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2.
Healthc Manage Forum ; 36(1): 61-63, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36510466

RESUMO

Impact Ethics (www.impactethics.ca) is a Canadian bioethics blog with a diversity of contributors who come from a range of backgrounds - from academics and clinicians to activists and concerned citizens. Our authors are also diverse with respect ethnicity, race, culture, and gender. We publish commentaries about ethical issues in healthcare that affect Canadians. As editors of the blog and as practicing healthcare ethicists, we make note of three crucial determinants of leadership in healthcare ethics. First, leadership in healthcare ethics requires building relationships with other leaders, including those who do not hold formal leadership roles. Second, it is essential for leaders to be open to learning new knowledge and to learning about new practices in healthcare ethics. Third, leaders must have an orientation towards the future, which means building capacity for healthcare ethics within their organizations. The Impact Ethics blog can be used to support each of these determinants of ethics leadership.


Assuntos
Bioética , Humanos , Canadá , Liderança , Eticistas , Atenção à Saúde
3.
Pediatr Blood Cancer ; 70(2): e30132, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36495529

RESUMO

As pediatric hematology/oncology (PHO) becomes more complex and sub-subspecialized, dedicated PHO ethicists have emerged as sub-subspecialists focused on addressing ethical issues encountered in clinical and research practices. PHO physicians and other clinicians with advanced training in bioethics contribute to the field through ethics research, education, and ethics consultation services. Furthermore, there exists a newer generation of PHO trainees interested in bioethics. This review details the experiences of current PHO ethicists, providing a blueprint for future educational, research and service activities to strengthen the trajectory of the burgeoning sub-subspecialty of PHO ethics. Creating an American Society of Pediatric Hematology/Oncology (ASPHO) ethics Special Interest Group, enhancing clinical ethics education for pediatric hematologists/oncologists (PHOs), developing multi-institutional research collaborations, and increasing attention to ethical issues germane to nonmalignant hematology will serve the interests of the entire field of PHO, enhancing the care of PHO patients and careers of PHOs.


Assuntos
Consultoria Ética , Hematologia , Humanos , Criança , Eticistas , Oncologia/educação , Hematologia/educação , Escolaridade
4.
Perspect Biol Med ; 65(4): 548-558, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36468383

RESUMO

Planet Earth and its growing human population are challenged by the health impacts of industrial policies that drive global emissions production and cause climate change. The health-care industry has capacity and responsibility to adopt environmentally sustainable policies and practices. Bioethicists have a responsibility to support environmental sustainability through their clinical, research, educational, and policy work. They communicate complex ideas to diverse stakeholders and can communicate similarly to improve understanding about emissions and the value of environmentally sustainable policy. A growing bioethics literature addresses climate change in collaboration with human and veterinary medicine and other disciplines. Pursuing environmental sustainability with the vigor that made autonomy a norm would help to reduce global emissions production in health care and make it a role model for other industries. Making environmental sustainability a health-care norm would be as significant an accomplishment as doing so for individual autonomy.


Assuntos
Bioética , Planetas , Humanos , Eticistas , Políticas , Escolaridade
5.
Perspect Biol Med ; 65(4): 559-568, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36468384

RESUMO

It may be too late to avoid the climate crisis, likely to be humanity's most expensive, widespread, and enduring catastrophe. This is a qualitatively different kind of catastrophe, in which increased costs, decreased revenue, and no possibility of bailout force communities to harshly cut budgets, especially in health care. Little is known about making such brutal cuts fair or efficient, nor how to help the public accept them. The crisis presents an opportunity for bioethicists to play a crucial role, but one for which traditional approaches are inherently inadequate. Although often dismissed as heartless, Garrett Hardin's "lifeboat ethics" started a conversation about making ethical choices in global disasters-where all options are painful and unacceptable-and may provide guidance. Bioethics during the climate crisis must focus on communities rather than individuals and help survivors grieve the terrible consequences. Because today's choices will affect many generations, with the burdens falling most heavily on poor communities, we have to construct a radical bioethics to help tomorrow's health care become green, efficient, and fair.


Assuntos
Bioética , Padrão de Cuidado , Humanos , Eticistas , Comunicação , Princípios Morais
6.
Perspect Biol Med ; 65(4): 569-585, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36468385

RESUMO

Many of humanity's most serious problems are global, intergenerational, and ecological, yet current institutions are poorly placed to confront such problems. In part, this institutional challenge reflects difficulties with our basic concepts and theories. Bioethics is a central area where such questions arise. Although some have argued for an environmentalized bioethics since its inception, biomedicine has thus far failed to embrace the challenge, and some accuse most bioethicists of being "asleep at the wheel" (Schenck and Churchill 2021). This paper discusses the basic ethical challenge, offers the "perfect moral storm" analysis, and explores one promising new concept for bioethics, planetary health, in light of that analysis. Drawing on the foundational report of the Rockefeller Foundation-Lancet Commission (Whitmee et al. 2015) and using climate change as the example, the author argues that planetary health has significant strengths but also some weaknesses, and that identifying both is helpful in charting a path forward for environmentalized bioethics.


Assuntos
Bioética , Princípios Morais , Humanos , Eticistas , Ocupações em Saúde
7.
Perspect Biol Med ; 65(4): 596-603, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36468387

RESUMO

Assumptions that bioethics was intended to focus only on a narrow set of issues related to research and health care are mistaken. The field of bioethics has long been focused on pressing contemporary issues, and it will play an unduly peripheral and less significant role than it could otherwise if it fails to focus on a broad set of issues, including human relations and the relationship of humans to nonhuman beings and the environment-and if it does not consider how to engage with others in addressing these issues. Bioethicists' traditional approaches, which emphasize an analytical role regarding values and goals, are important, but bioethicists also must include stakeholders in deliberations and consider how to translate goals into policy and practice.


Assuntos
Bioética , Eticistas , Humanos , Políticas
8.
Perspect Biol Med ; 65(4): 612-621, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36468389

RESUMO

Clinical ethics consultants bear witness to the direct harms of intersecting axes of oppression-such as racism and classism-as they impinge on elucidating and resolving ethical dilemmas in health care. Health Care Ethics Consultation (HCEC) professional guidance supports recognizing and analyzing power dynamics and social-structural obstacles to good care. However, the most relied upon bioethical principles in clinical ethics have been criticized for insufficiency in this regard. While individual ethics consultants have found ways to expand their approaches, they do so in an ad hoc way without frameworks to guide consistency. Motivated by the practical expertise of clinical ethicists, this essay offers a new framework to support openness to analyzing power imbalances and respecting marginalized voices and values. This framework is grounded in transformative justice, where the aim is to take responsibility for oppression by centering and responding to moral perspectives and value systems that are all too often silenced.


Assuntos
Consultoria Ética , Racismo , Humanos , Justiça Social , Eticistas , Princípios Morais
9.
Perspect Biol Med ; 65(4): 622-628, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36468390

RESUMO

Translational ethics is a practice that aims to apply bioethics insights and process to the real-world contexts of clinical medicine, but also government policy, systems issues, and public health. This work has been a career focus for a relatively small number of bioethicists over the years, but it has drawn greater attention due to the pandemic and a greater realization of the impact of health inequities and systemic injustice. This essay discusses the pathway, rewards, and challenges of translational bioethics as experienced by one bioethicist working with state and national groups on a range of translational ethics issues, often related to public health disasters. There is much remaining work to be done, and the goal of the essay is to encourage rising bioethicists to engage in translational bioethics.


Assuntos
Bioética , Desastres , Corrida , Humanos , Eticistas , Saúde Pública
10.
Perspect Biol Med ; 65(4): 654-663, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36468394

RESUMO

This essay explores how bioethics as a field, rather than as a collection of individual efforts by bioethicists working within it, can inform deliberation on matters of bioethical import that, for better or worse, are in the hands of civic processes. It is motivated by the repeal of a constitutional protection of abortion access in the Supreme Court Dobbs v. Jackson Women's Health Organization decision, which effectively returned abortion regulations to states rather than setting a baseline federal protection of abortion access up to fetal viability. Given the outsized role of local legislators in shaping health-care policy through legislation, about abortion as well as other health topics, the author proposes foundational bioethical education for legislators and considers two potential models for such education: one that operates on a clinical ethics consultation model, and one that mirrors bioethical coursework taught in traditional academic settings but modified for a legislator audience. Although both models present notable challenges requiring further conceptualization and problem-solving, overcoming these hurdles would enable bioethics to provide a service to civic learning and placemaking that would complement advocacy or lobbying efforts by individual bioethicists.


Assuntos
Aborto Induzido , Bioética , Gravidez , Feminino , Humanos , Escolaridade , Eticistas , Aprendizagem
11.
Perspect Biol Med ; 65(4): 664-671, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36468395

RESUMO

What more can be said about COVID-19 and the social determinants of health? This article describes neglected perspectives that derive from the history of social epidemiology, a field that identifies the social etiology of disease and variations in disease incidence among people differentially located in the social structure. The "discovery" of social determinants of diseases like COVID-19 is nothing new for epidemiology: debate over how to analyze structural determinants versus individual-level risk factors persisted throughout the 19th and 20th centuries. By the late 20th century, research had highlighted fundamental causes of health disparities, such as social conditions and structural racism; these are structural factors, embedded in the social fabric of life. Measurement of structured inequalities within systems faces complex and challenging problems, as research aims to better account for these lived realities at different levels of analysis and as multiple factors merge to influence outcomes (revealed in intersectionality theory). At each of these intersections, there are opportunities for bioethicists to consider their ethical implications. It is imperative to understand the social and ethical roots of our present conversations about health inequalities, in order to partner intelligently with researchers on the forefront of advocating for change.


Assuntos
COVID-19 , Eticistas , Humanos , Determinantes Sociais da Saúde , COVID-19/epidemiologia , Princípios Morais , Comunicação
12.
Perspect Biol Med ; 65(4): 672-679, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36468396

RESUMO

Bioethicists today are taking a greater role in the design and implementation of emerging technologies by "embedding" within the development teams and providing their direct guidance and recommendations. Ideally, these collaborations allow ethical considerations to be addressed in an active, iterative, and ongoing process through regular exchanges between ethicists and members of the technological development team. This article discusses a challenge to this embedded ethics approach-namely, that bioethical guidance, even if embraced by the development team in theory, is not easily actionable in situ. Many of the ethical problems at issue in emerging technologies are associated with preexisting structural, socioeconomic, and political factors, making compliance with ethical recommendations sometimes less a matter of choice and more a matter of feasibility. Moreover, incentive structures within these systemic factors maintain them against reform efforts. The authors recommend that embedded bioethicists utilize principles from behavioral science (such as behavioral economics) to better understand and account for these incentive structures so as to encourage the ethically responsible uptake of technological innovations.


Assuntos
Ciências do Comportamento , Bioética , Cefapirina , Humanos , Eticistas , Princípios Morais
13.
J Clin Ethics ; 33(4): 259-268, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36548230

RESUMO

A recently enacted law permits patients to see their electronic medical record (EMR) immediately after their careprovider writes in it. In this article I discuss a proposal that authors make in this issue of The Journal of Clinical Ethics, that ethics consultants (ECs) keep their notes in a separate section of the EMR that patients cannot access when their ethics notes may be troubling to patients, to avoid unduly harming them. I discuss this concern and three more widely applicable clinical goals: to help patients feel safe; to gain patients' trust; and to provide hope to patients, when possible. These goals apply to careproviders and ECs who seek to help patients and families resolve ethical conflicts. I explain why these goals are singularly important and how careproviders may pursue them, using as an example informing patients about temporal framing to help them find hope.


Assuntos
Eticistas , Consultoria Ética , Humanos , Ética Clínica , Emoções , Consultores
14.
J Clin Ethics ; 33(4): 314-322, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36548235

RESUMO

Tertiary healthcare ethics (HCE) consultation occurs when an HCE consultant at a healthcare facility requests guidance from one or more senior HCE consultants who are not members of that facility's HCE consultation service. Tertiary HCE consultants provide advanced HCE guidance and/or mentoring to facility (secondary) HCE consultants, mirroring healthcare consultation in clinical practice. In this article, we describe advantages and challenges of providing tertiary HCE consultation through a hub-and-spoke model administered by a national integrated HCE service.


Assuntos
Consultoria Ética , Humanos , Atenção Terciária à Saúde , Eticistas , Consultores
15.
BMC Med Ethics ; 23(1): 133, 2022 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-36494709

RESUMO

BACKGROUND: This study aims to quantitatively and qualitatively evaluate the activities of a Bioethics Unit (BU) 5 years since its implementation (2016-2020). The BU is a research unit providing empirical research on ethical issues related to clinical practice, clinical ethics consultation, and ethical education for health care professionals (HPS). METHODS: We performed an explanatory, sequential, mixed-method, observational study, using the subsequent qualitative data to explain the initial quantitative findings. Quantitative data were collected from an internal database and analyzed by descriptive analysis. Qualitative evaluation was performed by semi-structured interviews with 18 HPs who were differently involved in the BU's activities and analyzed by framework analysis. RESULTS: Quantitative results showed an extensive increment of the number of BU research projects over the years and the number of work collaborations with other units and wards. Qualitative findings revealed four main themes, concerning: 1. the reasons for contacting the BU and the type of collaboration; 2. the role of the bioethicist; 3. the impact of BU activities on HPs, in terms of developing deeper and more mature thinking; 4. the need to extend ethics support to other settings. Overall, our results showed that performing both empirical bioethics research and more traditional clinical ethics activities at the same unit would produce an impetus to increase collaboration and spread an 'ethical culture' among local HPs. CONCLUSIONS: Our findings contribute to a growing body of literature on the models of clinical ethics support services and the role of empirical research in bioethics internationally. They also prepare the ground for the implementation of a multidisciplinary Clinical Ethics Committee (CEC) that aims to support the BU's ethics consultation service within the local context.


Assuntos
Bioética , Consultoria Ética , Humanos , Eticistas , Ética Clínica , Hospitais
16.
Hastings Cent Rep ; 52(6): 33-43, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36537274

RESUMO

In pediatric health care, parents and clinicians sometimes have competing ideas of what should be done for a child. In this article, we explore the idea that notions of what should be done for a child partly depend on one's perception of one's role in the child's life and care. Although role-based appeals are common in health care, role-differentiated approaches to understanding parent-clinician conflicts are underexplored in the pediatric bioethics literature. We argue that, while the parental role is recognized as having social content or value, and sometimes legal force, it is not always recognized as having ethical content or value, as the clinician's role is. We draw together key insights from the normative and empirical literature on parental roles to show how a role-based lens might inform clinicians' and clinical ethicists' approach to cases in which parents and clinicians disagree.


Assuntos
Bioética , Tomada de Decisões , Humanos , Criança , Pais , Eticistas
17.
Hastings Cent Rep ; 52(6): 4-5, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36537271

RESUMO

Tiffany was seventeen when injury to her brain stem put her in the intensive care unit on life-sustaining treatment and in a permanently locked-in state-fully conscious but able to control no bodily movements other than her eye movements. As a clinical ethicist at the hospital, I was consulted by her neurologist, who had established a blink-once-for-yes, twice-for-no system of communication so that Tiffany could respond to questions. Her mother wanted Tiffany to continue receiving treatment that could prolong her life for years, potentially decades. In a meeting with the neurologist and family, I felt like suggesting what nobody seemed willing to suggest: that we should ask Tiffany what she wants.


Assuntos
Comunicação , Eticistas , Humanos , Feminino
18.
J Med Philos ; 47(5): 597-611, 2022 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-36409309

RESUMO

Recent debate among bioethicists concerns the potential to enhance human beings' physical or cognitive capacities by means of genetic, pharmacological, cybernetic, or surgical interventions. Between "transhumanists," who argue for unreserved enhancement of human capabilities, and "bioconservatives," who warn against any non-therapeutic manipulation of humanity's natural condition, lie those who support limited forms of enhancement for the sake of individual and collective human flourishing. Many scholars representing these views also share a concern over the status and interests of human beings with various types of cognitive and physical disabilities, some of which may be ameliorable by enhancement interventions. The question addressed in this paper is whether valuing the enhancement of human capabilities may be reconciled with valuing the existence and phenomenological experiences of human beings with various disabilities. Can we value enhanced capabilities without disvaluing those whose capabilities fall below a defined threshold of "normal function"? Furthermore, if certain forms of disability, particularly cognitive disabilities, negatively impact one's flourishing, could the enhancement of one's cognitive capacities through biotechnological means enhance one's flourishing.


Assuntos
Pessoas com Deficiência , Humanos , Eticistas
19.
Am J Bioeth ; 22(12): 30-33, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36416425
20.
Rev. bioét. derecho ; (56): 209-231, Nov. 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-210244

RESUMO

En la actualidad, la investigación en grandes simios ha dejado de realizarse en prácticamente todo el mundo. En este contexto, cabe preguntarse si es que ha llegado el tiempo de prohibir o restringir severamente la investigación con toda clase de primates no humanos. Una manera de abordar esta pregunta es evaluando si es que las razones que fueron esgrimidas—con éxito—en favor de restringir la investigación con grandes simios, pueden ser extendidas al caso de los demás primates no humanos. Teniendo como base una reciente revisión del debate sobre la restricción de la investigación con grandes simios (Aguilera, Perez Gomez, y DeGrazia, 2021), el presente artículo lleva a cabo esta tarea, analizando dominios de razones relacionados con el estatus moral, la ciencia, el bienestar animal, las actitudes de los expertos y el público, la conservación y el retiro de los primates, los costos financieros, y la atribución de respeto y derechos a los primates no humanos. De esta manera, se pretende iluminar el debate en torno a la restricción de la investigación con toda clase de primates no humanos, aportando herramientas estratégicas, persuasivas y filosóficas para quienes deseen avanzar en esta dirección.(AU)


En l'actualitat, la recerca en grans simis ha deixat de realitzar-se en pràcticament tothom. En aquest context, cal preguntar-se si és que ha arribat el temps de prohibir o restringir severament la recerca amb tota mena deprimats no humans. Una manera d'abordar aquesta pregunta és avaluant si és que les raons que van ser esgrimides—amb èxit—en favor de restringir la recerca amb grans simis, poden ser esteses al cas dels altres primats no humans. Tenint com a base una recent revisió del debat sobre la restricció de la recerca amb grans simis (Aguilera, Perez Gomez, i DeGrazia, 2021), el present article duu a terme aquesta tasca, analitzant dominis de raons relacionats amb l'estatus moral, la ciència, el benestar animal, les actituds dels experts i el públic, la conservació i el retir dels primats, els costos financers, i l'atribució de respecte i drets als primats no humans. D'aquesta manera, es pretén il·luminar el debat entorn de la restricció de la recerca amb tota classe de primats no humans, aportant eines estratègiques, persuasives i filosòfiques per qui desitgi avançar en aquesta direcció.(AU)


Currently, research on great apes has been phased out in practically all the world. In this context, the question arises as to whether it is time to ban or restrict research on all non-human primates. One way to address this question is to assess whether the reasons that were successfully put forward in favor of restricting research on great apes can be extended to other non-human primates. Based on a recent review of the debate on the restriction of research with great apes (Aguilera, Perez Gomez, y DeGrazia, 2021), the present article carriesout this task, analyzing domains of reasons related to moral status, science, animal welfare, attitudes of experts and the public, conservation and retirement of primates, financial costs, and the attribution of respect and rights to non-human primates. This way, the aim is to shed light on the debate around the restriction of research with all types of non-human primates, offering strategic, persuasive, and philosophical tools for those who would like to move forward in this direction.(AU)


Assuntos
Humanos , Primatas , Pesquisa Biomédica , Bem-Estar do Animal , Eticistas , Moral , Bioética , Princípios Morais , Ética
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