Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.956
Filtrar
3.
J Clin Ethics ; 31(4): 353-363, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33259340

RESUMO

A psychiatric advance directive (PAD) is a communication tool that promotes patients' autonomy and gives capacitated adults who live with serious mental illnesses the ability to record their preferences for care and designate a proxy decision maker before a healthcare crisis. Despite a high degree of interest by patients and previous studies that recommend that clinicians facilitate the completion of PADs, the rate of implementation of PAD remains low. Research indicates that many clinicians lack the necessary experience to facilitate the completion of PADs and to use them, and, as a consequence, do not effectively engage patients about PADs. This study developed practical recommendations for clinicians to improve their ability to communicate and facilitate PADs. We (1) thematically analyzed definitions of PADs published in 118 articles across disciplines, and (2) presented our recommendations for enhanced communication in clinical practice that emphasizes patient-centeredness, usefulness, and clarity, aligned with evidence-based practices that put patients' autonomy and understanding first. While there is no one-size-fits-all script to engage patients in complex conversations, our recommended strategies include an emphasis on patients' autonomy, the adaptation of word choices, the use of metaphor not simile, and checking for patients' understanding as effective methods of clinical communication.


Assuntos
Diretivas Antecipadas/ética , Comunicação , Transtornos Mentais/terapia , Serviços de Saúde Mental/ética , Guias de Prática Clínica como Assunto , Adulto , Humanos , Transtornos Mentais/psicologia , Princípios Morais , Direitos do Paciente , Assistência Centrada no Paciente , Autonomia Pessoal , Procurador , Assistência Terminal/psicologia
4.
Medicina (Kaunas) ; 56(12)2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33322462

RESUMO

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Italy has proven to be one of the countries with the highest coronavirus-linked death rate. To reduce the impact of SARS-CoV-2 coronavirus, the Italian Government decision-makers issued a series of law decrees that imposed measures limiting social contacts, stopped non-essential production activities, and restructured public health care in order to privilege assistance to patients infected with SARS-CoV-2. Health care services were substantially limited including planned hospitalization and elective surgeries. These substantial measures were criticized due to their impact on individual rights including freedom and autonomy, but were justified by the awareness that hospitals would have been unable to cope with the surge of infected people who needed treatment for COVID-19. The imbalance between the need to guarantee ordinary care and to deal with the pandemic, in a context of limited health resources, raises ethical concerns as well as clinical management issues. The emergency scenario caused by the COVID-19 pandemic, especially in the lockdown phase, led the Government and health care decision-makers to prioritize community safety above the individuals' rights. This new community-centered approach to clinical care has created tension among the practitioners and exposed health workers to malpractice claims. Reducing the morbidity and mortality rates of the COVID-19 pandemic is the priority of every government, but the legitimate question remains whether the policy that supports this measure could be less harmful for the health care system.


Assuntos
/prevenção & controle , Política de Saúde , Direitos do Paciente , Administração em Saúde Pública/ética , Quarentena/ética , /mortalidade , Emergências , Humanos , Itália/epidemiologia , Administração em Saúde Pública/legislação & jurisprudência , Quarentena/legislação & jurisprudência
5.
Rev. bioét. derecho ; (50): 1133-131, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191349

RESUMO

Han sucedido tantas cosas, y en tan poco tiempo, que no resulta fácil seleccionar alguna temática sin dejarnos fuera otras igualmente relevantes. Probablemente nos pasaremos los próximos años debatiendo sobre lo acontecido, entre otros motivos, por la escasa información que aun hoy tenemos sobre la apisonadora que ha triturado nuestro estilo de vida. Pues bien, he seleccionado, de entre las innumerables que podríamos estudiar, cuatro narrativas. En concreto, la pandemia como refriega entre neokantianos y utilitaristas; como datificación de rebaño; como ajuste de cuentas epistemológico y como singularidad española. Con este análisis podremos interrelacionar, aunque sea de forma breve, las implicaciones éticas, jurídicas, políticas y científicas de una historia que recién ha comenzado


So many things have happened, and in such a short time, that it is not easy to select some topic without leaving out other equally relevant ones. We will probably spend the next few years debating what happened, among other things, due to the scant information that we still have today about the steamroller that has crushed our lifestyle. Well, I have selected, from the innumerable ones that remain to be studied, four narratives. Specifically, the pandemic as a fray between neo-Kantians and utilitarians; as herd dating; as an epistemological reckoning and as a Spanish singularity. With this analysis we will be able to interrelate, albeit briefly, the ethical, legal, political and scientific implications of a history that has just begun


Han passat tantes coses, I en tan poc temps, que no resulta fàcil seleccionar alguna temàtica sense deixar-nos fora d'altres igualment rellevants. Probablement ens passarem els propers anys debatent sobre els fets, entre altres motius, per l'escassa informació que encara avui tenim sobre la piconadora que ha triturat el nostre estil de vida. Doncs bé, he seleccionat, d'entre els innombrables que podríem estudiar, quatre narratives. En concret, la pandèmia com la batalla entre neokantians I utilitaristes; com datificació de ramat; com venjança epistemològica I com a singularitat espanyola. Amb aquest anàlisi podrem interrelacionar, encara que sigui de forma breu, les implicacions ètiques, jurídiques, polítiques I científiques d'una història que just acaba de començar


Assuntos
Humanos , Triagem , Biotecnologia , Direitos do Paciente , Tomada de Decisões , Infecções por Coronavirus , Pneumonia Viral , Pandemias
6.
Bull World Health Organ ; 98(11): 801-808, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33177777

RESUMO

Four decades after the Declaration of Alma-Ata, its vision of health for all and strategy of primary health care are still an inspiration to many people. In this article we evaluate the current status of primary health care in the era of the Declaration of Astana, the sustainable development goals, universal health coverage and the coronavirus disease 2019 pandemic. We consider how best to guide greater application of the primary health care strategy, reflecting on tensions that remain between the political vision of primary health care and its implementation in countries. We also consider what is required to support countries to realize the aspirations of primary health care, arguing that national needs and action must dominate over global preoccupations. Changing contexts and realities need to be accommodated. A clear distinction is needed between primary health care as an inspirational vision and set of values for health development, and primary health care as policy and implementation space. To achieve this vision, political action is required. Stakeholders beyond the health sector will often need to lead, which is challenging because the concept of primary health care is poorly understood by other sectors. Efforts on primary health care as policy and implementation space might focus explicitly on primary care and the frontline of service delivery with clear links and support to complementary work on social determinants and building healthy societies. Such efforts can be partial but important implementation solutions to contribute to the much bigger political vision of primary health care.


Assuntos
Infecções por Coronavirus/epidemiologia , Saúde Global , Política de Saúde , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde/organização & administração , Assistência de Saúde Universal , Betacoronavirus , Setor de Assistência à Saúde/organização & administração , Prioridades em Saúde/organização & administração , Humanos , Sistemas de Informação , Pandemias , Direitos do Paciente/normas , Política , Desenvolvimento Sustentável
7.
Afr Health Sci ; 20(2): 936-947, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33163062

RESUMO

Background: South Africa is moving towards National Health Insurance (NHI), which aims to provide access to universal health coverage for all South Africans. The NHI will only accredit and contract eligible health facilities that meet nationally approved quality standards in the public and private sector. Detailed tools for measuring compliance with the National Core Standards (NCS) and Batho Pele principles have been developed and implemented in the public sector. To date and since its implementation in the public sector, very little is known about the national audit tool and the method used to evaluate quality and patient safety standards in private hospitals in eThekwini district. Objective: The aim of the study was to develop an audit tool for relicensing inspection of private hospitals in eThekwini district based on the clinical domains of the NCS and Batho Pele principles. Methodology: An exploratory sequential mixed method research design was used with a qualitative first phase involving 24 nurse managers through purposive sampling. This was followed by a quantitative phase in which a structured questionnaire was administered to 270 nurses who were randomly sampled for the study from 4 hospitals. Results: The results revealed that the NCS and the Batho Pele principles are not fully implemented or evaluated in the selected hospitals in eThekwini district. Conclusion: These findings were significant and denoted the need for a standardised clinical audit tool for private hospitals in eThekwini district.


Assuntos
Atitude do Pessoal de Saúde , Hospitais Privados/normas , Assistência ao Paciente/normas , Direitos do Paciente/normas , Guias de Prática Clínica como Assunto/normas , Qualidade da Assistência à Saúde/normas , Humanos , Entrevistas como Assunto , Enfermeiras Administradoras , Setor Privado , Pesquisa Qualitativa , África do Sul , Inquéritos e Questionários
8.
Soins Psychiatr ; 41(328): 23-25, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33039087

RESUMO

Psychiatric compulsory community treatment programmes are widely and heterogeneously used measures of coercion. The recovery oriented mental health service 59G21 used them to minimize violating the rights of persons under compulsory care. Based on a clinical situation of failing this objective, we discuss their place in the health system and the reasons why we chose to move towards a "zero recourse" objective.


Assuntos
Serviços Comunitários de Saúde Mental , Transtornos Mentais/terapia , Humanos , Direitos do Paciente
9.
Soins Psychiatr ; 41(328): 19-22, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33039086

RESUMO

The act of 5 July 2011 pertaining to the rights and the protection of persons under psychiatric care presents the possibility for compulsory care, without the need for full hospitalisation. Patients can be cared for through partial hospitalisation (day hospital and part-time therapeutic clinic) or in a medical-psychological centre. Treatments and all care are detailed in a care programme. This programme is sent, like all certificates, to the regional health agency and the prefecture in the case of psychiatric care by decision of the State representative, or to the hospital director for psychiatric care at the request of a third party. We propose two clinical vignettes.


Assuntos
Assistência Ambulatorial , Transtornos Mentais/terapia , Hospital Dia , Humanos , Direitos do Paciente/legislação & jurisprudência
10.
Soins Psychiatr ; 41(328): 26-29, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33039088

RESUMO

The care programmes are medical-legal and therapeutic systems that showcase different spaces, the law, the patient's clinic, their freedom and their rights. In this context, the patient preserves their freedom to come and go. In applying the care programme, the doctor must acquire their approval, not to say consent. Outside hospitalisation, the care programmes bring patients and teams together within the city. The matter of social and community psychiatry, a vector of catchment-area psychiatry, then makes full sense.


Assuntos
Transtornos Mentais/terapia , Psiquiatria Comunitária , Liberdade , Humanos , Direitos do Paciente
11.
Cien Saude Colet ; 25(suppl 2): 4197-4200, 2020 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33027356

RESUMO

Coronavirus disease 2019 made us question daily practices, such as the simple handshake. It also raised some ethical and legal issues. Are the ethical principles, that should guide the provision of individualized care, being fulfilled? Will we, as health professionals, be able to provide patients with instruments so that they can fully exercise their autonomy? The guarantee of necessary security solutions, to reduce the risk of contagion in the provision of care, safeguards the principle of non-maleficence. However, the risk of contagion is impossible to completely eliminate, and there is a residual risk associated with the use of physical facilities in healthcare services. But, shouldn't the decision to take that risk be the subject of the patient's free and informed will? The incorporation of telemedicine platforms is ideal for managing several challenges posed by COVID-19, such as the decrease in face-to-face health care assistance. Can the patient really decide how he prefers to be consulted, or are we imposing the consultation model? There have been profound changes in healthcare systems. However, one must remember that there are ethical principles of biomedicine, that should always prevail?


Assuntos
Infecções por Coronavirus/epidemiologia , Direitos do Paciente , Autonomia Pessoal , Pneumonia Viral/epidemiologia , Betacoronavirus , Confidencialidade , Humanos , Programas de Rastreamento , Pandemias , Preferência do Paciente , Portugal , Telemedicina
13.
Obstet Gynecol ; 136(5): 1036-1039, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030860

RESUMO

The population of women within carceral systems is growing rapidly. A portion of these individuals are pregnant and will deliver while incarcerated. Although shackling laws for pregnant persons have improved, incarcerated patients are forced to labor without the support of anyone but a carceral officer and their medical staff. We believe access to continuous labor support is critical for all pregnant persons. Carceral systems and their affiliated hospitals have the opportunity to change policies to reflect that continuous labor support is a basic human right and should be permitted for incarcerated pregnant persons in labor, either through a doula program or a selected person of choice.


Assuntos
Parto Obstétrico/ética , Trabalho de Parto/psicologia , Direitos do Paciente/legislação & jurisprudência , Assistência Perinatal/ética , Prisioneiros/psicologia , Entorno do Parto , Parto Obstétrico/legislação & jurisprudência , Feminino , Humanos , Assistência Perinatal/legislação & jurisprudência , Gravidez , Prisioneiros/legislação & jurisprudência
14.
J Law Med ; 27(4): 981-984, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32880414

RESUMO

Clinical issues involving ethical dilemmas arise daily and confound physicians as they provide medical care. These dilemmas require difficult decisions as physicians must respect patients' values, lifestyles, and freedom of choice while protecting life and promoting health. This is made more challenging as values and lifestyles become more diverse, making third-party support necessary to accommodate the wishes of stakeholders, particularly patients. Collaborative work is important for addressing clinical ethics issues. Government agencies and professional organisations should discuss individual cases as public policy concerns and release guidelines based on their deliberations. Medical institutions should refer to such guidelines in their own discussions on ethically challenging cases. This is not the case today as each organisation creates its own guidelines; there is no consensus on how clinical ethics committees or consultations should be conducted. Support systems that are public in nature are needed to protect patients' rights and freedoms in medical care.


Assuntos
Tomada de Decisão Clínica , Médicos , Ética Médica , Liberdade , Humanos , Japão , Direitos do Paciente
17.
Cuad Bioet ; 31(102): 167-182, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32910670

RESUMO

In this paper present, from a bioethical perspective, a reflection on how to reconcile efforts to combat the COVID-19 pandemic with the safeguard of human rights. To do this, I develop three points. First, the regulatory framework that justifies the restriction or suspension of rights in the face of serious threats to public health. Second, the declarations of the international bioethics committees on the way in which human rights should be protected during public health crisis. And third, a review of the main rights threatened both by the public health crisis and by the means adopted to combat it. Before going into each of these points, I offer a preliminary note to clarify certain legal concepts and underline the need to overcome disjunctive approaches in considering human rights.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis/legislação & jurisprudência , Direitos Humanos/ética , Pandemias/prevenção & controle , Saúde Pública/ética , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Comissão de Ética , União Europeia , Liberdade , Recursos em Saúde/ética , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde/ética , Direitos Humanos/legislação & jurisprudência , Humanos , Pandemias/ética , Pandemias/legislação & jurisprudência , Direitos do Paciente/ética , Direitos do Paciente/legislação & jurisprudência , Autonomia Pessoal , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Saúde Pública/legislação & jurisprudência , Quarentena/ética , Quarentena/legislação & jurisprudência , Sujeitos da Pesquisa , Alocação de Recursos/ética , Espanha , UNESCO
18.
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
19.
Clin Ter ; 171(5): e401-e406, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32901782

RESUMO

INTRODUCTION: The study in question starts from a general analysis of Law n. 219/2017 and then to deepen the patient's right to self-determination, which is exercised through the expression of an informed consent to medical therapy. The analysis refers in particular to the patient's decision-making autonomy, the professional autonomy of the doctor and his consequent responsibility. MATERIALS AND METHODS: This study examines the art. 5 of the Law n. 219/2017, where the Legislator has defined the theme of shared planning of care. The authors compare the Advance Treatment Provisions (Article 4 - Law No. 219/2017) and the Shared Care Planning, to then examine the emerging relationship of care between doctor and patient. RESULT: The relationship of care must be related to the patient's willingness to decide on his future and to the technical and scientific information that the doctor is required to give. CONCLUSION: In conclusion, the Authors highlight the innovative content of the shared care plan, emphasizing the importance for a patient suffering from a chronic and progressive disease to be actively involved in formulating their own therapeutic plan.


Assuntos
Consentimento Livre e Esclarecido/legislação & jurisprudência , Direitos do Paciente/legislação & jurisprudência , Humanos , Itália , Administração dos Cuidados ao Paciente , Participação do Paciente , Autonomia Pessoal
20.
Oncology (Williston Park) ; 34(8): 295, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32785921

RESUMO

In this issue of ONCOLOGY, the interview with Tanios S. Bekaii-Saab, MD, raises some interesting questions on next-generation sequencing (NGS) testing. In this interview, he says that NGS testing should be done at diagnosis for all patients with GI cancer, and this is no longer a privilege but a patient's right. Although I agree with the basic premise that NGS will give us the greatest amount of information in a single test, I think this statement needs a little more consideration.


Assuntos
Neoplasias , Medicina de Precisão , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Direitos do Paciente
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA