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1.
Med Health Care Philos ; 22(1): 129-140, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30030748

RESUMO

Breast cancer screening aims to help women by early identification and treatment of cancers that might otherwise be life-threatening. However, breast cancer screening also leads to the detection of some cancers that, if left undetected and untreated, would not have damaged the health of the women concerned. At the time of diagnosis, harmless cancers cannot be identified as non-threatening, therefore women are offered invasive breast cancer treatment. This phenomenon of identifying (and treating) non-harmful cancers is called overdiagnosis. Overdiagnosis is morally problematic as it leads to overall patient harm rather than benefit. Further, breast cancer screening is offered in a context that exaggerates cancer risk and screening benefit, minimises risk of harm and impedes informed choice. These factors combine to create pathogenic vulnerability. That is, breast cancer screening exacerbates rather than reduces women's vulnerability and undermines women's agency. This paper provides an original way of conceptualising agency-supporting responses to the harms of breast cancer overdiagnosis through application of the concept of pathogenic vulnerability.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/ética , Programas de Rastreamento/ética , Sobremedicalização/prevenção & controle , Medicalização/ética , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Medicina Preventiva/ética , Procedimentos Desnecessários/ética , Saúde da Mulher/ética
2.
Med Health Care Philos ; 22(1): 119-128, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29951940

RESUMO

Is medicalization always harmful? When does medicine overstep its proper boundaries? The aim of this article is to outline the pragmatic criteria for distinguishing between medicalization and over-medicalization. The consequences of considering a phenomenon to be a medical problem may take radically different forms depending on whether the problem in question is correctly or incorrectly perceived as a medical issue. Neither indiscriminate acceptance of medicalization of subsequent areas of human existence, nor criticizing new medicalization cases just because they are medicalization can be justified. The article: (i) identifies various consequences of both well-founded medicalization and over-medicalization; (ii) demonstrates that the issue of defining appropriate limits of medicine cannot be solved by creating an optimum model of health; (iii) proposes four guiding questions to help distinguish medicalization from over-medicalization. The article should foster a normative analysis of the phenomenon of medicalization and contribute to the bioethical reflection on the boundaries of medicine.


Assuntos
Programas de Rastreamento/ética , Sobremedicalização/prevenção & controle , Medicalização/ética , Promoção da Saúde/ética , Humanos , Filosofia Médica , Medicina Preventiva/ética , Valores Sociais , Procedimentos Desnecessários/ética
3.
J Med Ethics ; 44(12): 830-834, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30154216

RESUMO

Many healthy volunteers choose to take part in Alzheimer's disease (AD) prevention studies because they want to know whether they will develop dementia-and what they can do to reduce their risk-and are therefore interested in learning the results of AD biomarker tests. Proponents of AD biomarker disclosure often refer to the personal utility of AD biomarkers, claiming that research participants will be able to use AD biomarker information for personal purposes, such as planning ahead or making important life decisions. In this paper, the claim that AD biomarkers have personal utility for asymptomatic individuals is critically assessed. It demonstrates that in the absence of clinical validity, AD biomarkers cannot have personal utility and do not serve research participants' autonomy. Over the next few years, many research groups will be confronted with participants' preferences to learn the results of AD biomarker tests. When researchers choose to make results available upon explicit request, they should ensure adequate information provision and education, notably on the uncertain clinical significance of AD biomarker information. Routine disclosure of AD biomarkers to cognitively unimpaired individuals in research settings cannot be justified with an appeal to the personal utility of AD biomarker information.


Assuntos
Doença de Alzheimer/diagnóstico , Pesquisa Biomédica/ética , Voluntários Saudáveis , Medicina Preventiva/ética , Doença de Alzheimer/prevenção & controle , Doença de Alzheimer/psicologia , Apolipoproteína E4/análise , Biomarcadores/análise , Revelação , Humanos
4.
J Med Ethics ; 44(10): 685-689, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29907579

RESUMO

Mobile health (mHealth) is rapidly being implemented and changing our ways of doing, understanding and organising healthcare. mHealth includes wearable devices as well as apps that track fitness, offer wellness programmes or provide tools to manage chronic conditions. According to industry and policy makers, these systems offer efficient and cost-effective solutions for disease prevention and self-management. While this development raises many ethically relevant questions, so far mHealth has received only little attention in medical ethics. This paper provides an overview of bioethical issues raised by mHealth and aims to draw scholarly attention to the ethical significance of its promises and challenges. We show that the overly positive promises of mHealth need to be nuanced and their desirability critically assessed. Finally, we offer suggestions to bioethicists to engage with this emerging trend in healthcare to develop mHealth to its best potential in a morally sound way.


Assuntos
Assistência à Saúde/tendências , Medicina Preventiva/tendências , Autocuidado/ética , Telemedicina , Bioética , Análise Custo-Benefício , Assistência à Saúde/economia , Assistência à Saúde/ética , Humanos , Medicina Preventiva/economia , Medicina Preventiva/ética , Autocuidado/economia , Telemedicina/economia , Telemedicina/ética , Telemedicina/tendências
6.
J Med Philos ; 43(1): 22-43, 2018 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-29342286

RESUMO

Advances in DNA sequencing technology open new possibilities for public health genomics, especially in the form of general population preventive genomic sequencing (PGS). Such screening programs would sit at the intersection of public health and preventive health care, and thereby at once invite and resist the use of clinical ethics and public health ethics frameworks. Despite their differences, these ethics frameworks traditionally share a central concern for individual rights. We examine two putative individual rights-the right not to know, and the child's right to an open future-frequently invoked in discussions of predictive genetic testing, in order to explore their potential contribution to evaluating this new practice. Ultimately, we conclude that traditional clinical and public health ethics frameworks, and these two rights in particular, should be complemented by a social justice perspective in order adequately to characterize the ethical dimensions of general population PGS programs.


Assuntos
Genômica/métodos , Direitos Humanos , Diagnóstico Pré-Natal/ética , Justiça Social/ética , Temas Bioéticos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Acesso aos Serviços de Saúde , Humanos , Princípios Morais , Acesso dos Pacientes aos Registros/ética , Medicina Preventiva/ética , Saúde Pública/ética
8.
Curr Opin Endocrinol Diabetes Obes ; 24(6): 418-423, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28885275

RESUMO

PURPOSE OF REVIEW: To review the recent ethical, legal, and social issues surrounding human reproduction involving germline genome editing. RECENT FINDINGS: Genome editing techniques, such as CRISPR/Cas9, have facilitated genetic modification in human embryos. The most likely purpose of germline genome editing is the prevention of serious genetic disease in offspring. However, complex issues still remain, including irremediable risks to fetuses and future generations, the role of women, the availability of alternatives, long-term follow-up, health insurance coverage, misuse for human enhancement, and the potential effects on adoption. Further discussions, a broad consensus, and appropriate regulations are required before human germline genome editing is introduced into the global society. SUMMARY: Before germline genome editing is used for disease prevention, a broad consensus must be formed by carefully discussing its ethical, legal, and social issues.


Assuntos
Edição de Genes/ética , Terapia Genética/ética , Mutação em Linhagem Germinativa , Medicina Preventiva/ética , Blastocisto , Sistemas CRISPR-Cas/genética , Criança , Doença/genética , Pesquisas com Embriões/ética , Terapia Genética/métodos , Humanos
9.
Gesundheitswesen ; 78(2): 71-5, 2016 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-26906530

RESUMO

An obligation to be healthy in the sauce of a categorical imperative "You shall change your life!" (P. Sloterdijk) does not exist. There is however a moral responsibility to shape ones own life in such a way that the resulting potentials for development can be realized within one owns possibilities (I. Kant). The example of predictive medicine illustrates, why the right not to know can be a responsible way of self governance when dealing with the knowledge of modern biomedicine. This allows the setting of limits within prevention, which preserve the quality of life of the exposed as well as enabling the individual the "acceptance of self" (R. Guardini).


Assuntos
Ética Médica , Promoção da Saúde/ética , Planejamento de Assistência ao Paciente/ética , Relações Médico-Paciente/ética , Medicina Preventiva/ética , Responsabilidade Social , Alemanha , Papel do Médico , Serviços Preventivos de Saúde/ética
10.
Health (London) ; 20(3): 274-90, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-25956917

RESUMO

The field of population and public health ethics (PPHE) has yet to fully embrace the generation of evidence as an important project. This article reviews the philosophical debates related to the 'empirical turn' in clinical bioethics, and critically analyses how PPHE has and can engage with the philosophical implications of generating empirical data within the task of normative inquiry. A set of five conceptual and theoretical issues pertaining to population health that are unresolved and could potentially benefit from empirical PPHE approaches to normative inquiry are discussed. Each issue differs from traditional empirical bioethical approaches, in that they emphasize (1) concerns related to the population, (2) 'upstream' policy-relevant health interventions - within and outside of the health care system and (3) the prevention of illness and disease. Within each theoretical issue, a conceptual example from population and public health approaches to HIV prevention and health promotion is interrogated. Based on the review and critical analysis, this article concludes that empirical-normative approaches to population and public health ethics would be most usefully pursued as an iterative project (rather than as a linear project), in which the normative informs the empirical questions to be asked and new empirical evidence constantly directs conceptualizations of what constitutes morally robust public health practices. Finally, a conceptualization of an empirical population and public health ethics is advanced in order to open up new interdisciplinary 'spaces', in which empirical and normative approaches to ethical inquiry are transparently (and ethically) integrated.


Assuntos
Pesquisa Empírica , Política de Saúde , Saúde da População , Medicina Preventiva/ética , Saúde Pública/ética , Bioética , Infecções por HIV/terapia , Promoção da Saúde/ética , Promoção da Saúde/organização & administração , Humanos , Medicina Preventiva/organização & administração
11.
J Med Ethics ; 41(11): 914-6, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26340912

RESUMO

The innovative field of Regenerative Medicine (RM) is expected to extend the possibilities of prevention or early treatment in healthcare. Increasingly, clinical trials will be developed for people at risk of disease to investigate these RM interventions. These individuals at risk are characterised by their susceptibility for developing clinically manifest disease in future due to the existence of degenerative abnormalities. So far, there has been little debate about the ethical appropriateness of including such individuals at risk in clinical trials. We discuss three main challenges of selecting this participant model for testing RM interventions: the challenge of achieving a proportional risk-benefit balance; complexities in the trial design in terms of follow-up and sample size; and the difficulty of obtaining informed consent due to the many uncertainties. We conclude that selecting the model is not ethically justifiable for first-in-man trials with RM interventions due to the high risks and uncertainties. However, the model can be ethically appropriate for testing the efficacy of RM interventions under the following conditions: interventions should be low risk; the degenerative abnormalities (and other risk factors) should be strongly related with disease within a short time frame; robust preclinical evidence of efficacy needs to be present; and the informed consent procedure should contain extra safeguards with regard to communication on uncertainties.


Assuntos
Ensaios Clínicos como Assunto/ética , Seleção de Pacientes/ética , Medicina Preventiva , Prevenção Primária , Medicina Regenerativa , Humanos , Consentimento Livre e Esclarecido/ética , Obrigações Morais , Medicina Preventiva/ética , Prevenção Primária/ética , Medicina Regenerativa/ética , Medição de Risco , Incerteza
13.
Nutr Clin Pract ; 28(5): 543-55, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24046190

RESUMO

The purpose of this article is to present the application of patient-centered care and clinical ethics into nutrition practice, illustrate the process in a case study, and promote change in the current healthcare clinical ethics model. Nutrition support clinicians have an opportunity to add another dimension to their practice with the incorporation of patient-centered care and clinical ethics. This represents a culture change for healthcare professionals, including nutrition support clinicians, patients and their family. All of these individuals are stakeholders in the process and have the ability to modify the current healthcare system to improve communication and facilitate a change by humanizing nutrition support practice. Nutrition support is a medical, life-sustaining treatment, and the use of this therapy requires knowledge by the nutrition support clinician of patient-centered care concepts, preventive clinical ethics, religion/spirituality and cultural diversity, palliative care team role, and advance care planning. Integrating these into the practice of nutrition support is an innovative approach and results in new knowledge that requires a change in the culture of care and engagement and empowerment of the patient and their family in the process. This is more than a healthcare issue; it involves a social/family conversation movement that will be enhanced by the nutrition support clinician's participation.


Assuntos
Ética Clínica , Assistência Centrada no Paciente/ética , Pessoal de Saúde/ética , Humanos , Estado Nutricional , Apoio Nutricional/ética , Cuidados Paliativos/ética , Medicina Preventiva/ética , Assistência Terminal/ética
17.
Cuad Bioet ; 23(78): 323-36, 2012.
Artigo em Espanhol | MEDLINE | ID: mdl-23130746

RESUMO

The debate over compulsory or merely recommended vaccination remains open, albeit latent, in those countries that have mandatory vaccine schedules. Despite the advantages of preventive immunization from the point of medical, economic and social features, it's clear, in the current status of medical ethics, that the exercise of patient autonomy calls for personal responsibility in the election of treatments and, in fact, the vaccines. Therefore, it is necessary to change the simple idea of prevention as <>, characteristic of a <> in order to pass to a preventative medicine concept that will be able to support the achievement of moral attitudes towards achieving the good <> for the individual and for the community. This is only possible from a <> wherever is possible to present an alternative between mandatory vs. recommendation from the concept of <> that, with the help of a series of measures, could combine the effective protection for the whole community with the responsible exercise of the personal autonomy.


Assuntos
Responsabilidade Social , Vacinação/ética , Altruísmo , Atitude Frente a Saúde , Humanos , Imunidade Coletiva , Programas Obrigatórios/ética , Programas Obrigatórios/legislação & jurisprudência , Motivação , Aceitação pelo Paciente de Cuidados de Saúde , Autonomia Pessoal , Medicina Preventiva/ética , Medicina Preventiva/legislação & jurisprudência , Saúde Pública , Recusa de Participação/ética , Recusa de Participação/legislação & jurisprudência , Comportamento de Redução do Risco , Valores Sociais , Vacinação/legislação & jurisprudência , Vacinação/tendências , Vacinas/efeitos adversos
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