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2.
BMC Med Ethics ; 22(1): 36, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789633

RESUMO

BACKGROUND: Under COVID-19 pandemic, many organizations developed guidelines to deal with the ethical aspects of resources allocation. This study describes the results of an argument-based review of ethical guidelines developed at the European level. It aims to increase knowledge and awareness about the moral relevance of the outbreak, especially as regards the balance of equity and dignity in clinical practice and patient's care. METHOD: According to the argument-based review framework, we started our research from the following two questions: what are the ethical principles adopted by the ethical guidelines produced at the beginning of the COVID-19 outbreak related to resource allocation? And what are the practical consequences in terms of 'priority' of access, access criteria, management of the decision-making process and patient care? RESULTS: Twenty-two ethical guidelines met our inclusion criteria and the results of our analysis are organized into 4 ethical concepts and related arguments: the equity principle and emerging ethical theories; triage criteria; respecting patient's dignity, and decision making and quality of care. CONCLUSION: Further studies can investigate the practical consequences of the application of the guidelines described, in terms of quality of care and health care professionals' moral distress.


Assuntos
Guias como Assunto , Obrigações Morais , Respeito , Europa (Continente) , Humanos , Pandemias , Alocação de Recursos/ética
3.
J Clin Ethics ; 32(1): 35-37, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33656455

RESUMO

The excellent article by Daniel J. Benedetti, Mithya Lewis-Newby, Joan S. Roberts, and Douglas S. Diekema draws strength by dealing both with micro ethical (personal) and macro ethical (institutional policies and structures) considerations. One should further note that often, the macro factors are even stronger than the article implies, although individuals can affect the macro context. A particularly important macro factor for all matters concerning healthcare, indeed all human services, is the tension between the profit motive and ethical decisions.


Assuntos
Doenças Transmissíveis/terapia , Ética Institucional , Ética Profissional , Pandemias/ética , Pessoal de Saúde/ética , Humanos , Obrigações Morais
4.
Kennedy Inst Ethics J ; 31(1): 77-99, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33716228

RESUMO

What just societies owe to non-citizen immigrants is a controversial question. This paper considers three accounts of the requirements of distributive justice for non-citizens to determine what they might suggest about the provision of publicly funded health care to pregnant undocumented immigrants. These accounts are compared to locate an overlapping consensus on the duty of the state to provide care to pregnant undocumented immigrants. The aim of this paper is not to take a substantive position on the "right" prenatal policy, but rather to explore the moral space that this issue occupies and suggest that real moral progress can be achieved through the consistent application of shared values.


Assuntos
Financiamento Governamental/ética , Acesso aos Serviços de Saúde/economia , Serviços de Saúde Materna/economia , Imigrantes Indocumentados , Consenso , Feminino , Política de Saúde , Humanos , Obrigações Morais , Princípios Morais , Gravidez , Justiça Social , Problemas Sociais , Estados Unidos
7.
Hastings Cent Rep ; 51(1): 22-27, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33630324

RESUMO

The Covid-19 crisis has accelerated a trend toward burnout in health care workers, making starkly clear that burnout is especially likely when providing health care is not only stressful and sad but emotionally alienating; in such situations, there is no mental space for clinicians to experience authentic clinical empathy. Engaged curiosity toward each patient is a source of meaning and connection for health care providers, and it protects against sympathetic distress and burnout. In a prolonged crisis like Covid-19, clinicians provide care out of a sense of duty, especially the duty of nonabandonment. We argue that when duty alone is relied on too heavily, with fear and frustration continually suppressed, the risk of burnout is dramatically increased. Even before Covid-19, clinicians often worked under dehumanizing and unjust conditions, and rates of burnout were 50 percent for physicians and 33 percent for nurses. The Covid-19 intensification of burnout can serve as a wake-up call that the structure of health care needs to be improved if we are to prevent the loss of a whole generation of empathic clinicians.


Assuntos
Esgotamento Profissional/epidemiologia , Empatia , Obrigações Morais , Estresse Ocupacional/epidemiologia , Esgotamento Profissional/psicologia , Pessoal de Saúde/ética , Pessoal de Saúde/psicologia , Humanos , Estresse Ocupacional/psicologia , Estados Unidos
8.
Tex Med ; 117(2): 45-46, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33641122

RESUMO

It's no surprise that many physicians were among the more than 1.3 million confirmed COVID-19 cases in Texas last year. Texas Medicine spoke with three Texas physicians who contracted COVID-19 to learn how the disease affected them physically and impacted their outlook as caregivers.


Assuntos
/epidemiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional , Médicos , /transmissão , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Obrigações Morais , Texas/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-33435269

RESUMO

The aim of this article is to analyze how dignity and vulnerability, as declared principles of bioethics, both can be seen in a new light when they are thought of together, in their intertwining, in order to outline a proposal for an analytical framework for end-of-life care. It is thus shown, on the one hand, that the demand for respect for the equal dignity of every person, linked by the different anthropological and ethical theories to their autonomy as a rational agent, also refers to their fragile, vulnerable, and interdependent character, as an embodied subjectivity, sustained by a complex web of care. On the other hand, the vulnerability of these selves as others, constituted by the radical appeal of everything that affects them socially, emotionally, sensitively, and by their need for recognition and attention, would be pathological if it did not include the impulse towards autonomy, which, although precarious and connotative, requires dignified and equitable treatment. This intertwining of both principles points to a phenomenological conception of the person as a corporeal social existence, from which a number of studies on the attention to dignity and vulnerability at the end of life are analyzed.


Assuntos
Bioética , Assistência Terminal , Humanos , Obrigações Morais , Respeito
10.
J Card Fail ; 27(1): 126, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33402277
11.
HEC Forum ; 33(1-2): 45-60, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33449232

RESUMO

This paper introduces the model of Utilitarian Principlism as a framework for crisis healthcare ethics. In modern Western medicine, during non-crisis times, principlism provides the four guiding principles in biomedical ethics-autonomy, nonmaleficence, beneficence, and justice; autonomy typically emerges as the decisive principle. The physician-patient relationship is a deontological construct in which the physician's primary duty is to the individual patient and the individual patient is paramount. For this reason, we term the non-crisis ethical framework that guides modern medicine Deontological Principlism. During times of crisis, resources become scarce, standards of care become dynamic, and public health ethics move to the forefront. Healthcare providers are forced to work in non-ideal conditions, and interactions with individual patients must be considered in the context of the crisis. The COVID-19 pandemic has forced healthcare to shift to a more utilitarian framework with a greater focus on promoting the health of communities and populations. This paper puts forth the notion of Utilitarian Principlism as a framework for crisis healthcare ethics. We discuss each of the four principles from a utilitarian perspective and use clinical vignettes, based on real cases from the COVID-19 pandemic, for illustrative purposes. We explore how Deontological Principlism and Utilitarian Principlism are two ends of a spectrum, and the implications to healthcare as we emerge from the pandemic.


Assuntos
Bioética , Teoria Ética , Pandemias/ética , Relações Médico-Paciente/ética , Ética Baseada em Princípios , Beneficência , Humanos , Obrigações Morais , Autonomia Pessoal , Justiça Social/ética
12.
Acta Neurochir (Wien) ; 163(3): 593-598, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33469692

RESUMO

The COVID-19 pandemic has resulted in a widespread shortage of personal protective equipment (PPE). Many healthcare workers, including neurosurgeons, have expressed concern about how to safely and adequately perform their medical responsibilities in these challenging circumstances. One of these concerns revolves around the pressing question: should providers continue to work in the absence of adequate PPE? Although the first peak of the COVID-19 crisis seems to have subsided and supply of PPE has increased, concerns about insufficient PPE availability remain. Inconsistent supply, limited efficacy, and continued high demand for PPE, combined with the continued threat of a second COVID-19 wave, mean that the issues surrounding PPE availability remain unresolved, including a duty to work. This paper offers an ethical investigation of whether neurosurgeons should perform their professional responsibilities with limited availability of PPE. We evaluate ethical considerations and conflicting duties and thereby hope to facilitate providers in making a well-considered personal and moral decision about this challenging issue.


Assuntos
/prevenção & controle , Neurocirurgiões/ética , Saúde do Trabalhador/ética , Equipamento de Proteção Individual/provisão & distribução , Ética Médica , Pessoal de Saúde , Humanos , Obrigações Morais , Pandemias , Medição de Risco
13.
Am J Bioeth ; 21(4): 57-66, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33325811

RESUMO

Precision medicine relies on data and biospecimens from participants who willingly offer their personal information on the promise that this act will ultimately result in knowledge that will improve human health. Drawing on anthropological framings of the "gift," this paper contextualizes participation in precision medicine as inextricable from social relationships and their ongoing ethical obligations. Going beyond altruism, reframing biospecimen and data collection in terms of socially regulated gift-giving recovers questions of responsibility and care. As opposed to conceiving participation in terms of donations that elide clinical labor critical to precision medicine, the gift metaphor underscores ethical commitments to reciprocity and responsibility. This demands confronting inequities in precision medicine, such as systemic bias and lack of affordability and access. A focus on justice in precision medicine that recognizes the sociality of the gift is a critical frontier for bioethics.


Assuntos
Bioética , Medicina de Precisão , Altruísmo , Humanos , Obrigações Morais , Justiça Social , Responsabilidade Social
14.
Br Med Bull ; 137(1): 4-12, 2021 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-33367873

RESUMO

Vaccination decisions and policies present tensions between individual rights and the moral duty to contribute to harm prevention. This article focuses on ethical issues around vaccination behaviour and policies. It will not cover ethical issues around vaccination research. SOURCES OF DATA: Literature on ethics of vaccination decisions and policies. AREAS OF AGREEMENT: Individuals have a moral responsibility to vaccinate, at least against certain infectious diseases in certain circumstances. AREAS OF CONTROVERSY: Some argue that non-coercive measures are ethically preferable unless there are situations of emergency. Others hold that coercive measures are ethically justified even in absence of emergencies. GROWING POINTS: Conscientious objection to vaccination is becoming a major area of discussion. AREAS TIMELY FOR DEVELOPING RESEARCH: The relationship between individual, collective and institutional responsibilities to contribute to the public good of herd immunity will be a major point of discussion, particularly with regard to the COVID-19 vaccine.


Assuntos
/prevenção & controle , Política de Saúde , Vacinação/ética , Humanos , Obrigações Morais
15.
PLoS One ; 15(12): e0244767, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382835

RESUMO

BACKGROUND: With the emergence of new health information technologies, health information can be shared across networks, with or without patients' awareness and/or their consent. It is often argued that there can be an ethical obligation to participate in biomedical research, motivated by altruism, particularly when risks are low. In this study, we explore whether altruism contributes to the belief that there is an ethical obligation to share information about one's health as well as how other health care experiences, perceptions, and concerns might be related to belief in such an obligation. METHODS: We conducted an online survey using the National Opinion Research Center's (NORC) probability-based, nationally representative sample of U.S. adults. Our final analytic sample included complete responses from 2069 participants. We used multivariable logistic regression to examine how altruism, together with other knowledge, attitudes, and experiences contribute to the belief in an ethical obligation to allow health information to be used for research. RESULTS: We find in multivariable regression that general altruism is associated with a higher likelihood of belief in an ethical obligation to allow one's health information to be used for research (OR = 1.22, SE = 0.14, p = 0.078). Trust in the health system and in care providers are both associated with a significantly higher likelihood of believing there is an ethical obligation to allow health information to be used (OR = 1.48, SE = 0.76, p<0.001; OR = 1.58, SE = 0.26, p<0.01, respectively). CONCLUSIONS: Belief that there is an ethical obligation to allow one's health information to be used for research is shaped by altruism and by one's experience with, and perceptions of, health care and by general concerns about the use of personal information. Altruism cannot be assumed and researchers must recognize the ways encounters with the health care system influence (un)willingness to share one's health information.


Assuntos
Altruísmo , Atitude , Disseminação de Informação/ética , Obrigações Morais , Revelação da Verdade/ética , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Inquéritos e Questionários
16.
Wiad Lek ; 73(9 cz. 2): 2056-2061, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33148859

RESUMO

OBJECTIVE: The aim: The article is aimed at elucidating the prospects for the formation of universal ethical and legal standards in the work of medical workers in order to ensure the reproductive choice of a person according to the analysis of international documents, court practice of the ECHR, and the national legislation of individual European countries. PATIENTS AND METHODS: Materials and methods: Research materials include scientific developments of both domestic and Western theorists and human rights defenders in the field of medical law in the aspect of reproductive choice. The recommendations of the Center for Reproductive Rights in the USA, the World Health Organization, the United Nations, and the ECHR practices were of great importance. This article used the methods of searching, analyzing, organizing, and summarizing information. CONCLUSION: Conclusions: It is necessary to ensure the provision and guarantee of reproductive choice for everyone at the level of the Constitution. Given the public debate about the contradictions of individual manifestations of reproductive autonomy, it is proposed at the first stage of legal regulation to develop national principles and ethical standards for medical workers in this area.


Assuntos
Obrigações Morais , Direitos Sexuais e Reprodutivos , Europa (Continente) , Humanos , Princípios Morais
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
20.
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
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