética , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Cuidados Críticos , Tomada de Decisões/ética , Emergências , Ética Clínica , Saúde Global , Alocação de Recursos para a Atenção à Saúde , Equidade em Saúde , Recursos em Saúde , Humanos , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Fatores Socioeconômicos , Estresse Psicológico
15.
Prof Case Manag ; 25(5): 267-284, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32452940

RESUMO

OBJECTIVES: This is the second of a 2-part article that discusses essential case management practices and strategies amidst the novel coronavirus disease 2019 (COVID-19). The series showcases the potential professional case managers have in support of managing during a crisis such as a global pandemic. Part II continues to describe reenvisioned roles and responsibilities of case managers and their leaders to meet the needs of patients/support systems during the crisis. It focuses on the increased need for end-of-life care, impact on workers' compensation case management practice, and the self-care needs of the professional case manager. PRIMARY PRACTICE SETTINGS: Applicable to the various case management practice settings across the continuum of health and human services, with special focus on acute care. FINDINGS/CONCLUSIONS: The COVID-19 global pandemic has resulted in a crisis case managers and other health care professionals never faced something like it before. At the same time, it has provided opportunities for innovation and creativity including use of digital and telecommunication technology in new ways to ensure the continued delivery of health and human services to those who need them regardless of location. It has also resulted in the development of necessary and impactful partnerships within and across different health care organizations and diverse professional disciplines. Most importantly, this pandemic has required special attention to the increased need of patients for timely palliative and end-of-life care. In addition, it has prompted a focus on the safety, health, and well-being of case managers and other health care professionals, resulting in expanded workers' compensation case management practice coupled with the need for self-care and resilience. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Professional case managers are integral members of interprofessional health care teams. Their roles and responsibilities are even more necessary during the uncertainty of a global pandemic such as COVID-19. So far, the experience of this crisis has resulted in a deliberate need to ensure the safety of both, those who are the recipients of health care services and those who are responsible for the provision of care. Self-care and resilience of health care professionals and case managers, especially due to the complex dynamics of the COVID-19 pandemic, have advanced a desirable and necessary view of remote/virtual practice and as a strategy for enhancing the person's health and well-being. This pandemic has forced the development of impactful partnerships and collaborations among the diverse contexts of health care organizations and support service providers. These contexts of care delivery have also emphasized the necessary legal and ethical practice of case managers and the other involved parties. Experts agree that the innovative care delivery methods practiced during the pandemic will undoubtedly remain as desirable beyond the current crisis period.


Assuntos
Betacoronavirus/isolamento & purificação , Administração de Caso , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Resiliência Psicológica , Assistência Terminal , Indenização aos Trabalhadores , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Incidência , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Assistência Terminal/ética , Estados Unidos/epidemiologia , Indenização aos Trabalhadores/ética
16.
Am J Bioeth ; 20(6): 52-64, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32441594

RESUMO

Ethically challenging situations routinely arise in the course of illness and healthcare. However, very few studies have surveyed patients and family members about their experiences with ethically challenging situations. To address this gap in the literature, we surveyed patients and family members at three hospitals. We conducted a content analysis of their responses to open-ended questions about their most memorable experience with an ethical concern for them or their family member. Participants (N = 196) described 219 unique ethical experiences that spanned many of the prevailing themes of bioethics, including the patient-physician relationship, end-of-life care, decision-making capacity, healthcare costs, and genetic testing. Participants focused on relational issues in the course of experiencing illness and receiving medical care and concerns regarding the patient-physician encounters. Many concerns arose outside of a healthcare setting. These data indicate areas for improvement for healthcare providers but some concerns may be better addressed outside of the traditional healthcare setting.


Assuntos
Temas Bioéticos , Família/psicologia , Pacientes Internados/psicologia , Qualidade da Assistência à Saúde/ética , Adulto , Idoso , Tomada de Decisões/ética , Dissidências e Disputas , Conflito Familiar/ética , Feminino , Acesso aos Serviços de Saúde/ética , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Relações Profissional-Paciente/ética , Pesquisa Qualitativa , Inquéritos e Questionários , Assistência Terminal/ética , Estados Unidos
18.
Rev Esp Salud Publica ; 942020 May 05.
Artigo em Espanhol | MEDLINE | ID: mdl-32382000

RESUMO

OBJECTIVE: Terminal patients and their relatives must know their real situation, and be treated according to the principle of autonomy, to establish therapeutic objectives adapted each one, according to their needs and decisions. The objective of this study is to identify the sufficient existence of records in the Medical Histories of terminal patients, which indicate their situation, such as the information given to the patients, or the LET, No-RCP or Z.51.5 codes, and the statistical relation they have with the sociodemographic and clinical variables. METHODS: Cross-sectional study in a third-level hospital, with patients admitted between January and December 2017, who died with terminal illness criteria. Data were collected from the medical records, and, fundamentally, from the nursing clinical notes. The statistical analysis was performed with the SPSS program, version 22. RESULTS: Participants were 140 people, 54.3% men, of 78.51 (SD=13.5) of middle age. People up to 70 years of age received less information (Odds ratio (OR): 0.077, 95% Confidence interval (CI): 0.015-0.390) and lower sedation (OR: 0.366, 95% CI: 0.149-0.899). Proceeding from city reduced the probability of receiving information (OR: 0.202; IC95%: 0.058-0.705). Presenting dyspnea reduced LTE (OR: 0.44, 95% CI: 0.20-093), No CPR (0.29, 95% CI: 0.12-0.68) and sedation (OR: 0.27; 95% CI: 0.12-060). Fatigue increased the probability of being Non-CPR (OR: 2.77, 95% CI: 1.166-6.627) and of receiving sedation (OR: 2.6, 95% CI: 1.065-6.331). CONCLUSIONS: Efforts to empower the patient in the decision of their process and the management of the information of their diagnosis and prognosis are still lacking. A greater and better clinical records facilitates knowing how actions are developed, allowing to identify and implement ethical and responsible interventions.


Assuntos
Diretivas Antecipadas/ética , Registros Médicos , Participação do Paciente , Autonomia Pessoal , Melhoria de Qualidade/ética , Assistência Terminal/ética , Centros de Atenção Terciária/ética , Adulto , Diretivas Antecipadas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Tomada de Decisões/ética , Feminino , Hospitalização , Humanos , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/normas , Consentimento Livre e Esclarecido/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/métodos , Participação do Paciente/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Estudos Retrospectivos , Espanha , Assistência Terminal/normas , Assistência Terminal/estatística & dados numéricos , Centros de Atenção Terciária/normas , Centros de Atenção Terciária/estatística & dados numéricos
19.
Monash Bioeth Rev ; 38(1): 49-67, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32335862

RESUMO

End-of-life decision-making in patients with dementia is a complex topic. Belgium and the Netherlands have been at the forefront of legislative advancement and progressive societal changes concerning the perspectives toward physician-assisted death (PAD). Careful consideration of clinical and social aspects is essential during the end-of-life decision-making process in patients with dementia. Geriatric assent provides the physician, the patient and his family the opportunity to end life with dignity. Unbearable suffering, decisional competence, and awareness of memory deficits are among the clinical considerations that physicians should incorporate during the end-of-life decision-making process. However, as other societies introduce legislature granting the right of PAD, new social determinants should be considered; Mexico City is an example. Current perspectives regarding advance euthanasia directives (AED) and PAD in patients with dementia are evolving. A new perspective that hinges on the role of the family and geriatric assent should help culturally heterogeneous societies in the transition of their public health care policies regarding end-of-life choices.


Assuntos
Diretivas Antecipadas/ética , Tomada de Decisões/ética , Demência , Ética Médica , Eutanásia/ética , Legislação Médica , Suicídio Assistido/ética , Diretivas Antecipadas/legislação & jurisprudência , Idoso , Bélgica , Bioética , Cultura , Eutanásia/legislação & jurisprudência , Família , Humanos , Consentimento Livre e Esclarecido , México , Países Baixos , Pessoalidade , Médicos , Políticas , Mudança Social , Fatores Sociológicos , Suicídio Assistido/legislação & jurisprudência , Assistência Terminal/ética , Assistência Terminal/legislação & jurisprudência
20.
J Pain Symptom Manage ; 60(2): e93-e97, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32333961

RESUMO

Family support is more, not less, important during crisis. However, during the COVID-19 pandemic, maintaining public safety necessitates restricting the physical presence of families for hospitalized patients. In response, health systems must rapidly adapt family-centric procedures and tools to circumvent restrictions on physical presence. Strategies for maintaining family integrity must acknowledge clinicians' limited time and attention to devote to learning new skills. Internet-based solutions can facilitate the routine, predictable, and structured communication, which is central to family-centered care. But the reliance on technology may compromise patient privacy and exacerbate racial, socioeconomic, and geographic disparities for populations that lack access to reliable internet access, devices, or technological literacy. We provide a toolbox of strategies for supporting family-centered inpatient care during physical distancing responsive to the current clinical climate. Innovations in the implementation of family involvement during hospitalizations may lead to long-term progress in the delivery of family-centered care.


Assuntos
Infecções por Coronavirus/terapia , Família , Pneumonia Viral/terapia , Comunicação , Infecções por Coronavirus/prevenção & controle , Hospitalização , Humanos , Pandemias/prevenção & controle , Assistência Centrada no Paciente/métodos , Pneumonia Viral/prevenção & controle , Assistência Terminal/ética , Assistência Terminal/métodos
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