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1.
Rev. esp. med. legal ; 46(3): 119-126, jul.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192313

RESUMO

La pandemia por COVID-19 ha suscitado problemas éticos y médico-legales, entre los que destaca la asignación equitativa de recursos sanitarios, sobre todo en relación a la priorización de pacientes y el racionamiento de recursos. El establecimiento de prioridades está siempre presente en los sistemas sanitarios y depende de la teoría de justicia aplicable en cada sociedad. El racionamiento de recursos ha sido necesario en la pandemia por COVID-19, por lo que se han publicado documentos de consenso para la toma de decisiones sustentadas en cuatro valores éticos fundamentales: maximización de los beneficios, tratar a las personas igualmente, contribuir en la creación de valor social y dar prioridad a la situación más grave. De ellos derivan recomendaciones específicas: maximizar beneficios; priorizar a los trabajadores de la salud; no priorizar la asistencia por orden de llegada; ser sensible a la evidencia científica; reconocer la participación en la investigación y aplicar los mismos principios a los pacientes COVID-19 que a los no-COVID-19


The COVID-19 pandemic has raised ethical and medico-legal problems, which include the equitable allocation of health resources, especially in relation to the prioritization of patients and the rationing of resources. Priority setting is always present in healthcare systems and depends on the theory of justice applicable in each society. Resource rationing has been necessary in the COVID-19 pandemic, and therefore consensus documents have been published for decision-making based on four fundamental ethical values: maximization of benefits, treating people equally, contributing to creating social value and giving priority to the worst off, from which specific recommendations derive: maximize benefits; prioritize health workers; do not prioritize attendance on a first-come, first-served basis; be sensitive to scientific evidence; recognize participation in research and apply the same principles to COVID-19 patients as to non-COVID-19 patients


Assuntos
Humanos , Valor da Vida , Administração dos Cuidados ao Paciente/legislação & jurisprudência , Seleção de Pacientes/ética , Infecções por Coronavirus , Cuidados Paliativos na Terminalidade da Vida/ética , Cuidados para Prolongar a Vida/ética , Pandemias/legislação & jurisprudência , Tomada de Decisões/ética , Temas Bioéticos , Revisão da Utilização de Recursos de Saúde/legislação & jurisprudência , Alocação de Recursos/legislação & jurisprudência , Recusa do Médico a Tratar/ética , Recusa do Médico a Tratar/legislação & jurisprudência
2.
J Clin Ethics ; 31(2): 111-125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32585654

RESUMO

INTRODUCTION: In highly developed countries, as many as 16 percent of children are physically abused each year. Traumatic brain injury (TBI) is the most common injury in non-accidental trauma (NAT) and is responsible for 80 percent of fatal NAT cases, with most deaths occurring in children younger than three years old. Cases of abusers who refuse withdrawal of life-sustaining medical treatment (LSMT) to avoid criminal charges have previously been reported. Therefore, we hypothesized that NAT is associated with a lower risk for withdrawal LSMT in pediatric TBI. METHODS: The pediatric Trauma Quality Improvement Program database was analyzed (2014 to 2016) for patients aged 16 and younger with TBI and Glasgow Coma Scale (GCS) of 8 and lower on admission. Patients with a head Abbreviated Injury Scale (AIS) of 2 or less or who died within 48 hours were excluded. A multivariable logistic regression model was used for analysis. RESULTS: Of 2,209 TBI patients, 92 (4.2 percent) had withdrawal of LSMT. Compared to those without withdrawal of LMST, those with LMST had statistically similar median age (three years of age versus seven years) and a higher rate of NAT (33.7 percent versus 13.5 percent). The most common specified perpetrator was a father/stepfather/male partner (70 percent). After adjusting for covariates, factors associated with higher risk for withdrawal of LSMT included age of less than three years (OR 2.38, CI 1.34-4.23) and NAT (OR 1.86, CI 1.02-3.41). CONCLUSION: NAT is associated with increased risk for withdrawal of LSMT in pediatric TBI. Age of less than three years is similarly associated with a higher risk for withdrawal of LSMT. Future research in this population is needed to determine what other factors predict withdrawal of LSMT and what resources, such as social workers and/or ethics consults, are utilized.


Assuntos
Lesões Encefálicas Traumáticas , Lesões Encefálicas , Cuidados para Prolongar a Vida , Suspensão de Tratamento , Adolescente , Criança , Pré-Escolar , Escala de Coma de Glasgow , Humanos , Cuidados para Prolongar a Vida/ética , Masculino , Estudos Retrospectivos , Suspensão de Tratamento/ética
3.
Rev. bioét. derecho ; (48): 5-21, mar. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192075

RESUMO

La medicina en general, y la medicina intensiva (SMI) en particular, han presentado grandes cambios a lo largo de los últimos años, en especial en relación a la toma de decisiones sobre las actuaciones a realizar en pacientes efectos de enfermedades crónicas. De esta manera, tanto la enfermedad oncológica como las enfermedades crónicas no oncológicas, en la mayoría de casos, tienen un curso evolutivo mucho más largo, con episodios de descompensación que pueden requerir la instauración de medicina intensiva. Es por ello que actualmente enfermedades que cursan con insuficiencia de un solo órgano, como pueden ser la cirrosis hepática o la miocardiopatía dilatada, por ejemplo, se pueden considerar terminales según su grado de evolución. Esto obliga a los equipos asistenciales a tener no solo conocimientos científico-técnicos sino también bioéticos, para decidir la correcta adecuación diagnóstico-terapéutica en cada caso concreto. En este trabajo se pretenden dar algunas nociones básicas para tomar decisiones clínicas en este grupo de pacientes


Medicine in general and the intensive medicine (ICM) in particular, have presented major changes in recent years, especially in relation to decision-making on the actions to be taken in patients with chronic diseases. Thus, both oncological and non-oncological chronic diseases, in most cases, have a much longer evolutionary course, with decompensation episodes that may require the establishment of intensive medicine. That is why currently diseases with a single organ failure, such as liver cirrhosis or dilated cardiomyopathy, for example, can be considered terminal according to their degree of evolution. This requires health care teams to have not only scientifictechnical knowledge but also bioethical knowledge in order to decide on the correct diagnostic-therapeutic approach in each specific case. In this work, we intend to give some basic notions to make clinical decisions in this group of patients


La medicina en general, I la medicina intensiva (SMI) en particular, han presentat grans canvis al llarg dels últims anys, especialment en relació a la presa de decisions sobre les actuacions que cal dur a terme en pacients afectats de malalties cròniques. Tant la malaltia oncològica com les malalties cròniques no oncològiques, en la majoria de casos, tenen un curs evolutiu molt més llarg, amb episodis de descompensació que poden requerir la instauració de medicina intensiva. És per això que actualment malalties que cursen amb insuficiència d'un sol òrgan, com pot ser la cirrosi hepàtica o la miocardiopatia dilatada, per exemple, es poden considerar terminals segons el seu grau d'evolució. Això obliga els equips assistencials a tenir no només coneixements cientificotècnics sinó també bioètics per decidir la correcta adequació diagnòstic-terapèutica en cada cas concret. En aquest treball es preté aportar algunes nocions bàsiques per a prende decisions clíniques en aquest grup de pacients


Assuntos
Humanos , Cuidados Paliativos na Terminalidade da Vida/ética , Unidades de Cuidados Coronarianos , Cuidados para Prolongar a Vida/ética , Hospitalização , Tomada de Decisões/ética , Doença Crônica , Demência
4.
Rev. bioét. derecho ; (48): 81-93, mar. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192079

RESUMO

La misión de los cuidados intensivos es restaurar la situación basal de salud libre de discapacidad severa atendiendo al principio bioético de beneficencia, respetando la dignidad y voluntad del paciente de ser tratado lo que vendría a ser atender al principio bioético de autonomía, y realizando todo esto de una forma adecuada a la mejor evidencia actual, justa y sostenible atendiendo a los principios de no maleficencia y de justicia. Cuando no es posible es cuando los profesionales tienen la obligación ética de iniciar un diálogo de manera respetuosa y prudente con el  paciente y/o la familia y el resto de profesionales implicados (atención primaria, enfermería, especialistas...etc.) de cara a llegar a un consenso sobre limitar los tratamientos de soporte vital y/o adecuar  los cuidados y continuar el tratamiento con un plan terapéutico de cuidados dirigidos al confort, control de síntomas y a mejorar la calidad de vida (Plan de cuidados paliativos) para preservar la dignidad del paciente, evitar el sufrimiento y proporcionar un tratamiento compasivo de soporte y acompañamiento durante el proceso de muerte si se diera el mismo atendiendo al paciente y a la familia con el máximo cuidado y respeto en un marco de humanización de la salud. Atender de forma excelente el final de la vida significa dignificar a las personas que están pasando por ese proceso, aportar un valor extraordinario de humanidad y debe ser un objetivo prioritario actual en nuestro quehacer diario en las unidades de cuidados intensivos


The mission of intensive care is to restore the baseline health situation free of severe disability by following the bioethical principle of beneficence, respecting the dignity and willingness of the patient to be treated what would be to attend to the bioethical principle of autonomy, and doing all this in a manner appropriate to the best current, fair and sustainable evidence, taking into account the principles of non-maleficence and justice. When it is not possible, it is when professionals have the ethical obligation to initiate a dialogue in a respectful and prudent manner with the patient and / or the family and the rest of the professionals involved (primary care, nursing, specialists ... etc.) Face to reach a consensus on limiting life support treatments and / or adapt care and continue treatment with a therapeutic plan of care aimed at comfort, symptom control and improving the quality of life (Palliative Care Plan) to preserve the dignity of the patient, avoid suffering and provide a compassionate support and support during the death process if the same were given to the patient and the family with the utmost care and respect in a framework of humanization of health. Addressing the end of life in an excellent way means dignifying the people who are going through this process, providing an extraordinary value of humanity and must be a current priority in our daily work in the intensive care units


La finalitat de la vigilància intensiva és restaurar la situació basal de salut lliure de discapacitat severa atenent al principi bioètic de beneficència, respectant la dignitat I voluntat del pacient de ser tractat, cosa que vindria a ser atendre al principi bioètic d'autonomia, I realitzant tot això d'una forma adequada a la millor evidència actual, justa I sostenible, atesos els principis de no maleficència I de justícia. Quan tot això no és possible és quan els professionals tenen l'obligació ètica d'iniciar un diàleg de manera respectuosa I prudent amb el pacient i/o la família I amb la resta de professionals implicats (atenció primària, infermeria, especialistes...etc.) de cara a arribar a un consens sobre limitar els tractaments de suport vital i/o adequar les cures I continuar el tractament amb un pla terapèutic de cures dirigides al confort, el control de símptomes I a millorar la qualitat de vida (Pla de Cures Pal·liatives) per a preservar la dignitat del pacient, evitar el sofriment I proporcionar-li un tractament compassiu de suport I acompanyament durant el procés de mort, atenent el pacient I a la família amb la màxima cura I respecte en un marc d'humanització de la salut. Atendre de forma excel·lent el final de la vida significa dignificar les persones que están passant per aquest procés, aportar un valor extraordinari d'humnaitat I ha de ser un objectiu prioritari actual en el nostre qufer diari en les unitats de vigilancia intensiva


Assuntos
Humanos , Cuidados para Prolongar a Vida/ética , Cuidados Paliativos na Terminalidade da Vida/ética , Cuidados Paliativos na Terminalidade da Vida/legislação & jurisprudência , Tomada de Decisões/ética , Cuidados para Prolongar a Vida/classificação , Cuidados para Prolongar a Vida/métodos , Unidades de Terapia Intensiva
5.
J Law Health ; 33(1): 79-106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31841618

RESUMO

Alfie Evans was a terminally ill British child whose parents, clinging to hope, were desperately trying to save his life. Hospital authorities disagreed and petitioned the court to enjoin the parents from removing him and taking him elsewhere for treatment. The court stepped in and compelled the hospital to discontinue life support and claimed that further treatment was not in the child's best interest. This note discusses the heartbreaking stories of Alfie and two other children whose parents' medical decisions on their behalf were overridden by the court. It argues that courts should never decide that death is in a child's best interest and compel parents to withdraw life support from their children. Such a decision is outside the scope of the judiciary. Furthermore, it argues that even in those instances when the court may or must intervene, a new framework is necessary because the current framework used by the court to determine the best interest of the child ignores fundamental realities of child psychology. Too often, as a result of the court's mistaken framework, the court illegitimately trespasses into the parental domain. By adopting a new framework, the court will intervene only when actual abuse or neglect is suspected. In all other cases, judicial restraint will be practiced and the court will show greater deference to the parents' wishes.


Assuntos
Tomada de Decisões , Dissidências e Disputas , Função Jurisdicional , Pais , Adolescente , Adulto , Terapias Complementares/ética , Terapias Complementares/legislação & jurisprudência , Ética Institucional , Ética Médica , Feminino , Humanos , Identificação Psicológica , Lactente , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/legislação & jurisprudência , Masculino , Obrigações Morais , Autonomia Pessoal , Autonomia Profissional
7.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570361

RESUMO

A 28-year-old woman suffered a traffic accident resulting in severe head injuries with deleterious prognosis. Diagnostics further revealed a hitherto unknown pregnancy, at suspected week 9. Based on the patient's wish to donate organs, brain death protocol confirmed irreversible loss of brain function. Yet, vital pregnancy rendered organ transplantation impossible. Multiple ethical and legal issues arose, from invalidation of established legal care after brain death to the delivery of a healthy child after trauma and long-term critical care. After medicolegal and ethical counselling, pregnancy was sustained, and the goal of organ donation postponed. Critical care focused on foetal homeostasis. At 30+4 weeks, a viable girl was born via assisted vaginal delivery. Postpartal organ donation resulted in heart, kidney and pancreas transplantation. The case emphasises the medical, legal and ethical challenges to combine two apparently diametrical goals: the successful full-term pregnancy and the fulfilment of a patient's wish to donate organs.


Assuntos
Morte Encefálica , Viabilidade Fetal/fisiologia , Cuidados para Prolongar a Vida/ética , Doadores Vivos/ética , Mães , Defesa do Paciente/ética , Cuidado Pré-Natal/ética , Obtenção de Tecidos e Órgãos/ética , Adulto , Diretivas Antecipadas , Aconselhamento , Cuidados Críticos , Feminino , Humanos , Cuidados para Prolongar a Vida/métodos , Direitos do Paciente/ética , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal/métodos
9.
Neuron ; 102(3): 526-528, 2019 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-31071287

RESUMO

In recent years, rapid technological developments in the field of neuroimaging have provided new methods for assessing residual cognition, detecting consciousness, and even communicating with patients who clinically appear to be in a vegetative state. Here, I highlight some of the major implications of these developments, discuss their scientific, clinical, legal, and ethical relevance, and make my own recommendations for future directions in this field.


Assuntos
Lesão Encefálica Crônica/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Estado de Consciência , Cuidados para Prolongar a Vida , Estado Vegetativo Persistente/diagnóstico por imagem , Conscientização , Interfaces Cérebro-Computador , Erros de Diagnóstico , Eletroencefalografia , Ética Médica , Neuroimagem Funcional , Humanos , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/legislação & jurisprudência , Imagem por Ressonância Magnética , Recuperação de Função Fisiológica , Espectroscopia de Luz Próxima ao Infravermelho
10.
Int J Gynaecol Obstet ; 146(2): 149-156, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31127869

RESUMO

The aim of the present study is to assess the ethical, legal, and social issues of brain death in pregnancy through a literature review, and, based on the review results, to provide ethical and social guidelines. A search of PubMed using MeSH terms was conducted and yielded 844 results for the period from 1979 to 2017. After articles were screened based on the title and abstract content, 45 were found to refer to the existing ethical, social, and legal implications in cases of brain death during pregnancy, and 40 articles were selected as the source for our set of ethical and social guidelines. From the findings of the study, issues referring to the legitimacy and justification of performing a corporeal support procedure have been identified, as have the issues focusing on fetus or mother, and, finally, those relating to the decision-making process. Given the increasing number of successful births after a diagnosis of brain death during pregnancy, there is justification for an ethical duty to continue prolonged corporeal support, even if there is little likelihood of success, despite the apparent absence of a legal duty, and relying on the international jurisdictional discrepancies in the attribution of legal rights to the fetus.


Assuntos
Morte Encefálica , Complicações na Gravidez , Tomada de Decisões , Feminino , Feto , Humanos , Cuidados para Prolongar a Vida/ética , Guias de Prática Clínica como Assunto , Gravidez
11.
Bioethics ; 33(8): 896-907, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30989675

RESUMO

This article explores the links between our roles as academics, advocates, and activists, focusing on our research on treatment decisions for patients in vegetative and minimally conscious states. We describe how our work evolved from personal experience through traditional social science research to public engagement activities and then to advocacy and activism. We reflect on the challenges we faced in navigating the relationship between our research, advocacy, and activism, and the implications of these challenges for our research ethics and methodology-giving practical examples of how we worked with research participants, wrote up case studies and developed interventions into legal debates. We also address the implications of the impact agenda-imposed by the British Research Excellence Framework- for our actions as scholar-activists. Finally, we ask how practicing at the borders of academia, advocacy, and activism can inform research-helping to contextualize, sensitize, and engage theory with practice, leading to a more robust analysis of data and its implications, and helping to ensure a dialogue between research, theory, lived experience, front-line practice, law, and public policy.


Assuntos
Bioética , Tomada de Decisões/ética , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/legislação & jurisprudência , Defesa do Paciente/ética , Estado Vegetativo Persistente/terapia , Ativismo Político , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reino Unido
14.
Neurocrit Care ; 30(1): 33-41, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30143963

RESUMO

BACKGROUND: Withdrawal of life-sustaining treatment (WOLST) is the leading proximate cause of death in patients with perceived devastating brain injury (PDBI). There are reasons to believe that a potentially significant proportion of WOLST decisions, in this setting, are premature and guided by a number of assumptions that falsely confer a sense of certainty. METHOD: This manuscript proposes that these assumptions face serious challenges, and that we should replace unwarranted certainty with an appreciation for the great degree of multi-dimensional uncertainty involved. The article proceeds by offering a taxonomy of uncertainty in PDBI and explores the key role that uncertainty as a cognitive state, may play into how WOLST decisions are reached. CONCLUSION: In order to properly share decision-making with families and surrogates of patients with PDBI, we will have to acknowledge, understand, and be able to communicate the great degree of uncertainty involved.


Assuntos
Lesões Encefálicas/diagnóstico , Lesões Encefálicas/terapia , Tomada de Decisão Clínica/métodos , Cuidados para Prolongar a Vida/normas , Incerteza , Suspensão de Tratamento/normas , Adulto , Tomada de Decisão Clínica/ética , Humanos , Cuidados para Prolongar a Vida/ética , Prognóstico , Suspensão de Tratamento/ética
15.
Bioethics ; 33(1): 201-206, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30341933

RESUMO

Limiting intensive care is paid increasing attention. In the echoing call for physicians' ethical self-restriction, it is easily overlooked, however, that ethics needs a critical epistemological analysis before it can suffice as an emergency brake to futile treatment. This analysis is provided by the present essay. The authors suggest that the difficulties of resolving moral dilemmas related to limiting intensive care may just be due to the unclarified epistemological status of moral claims. Even if normative ethics cannot prescribe right decisions, but only draw conclusions from defined premises, the premises may or may not be true. Their intertwined descriptive and normative evidence is endorsed in an academic and political discourse. There will necessarily be various demands for rationality in prudent decisions between physicians, their patients and society. These demands are formulated dialogically through critical questions and justified answers. A good argument is the convincing one that, finally and ideally, leads to the absence of open objections. Thus, in the end the rightness of a given decision does not depend on axiomatic moral principles, but is comparative and conditional, as it is given in an omnilateral argument. Neither is it the democratic process of shared decision making that we should evaluate, but rather the argumentative state itself, when we judge the morality of health politics and clinical practice.


Assuntos
Cuidados Críticos/ética , Tomada de Decisões/ética , Cuidados para Prolongar a Vida/ética , Filosofia , Médicos/ética , Assistência Terminal/ética , Suspensão de Tratamento , Adaptação Psicológica , Atitude do Pessoal de Saúde , Atitude Frente a Morte , Morte , Dissidências e Disputas , Análise Ética , Teoria Ética , Ética Médica , Humanos , Conhecimento , Princípios Morais , Filosofia Médica , Médicos/psicologia , Política
16.
Indian J Med Res ; 150(6): 598-605, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-32048623

RESUMO

Background & objectives: In developing countries like India, there is a lack of clarity regarding the factors that influence decisions pertaining to life supports at the end-of-life (EOL). The objectives of this study were to assess the factors associated with EOL-care decisions in the Indian context and to raise awareness in this area of healthcare. Methods: This retrospectively study included all patients admitted to the medical unit of a tertiary care hospital in southern India, over one year and died. The baseline demographics, economic, physiological, sociological, prognostic and medical treatment-related factors were retrieved from the patient's medical records and analysed. Results: Of the 122 decedents included in the study whose characteristics were analyzed, 41 (33.6%) received full life support and 81 (66.4%) had withdrawal or withholding of some life support measure. Amongst those who had withdrawal or withholding of life support, 62 (76.5%) had some support withheld and in 19 (23.5%), it was withdrawn. The documentation of the disease process, prognosis and the mention of imminent death in the medical records was the single most important factor that was associated with the EOL decision (odds ratio - 0.08; 95% confidence interval, 0.01-0.74; P=0.03). Interpretation & conclusions: The documentation of poor prognosis was the only factor found to be associated with EOL care decisions in our study. Prospective, multicentric studies need to be done to evaluate the influence of various other factors on the EOL care.


Assuntos
Morte , Cuidados para Prolongar a Vida/psicologia , Ordens quanto à Conduta (Ética Médica)/psicologia , Assistência Terminal/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais de Ensino , Humanos , Índia/epidemiologia , Cuidados para Prolongar a Vida/ética , Masculino , Pessoa de Meia-Idade , Ordens quanto à Conduta (Ética Médica)/ética , Atenção Terciária à Saúde
17.
Hastings Cent Rep ; 48 Suppl 4: S77-S80, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584845

RESUMO

For nearly five years, bioethicists and neurologists debated whether Jahi McMath, an African American teenager, was alive or dead. While Jahi's condition provides a compelling study for analyzing brain death, circumscribing her life status to a question of brain death fails to acknowledge and respond to a chronic, if uncomfortable, bioethics problem in American health care-namely, racial bias and unequal treatment, both real and perceived. Bioethicists should examine the underlying, arguably broader social implications of what Jahi's medical treatment and experience represented. On any given day, disparities in the quality of health care and health outcomes for people of color in comparison to whites are evidenced in American hospitals and clinics. These disparities are not entirely explained by differences in patient education, insurance status, employment, income, expressed preference for treatments, and severity of disease. Instead, research indicates that, even for African Americans able to gain access to health care services and navigate institutional nuances, disparities persist across a broad range of services, including diagnostic screening and general medical care, mental health diagnosis and treatment, pain management, HIV-related care, and treatments for cancer, heart disease, diabetes, and kidney disease.


Assuntos
Morte Encefálica , Morte , Erros de Diagnóstico , Cuidados para Prolongar a Vida , Administração dos Cuidados ao Paciente , Afro-Americanos , Morte Encefálica/diagnóstico , Morte Encefálica/fisiopatologia , Erros de Diagnóstico/ética , Erros de Diagnóstico/psicologia , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/normas , Disparidades em Assistência à Saúde/etnologia , Humanos , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/psicologia , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/normas , Racismo , Fatores Socioeconômicos
18.
Hastings Cent Rep ; 48 Suppl 4: S53-S55, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584847

RESUMO

The definition of death was clearer one hundred years ago than it is today. People were declared dead if diagnosed with permanent cessation of both cardio-circulatory function and respiratory function. But the definition has been muddled by the development of new technologies and interventions-first by cardiopulmonary resuscitation and ventilators, which were introduced in the mid-twentieth century, and now by extracorporeal membrane oxygenation, which creates the ability to keep oxygenated blood circulating, with or without a beating heart or functioning lungs. In Defining Death: The Case for Choice, Robert Veatch and I argue that the definition of death should focus on "what change in a human being is so fundamental that we can say the individual is no longer with us as a member of the human community bearing rights such as the right not to be killed." We assert that this decision is a normative issue about which different stakeholders may believe that different changes are fundamental, and we therefore propose that the optimal policy solution may be to allow stakeholders to choose their own definition within a reasonable range of options. There are three caveats that need to be highlighted regarding this approach.


Assuntos
Morte Encefálica/diagnóstico , Comportamento de Escolha , Morte , Tomada de Decisões , Direitos Humanos , Cuidados para Prolongar a Vida , Atitude Frente a Morte , Direitos Humanos/legislação & jurisprudência , Direitos Humanos/tendências , Humanos , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/psicologia , Cuidados para Prolongar a Vida/tendências , Formulação de Políticas , Tanatologia
19.
Hastings Cent Rep ; 48 Suppl 4: S36-S38, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584849

RESUMO

Discussion of the "dead donor rule" is challenging because it implicates views about a wide range of issues, including whether and when patients are appropriately declared dead, the validity of the doctrine of double effect, and the moral difference between or equivalence of active euthanasia and withdrawal of life-sustaining treatment. The DDR will be defined here as the prohibition against removal of organs necessary for the life of the patient-that is, the prohibition of intentionally ending the life of a patient through organ removal. At a minimum, it is difficult not to see the DDR as grounded in a set of laws, norms, values, and practices that are firmly entrenched and have a great deal of philosophical, religious, and legal support. Obviously, the primary argument against the DDR is that it is highly desirable that we continue to procure organs for transplantation, combined with the belief that those from whom we often and possibly typically procure organs are not "really" dead. If donors are not really dead, then we are left with a dilemma: either we abandon organ procurement, or we abandon the DDR. Such a move should be taken only if the way we currently delineate the dead (those from whom it is acceptable to remove organs) cannot be maintained or defended. I will suggest that this is not the case.


Assuntos
Morte Encefálica/diagnóstico , Tomada de Decisão Clínica/ética , Morte , Cuidados para Prolongar a Vida , Doadores de Tecidos/legislação & jurisprudência , Eutanásia Ativa Voluntária , Humanos , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/legislação & jurisprudência , Cuidados para Prolongar a Vida/métodos , Coleta de Tecidos e Órgãos/ética , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/psicologia , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência
20.
Hastings Cent Rep ; 48 Suppl 4: S74-S76, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584850

RESUMO

From the start, I followed the case of Jahi McMath with great interest. In December 2013, she clearly fulfilled the diagnostic criteria for brain death. As a neurologist with a special interest in chronic brain death, I was not surprised that, after she was flown to New Jersey, where she became statutorily resurrected and was treated as a comatose patient, Jahi's condition quickly improved. In 2014, her family reported that she sometimes responded to simple motor commands. I shared the general skepticism regarding these reports, assuming that the family was in denial and was misinterpreting spinal myoclonus (a rapid, involuntary twitch generated by the spinal cord) as volitional. The family had noticed that when Jahi's heart rate was above eighty beats per minute, she was more likely to respond, as though the heart rate reflected some sort of inner level of arousal. So they began to make video recordings. I have been privileged to be entrusted with copies of these recordings, forty-eight of which proved suitable for assessing alleged responsiveness. All have been certified by a forensic video expert as unaltered. The first thing that struck me was that the great majority of the alleged responses were not spinal myoclonus. In fact, they did not resemble any type of spontaneous, involuntary movement described in patients paralyzed from high spinal cord lesions.


Assuntos
Atitude do Pessoal de Saúde , Morte Encefálica , Morte , Erros de Diagnóstico , Cuidados para Prolongar a Vida , Morte Encefálica/diagnóstico , Morte Encefálica/fisiopatologia , Estado de Consciência/fisiologia , Erros de Diagnóstico/ética , Erros de Diagnóstico/psicologia , Técnicas de Diagnóstico Neurológico , Feminino , Humanos , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/psicologia
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