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1.
HEC Forum ; 33(1-2): 73-90, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33587216

RESUMO

The Covid-19 pandemic has presented major challenges to society, exposing preexisting ethical weaknesses in the modern social fabric's ability to respond. Distrust in government and a lessened authority of science to determine facts have both been exacerbated by the polarization and disinformation enhanced by social media. These have impaired society's willingness to comply with and persevere with social distancing, which has been the most powerful initial response to mitigate the pandemic. These preexisting weaknesses also threaten the future acceptance of vaccination and contact tracing, two other tools needed to combat epidemics. Medical ethicists might best help in this situation by promoting truth-telling, encouraging the rational adjudication of facts, providing transparent decision-making and advocating the virtue of cooperation to maximize the common good. Those interventions should be aimed at the social level. The same elements of emphasizing cooperation and beneficence also apply to the design of triage protocols for when resources are overwhelmed. A life-stages approach increases beneficence and reduces harms. Triage should be kept as simple and straightforward as reasonably possible to avoid unwieldly application during a pandemic.


Assuntos
/prevenção & controle , Eticistas , Pandemias/prevenção & controle , Papel Profissional , Comportamento Cooperativo , Tomada de Decisões/ética , Humanos , Alocação de Recursos/ética , Triagem/ética , Revelação da Verdade/ética
2.
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
3.
PLoS One ; 15(9): e0239046, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941496

RESUMO

The increasing recidivism rate of sex offenders indicates potential problems in existing recidivism programs. The present study was conducted to determine whether the polygraph examination is a useful technique to obtain a sex offender's concealed past sexual history. We collected fifty-two sex offenders' data and analyzed it. Among the 52 participants, the court ordered 26 sex offenders to take the psychiatric evaluation and the polygraph test. The other half were prisoners at the hospital who were currently undergoing treatment. The participants in the polygraph group disclosed more deviant sexual behaviors and paraphilia interests/behaviors than the comparison group. Thus, the polygraph examination is a powerful tool that can encourage sex offenders to disclose hidden information to help create suitable psychological therapy programs for preventing recidivism in the future.


Assuntos
Detecção de Mentiras/psicologia , Reincidência/prevenção & controle , Delitos Sexuais/psicologia , Adulto , Criminosos/psicologia , Humanos , Masculino , Transtornos Parafílicos/diagnóstico , Transtornos Parafílicos/psicologia , Prisioneiros/psicologia , Comportamento Sexual/psicologia , Revelação da Verdade/ética
4.
Sex., salud soc. (Rio J.) ; (35): 237-259, maio-ago. 2020.
Artigo em Português | LILACS | ID: biblio-1139637

RESUMO

Resumo Um importante dispositivo do poder médico pode ser caracterizado pela atitude paternalista frente ao paciente, estabelecendo uma relação assimétrica na qual o médico possui o conhecimento necessário para definir o melhor para o paciente. A bioética busca minimizar essa assimetria através da ideia de que o paciente possui o direito de consentir sobre as intervenções que serão (ou não) realizadas em seu corpo. Porém, uma situação comum para algumas especialidades médicas é o recurso da mentira terapêutica. O presente artigo busca refletir sobre o uso da mentira terapêutica a partir da análise de um caso viés etnográfico. A análise realizada evidencia a mentira terapêutica enquanto um desdobramento do ocultamento da morte e do morrer. Além disto, possibilita a reflexão sobre o processo de apagamento da capacidade de autonomia e de consentimento entre idosos como resultado da individualidade e da independência enquanto valores fundamentais para a sociedade moderna contemporânea.


Abstract An important device of medical power can be characterized by the paternalistic attitude towards the patient, establishing an asymmetric relationship in which the doctor has the necessary knowledge to define the best for the patient. Bioethics seeks to minimize this asymmetry through the idea that the patient has the right to consent to interventions that will be (or not) performed on their body. However, a common situation for some medical specialties is the use of therapeutic lying. This article reflects on the use of therapeutic lying based on the analysis of an ethnographic bias case. The analysis carried out shows the therapeutic lie as an unfolding from the concealment of death and dying. In addition, it enables reflection on the process of erasing the capacity for autonomy and consent among the elderly as a result of individuality and independence as fundamental values for modern contemporary society.


Resumen Un dispositivo importante de poder médico puede caracterizarse por la actitud paternalista hacia el paciente, estableciendo una relación asimétrica en la que el médico tiene los conocimientos necesarios para definir lo mejor para el paciente. La bioética busca minimizar esta asimetría a través de la idea de que el paciente tiene derecho a consentir las intervenciones que se realizarán (o no) en su cuerpo. Sin embargo, una situación común para algunas especialidades médicas es el uso de la mentira terapéutica. Este artículo busca reflexionar sobre el uso de la mentira terapéutica a partir del análisis de un caso de sesgo etnográfico. El análisis realizado muestra la mentira terapéutica como un despliegue del encubrimiento de la muerte y el morir. Además, permite reflexionar sobre el proceso de borrado de la capacidad de autonomía y consentimiento de las personas mayores como resultado de la individualidad y la independencia como valores fundamentales para la sociedad contemporánea moderna.


Assuntos
Humanos , Idoso de 80 Anos ou mais , Terapêutica , Revelação da Verdade/ética , Bioética , Idoso Fragilizado , Estado Terminal , Paternalismo , Relações Médico-Paciente , Envelhecimento , Cuidados Paliativos na Terminalidade da Vida , Autonomia Pessoal , Ética Médica , Consentimento Livre e Esclarecido
10.
Rev. bioét. derecho ; (48): 23-39, mar. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192076

RESUMO

La comunicación es una competencia que no desarrollamos suficientemente en la práctica médica. Una mala comunicación puede dañar la relación con la familia y las personas a nuestro cargo, además de crear confusión, ansiedad y desconfianza en el equipo asistencial. Debemos ser capaces de dar a la familia la información de un modo que puedan asimilar y estimular para que nos pregunten con confianza todo aquello que no comprendan. Existen pautas para desarrollar nuestras competencias comunicativas: desarrollando empatía, cuidando el entorno, usando un lenguaje comprensible y veraz. El uso de estas pautas nos puede llevar a tener éxito en nuestros objetivos de comunicación: confianza, soporte emocional, entender el diagnóstico y pronóstico, ayuda en la toma de decisiones. La comunicación de malas noticias, entre ellas la comunicación de la limitación de tratamientos de soporte vital (LTSV), pone de relieve la gran importancia de comunicar adecuadamente. Es importante apoyarse en soporte escrito, como el que se encuentra disponible en la web del grupo de trabajo de la Sociedad Española de Medicina Intensiva y Unidades Coronarias (SEMICYUC). La información es un deber de los profesionales y así está contemplado en la ley, en el código ético y en los indicadores de calidad de la SEMICYUC


Communication is a competence that we do not develop sufficiently in medical practice. Poor communication can damage the relationship with family and caregivers, and create confusion, anxiety and distrust in the healthcare team. We must be able to give the family information in a way that they can assimilate and encourages them to ask us confidently about anything they do not understand. There are guidelines to develop our communication skills: developing empathy, taking care of the environment, using a comprehensible and truthful language. The use of these guidelines can lead us to succeed in our communication objectives: confidence, emotional support, understanding the diagnosis and prognosis, help in decision making. The communication of bad news, including the communication of the Limitation of Advanced Life Support Treatment (LLST) highlights the importance of communicating properly. It is important to rely on written support, such as that available on the website of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) working group. Information is a duty of professionals and this is contemplated in the law, in the code of ethics, and the quality indicators of the SEMICYUC


La comunicació en la pràctica mèdica és una competència que no desenvolupem prou. Una mala comunicació pot danyar la relació amb la família I les persones al nostre càrrec, a més de crear confusió, ansietat I desconfiança en l'equip assistencial. Hem de ser capaços de donar a la família la informació d'una manera que puguin assimilar I estimular perquè ens preguntin amb confiança tot allò que no comprenguin. Existeixen pautes per a desenvolupar les nostres competències comunicatives: desenvolupant empatia, cuidant l'entorn, usant un llenguatge comprensible I veraç. L'ús d'aquestes pautes ens pot portar a tenir èxit en els nostres objectius de comunicació: confiança, suport emocional, entendre el diagnòstic I pronòstic, ajuda en la presa de decisions. La comunicació de males notícies, entre elles la comunicació de la limitació de tractaments de suport vital (LTSV), posa de relleu la gran importància de comunicar adequadament. És important recolzar-se en el suport escrit, com el que es troba disponible en la web del grup de treball de la Societat Espanyola de Medicina Intensiva I Unitats Coronàries (SEMICYUC). La informació és un deure dels professionals I així està contemplat en la llei, en el codi ètic I en els indicadors de qualitat de la SEMICYUC


Assuntos
Humanos , Comunicação , Confidencialidade/ética , Relações Profissional-Paciente/ética , Unidades de Terapia Intensiva/ética , Competência Profissional , Revelação da Verdade/ética
12.
PLoS One ; 15(1): e0227585, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923918

RESUMO

Disclosure of patient safety incidents is a healthcare management strategy that primarily involves responding after incidents. We investigated the association between nursing students' moral sensitivity, attitudes about patient safety, and perceptions of open disclosure of patient safety incidents in Korea. Data were collected from 407 nursing students at four nursing universities using self-reported moral sensitivity, attitudes about patient safety, and perceptions about open disclosure of patient safety incidents as measures. The data were analyzed using t-test, one-way analysis of variance, and a multiple regression. As moral sensitivity and attitudes about patient safety improved, nursing students' perceptions regarding the open disclosure of patient safety incidents improved significantly. After controlling for gender, grade, and major satisfaction, the effect of changing attitudes about patient safety was greater than that of moral sensitivity for all perceptions of open disclosure. An education and intervention program is needed to improve nursing students' attitudes about patient safety and promote the open disclosure of patient safety incidents during undergraduate training.


Assuntos
Estudantes de Enfermagem/psicologia , Revelação da Verdade/ética , Adulto , Atitude , Atitude do Pessoal de Saúde , Estudos Transversais , Revelação , Feminino , Humanos , Masculino , Princípios Morais , Segurança do Paciente , República da Coreia , Inquéritos e Questionários , Universidades , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-31671746

RESUMO

In this commentary, we submit that the current emphasis of precision cancer screening and treatment (PCST) has been to provide and interpret the implications of "positive" screening results for those deemed to be at greatest risk for cancer or most likely to benefit from targeted treatments. This is an important, but proportionately small target group, regardless of the cancer context. Overlooked by this focus is the larger majority of those screened who receive "negative" results. We contend that for optimal dissemination of PCST, the complement of positive and negative results be viewed as an inseparable yin-yang duality with the needs of those who receive negative screening results viewed as important as those deemed to be at highest risk or derive targeted treatment benefit. We describe three areas where communication of negative PCST results warrant particular attention and research consideration: population-based family history screening, germline testing for hereditary cancer syndromes, and tumor testing for targeted cancer treatment decision-making. Without thoughtful consideration of the potential for negative results to have psychological and behavioral influences, there is a potential to create a "neglected majority". This majority may be inclined to misinterpret results, disseminate inaccurate information to family, dismiss the credibility of results, or become disillusioned with existing medical treatments.


Assuntos
Atitude Frente a Saúde , Detecção Precoce de Câncer/métodos , Neoplasias/diagnóstico , Neoplasias/terapia , Relações Profissional-Paciente , Revelação da Verdade , Detecção Precoce de Câncer/ética , Detecção Precoce de Câncer/psicologia , Testes Genéticos/ética , Testes Genéticos/métodos , Humanos , Terapia de Alvo Molecular/ética , Terapia de Alvo Molecular/métodos , Terapia de Alvo Molecular/psicologia , Neoplasias/genética , Neoplasias/psicologia , Relações Profissional-Paciente/ética , Medição de Risco , Revelação da Verdade/ética
16.
Cuad Bioet ; 30(100): 315-329, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31618593

RESUMO

Down Syndrome diagnosis communication has got serious ethical implications, since the aim thereof can be either eugenic or therapeutic. The purpose of this paper is, on the one hand, to highlight the fundamental role which sanitary proffesionals play in diagnosis communication and the subsequent decission of the mother. On the other, recommendations on the way to communicate a diagnosis are set out. Finally, in order to analize the state of play in Spain the results of a cross-sectional descriptive study with a sample of 352 mothers are exposed. In this study the mothers express, by means of a survey, their personal experiencies of how they have received the news. It is concluded that the communication of Down syndrome diagnosis can be improved in many aspects.


Assuntos
Síndrome de Down/diagnóstico , Mães/psicologia , Diagnóstico Pré-Natal/ética , Revelação da Verdade/ética , Aborto Eugênico/ética , Adulto , Atitude , Estudos Transversais , Tomada de Decisões , Síndrome de Down/embriologia , Síndrome de Down/prevenção & controle , Síndrome de Down/psicologia , Emoções , Feminino , Humanos , Recém-Nascido , Relações Médico-Paciente , Gravidez , Diagnóstico Pré-Natal/psicologia , Espanha , Valor da Vida
17.
Rev Gaucha Enferm ; 40: e20190017, 2019 Sep 16.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31531595

RESUMO

OBJECTIVE: To identify aspects that hinder or facilitate the work of nurses in primary health care when disclosing difficult news. METHOD: Qualitative, descriptive and exploratory study addressing 15 nurses from ten primary health care units located in the south of Brazil. Data were collected from February to April 2017, using a semi-structured interview. Interviews were audio-recorded and analyzed based on discourse analysis. RESULTS: The aspects that hinder communication include the demand for services; work organization; the characteristics of patients; and personal aspects. Facilitating aspects include privacy and being in the community. Also hindering or facilitating communication: the way the network functions and the staff; academic training; professional experience; personal aspects. CONCLUSION: This topic is seldom addressed during academic training and this lack of preparedness is one of the main barriers hindering the disclosure of difficult news. Hence, it is essential that teaching institutions establish a discussion regarding this topic.


Assuntos
Atitude do Pessoal de Saúde , Comunicação , Enfermeiras e Enfermeiros/psicologia , Atenção Primária à Saúde , Revelação da Verdade , Barreiras de Comunicação , Confidencialidade , Educação em Enfermagem , Ética em Enfermagem , Humanos , Atenção Primária à Saúde/ética , Privacidade , Pesquisa Qualitativa , Revelação da Verdade/ética
18.
J Pediatr Nurs ; 49: 1-9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398578

RESUMO

PURPOSE: The aim of this study was to explore the views of chronically-ill pediatric patients on medical errors and disclosure processes. DESIGN AND METHODS: Semi-structured, qualitative interviews were conducted with twenty pediatric patients. Participants comprised ten children (8-12 years) and ten adolescents (13-18 years). Multiple methods using qualitative approaches were applied to explore and elicit views on medical errors, disclosure and recommendations for patient safety. For the children, art and play-based methods along with visual aids and vignettes were used to facilitate discussion. Older participants predominantly engaged in discussing the issue of medical errors through an examination of vignettes representing levels of harm. RESULTS: Participants revealed a range of perspectives including a strong desire to be told of errors. While they wanted those responsible for the error to be held accountable, they acknowledged that everyone makes mistakes. Children's rights and participation in patient safety as well as the existence of secret errors emerged spontaneously through the data analysis. CONCLUSIONS: Chronically-ill children want to know about errors, from the person responsible for the error, and consider apologies and genuine remorse to be critical for coping. Children acknowledge that disclosure requires a case-by-case analysis. PRACTICE IMPLICATIONS: The results have implications for how we view disclosure processes with children and how to engage them in patient safety.


Assuntos
Atitude Frente a Saúde , Bem-Estar da Criança , Doença Crônica/terapia , Erros Médicos/psicologia , Segurança do Paciente , Revelação da Verdade/ética , Adaptação Psicológica , Adolescente , Fatores Etários , Canadá , Criança , Comportamento Infantil , Doença Crônica/psicologia , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Erros Médicos/estatística & dados numéricos , Relações Enfermeiro-Paciente , Participação do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Pesquisa Qualitativa , Medição de Risco , Fatores Sexuais , Inquéritos e Questionários
19.
J Med Ethics ; 45(12): 821-823, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31399496

RESUMO

Defined as patients who 'lack decision-making capacity and a surrogate decision-maker', the unrepresented (sometimes referred to as the 'unbefriended', 'isolated patients' and/or 'patients without surrogates') present a major quandary to clinicians and ethicists, especially in handling errors made in their care. A novel concern presented in the care of the unrepresented is how to address an error when there is seemingly no one to whom it can be disclosed. Given that the number of unrepresented Americans is expected to rise in the coming decades, and some fraction of them will experience a medical error, creating protocols that answer this troubling question is of the utmost importance. This paper attempts to begin that conversation, first arguing that the precarious position of unrepresented patients, particularly in regards to errors made in their care, demands their recognition as a vulnerable patient population. Next, it asserts that the ethical obligation to disclose error still exists for the unrepresented because the moral status of error does not change with the presence or absence of surrogate decision-makers. Finally, this paper concludes that in outwardly acknowledging wrongdoing, a clinician or team leader can alleviate significant moral distress, satisfy the standards of a genuine apology, and validate the inherent and equivalent moral worth of the unrepresented patient.


Assuntos
Erros Médicos/ética , Revelação da Verdade/ética , Populações Vulneráveis , Tomada de Decisões/ética , Humanos , Competência Mental
20.
Medicina (Kaunas) ; 55(8)2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31382540

RESUMO

Background and objectives: This study aimed to assess the level of HIV disclosure to children in sub-Saharan Africa as it relates to prevalence of disclosure, barriers, merits and demerits, timing of disclosure, and factors that promote parents and caregivers' decisions to disclose the information. Materials and Methods: A systematic literature search was performed using the following online databases: PubMed, Google Scholar, Web of Science, Scopus, and Embase, to obtain relevant articles on HIV disclosure to children in sub-Saharan Africa. The following search terms were used: "HIV" AND "Disclosure" AND "Sub-Saharan Africa" AND "Children". Results: A total of 18 articles were included in this systematic review. The studies on HIV status disclosure to children in sub-Saharan Africa included a total of 1343 HIV-positive children and 1879 caregiver/child or healthcare worker-child dyads, from the following countries: Ethiopia, South Africa, Ghana, Kenya, Cote d'Ivoire, Burundi, Cameroon, Democratic Republic of Congo, Uganda, Burkina Faso, and Zambia. The prevalence of HIV disclosure ranged from as low as 9% to 72%. Age was a major factor associated with disclosure. Conclusions: HIV status disclosure to children is quite low in sub-Saharan Africa. This is a result of multiple factors such as parents'/caregivers' fear of the child disclosing status to others, a lack of knowledge on how the disclosure should be made, and the assertion that the children are young and cannot withstand the psychological impact of diagnosis.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Revelação da Verdade/ética , Adolescente , África ao Sul do Saara/epidemiologia , Criança , Pré-Escolar , Feminino , Infecções por HIV/epidemiologia , Letramento em Saúde/normas , Humanos , Masculino , Estigma Social
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