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4.
Cuad. bioét ; 31(103): 423-427, sept.-dic. 2020.
Artigo em Espanhol | IBECS | ID: ibc-200031

RESUMO

La interacción entre los médicos y las compañías farmacéuticas ha sido y es habitual, se produce de múltiples formas y ha demostrado, en muchos casos, ser necesaria para el desarrollo de la medicina. Sin embargo, algunas de las técnicas de venta de la industria farmacéutica no son éticamente admisibles y pueden comprometer la independencia de los médicos. Se plantea un dilema ético a partir de un caso real en el que la búsqueda de la vulnerabilidad en la prescripción a partir de una donación por parte de una compañía farmacéutica no fue fácil de identificar


The interaction between doctors and pharmaceutical companies has been and is common, occurs in multiple ways and has proven, in many cases, to be necessary for the development of medicine. However, some of the sales techniques of the pharmaceutical industry are not ethically acceptable and can compromise the independence of physicians. An ethical dilemma arises from a real case in which the search for vulnerability in prescription based on a donation by a pharmaceutical company was not easy to identify


Assuntos
Humanos , Doações/ética , Indústria Farmacêutica/ética , Prescrições de Medicamentos , Ética Médica , Publicidade de Medicamentos , Conflito de Interesses , Médicos/ética , Instalações de Saúde/ética
8.
J Med Ethics ; 46(11): 732-735, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32958693

RESUMO

A recent update to the Geneva Declaration's 'Physician Pledge' involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of COVID-19, pockets exist in every country with different viral expressions. In the Chareidi ('ultra-orthodox') religious community, for example, rates of COVID-19 transmission and dissemination are above average compared with other communities within the same countries. While viral spread in densely populated communities is common during pandemics, several reasons have been suggested to explain the blatant flouting of public health regulations. It is easy to fault the Chareidi population for their proliferation of COVID-19, partly due to their avoidance of social media and internet aversion. However, the question remains: who is to blame for their community crisis? The ethical argument suggests that from a public health perspective, the physician needs to reach out and share medical knowledge with the community. The public's best interests are critical in a pandemic and should supersede any considerations of cultural differences. By all indications, therefore, the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, non-maleficence, utilitarian ethics as well as social, procedural and distributive justice. This includes the ethical duty to reduce health disparities and convey the message that individual responsibility for health has repercussions within the context of broader social accountability. Creative channels are clearly demanded for this ethical challenge, including measured medical paternalism with appropriate cultural sensitivity in physician community outreach.


Assuntos
Educação em Saúde/ética , Obrigações Morais , Pandemias/ética , Médicos/ética , Papel Profissional , Responsabilidade Social , Acesso à Informação , Beneficência , Betacoronavirus , Códigos de Ética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Competência Cultural , Cultura , Teoria Ética , Equidade em Saúde , Promoção da Saúde/ética , Humanos , Internet , Pandemias/prevenção & controle , Paternalismo , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia , Saúde Pública/ética , Religião , Justiça Social
9.
Philos Ethics Humanit Med ; 15(1): 7, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32900388

RESUMO

BACKGROUND: Normally, physicians understand they have a duty to treat patients, and they perform accordingly consistent with codes of medical practice, standards of care, and inner moral motivation. In the case of COVID-19 pandemic in a developing country such as Bangladesh, however, the fact is that some physicians decline either to report for duty or to treat patients presenting with COVID-19 symptoms. At issue ethically is whether such medical practitioners are to be automatically disciplined for dereliction of duty and gross negligence; or, on the contrary, such physicians may legitimately claim a professional right of autonomous judgment, on the basis of which professional right they may justifiably decline to treat patients. METHODS: This ethical issue is examined with a view to providing some guidance and recommendations, insofar as the conditions of medical practice in an under-resourced country such as Bangladesh are vastly different from medical practice in an industrialized nation such as the USA. The concept of moral dilemma as discussed by philosopher Michael Shaw Perry and philosopher Immanuel Kant's views on moral appeal to "emergency" are considered pertinent to sorting through the moral conundrum of medical care during pandemic. RESULTS: Our analysis allows for conditional physician discretion in the decision to treat COVID-19 patients, i.e., in the absence of personal protective equipment (PPE) combined with claim of duty to family. Physicians are nonetheless expected to provide a minimum of initial clinical assessment and stabilization of a patient before initiating transfer of a patient to a "designated" COVID-19 hospital. The latter is to be done in coordination with the national center control room that can assure admission of a patient to a referral hospital prior to ambulance transport. CONCLUSIONS: The presence of a moral dilemma (i.e., conflict of obligations) in the pandemic situation of clinical care requires institutional authorities to exercise tolerance of individual physician moral decision about the duty to care. Hospital or government authority should respond to such decisions without introducing immediate sanction, such as suspension from all clinical duties or termination of licensure, and instead arrange for alternative clinical duties consistent with routine medical care.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Obrigações Morais , Pandemias , Médicos/ética , Pneumonia Viral , Recusa do Médico a Tratar/ética , Bangladesh , Humanos , Autonomia Profissional
10.
Tex Med ; 116(8): 38-40, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32866276

RESUMO

Under Texas law, physicians treating COVID-19 patients in a volunteer capacity have potential defenses against lawsuits that might arise from that care. But for non-volunteer physicians on the COVID battlefield - often working in harrowing, overloaded settings, high on patient count and low on equipment - the same liability shields don't exist. And with a resurgence in COVID-19 cases and hospitalizations taking hold in June, the Texas Medical Association continued its pandemic-long push to extend liability protections to all frontline physicians, volunteer or not.


Assuntos
Infecções por Coronavirus , Responsabilidade Legal , Pandemias , Administração dos Cuidados ao Paciente , Médicos , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Seguro de Responsabilidade Civil/legislação & jurisprudência , Determinação de Necessidades de Cuidados de Saúde , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/legislação & jurisprudência , Administração dos Cuidados ao Paciente/métodos , Médicos/ética , Médicos/legislação & jurisprudência , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Texas/epidemiologia , Voluntários/legislação & jurisprudência
12.
AIDS Rev ; 22(2): 123-124, 2020 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-32628222

RESUMO

The unprecedented COVID-19 pandemic has risen a number of clinical situations where the principles of the medical act, the singularity of the patient-physician relationship and the need for revitalizing the medical vocation have all become at front line. Original articles, viewpoints, and perspectives addressing these aspects have appeared in major medical journals. Never before but perhaps with AIDS in the eighties, a disease awakened such feelings of commitment in medicine. Herein, we discuss some of these very sensitive issues for physicians that emerged during the past months of global COVID-19 crisis.


Assuntos
Tomada de Decisão Clínica/ética , Alocação de Recursos para a Atenção à Saúde/ética , Pandemias/ética , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Ética Médica , Humanos , Unidades de Terapia Intensiva , Casas de Saúde , Papel do Médico , Relações Médico-Paciente , Médicos/ética , Médicos/psicologia , Pneumonia Viral/epidemiologia , Respiração Artificial , Identificação Social , Estresse Psicológico/psicologia , Triagem/ética
19.
BMJ ; 369: m1505, 2020 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-32461201

RESUMO

OBJECTIVE: To investigate the nature and extent of financial relationships between leaders of influential professional medical associations in the United States and pharmaceutical and device companies. DESIGN: Cross sectional study. SETTING: Professional associations for the 10 costliest disease areas in the US according to the US Agency for Healthcare Research and Quality. Financial data for association leadership, 2017-19, were obtained from the Open Payments database. POPULATION: 328 leaders, such as board members, of 10 professional medical associations: American College of Cardiology, Orthopaedic Trauma Association, American Psychiatric Association, Endocrine Society, American College of Rheumatology, American Society of Clinical Oncology, American Thoracic Society, North American Spine Society, Infectious Diseases Society of America, and American College of Physicians. MAIN OUTCOME MEASURES: Proportion of leaders with financial ties to industry in the year of leadership, the four years before and the year after board membership, and the nature and extent of these financial relationships. RESULTS: 235 of 328 leaders (72%) had financial ties to industry. Among 293 leaders who were medical doctors or doctors of osteopathy, 235 (80%) had ties. Total payments for 2017-19 leadership were almost $130m (£103m; €119m), with a median amount for each leader of $31 805 (interquartile range $1157 to $254 272). General payments, including those for consultancy and hospitality, were $24.8m and research payments were $104.6m-predominantly payments to academic institutions with association leaders named as principle investigators. Variation was great among the associations: median amounts varied from $212 for the American Psychiatric Association leaders to $518 000 for the American Society of Clinical Oncology. CONCLUSIONS: Financial relationships between the leaders of influential US professional medical associations and industry are extensive, although with variation among the associations. The quantum of payments raises questions about independence and integrity, adding weight to calls for policy reform.


Assuntos
Conflito de Interesses/economia , Indústrias/economia , Médicos/economia , Sociedades Científicas/economia , Consultores/estatística & dados numéricos , Estudos Transversais , Indústria Farmacêutica/economia , Equipamentos e Provisões/economia , Humanos , Indústrias/ética , Indústrias/organização & administração , Liderança , Avaliação de Resultados em Cuidados de Saúde , Médicos/ética , Médicos/organização & administração , Sociedades Científicas/organização & administração , Sociedades Científicas/tendências , Estados Unidos/epidemiologia , United States Agency for Healthcare Research and Quality/organização & administração
20.
Acta bioeth ; 26(1): 81-90, mayo 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1114601

RESUMO

Doctor moral hazard has a significant effect on the doctor-patient relationship, increases the cost of healthcare, and introduces medical risks. It is a global concern. Doctor moral hazard behaviour is evolving in response to China's healthcare reform program which was inaugurated in 2009.A scientific understanding of doctor behaviour would facilitate the prevention and control of doctor moral hazard behaviour. This study used the principles and methodology of Glaser and Strauss's grounded theory. Theoretical and snowball samplings were used to identify 60 subjects. Semi-structured in-depth interviews were conducted with each subject. Themes were identified through substantial (open) coding and theoretical coding. Six types of doctor moral hazard behaviour were extracted from the data. A behavioural model was described and diagrammed to provide a conceptual framework of current doctor moral hazard behaviour. The conceptual model of doctor moral hazard behaviour can be used in several ways to correct or prevent undesirable actions. Rules governing hospital procedures can be strengthened and enforced by supervision and punishment; the asymmetry of information between doctor and patient can be reduced; patient participation in treatment decisions can be increased; the effectiveness of medical ethics education can be improved.


Para un médico, el riesgo moral tiene un efecto significativo en la relación médico-paciente, incrementa el costo de la atención de salud e introduce riesgos en la salud. Se trata de una preocupación global. El riesgo moral del comportamiento médico ha evolucionado en respuesta al programa de reforma de atención de salud del gobierno de China, inaugurado en 2009. Un entendimiento científico del comportamiento de los médicos facilitaría la prevención y el control del riesgo moral. El presente estudio usa los principios y metodología de la teoría fundamentada de Glaser y Strauss. Se usaron muestras teóricas y multiplicativas para identificar 60 sujetos y realizar entrevistas semiestructuradas en profundidad. Los temas se identificaron mediante codificación sustancial abierta y teórica. De los datos se extrajeron seis tipos de riesgo moral del comportamiento médico. Se describió y diagramó un modelo de comportamiento para proporcionar una estructura conceptual del riesgo moral del comportamiento médico actual. El modelo conceptual de riesgo moral del comportamiento médico puede usarse de varias maneras para corregir o prevenir acciones no deseadas. Las normas procedimentales de los hospitales pueden fortalecerse y exigirse mediante supervisión y castigo; se puede reducir la asimetría de la información que se da entre el médico y el paciente, incrementar la participación del paciente en decisiones de tratamiento y mejorar la efectividad en la educación en ética médica.


Risco moral médico tem um efeito significativo na relação médico-paciente, aumenta o custo dos cuidados à saúde e introduz riscos médicos. É uma preocupação global. Comportamento de risco moral médico vem se desenvolvendo em resposta ao programa de reforma de cuidados à saúde da China, que se iniciou em 2009. Uma compreensão científica do comportamento médico facilitaria a prevenção e controle do comportamento de risco moral médico. Este estudo utilizou os princípios da metodologia da Teoria Fundamentada de Glaser e Strauss. Amostragem teóricas e por bola de neve foram utilizadas para identificar 60 participantes. Entrevistas detalhadas semi-estruturadas foram realizadas com cada participante. Temas foram identificados através de codificação (aberta) substancial e codificação teórica. Seis tipos de comportamento de risco moral médico foram obtidos dos dados. Um modelo comportamental foi descrito e diagramado de forma a fornecer um enquadre conceitual do comportamento de risco moral médico. O modelo conceitual de comportamento de risco moral médico pode ser utilizado de diversas formas para corrigir ou prevenir ações indesejáveis. Regras que governam procedimentos em hospitais podem ser fortalecidas e reforçadas por supervisão e punição; a assimetria de informações entre médicos e pacientes pode ser reduzida; a participação dos pacientes nas decisões sobre tratamento pode ser aumentada; e a efetividade da educação ética médica pode ser melhorada.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Médicos/psicologia , Reforma dos Serviços de Saúde , Moral , Relações Médico-Paciente , Médicos/ética , Padrões de Prática Médica , Comportamentos Relacionados com a Saúde , China , Comportamento de Escolha , Risco , Entrevistas como Assunto , Teoria Fundamentada , Sobremedicalização
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