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1.
Hist Philos Life Sci ; 43(1): 3, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33417016

RESUMO

Many governments have seen digital health technologies as promising tools to tackle the current COVID-19 pandemic. A much-talked example in this context involves the recent deluge of digital contact tracing apps (DCT) aimed at detecting Covid-19 exposure. In this short contribution we look at the bio-political justification of this phenomenon and reflect on whether DCT apps constitute, as it is often argued, a serious potential breach of our right to privacy. Despite praising efforts attempting to develop legal and ethical frameworks for DCT apps' usage; we argue that such endeavours are not sufficient to tackle the more fundamental problem of mass surveillance, which will remain largely unaddressed unless we deal with the biopolitical arguments presented and resort to a technical and structural defence.


Assuntos
/epidemiologia , Busca de Comunicante/ética , Liberdade , Pandemias/prevenção & controle , Filosofia , Privacidade , /prevenção & controle , Humanos
2.
PLoS One ; 15(12): e0242652, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33362218

RESUMO

OBJECTIVE: To study the U.S. public's attitudes toward surveillance measures aimed at curbing the spread of COVID-19, particularly smartphone applications (apps) that supplement traditional contact tracing. METHOD: We deployed a survey of approximately 2,000 American adults to measure support for nine COVID-19 surveillance measures. We assessed attitudes toward contact tracing apps by manipulating six different attributes of a hypothetical app through a conjoint analysis experiment. RESULTS: A smaller percentage of respondents support the government encouraging everyone to download and use contact tracing apps (42%) compared with other surveillance measures such as enforcing temperature checks (62%), expanding traditional contact tracing (57%), carrying out centralized quarantine (49%), deploying electronic device monitoring (44%), or implementing immunity passes (44%). Despite partisan differences on a range of surveillance measures, support for the government encouraging digital contact tracing is indistinguishable between Democrats (47%) and Republicans (46%), although more Republicans oppose the policy (39%) compared to Democrats (27%). Of the app features we tested in our conjoint analysis experiment, only one had statistically significant effects on the self-reported likelihood of downloading the app: decentralized data architecture increased the likelihood by 5.4 percentage points. CONCLUSION: Support for public health surveillance policies to curb the spread of COVID-19 is relatively low in the U.S. Contact tracing apps that use decentralized data storage, compared with those that use centralized data storage, are more accepted by the public. While respondents' support for expanding traditional contact tracing is greater than their support for the government encouraging the public to download and use contact tracing apps, there are smaller partisan differences in support for the latter policy.


Assuntos
/epidemiologia , Busca de Comunicante/ética , Pandemias , Quarentena/psicologia , Adulto , /virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Percepção , Privacidade , Vigilância em Saúde Pública , Smartphone , Inquéritos e Questionários , Estados Unidos
4.
J Glob Health ; 10(2): 020103, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33110502

RESUMO

The COVID-19 pandemic has put health systems, economies and societies under unprecedented strain, calling for innovative approaches. Scotland's government, like those elsewhere, is facing difficult decisions about how to deploy digital technologies and data to help contain, control and manage the disease, while also respecting citizens' rights. This paper explores the ethical challenges presented by these methods, with particular emphasis on mobile apps associated with contact tracing. Drawing on UK and international experiences, it examines issues such as public trust, data privacy and technology design; how changing disease threats and contextual factors can affect the balance between public benefits and risks; and the importance of transparency, accountability and stakeholder participation for the trustworthiness and good-governance of digital systems and strategies. Analysis of recent technology debates, controversial programmes and emerging outcomes in comparable countries implementing contact tracing apps, reveals sociotechnical complexities and unexpected paradoxes that warrant further study and underlines the need for holistic, inclusive and adaptive strategies. The paper also considers the potential role of these apps as Scotland transitions to the 'new normal', outlines challenges and opportunities for public engagement, and poses a set of ethical questions to inform decision-making at multiple levels, from software design to institutional governance.


Assuntos
Busca de Comunicante/ética , Transmissão de Doença Infecciosa/ética , Direitos Humanos/ética , Aplicativos Móveis/ética , Pandemias/ética , Betacoronavirus , Busca de Comunicante/métodos , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Governo , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Escócia/epidemiologia , Participação dos Interessados , Tecnologia/ética
5.
S Afr Med J ; 110(7): 617-620, 2020 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-32880334

RESUMO

In response to the COVID-19 pandemic, South Africa (SA) has established a Tracing Database, collecting both aggregated and individualised mobility and locational data on COVID-19 cases and their contacts. There are compelling public health reasons for this development, since the database has the potential to assist with policy formulation and with contact tracing. While potentially demonstrating the rapid facilitation through technology of an important public service, the Tracing Database does, however, infringe immediately upon constitutional rights to privacy and heightens the implications of ethical choices facing medical professionals. The medical community should be aware of this surveillance innovation and the risks and rewards it raises. To deal with some of these risks, including the potential for temporary rights- infringing measures to become permanent, there are significant safeguards designed into the Tracing Database, including a strict duration requirement and reporting to a designated judge. African states including SA should monitor this form of contact tracing closely, and also encourage knowledge-sharing among cross-sectoral interventions such as the Tracing Database in responding to the COVID-19 pandemic.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Confidencialidade/ética , Busca de Comunicante/ética , Infecções por Coronavirus/prevenção & controle , Bases de Dados Factuais/ética , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Busca de Comunicante/métodos , Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento , Feminino , Humanos , Masculino , Pandemias/estatística & dados numéricos , Papel do Médico , Pneumonia Viral/epidemiologia , Saúde Pública , Medição de Risco , África do Sul
6.
Hastings Cent Rep ; 50(3): 43-46, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596893

RESUMO

Digital contact tracing, in combination with widespread testing, has been a focal point for many plans to "reopen" economies while containing the spread of Covid-19. Most digital contact tracing projects in the United States and Europe have prioritized privacy protections in the form of local storage of data on smartphones and the deidentification of information. However, in the prioritization of privacy in this narrow form, there is not sufficient attention given to weighing ethical trade-offs within the context of a public health pandemic or to the need to evaluate safety and effectiveness of software-based technology applied to public health.


Assuntos
Busca de Comunicante/ética , Busca de Comunicante/métodos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Privacidade , Smartphone/ética , Betacoronavirus , Humanos , Aplicativos Móveis , Pandemias , Saúde Pública , Medição de Risco
8.
J Med Ethics ; 46(7): 427-431, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32366705

RESUMO

In this paper we discuss ethical implications of the use of mobile phone apps in the control of the COVID-19 pandemic. Contact tracing is a well-established feature of public health practice during infectious disease outbreaks and epidemics. However, the high proportion of pre-symptomatic transmission in COVID-19 means that standard contact tracing methods are too slow to stop the progression of infection through the population. To address this problem, many countries around the world have deployed or are developing mobile phone apps capable of supporting instantaneous contact tracing. Informed by the on-going mapping of 'proximity events' these apps are intended both to inform public health policy and to provide alerts to individuals who have been in contact with a person with the infection. The proposed use of mobile phone data for 'intelligent physical distancing' in such contexts raises a number of important ethical questions. In our paper, we outline some ethical considerations that need to be addressed in any deployment of this kind of approach as part of a multidimensional public health response. We also, briefly, explore the implications for its use in future infectious disease outbreaks.


Assuntos
Telefone Celular , Busca de Comunicante/ética , Busca de Comunicante/métodos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Temas Bioéticos , Controle de Doenças Transmissíveis/métodos , Liberdade , Humanos , Aplicativos Móveis , Pandemias , Privacidade , Confiança
10.
Hastings Cent Rep ; 50(3): 46-49, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32468631

RESUMO

The Covid-19 pandemic needs to be considered from two perspectives simultaneously. First, there are questions about which policies are most effective and fair in the here and now, as the pandemic unfolds. These polices concern, for example, who should receive priority in being tested, how to implement contact tracing, or how to decide who should get ventilators or vaccines when not all can. Second, it is imperative to anticipate the medium- and longer-term consequences that these policies have. The case of vaccine rationing is particularly instructive. Ethical, epidemiological, and economic reasons demand that rationing approaches give priority to groups who have been structurally and historically disadvantaged, even if this means that overall life years gained may be lower.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Alocação de Recursos para a Atenção à Saúde/ética , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Vacinas/provisão & distribução , Fatores Etários , Betacoronavirus , Controle de Doenças Transmissíveis/organização & administração , Comorbidade , Busca de Comunicante/ética , Busca de Comunicante/métodos , Grupos de Populações Continentais , Infecções por Coronavirus/etnologia , Nível de Saúde , Disparidades nos Níveis de Saúde , Humanos , Pneumonia Viral/etnologia , Justiça Social , Fatores Socioeconômicos , Ventiladores Mecânicos/provisão & distribução
11.
Science ; 368(6491)2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32234805

RESUMO

The newly emergent human virus SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) is resulting in high fatality rates and incapacitated health systems. Preventing further transmission is a priority. We analyzed key parameters of epidemic spread to estimate the contribution of different transmission routes and determine requirements for case isolation and contact tracing needed to stop the epidemic. Although SARS-CoV-2 is spreading too fast to be contained by manual contact tracing, it could be controlled if this process were faster, more efficient, and happened at scale. A contact-tracing app that builds a memory of proximity contacts and immediately notifies contacts of positive cases can achieve epidemic control if used by enough people. By targeting recommendations to only those at risk, epidemics could be contained without resorting to mass quarantines ("lockdowns") that are harmful to society. We discuss the ethical requirements for an intervention of this kind.


Assuntos
Betacoronavirus , Telefone Celular , Busca de Comunicante/métodos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Aplicativos Móveis , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Algoritmos , Doenças Assintomáticas , Número Básico de Reprodução , China/epidemiologia , Busca de Comunicante/ética , Infecções por Coronavirus/epidemiologia , Epidemias/prevenção & controle , Humanos , Controle de Infecções , Aplicativos Móveis/ética , Modelos Teóricos , Pneumonia Viral/epidemiologia , Probabilidade , Quarentena , Fatores de Tempo
12.
Soc Sci Med ; 178: 38-45, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28192745

RESUMO

During the 2014-2016 West Africa Ebola epidemic, transmission chains were controlled through contact tracing, i.e., identification and follow-up of people exposed to Ebola cases. WHO recommendations for daily check-ups of physical symptoms with social distancing for 21 days were unevenly applied and sometimes interpreted as quarantine. Criticisms arose regarding the use of coercion and questioned contact tracing on ethical grounds. This article aims to analyze contact cases' perceptions and acceptance of contact monitoring at the field level. In Senegal, an imported case of Ebola virus disease in September 2014 resulted in placing 74 contact cases in home containment with daily visits by volunteers. An ethnographic study based on in-depth interviews with all stakeholders performed in September-October 2014 showed four main perceptions of monitoring: a biosecurity preventive measure, suspension of professional activity, stigma attached to Ebola, and a social obligation. Contacts demonstrated diverse attitudes. Initially, most contacts agreed to comply because they feared being infected. They adhered to the national Ebola response measures and appreciated the empathy shown by volunteers. Later, acceptance was improved by the provision of moral, economic, and social support, and by the final lack of any new contamination. But it was limited by the socio-economic impact on fulfilling basic needs, the fear of being infected, how contacts' family members interpreted monitoring, conflation of contacts as Ebola cases, and challenging the rationale for containment. Acceptance was also related to individual aspects, such as the professional status of women and health workers who had been exposed, and contextual aspects, such as the media's role in the social production of stigma. Ethnographic results show that, even when contacts adhere rather than comply to containment through coercion, contact monitoring raises several ethical issues. These insights should contribute to the ethics debate about individual rights versus crisis public health measures.


Assuntos
Coerção , Busca de Comunicante/ética , Doença pelo Vírus Ebola/psicologia , Percepção , Quarentena/psicologia , Adulto , Ansiedade/etiologia , Ansiedade/psicologia , Ebolavirus/patogenicidade , Humanos , Pessoa de Meia-Idade , Saúde Pública/métodos , Quarentena/normas , Senegal
13.
Bull Soc Pathol Exot ; 109(4): 296-302, 2016 Oct.
Artigo em Francês | MEDLINE | ID: mdl-26850106

RESUMO

Quarantine has been widely used during the Ebola outbreak in West Africa mainly to control transmission chains. This measure raises ethical issues that require documentation of the modalities of quarantine at the field level and its social effects for contact persons. In Senegal, 74 people were in contact with the Ebola case coming from Guinea in September 2014. Of these, 34 members of the case's household were contained together at home and monitored by officers. The remaining 40 health care workers from two facilities were dispersed in their family households and monitored by telephone or during doctors' visits. The study is based on in-depth interviews with 43 adult contacts about their experiences and perceptions, with additional observation for interpretation and contextualization.Containment at home was applied differently to contacts who lived with patient zero than to professional health care contacts. No coercion was used at first since all contacts adhered to surveillance, but some of them did not fully comply with movement restrictions. Contacts found biosafety precautions stigmatizing, especially during the first days when health workers and contacts were feeling an acute fear of contagion. The material support that was provided-food and money-was necessary since contacts could not work nor get resources, but it was too limited and delayed. The relational support they received was appreciated, as well as the protection from stigmatization by the police and follow-up workers. But the information delivered to contacts was insufficient, and some of them, including health workers, had little knowledge about EVD and Ebola transmission, which caused anxiety and emotional suffering. Some contacts experienced the loss of their jobs and loss of income; several could not easily or fully return to their previous living routines.Beyond its recommendations to enhance support measures, the study identifies the ethical stakes of quarantine in Senegal regarding informed consent and individual autonomy, non-maleficence and benevolence, and equity and adaptation to specific situations. Nevertheless, the balance between preventive benefits and individual inconveniences of quarantine should still be evaluated from a public health perspective.


Assuntos
Busca de Comunicante , Doença pelo Vírus Ebola/prevenção & controle , Vigilância da População/métodos , Saúde Pública , Adulto , África Ocidental/epidemiologia , Busca de Comunicante/ética , Busca de Comunicante/métodos , Surtos de Doenças/prevenção & controle , Feminino , Guiné/epidemiologia , Doença pelo Vírus Ebola/epidemiologia , Humanos , Masculino , Saúde Pública/ética , Saúde Pública/métodos , Senegal , Mudança Social , Isolamento Social , Estereotipagem
14.
Epidemiol Prev ; 39(4 Suppl 1): 21-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26499411

RESUMO

INTRODUCTION: Healthcare-Associated Infections (HAIs) are an important cause of morbidity and mortality worldwide and have a significant economic impact for health systems. Molecular epidemiology tools have a central role in HAI prevention programs. In order to give an overview of their specific advantages and disadvantages we reported current and new molecular typing methods for HAI outbreak detection and epidemiological surveillance. METHODS: The current review was drafted as a short version of a longer document written by the Public Health Genomics (GSP) working group, and the Italian Study Group of Hospital Hygiene (GISIO), entitled Molecular epidemiology of Healthcare Associated Infections: recommendations from the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI). This text considers various aspects related to HAIs: the role of genotyping and bioinformatics, the organizational levels of laboratories, as well as ethical and economic aspects. CONCLUSIONS: The use of molecular epidemiology represents a key tool in the management of HAIs, to be used as a complement to conventional control measures. The present contribution aims to increase knowledge on the proper use of such methods, given the major challenge HAI represents for National Health systems.


Assuntos
Infecções Bacterianas/epidemiologia , Técnicas de Tipagem Bacteriana/métodos , Infecção Hospitalar/epidemiologia , Controle de Infecções/métodos , Epidemiologia Molecular/métodos , Guias de Prática Clínica como Assunto , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Biologia Computacional , Busca de Comunicante/ética , Busca de Comunicante/métodos , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Resistência Microbiana a Medicamentos , Europa (Continente)/epidemiologia , Técnicas de Genotipagem , Humanos , Controle de Infecções/organização & administração , Segurança do Paciente , Vigilância da População , Prevalência
15.
Sex Transm Infect ; 89(4): 276-9, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23580609

RESUMO

In England, Wales and Scotland, those who unintentionally transmit HIV through sexual intercourse are at risk of criminal prosecution, and furthermore may be at risk of imprisonment under the Offences Against the Person Act 1861. These sentences have ranged between 1 and 10 years. There has been a long debate on whether this is an acceptable use of the law, and indeed whether those who transmit HIV in this manner should be subjected to legal proceedings. Previous debate has embraced the rhetoric of shared responsibility and public health. In this paper, we wished instead to apply traditional justifications for sentencing (including retribution, deterrence, rehabilitation, incapacitation and reparation) to imprisonment for non-intentional transmission of HIV through consensual sexual intercourse. We argue that when these principles are applied to imprisonment for this 'crime', we are unable to justify imprisonment sufficiently, and therefore, that imprisonment is a misguided response to HIV transmission.


Assuntos
Busca de Comunicante/legislação & jurisprudência , Direito Penal , Transmissão de Doença Infecciosa/legislação & jurisprudência , Infecções por HIV/transmissão , Responsabilidade Legal , Parceiros Sexuais , Sexo sem Proteção , Busca de Comunicante/ética , Inglaterra , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Aplicação da Lei , Masculino , Saúde Pública , Escócia , Autocuidado , Autorrevelação , País de Gales
16.
Euro Surveill ; 18(4): 20384, 2013 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-23369395

RESUMO

Current thinking on the development of molecular microbial characterisation techniques in public health focuses mainly on operational issues that need to be resolved before incorporation into daily practice can take place. Notwithstanding the importance of these operational challenges, it is also essential to formulate conditions under which such microbial characterisation methods can be used from an ethical perspective. The potential ability of molecular techniques to show relational patterns between individuals with more certainty brings a new sense of urgency to already difficult ethical issues associated with privacy, consent and a moral obligation to avoid spreading a disease. It is therefore important that professionals reflect on the ethical implications of using these techniques in outbreak management, in order to be able to formulate the conditions under which they may be applied in public health practice.


Assuntos
Busca de Comunicante/ética , Surtos de Doenças/ética , Tipagem Molecular , Obrigações Morais , Temas Bioéticos , Controle de Doenças Transmissíveis , Surtos de Doenças/prevenção & controle , Humanos , Saúde Pública/ética
17.
Med Law Rev ; 20(3): 399-422, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22752004

RESUMO

Research has shown that HIV-positive patients sometimes refuse to take precautionary measures against sexual transmission as well as to notify their sexual partner(s) of their status. Faced with such a situation, physicians find themselves in a dilemma as they are forced to choose between honouring their duty of professional confidentiality and protecting their patients' partner(s). Recent advice from the Belgian Medical Council (BMC) for the first time accepts that physicians can exceptionally, and under certain conditions, invoke necessity to breach confidentiality and inform usual and occasional sexual partners of HIV-infected patients who refuse to take precautions against transmission. This article sketches the ethical evolution of this position from 1987 up to now in Belgium, and examines whether or not the BMC's opinion on the matter corresponds to the applicable substantive criminal law provisions and whether or not partner notification could also be defended for other sexually transmissible infections (STIs). A case study of the situation in Belgium illustrates how discussions about STIs can deeply influence the evolution of legal and ethical rules about medical confidentiality.


Assuntos
Confidencialidade/legislação & jurisprudência , Busca de Comunicante/ética , Busca de Comunicante/legislação & jurisprudência , Doenças Sexualmente Transmissíveis , Bélgica , Responsabilidade pela Informação/ética , Responsabilidade pela Informação/legislação & jurisprudência , Soropositividade para HIV , Humanos
18.
J Med Ethics ; 38(6): 380-2, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22252417

RESUMO

Population-based research is enhanced by biological measures, but biological sampling raises complex ethical issues. The third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) will estimate the population prevalence of five sexually transmitted infections (STIs) (Chlamydia trachomatis, Neisseria gonorrhoeae, human papillomavirus (HPV), HIV and Mycoplasma genitalium) in a probability sample aged 16-44 years. The present work describes the development of an ethical approach to urine testing for STIs, including the process of reaching consensus on whether to return results. The following issues were considered: (1) testing for some STIs that are treatable and for which appropriate settings to obtain free testing and advice are widely available (Natsal-3 provides all respondents with STI and healthcare access information), (2) limits on test accuracy and timeliness imposed by survey conditions and sample type, (3) testing for some STIs with unknown clinical and public health implications, (4) how a uniform approach is easier to explain and understand, (5) practical difficulties in returning results and cost efficiency, such as enabling wider STI testing by not returning results. The agreed approach, to perform voluntary anonymous testing with specific consent for five STIs without returning results, was approved by stakeholders and a research ethics committee. Overall, this was acceptable to respondents in developmental piloting; 61% (68 of 111) of respondents agreed to provide a sample. The experiences reported here may inform the ethical decision making of researchers, research ethics committees and funders considering population-based biological sampling.


Assuntos
Programas de Rastreamento/métodos , Comportamento Sexual/psicologia , Doenças Sexualmente Transmissíveis/diagnóstico , Adolescente , Adulto , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Busca de Comunicante/ética , Feminino , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Programas de Rastreamento/ética , Mycoplasma genitalium/isolamento & purificação , Papillomaviridae/isolamento & purificação , Prevalência , Comportamento Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Revelação da Verdade/ética , Reino Unido/epidemiologia , Adulto Jovem
19.
Ann Emerg Med ; 58(1 Suppl 1): S33-43, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21684406

RESUMO

OBJECTIVES: We seek to identify and analyze, from a group of participants experienced with HIV screening, the perceived challenges and solutions to the ethical, financial, and legal considerations of emergency department (ED)-based HIV screening. METHODS: We performed a qualitative analysis of the focus group discussions from the ethical, financial, and legal considerations portion of the inaugural National Emergency Department HIV Testing Consortium conference. Four groups composed of 20 to 25 consortium participants engaged in semistructured, facilitated focus group discussions. The focus group discussions were audiotaped and transcribed. A primary reader identified major themes and subthemes and representative quotes from the transcripts and summarized the discussions. Secondary and tertiary readers reviewed the themes, subthemes, and summaries for accuracy. RESULTS: The focus group discussions centered on the following themes. Ethical considerations included appropriateness of HIV screening in the ED and ethics of key elements of the 2006 Centers for Disease Control and Prevention HIV testing recommendations. Financial considerations included models of payment and support, role of health care insurance, financial ethics and downstream financial burdens, and advocacy approaches. Legal considerations included the adequacy of obtaining consent, partner notification, disclosure of HIV results, difficulties in addressing special populations, failure of not performing universal screening, failure to notify a person of being tested, failure to notify someone of their test results, liability of inaccurate tests, and failure to link to care. CONCLUSION: This qualitative analysis provides a broadly useful foundation to the ethical, financial, and legal considerations of implementing HIV screening programs in EDs throughout the United States.


Assuntos
Sorodiagnóstico da AIDS , Serviço Hospitalar de Emergência , Sorodiagnóstico da AIDS/economia , Sorodiagnóstico da AIDS/ética , Sorodiagnóstico da AIDS/legislação & jurisprudência , Busca de Comunicante/ética , Busca de Comunicante/legislação & jurisprudência , Continuidade da Assistência ao Paciente , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/ética , Serviço Hospitalar de Emergência/legislação & jurisprudência , Grupos Focais , Infecções por HIV/diagnóstico , Custos Hospitalares , Humanos , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência , Cobertura do Seguro , Programas de Rastreamento/economia , Programas de Rastreamento/ética , Programas de Rastreamento/legislação & jurisprudência , Guias de Prática Clínica como Assunto , Estados Unidos
20.
Int J STD AIDS ; 22(5): 281-5, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21571977

RESUMO

When treating contacts of patients with sexually transmitted infections (STIs), health professionals may face conflicting ethical imperatives. We surveyed middle grade doctors in genitourinary (GU) medicine and asked how they would manage a hypothetical clinical scenario. This was analysed on the basis of principles of respect for autonomy and beneficence/non-maleficence to assess how they weigh up duties of informed consent (autonomy of patient), partner confidentiality (autonomy of partner) and the need to achieve a good medical outcome. Responses indicated that the strategies that they employ in practice - what they actually say to patients (and what they leave unsaid) - balance the conflicting requirements of these ethical principles in quite different ways, some of which appear ethically problematic.


Assuntos
Confidencialidade/ética , Busca de Comunicante/ética , Consentimento Livre e Esclarecido/ética , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Ética Médica , Feminino , Humanos , Masculino , Médicos , Doenças Sexualmente Transmissíveis/prevenção & controle , Inquéritos e Questionários
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