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2.
Bull Hist Med ; 93(3): 305-334, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31631069

RESUMO

Situated on the intersection of medicine and religion, postmortem caesarean sections exposed ideological boundaries in nineteenth-century medicine. According to clerical guidelines circulating in Catholic territories, Catholics who had not necessarily received medical training had to perform operations on deceased women in the absence of medical staff. Most doctors, on the other hand, objected to surgical interventions by unqualified Catholics. This article uses the Belgian debates about the postmortem caesarean section as a means to investigate methods of negotiation between liberal and Catholic doctors. The article analyzes, first, how doctors incorporated religious concerns such as baptism in the medical profession. Second, physicians' strategies to come to a compromise in ideologically diverse settings are examined. Overall, this article casts light on the dynamics of medical debate in times of both ideological rapprochement and polarization.


Assuntos
Catolicismo/história , Cesárea/história , Religião e Medicina , Bélgica , Cesárea/ética , Feminino , História do Século XIX , Humanos , Médicos/ética , Médicos/história
3.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31597691

RESUMO

Social media pervades all aspects of our lives. In medicine, it has changed the ways that patients and parents get health information, advocate for particular treatments for themselves and their children, and raise money for expensive treatments. In this Ethics Rounds, we present a case in which the use of social media seemed to cross the boundaries of acceptable professionalism. What should the ground rules be for doctors who are tempted to give medical opinions online about patients whom they have never seen?


Assuntos
Ética Médica , Médicos/ética , Profissionalismo/ética , Encaminhamento e Consulta/ética , Mídias Sociais/ética , Adolescente , Humanos , Relações Interprofissionais/ética , Masculino
4.
Schmerz ; 33(5): 466-470, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31478143

RESUMO

Since the adoption of the law of March 6, 2017, any German physician can prescribe medical cannabis flowers and cannabis-based magistral and finished medicinal products. No specific indications for prescriptions are provided in the law. The statutory health insurance companies bear the costs once an application for cost coverage has been approved by the Medical Service of the Health Funds. The German associations of psychiatry (child, adolescents, and adults), neurology, palliative care, addictology, and pain medicine are watching these developments in the media, politics, and medical world with concern due to: the option to prescribe cannabis flowers despite the lack of sound evidence and against the recommendations of the German Medical Association; the lack of distinction between medical cannabis flowers and cannabis-based magistral and finished medical products; the indiscriminately positive reports on the efficacy of cannabis-based medicines for chronic pain and mental disorders; the attempts by the cannabis industry to influence physicians; the increase in potential indications by leaders of medical opinion paid by manufacturers of cannabis-based medicines. The medical associations make the following appeal to journalists: To report on the medical benefits and risks of cannabis-based medicines in a balanced manner. To physicians: to prescribe cannabis-based medicines with caution; to prefer magistral and finished medicinal products over cannabis flowers. To politicians: to consider data according to the standards of evidence-based medicine when making decisions and provide financial support for medical research into cannabis-based medicines.


Assuntos
Cannabis , Dor Crônica , Seguro Saúde , Jornalismo , Maconha Medicinal , Política , Padrões de Prática Médica , Dor Crônica/tratamento farmacológico , Alemanha , Humanos , Seguro Saúde/ética , Seguro Saúde/normas , Maconha Medicinal/uso terapêutico , Médicos/ética , Médicos/normas , Padrões de Prática Médica/ética , Padrões de Prática Médica/normas
5.
Perspect Biol Med ; 62(3): 401-413, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31495788

RESUMO

"Conscience clauses" define conscience as "religious beliefs" or "moral convictions," and they come up, therefore, usually in relation to women's reproductive rights. This article argues that conscience is better understood as a feeling of integrity, rightness, and self, and that we need it especially now, as huge corporations take over health care. After an illustrative story, the author reviews the history of patients' rights and also the health-care consumer movement, which introduced the idea that health care is a commodity, and the doctor, therefore, simply a tradesman, whose duty is to provide what his patient wants. The author examines where this new commercial model of medicine leads: patients demanding treatments that are bad for them and expensive for the health-care system; doctors who are forced to do what they think is wrong; a world where patients cannot trust their physicians to do their best for them. Patients need their doctors to have consciences. But in this time of expanding corporate power in health care, can the right to have a conscience also be a Trojan horse? Protecting corporate entities who legally are also entitled to have a conscience? The author proposes that the most powerful rule of conscience is the oldest, the Hippocratic oath's formulation that doctors should enter the exam room solely for the benefit of their patients. When the definition of "benefit" comes into question, then we should use the strategies developed over the past 45 years-shared decision making, ethics committees, media oversight-all of which will become ever more important as technology creates ever new dilemmas for conscience.


Assuntos
Consciência , Relações Médico-Paciente/ética , Médicos/ética , Aborto Induzido/ética , Anticoncepção/ética , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Princípios Morais , Gravidez
6.
Perspect Biol Med ; 62(3): 414-433, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31495789

RESUMO

While conscience in medicine has been a source of debate for decades, the role of conscience in medical training remains largely unexamined. Insofar as conscience is addressed, trainees are typically urged to avoid practices that will conflict with their internal moral codes, refer to practitioners who will provide such practices, or even consider leaving the profession. This essay considers Lauris Kaldjian's articulation of two rival definitions of conscience: conscience as mere private and idiosyncratic moral belief, or conscience as a fundamental capacity for moral reasoning, akin to good clinical judgment. The authors propose that these definitions reflect two rival conceptions of medicine-medicine as product, or medicine as moral practice-and argue that the latter definition is vital to understanding both the purposed nature of medicine and the role of the conscience within that purpose. The authors conclude that because medicine is fundamentally moral and the conscience is the capacity for moral reasoning, medical education is essentially a training in conscience. Therefore, neglecting or disparaging conscience in medical training will have serious consequences for the future of trainees and the practice of medicine alike.


Assuntos
Consciência , Educação Médica , Médicos/ética , Educação Médica/ética , Humanos
7.
Perspect Biol Med ; 62(3): 519-526, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31495795

RESUMO

There is much to admire in Lauris Kaldjian's explication of conscience and its uses for medical practitioners. Yet his claim that conscience is the final and best assessment of moral judgments is flawed, because it diminishes the influence of moral reasoning that balances and often corrects conscience. Skepticism about conscientious judgments is an important feature of ethics. Kaldjian's close linkage of conscience with moral integrity blunts the necessary recognition that one's conscience can be mistaken. His defense of physician refusals to refer patients gives insufficient weight to the idea that patients' actions in seeking services may also reflect conscientious judgments. Analyses of cases near the end of this essay present no problems with respecting physicians' conscientious refusals to provide services themselves, but they also mostly leave moral room for physicians to make referrals. Examination of these cases suggests other ways to resolve moral conflicts than recourse to one's conscience.


Assuntos
Consciência , Médicos/ética , Ética Médica , Humanos , Princípios Morais , Relações Médico-Paciente
8.
Perspect Biol Med ; 62(3): 527-542, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31495796

RESUMO

Medical professionals have a duty to prioritize patient needs and well-being, even when doing so is deemed distasteful or unpleasant. This does not mean, however, that such professionals are obliged to provide medical interventions when participation threatens their core moral integrity. Myriad state and federal "conscience clause" statutes and regulations have codified such protections, but in a way that makes it too easy to claim exemption. This essay argues that, given professional obligations and systemic power asymmetries, the burden of proof falls upon professionals to show that participation in the requested service represents a genuine threat to their integrity, as opposed to being merely offensive or economically disadvantageous. It concludes with a suggested mechanism for determining whether the exemption request is justified.


Assuntos
Recusa Consciente em Tratar-se , Obrigações Morais , Relações Médico-Paciente/ética , Humanos , Programas Obrigatórios/ética , Programas Obrigatórios/legislação & jurisprudência , Militares/legislação & jurisprudência , Médicos/ética
9.
Perspect Biol Med ; 62(3): 543-559, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31495797

RESUMO

Lauris Kaldjian defends conscientious objection against opponents who claim that there is no place for a physician's personal moral beliefs in the practice of medicine. This essay argues that Kaldjian's defense of conscientious objection relies on a controversial "thick" conception of conscience that opponents may justifiably question. It offers a defense that relies on a relatively "thin" conception of conscience as an agent's core moral beliefs and that understands conscience-based refusals to provide medical services as refusals based on those core beliefs. Enabling physicians to practice medicine without compromising their moral integrity is an important pro tanto reason to accommodate physicians who conscientiously object to providing medical services. However, giving due consideration to the professional obligations of physicians requires constraints on accommodation. Accommodation should not: (1) impede a patient's timely access to relevant information; (2) impede a patient's timely access to referral and counselling; (3) impede a patient's timely access to medical services that are consistent with prevailing professional standards; (4) enable physicians to practice invidious discrimination; (5) place an excessive burden on other health professionals and institutions; or (6) authorize physicians to unilaterally decide to forgo life-sustaining treatment against the wishes of patients or surrogates.


Assuntos
Princípios Morais , Relações Médico-Paciente/ética , Médicos/ética , Atitude do Pessoal de Saúde , Consciência , Recusa Consciente em Tratar-se/ética , Dissidências e Disputas , Humanos , Obrigações Morais , Sociedades Médicas , Suicídio Assistido/ética , Suicídio Assistido/legislação & jurisprudência , Estados Unidos
10.
Perspect Biol Med ; 62(3): 560-575, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31495798

RESUMO

Disputes about conscientious refusals reflect, at root, two rival accounts of what medicine is for and what physicians reasonably profess. On what we call the "provider of services model," a practitioner of medicine is professionally obligated to provide interventions that patients request so long as the interventions are legal, feasible, and are consistent with well-being as the patient perceives it. On what we call the "Way of Medicine," by contrast, a practitioner of medicine is professionally obligated to seek the patient's health, objectively construed, and to refuse requests for interventions that contradict that profession. These two accounts coexist amicably so long as what patients want is for their practitioners to use their best judgment to pursue the patient's health. But conscientious refusals expose the fact that the two accounts are ultimately irreconcilable. As such, the medical profession faces a choice: either suppress conscientious refusals, and so reify the provider of services model and demoralize medicine, or recover the Way of Medicine, and so allow physicians to refuse requests for any intervention that is not unequivocally required by the physician's profession to preserve and restore the patient's health.


Assuntos
Relações Médico-Paciente/ética , Atitude do Pessoal de Saúde , Consciência , Recusa Consciente em Tratar-se , Dissidências e Disputas , Feminino , Humanos , Masculino , Médicos/ética , Suicídio Assistido/ética
11.
J Bioeth Inq ; 16(3): 309-321, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31297690

RESUMO

The Arab and Islamic world is in cultural, political and ethical flux. Pressures of globalisation contend with ancient ideas and concepts that permeate cultural frameworks. Health professionals are among the many groups battling to accommodate the rapidly changing conditions. In many predominantly Muslim countries intense debates are underway among clinicians about the impact of the forces of change on their practices. To help understand these forces we conducted a study of the experiences of clinicians in the Hashemite Kingdom of Jordan, a Middle Eastern nation state where the overwhelming majority of the population is Muslim. The sample contained 508 doctors and doctors-in-training, of whom 63% were male and 80% were younger than 40 years of age. It included both a quantitative survey, covering a wide range of issues, and qualitative, free-text written responses. Our results demonstrated high levels of disquiet related to the overall organisation and administration of the health care system, the specific content of ethical decisionmaking, and the impact of changing social, cultural and religious factors. Concerns included overcrowding, widespread corruption and hierarchical, non- democratic, management practices, and tensions relating to traditional and modern approaches to ethics, especially in relation to consent, organ donation, confidentiality, privacy, abortion, and the role of women. The roles of religion and religious authorities, the relative importance of the family, and community and tribal obligations were also areas of contention. The study exposes profound divisions and widely differing perspectives among Jordanian doctors and an abiding sense of uncertainty and instability within the profession. Many doctors express ambivalence in relation to both modern trends and traditional precepts. Three main axes of ethical contention were demonstrated, relating to the tensions between: "conservative" and "pragmatic" styles of decision-making; "traditional" approaches and internationalised standards of ethics; and the role of Islam and pressures to disengage ethical decision- making from religious authority. We speculate that these issues and divisions, and the deep sense of disquiet revealed by our data reflect large-scale forces to which Jordanian society is exposed and to a substantial degree may provide a way to understand the ethical predicament of many other countries in the contemporary Arab world.


Assuntos
Tomada de Decisões/ética , Ética Clínica , Islamismo , Médicos/ética , Médicos/psicologia , Religião e Medicina , Adulto , Idoso , Temas Bioéticos , Feminino , Hospitais/ética , Humanos , Jordânia , Masculino , Pessoa de Meia-Idade , Mudança Social , Inquéritos e Questionários , Incerteza , Adulto Jovem
12.
Perspect Biol Med ; 62(2): 273-300, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281122

RESUMO

Recent events, including the arrest of physicians in Michigan, have renewed bioethical debates surrounding the practice of female genital cutting (FGC). The secular discourse remains divided between zero-tolerance activists and harm-reduction strategists, while Islamic bioethical debates on FGC similarly comprise two camps. "Traditionalists" find normative grounds for a minor genital procedure in statements from the Prophet Muhammad and in classical law manuals. "Reformers" seek to decouple FGC from Islam by reexamining its ethico-legal status in light of the deficiencies within narrations ascribed to the Prophet, the health risks posed by FGC, and contemporary perspectives on human rights, and thereby delegitimize the practice. This paper argues that alignment between secular and Islamic views can be found in a harm-reduction strategy by demonstrating that the impetus to reduce harms is found within Prophetic statements on FGC. From an Islamic ethico-legal standpoint, it is justified to acknowledge the permitted status of FGC procedures that do not harm-in other words, the ritual nick-and at the same time the prohibited status of procedures that lead to credible medical and psychological harms. Bringing these multiple perspectives and data points into conversation forges a common ground to delegitimize and eradicate harmful genital procedures among Muslim communities.


Assuntos
Circuncisão Feminina/ética , Circuncisão Feminina/métodos , Islamismo , África , Circuncisão Feminina/estatística & dados numéricos , Feminino , Humanos , Consentimento Livre e Esclarecido , Médicos/ética , Opinião Pública , Abstinência Sexual , Organização Mundial da Saúde
14.
J Assist Reprod Genet ; 36(9): 1779-1780, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31346918

RESUMO

In this unique time of technological advancement in medicine and the culture of public discourse that surrounds it, trainees in obstetrics and gynecology require more intensive education in medical ethics to appropriately guide patient decision-making and to become more responsible voices in such an ethically complex field.


Assuntos
Ginecologia , Obstetrícia , Médicos/ética , Medicina Reprodutiva/educação , Medicina Reprodutiva/ética , Currículo , Tomada de Decisões , Educação Médica , Feminino , Ginecologia/educação , Ginecologia/ética , Humanos , Obstetrícia/educação , Obstetrícia/ética , Gravidez
15.
N Z Med J ; 132(1499): 64-71, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31352476

RESUMO

After five decades of restrictive laws, New Zealand is on the cusp of law reform that may result in abortion being treated as a health, rather than a criminal, matter. Given this possible liberalisation, a pressing issue is the way in which 'conscientious objection' (CO) will be accommodated within the new legislative landscape. In this context, CO constitutes a health provider refusing, on the grounds of personal conscience, to provide care that, although legal and potentially clinically appropriate, conflicts with their personal moral views. Currently, New Zealand law permits significant concessions for conscientious objectors. This paper argues that in the light of current reform, the justification for permitting CO should be revisited. It claims that even if it is conceded that some form of CO should be respected, a pragmatic compromise must be adopted so that both provider's and women's rights are sufficiently protected. We argue that the current legal situation in New Zealand is unbalanced, favouring the rights of providers at the expense of women's timely access to abortion care. At a minimum, providers with a CO should be required to ensure an indirect referral to another provider who is willing to refer the woman to abortion services.


Assuntos
Aborto Induzido , Atitude do Pessoal de Saúde , Médicos , Encaminhamento e Consulta , Direitos da Mulher , Feminino , Humanos , Nova Zelândia , Médicos/ética , Médicos/psicologia , Ética Baseada em Princípios , Profissionalismo/ética
16.
Australas Psychiatry ; 27(5): 441-443, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31179722

RESUMO

OBJECTIVE: In inpatient forensic settings, a psychiatrist is expected to wear 'Two Hats', as a treating physician and as an expert to provide risk assessments and expert advice to the judicial authorities for leave and release decisions. Although dual roles have long been accepted as an inevitable part of independent forensic practice, there are additional ethical challenges for the treating psychiatrist to provide an expert opinion. This paper examines the specific ethical ambiguities for a treating psychiatrist at the interface of legal process related to leave and release decisions in the treatment of forensic patients. CONCLUSIONS: While respect for justice is the prevailing ethical paradigm for court-related forensic work, the medical paradigm should remain the key ethical framework for psychiatrists in treatment settings. Thus, psychiatrist should be aware of possible adverse consequences in acting as forensic experts for their patients. A conscientious adherence to clinical facts and awareness of the 'Two Hats' ethical pitfall can serve as important reference points in framing the psychiatric evidence in the decision-making process and safeguard treating psychiatrist's role.


Assuntos
Psiquiatria Legal/ética , Psiquiatria Legal/legislação & jurisprudência , Transtornos Mentais/terapia , Pessoas Mentalmente Doentes/legislação & jurisprudência , Médicos/ética , Médicos/legislação & jurisprudência , Humanos , Medição de Risco/legislação & jurisprudência
18.
J Bone Joint Surg Am ; 101(11): e50, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31169583

RESUMO

BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) Open Payments public database, resulting from the Physician Payments Sunshine Act of 2010, was designed to increase transparency of physicians' financial relationships with pharmaceutical manufacturers. We compared physician-reported conflict-of-interest (COI) disclosures in journal articles with this database to determine any discrepancies in physician-reported disclosures. METHODS: COIs reported by authors from 2014 through 2016 were analyzed in 3 journals: Foot & Ankle International (FAI), The Journal of Bone & Joint Surgery (JBJS), and The Journal of Arthroplasty (JOA). Payment information in the CMS Open Payments database was cross-referenced with each author's disclosure statement to determine if a disclosure discrepancy was present. RESULTS: We reviewed 3,465 authorship positions (1,932 unique authors) in 1,770 articles. Within this sample, 7.1% of authorships had a recorded undisclosed COI (disclosure discrepancy), and 13.2% of articles had first and/or last authors with a disclosure discrepancy. Additionally, we saw a great variation in the percentage of authorships with disclosure discrepancies among the journals (JBJS, 2.3%; JOA, 3.6%; and FAI, 23.7%). CONCLUSIONS: Discrepancies exist between payment disclosures made by authors and those published in the CMS Open Payments database. Although the percentage of articles with these discrepancies varies widely among the journals that were analyzed in this study, no trend was found when analyzing the number of discrepancies over the 3-year period. CLINICAL RELEVANCE: COI disclosures are important for the interpretation of study results and need to be accurately reported. However, COI disclosure criteria vary among orthopaedic journals, causing uncertainty regarding which conflicts should be disclosed.


Assuntos
Conflito de Interesses , Revelação , Indústria Farmacêutica/ética , Ortopedia/ética , Médicos/ética , Bases de Dados Factuais , Humanos , Ortopedia/economia , Médicos/economia , Estados Unidos
19.
Phys Med Rehabil Clin N Am ; 30(3): 649-655, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31227139

RESUMO

Any physician who has authored an Independent Medical Evaluation or medical record review can and should anticipate being called as an expert witness (EW). Litigants rely on EW testimony in most civil cases. The most common areas in which EWs participate and provide opinions and testimony are workers' compensation, personal injury, and medical malpractice. This report will become part of the discovery process, the process by which a party to a lawsuit can obtain information from another party or other entities involved in the lawsuit.


Assuntos
Prova Pericial/legislação & jurisprudência , Médicos/legislação & jurisprudência , Conflito de Interesses/legislação & jurisprudência , Prova Pericial/ética , Humanos , Papel do Médico , Médicos/ética , Profissionalismo/legislação & jurisprudência
20.
Pak J Pharm Sci ; 32(2): 687-695, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31081784

RESUMO

Pharmaceutical drug promotion practices are found to have potentially controversial ethical standards. They may compromise on patient's wellbeing especially when it inordinately affects the clinical care and patient's interests by influencing the prescribing behavior of physicians. There is no proper system to keep a watch on the drug marketing and promotion strategies by the pharmaceuticals in Pakistan. A cross sectional study using a specially designed questionnaire and convenience sampling was conducted in Karachi for 6 months targeting prescribers and medical sales representative (MSRs). A total of 600 MSRs and prescribers consented to participate. 66% of MSRs highlighted that prescribers follow ethical prescribing but only (58%) seek evidence base behind promoted drug. This was contradictory to prescribers' response to same, which was 87%. Only (10%) of prescribers acknowledged demanding expensive gifts such as laptops, ACs, furniture and renovation of the clinic which was about 40% according to MSRs. This study offered intricate insights into the MSR and physicians interactions. It highlighted various aspects of these relationships from both MSRs' and prescribers' point of view. Although majority of the physicians negated the notion of expecting expensive favors from the sales representatives, responses by MSRs suggest that anticipation of gifts and incentives exists on part of the physicians. This has the potential to indulge in unethical promotion and irrational prescribing on part of MSRs and prescribers respectively that may further contribute to untoward patient outcomes such as increased treatment costs and adverse drug reactions.


Assuntos
Conflito de Interesses , Prescrições de Medicamentos , Marketing de Serviços de Saúde , Atitude do Pessoal de Saúde , Estudos Transversais , Indústria Farmacêutica , Doações , Humanos , Marketing de Serviços de Saúde/estatística & dados numéricos , Paquistão , Médicos/ética , Padrões de Prática Médica , Inquéritos e Questionários
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