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1.
J Clin Ethics ; 32(1): 3-12, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33656453

RESUMO

This article discusses how careproviders of all types can help people with differences of sexual development (DSD): people with ambiguous genitalia, who used to be referred to as intersexed. Careproviders may be in a unique position to benefit these people by offering to discuss difficult issues that concern them, even when the discussions are brief. Specific interventions include learning about people with DSD, whether through the literature or in the clinic; treating them with optimal respect; raising difficult topics such as sex, fertility, and social stigma; encouraging them and helping them to meet others with DSD; and sharing the strengths that we can see that they have. We have come far, but have a long way to go.


Assuntos
Tomada de Decisão Clínica/ética , Transtornos do Desenvolvimento Sexual/psicologia , Comportamento Sexual/psicologia , Desenvolvimento Sexual/fisiologia , Humanos , Estigma Social
2.
Medicine (Baltimore) ; 100(7): e24871, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607861

RESUMO

BACKGROUND: Idiopathic short stature (ISS) causes a high economic burden worldwide. As part of a research project that synthesizes economic evidence for Korean medicine treatment of ISS, we describe the methods that will be used for the comprehensive review of articles that analyze health-related economic evaluation for available interventions for ISS using a systematic review methodology. METHODS: Eight electronic English, Korean, and Chinese databases will be searched from their inception until December 2020 to identify studies on the economic evaluation of available interventions on ISS, without language, study design, or publication status restrictions. From the included studies, the effectiveness, utility, and cost data will be collected as the outcome measures by two researchers independently. Descriptive analysis of individual studies will be conducted. If it is judged that the interventions and outcomes of the included studies are sufficiently homogeneous, we will attempt a quantitative synthesis through meta-analysis using Review Manager version 5.4 software (Cochrane, London, UK). RESULTS: This study will summarize the evidence regarding the economic evaluation of available interventions for ISS. CONCLUSIONS: The findings of this review will help clinicians and patients in evidence-based decision-making in clinical settings and help policy makers develop effective policies and distribute resources based on the available evidence.


Assuntos
Análise Custo-Benefício/métodos , Nanismo/economia , Nanismo/terapia , Acupuntura/métodos , Pessoal Administrativo/legislação & jurisprudência , Tomada de Decisão Clínica/ética , Efeitos Psicossociais da Doença , Gerenciamento de Dados , Nanismo/epidemiologia , Feminino , Recursos em Saúde/provisão & distribução , Medicina Herbária/métodos , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , República da Coreia/epidemiologia
3.
Medicine (Baltimore) ; 100(6): e24657, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578594

RESUMO

BACKGROUND: Alzheimer's disease (AD) occurs in the elderly and the early stage of aging, with early clinical manifestations of memory impairment, cognitive impairment, behavioral change and decline in language function, etc., and eventually loss of the ability to live independently, requiring 24-hour care, and a variety of complications. However, these complications are the direct cause of death in AD patients. With the acceleration of the aging process of society, the incidence of AD is increasing year by year, seriously threatening the physical health and quality of life of the elderly. There are many ways to treat AD, however, moxibustion is especially popular in China. Therefore, our systematic review aims to evaluate the efficacy and safety of moxibustion in the treatment of ADand to provide reliable evidence for clinical decision-makers. METHODS: We will search electronic databases including PubMed, Embase, Cochrane Library, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database (WF), and China Scientific Journals Database (VIP) from inception to January 2021. Two authors will independently screen the studies, extract data information, and assess methodological quality through the Cochrane risk of bias (ROB) tool. The RevmanV.5.3 software will be used for statistical analysis. RESULTS: The results of this study will evaluate the current status of moxibustion therapy for AD, aiming to prove the effectiveness and safety of moxibustion therapy, and will be published in a peer-reviewed journal. CONCLUSION: This systematic review will provide a credible evidence-based for moxibustion in the treatment of AD. INPLASY REGISTRATION NUMBER: INPLASY202110021.


Assuntos
Terapia por Acupuntura/métodos , Doença de Alzheimer/terapia , Moxibustão/métodos , Terapia por Acupuntura/efeitos adversos , Idoso , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/psicologia , China/epidemiologia , Tomada de Decisão Clínica/ética , Gerenciamento de Dados , Feminino , Humanos , Incidência , Masculino , Moxibustão/efeitos adversos , Qualidade de Vida , Projetos de Pesquisa , Segurança , Resultado do Tratamento
5.
J Subst Abuse Treat ; 124: 108223, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33342667

RESUMO

COVID-19 necessitated rapid changes in methadone take-home policies in opioid treatment programs (OTPs); these changes markedly contrast with existing, long-standing federal mandates on OTP rules about take-home methadone. OTP providers describe how these changes have affected clinical decision-making, equity in patient care, and workflow. We also discuss implications for medical ethics and patient autonomy. We provide suggestions for future research that will examine the impact of COVID-19 on OTP treatment and its patients, as well as the effect of making methadone take-home polices patient centered, all of which may foreshadow larger changes in the ways OTPs deliver their services.


Assuntos
Tomada de Decisão Clínica/ética , Pessoal de Saúde/psicologia , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Acesso aos Serviços de Saúde , Humanos , Metadona/provisão & distribução , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/reabilitação , Fluxo de Trabalho
6.
Cuad. bioét ; 31(103): 367-375, sept.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-200028

RESUMO

La identificación, priorización y anticipación de los conflictos éticos, permite a los Comités de Ética Asistencial (CEA) un mejor abordaje de los mismos, así como la adopción de medidas para evitar su aparición y/o mitigación. Para este cometido, nos planteamos como objetivo conocer cuáles eran en el presente, que importancia tenían, y cuál sería el escenario futuro al que enfrentarse. Se realizó una investigación cualitativa estructurada con 2 grupos focales compuestos por personal de enfermería, auxiliares de enfermería y médicos del área de Hospitalización, que contestaron además a un decálogo de conflictos éticos futuros. Los datos obtenidos se evaluaron posteriormente según su nivel de importancia (Relevancia-Frecuencia-Consistencia). La edad media del personal fue de 34,7 ± 15,4, con una experiencia laboral media de 11,7 ± 15,4 años. Se identificaron 40 conflictos éticos agrupados en 5 áreas de riesgo: profesional, asistencial, social, organizacional y legal. De ellos 21 resultaron ser los de la mayor importancia, entre los cuales se encuentran el abandono de los pacientes, inexistencia de protocolos de actuación internos, falsas expectativas de los pacientes y familiares que esperan cuidados no asistenciales, los cuidados innecesarios al final de la vida, la falta de normas para familiares/cuidadores, y el desconocimiento de la legalidad. Los dilemas éticos más importantes identificados por el personal a los que podría enfrentarse en el futuro serían los pacientes en situación de abandono, la escasez de recursos socio-sanitarios, los conflictos con familiares/cuidadores y la falta de información para la toma de decisiones al final de la vida. Se identificaron los conflictos entre el personal de un hospital de pacientes crónicos y los familiares/cuidadores, se priorizaron los más importantes, y se anticiparon los futuros. En estos escenarios, destacamos el abandono como el de mayor importancia. Un mapa de conflictos es una herramienta útil para identificar áreas de riesgo de conflicto ético, observamos diferencia respecto a conflictos éticos en hospitales de otras características. La realización de los mapas de conflicto debe hacerse periódicamente para mantener su validez


The identification, priorization and anticipation of the ethics conflicts, allow the Healthcare Ethics Committees (HEC) a better approach to them, as well as the adoption of measures to prevent its appearance and/or its mitigation. For this purpose, we set ourselves the objective of knowing what they are in the present, how important they are, and what would be the future scenario to face. An qualitative structure research was made whit two focal groups whit the participation of nurses, nurse auxiliary and doctors from the hospitalization area, they also answer a future ethics conflicts Decalogue. The results were tested after by their importance level (Relevance-Frequency-Consistency). The medium age of the participants was 34,7 ± 15,4, whit a medium experience at work of 11,7 ± 15,4 years. A total of 40 ethics conflicts was identify grouped in 5 risk areas: professional, assistance, social, organizational and legal. From there 21 results the more important, between them we find patient abandonment, inexistence of internal performance protocols, patient and relatives false expectations waiting for non-assistance care, unnecessary care at the end of the life, lack of rules for family / caregivers, and ignorance of legality. The more important ethical dilemmas for the future identified by the personal will be patients in abandonment, the lack of socio-health resources, conflicts with family / caregivers situation and lack of information for decision making at the end of the life. The ethical conflicts between the personal from a chronic patients hospital and the relatives/caregivers was identifying, the most important were prioritized, and futures were anticipated. In these scenarios, we highlight abandonment as the most important. A map of ethics conflicts is a good tool to identify risk areas for ethics conflicts, we see the difference between the ethics conflicts found in other kind of hospitals. The map of ethics conflicts need to be update periodically to keep the validity


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Hospitalização , Ética Institucional , Doença Crônica/terapia , Grupos Focais , Fatores de Risco , Tomada de Decisão Clínica/ética , Cuidadores/ética
8.
Rev Med Suisse ; 16(708): 1790-1795, 2020 Sep 30.
Artigo em Francês | MEDLINE | ID: mdl-32997448

RESUMO

Medical care of adults with disabilities, especially those with intellectual disabilities, can be ethically difficult. Several questions arise frequently. Can we administer a life-saving treatment that could impact negatively the patient's quality of life when the patient isn't able to give consent? During this Covid-19 period, can the use of chemical or physical restraints be considered as mistreatment, whereas the aim is to protect others? These are situations where the ethical question holds a central role. Although each clinical situation is unique, this article highlights, through four clinical cases, the ethical principles that should guide physicians in their decision-making process.


Assuntos
Tomada de Decisão Clínica/ética , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Pessoas com Deficiência , Deficiência Intelectual , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Qualidade de Vida , Adulto , Infecções por Coronavirus/epidemiologia , Humanos , Consentimento Livre e Esclarecido/ética , Pandemias , Pneumonia Viral/epidemiologia , Restrição Física/ética
9.
Prax Kinderpsychol Kinderpsychiatr ; 69(6): 517-523, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32988305

RESUMO

Trans-Identity in Minors: Basic Ethical Principles for Individual Decision-Making in Healthcare The treatment of minors with gender incongruence has been the subject of controversial discussion for some time. In 2020, the German Ethics Council adopted the ad-hoc recommendation "Trans-identity in children and adolescents: Therapeutic Controversies - Ethical Orientations" with the aim of sensitising to the relevant ethically problematic aspects and of setting out orienting guidelines for medical and psychotherapeutic support and treatment. According to the Ethics Council, every person has the constitutional right to lead a life in accordance with one's own gender identity and to be respected in this identity. Healthcare professionals must assess the consequences of treatment as well as the consequences of refraining to provide treatment. All interactions with the child must be designed in such a way that the child can participate in decision-making and is ultimately enabled to give full informed consent. Stigmatisation and discriminatory pathologisation of gender incongruence must be avoided.


Assuntos
Tomada de Decisão Clínica/ética , Identidade de Gênero , Menores de Idade/psicologia , Adolescente , Criança , Feminino , Humanos , Consentimento Livre e Esclarecido , Masculino
11.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 106-111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965367

RESUMO

The respiratory disease caused by the coronavirus SARS-CoV-2 (COVID-19) is a pandemic that produces a large number of simultaneous patients with severe symptoms and in need of special hospital care, overloading the infrastructure of health services. All of these demands generate the need to ration equipment and interventions. Faced with this imbalance, how, when, and who decides, there is the impact of the stressful systems of professionals who are at the front line of care and, in the background, issues inherent to human subjectivity. Along this path, the idea of using artificial intelligence algorithms to replace health professionals in the decision-making process also arises. In this context, there is the ethical question of how to manage the demands produced by the pandemic. The objective of this work is to reflect, from the point of view of medical ethics, on the basic principles of the choices made by the health teams, during the COVID-19 pandemic, whose resources are scarce and decisions cause anguish and restlessness. The ethical values for the rationing of health resources in an epidemic must converge to some proposals based on fundamental values such as maximizing the benefits produced by scarce resources, treating people equally, promoting and recommending instrumental values, giving priority to critical situations. Naturally, different judgments will occur in different circumstances, but transparency is essential to ensure public trust. In this way, it is possible to develop prioritization guidelines using well-defined values and ethical recommendations to achieve fair resource allocation.


Assuntos
Tomada de Decisão Clínica/ética , Infecções por Coronavirus/epidemiologia , Alocação de Recursos para a Atenção à Saúde/ética , Pandemias , Pneumonia Viral/epidemiologia , Triagem/ética , Inteligência Artificial , Betacoronavirus , Infecções por Coronavirus/terapia , Humanos , Pneumonia Viral/terapia , Ventiladores Mecânicos/provisão & distribução
13.
Rev. med. cine ; 16(3): 155-163, sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197478

RESUMO

Este artículo profundiza en los acontecimientos narrados en el cuarto episodio de la sexta temporada de la serie House M.D. (título en inglés, en España es conocida como House o Dr. House). En él, el Doctor Chase se ve en el dilema de tratar a un dictador africano. Por un lado, el juramento hipocrático al que está ligado le obliga a sanar a su paciente, sin embargo, su moral individual lo empuja a tomar una decisión fatal. Y es que en eso estriba la peculiaridad ética de esta narración, en el choque de actitudes que codifican lo que se considera «el deber». Entre los principios y los fines, es el territorio en el que Chase se encuentra perdido. Una tierra de nadie que atormenta al profesional de la medicina, en general, y al Doctor Chase, en particular. El análisis cinematográfico dilucidará las claves éticas (temas) y estéticas (estrategias narrativas) de esta obra. El demiurgo que controla los aconteceres de la narración decide que el doctor tome el bando de los fines, aunque eso no signifique que sea lo correcto. Sin pretender ser ejemplo de lo que debiera hacerse en la vida real, esta obra, junto al estudio de la misma, invitan a explorar los límites de la deontología médica


This article delves into the events narrated in the fourth episode of the sixth season of House M.D. In it, Dr. Chase finds himself in the dilemma of treating an African dictator. On the one hand, the Hippocratic oath to which he is bound forces him to heal his patient, however, his individual morale pushes him to make a fatal decision. And it is that, in that lies the ethical peculiarity of this narrative, in the clash of attitudes that codify what is considered «duty». Between principles and ends, it’s the territory in which Chase is lost. A no man’s land that torments the medical professional, in general, and Dr. Chase in particular. Cinematic analysis will elucidate the ethical (themes) and aesthetic keys (narrative strategies) of this work. The demiurge that controls the storytelling happenings decides that the doctor takes the side of the ends, even if that does not mean that it is the right thing to do. Without pretending to be an example of what should be done in real life, this article, with the study of it, invites to explore the limits of medical deontology


Assuntos
Humanos , Medicina nas Artes , Filmes Cinematográficos , Ética Médica , Teoria Ética , Julgamento Moral Retrospectivo , Tomada de Decisão Clínica/ética , Juramento Hipocrático
14.
Adv Biol Regul ; 77: 100742, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32773103

RESUMO

The rapid onset and worldwide spread of the COVID-19 epidemic (caused by SARS-CoV-2 coronavirus) has been associated with a profound impact in clinical practice also in the hematologic setting. First of all, given the immunosuppressive effect of many therapies that are normally administered to patients with hematological diseases, with a consequent increased risk of contracting a more severe viral infection, it has been necessary to reconsider in each individual patient the urgency and priority of the treatments foreseen by the normal standards of care. In particular, as regards allogeneic (and to a lesser extent autologous) hematopoietic cell transplantation and CAR T-cell therapy, specific recommendations have been issued by the transplant community on the criteria to be used to decide whether or not to postpone these procedures and on the clinical management of recipients and donors exposed to COVID-19. As to cytotoxic chemotherapy and other antineoplastic therapies, criteria have been proposed to decide, in the various clinical situations, which treatments were not deferrable and which instead could be postponed or replaced by less aggressive therapies. In the outpatient clinics, various organizational solutions for telemedicine have been adopted, resorting to telephone interviews and/or Information Technology, with the aim of reducing the influx of patients while maintaining an adequate control of their clinical condition. The collection of blood by the transfusion centers has been the subject of organizational measures, in order to avoid the transmission of COVID 19 while maintaining a sufficient blood collection for clinical needs. Finally, some hematologic laboratory alterations have been identified, such as thrombocytopenia, lymphopenia and coagulation abnormalities, useful for the prognostic evaluation of infected patients.


Assuntos
Anticoagulantes/uso terapêutico , Antineoplásicos/uso terapêutico , Antivirais/uso terapêutico , Infecções por Coronavirus/terapia , Doenças Hematológicas/terapia , Pandemias , Pneumonia Viral/terapia , Tromboembolia Venosa/terapia , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Transfusão de Sangue/ética , Tomada de Decisão Clínica/ética , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Gerenciamento Clínico , Doenças Hematológicas/epidemiologia , Doenças Hematológicas/imunologia , Doenças Hematológicas/virologia , Transplante de Células-Tronco Hematopoéticas/ética , Humanos , Pacientes Ambulatoriais , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Telemedicina/métodos , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/imunologia , Tromboembolia Venosa/virologia
15.
J Perinat Med ; 48(9): 867-873, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-32769228

RESUMO

The goal of perinatal medicine is to provide professionally responsible clinical management of the conditions and diagnoses of pregnant, fetal, and neonatal patients. The New York Declaration of the International Academy of Perinatal Medicine, "Women and children First - or Last?" was directed toward the ethical challenges of perinatal medicine in middle-income and low-income countries. The global COVID-19 pandemic presents common ethical challenges in all countries, independent of their national wealth. In this paper the World Association of Perinatal Medicine provides ethics-based guidance for professionally responsible advocacy for women and children first during the COVID-19 pandemic. We first present an ethical framework that explains ethical reasoning, clinically relevant ethical principles and professional virtues, and decision making with pregnant patients and parents. We then apply this ethical framework to evidence-based treatment and its improvement, planned home birth, ring-fencing obstetric services, attendance of spouse or partner at birth, and the responsible management of organizational resources. Perinatal physicians should focus on the mission of perinatal medicine to put women and children first and frame-shifting when necessary to put the lives and health of the population of patients served by a hospital first.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Defesa do Paciente/ética , Assistência Perinatal/ética , Pneumonia Viral/epidemiologia , Tomada de Decisão Clínica/ética , Cuidados Críticos/ética , Ética Médica , Feminino , Feto , Hospitalização , Humanos , Recém-Nascido , Obstetrícia/ética , Pediatria/ética , Assistência Perinatal/métodos , Gravidez , Resultado da Gravidez , Fatores de Risco , Triagem
16.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732263

RESUMO

With increasing focus in the last decade on post-cardiac arrest care in pediatrics, return of spontaneous circulation, survival rates, and neurologic outcome have improved. As part of this postarrest care, both the American Heart Association and the American Academy of Neurology state it is reasonable to consider targeted temperature management in pediatric comatose patients, although this care is challenging and time sensitive, with many gaps in knowledge remaining. Many pediatric patients will still not survive or will suffer severe neurocognitive impairment despite the therapeutic arsenal provided. Adult guidelines suggest providing postarrest supportive care and limiting prognosis discussions with families until after 72 hours of therapy, but pediatric clinicians are advised to consider a multitude of factors given the lack of data. What, then, should clinicians do if family members of a patient who has been resuscitated request the withdrawal of all life support in the 24 hours immediately postarrest? In this Ethics Rounds, we present such a case and the responses of different clinicians and bioethicists.


Assuntos
Eutanásia Passiva/ética , Parada Cardíaca/terapia , Ressuscitação , Suspensão de Tratamento/ética , Tomada de Decisão Clínica/ética , Eletroencefalografia , Humanos , Hipotermia Induzida , Lactente , Prognóstico
17.
Pediatrics ; 146(Suppl 1): S3-S8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737225

RESUMO

One of the earliest controversies in the modern history of bioethics was known at the time as "the Hopkins Mongol case," involving an infant with Trisomy 21 and duodenal atresia whose parents declined to consent to surgery. Fluids and feeding were withheld, and the infant died of dehydration after 15 days. The child's short life had a profound impact on the author's career and that of several others and ultimately led to changes in the care of children and adults with disabilities and the way difficult end-of-life decisions are made in US hospitals today. It also contributed to the growth of the modern bioethics movement and scholarship focused on pediatric bioethics issues.


Assuntos
Temas Bioéticos , Tomada de Decisão Clínica/ética , Síndrome de Down/terapia , Pediatria/ética , Suspensão de Tratamento/ética , Comitês Consultivos/ética , Temas Bioéticos/história , Temas Bioéticos/legislação & jurisprudência , Crianças com Deficiência/legislação & jurisprudência , Síndrome de Down/história , Atresia Esofágica/história , Atresia Esofágica/terapia , Fundações , História do Século XX , Humanos , Recém-Nascido , Consentimento dos Pais/ética , Consentimento dos Pais/legislação & jurisprudência , Pais , Pediatria/legislação & jurisprudência , Assistência Terminal/ética , Suspensão de Tratamento/legislação & jurisprudência
18.
Pediatrics ; 146(Suppl 1): S9-S12, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737226

RESUMO

The "Baby Doe" case of the early 1980s was marked by considerable controversy, primarily regarding the legal response of the federal government to the case at the time. In the decades that followed, the decision-making for children with trisomy 21, like Baby Doe, has been substantially reevaluated. The data, the assumptions about quality of life that were based on those data, and the ethical principles underpinning the decision-making in the Baby Doe case have all evolved significantly over time. The present strategies for decision-making for children with trisomy 13 and 18 appear to be following a similar pattern. The data, quality-of-life assumptions based on those data, and even the ethical principles underlying the decision-making for these children are currently being reexamined. Children with trisomy 13 and 18 are, in this regard, the next Baby Doe(s).


Assuntos
Tomada de Decisão Clínica/ética , Síndrome de Down/terapia , Síndrome da Trissomia do Cromossomo 13/terapia , Síndrome da Trissomía do Cromossomo 18/terapia , Desenvolvimento Infantil , Atresia Esofágica , Humanos , Recém-Nascido , Estimativa de Kaplan-Meier , Pais , Qualidade de Vida , Síndrome da Trissomia do Cromossomo 13/mortalidade , Síndrome da Trissomía do Cromossomo 18/mortalidade , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência
19.
Pediatrics ; 146(Suppl 1): S13-S17, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737227

RESUMO

Although parents are typically the most appropriate decision-makers for their children, there are limits to this authority. Medical providers may be ethically obligated to seek state intervention against a parental decision if the parent places a child at significant and imminent risk of serious harm. When parents make medical decisions for their children, they assess both the projected benefits and risks of their choices for their family. These assessments are impacted by uncertainty, which is a common feature of neonatal intensive care. The relative presence or absence of uncertainty may impact perceptions of parental decisions and a medical provider's decision to seek state intervention to overrule parents. In this article, we propose a model integrating prognostic uncertainty into pediatric decision-making that may aid providers in such assessments. We will demonstrate how to apply this model to 3 neonatal cases and propose that the presence of greater uncertainty ought to permit parents greater latitude to incorporate family values into their decision-making even if these decisions are contradictory to the recommendations of the medical team.


Assuntos
Temas Bioéticos , Tomada de Decisão Clínica/ética , Pais , Incerteza , Família , Feminino , Idade Gestacional , Humanos , Hipóxia-Isquemia Encefálica/etiologia , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Cuidados Paliativos , Consentimento dos Pais/ética , Prognóstico , Estenose da Valva Pulmonar/cirurgia , Valores Sociais , Suspensão de Tratamento/ética
20.
Pediatrics ; 146(Suppl 1): S25-S32, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737229

RESUMO

In this article, I examine the role of minors' competence for medical decision-making in modern American law. The doctrine of parental consent remains the default legal and bioethical framework for health care decisions on behalf of children, complemented by a complex array of exceptions. Some of those exceptions vest decisional authority in the minors themselves. Yet, in American law, judgments of minors' competence do not typically trigger shifts in decision-making authority from adults to minors. Rather, minors' decisional capacity becomes relevant only after legislatures or courts determine that the default of parental discretion does not achieve important policy goals or protect implicated constitutional rights in a particular health care context and that those goals can best be achieved or rights best protected by authorizing capable minors to choose for themselves. It is at that point that psychological and neuroscientific evidence plays an important role in informing the legal inquiry as to whether minors whose health is at issue are legally competent to decide.


Assuntos
Tomada de Decisão Clínica , Competência Mental/legislação & jurisprudência , Menores de Idade/legislação & jurisprudência , Consentimento dos Pais/legislação & jurisprudência , Adolescente , Desenvolvimento do Adolescente , Criança , Desenvolvimento Infantil , Serviços de Saúde da Criança/legislação & jurisprudência , Educação Infantil , Bem-Estar da Criança/legislação & jurisprudência , Direitos Civis , Tomada de Decisão Clínica/ética , Família , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Consentimento Informado por Menores/ética , Consentimento Informado por Menores/legislação & jurisprudência , Competência Mental/normas , Menores de Idade/psicologia , Relações Pais-Filho , Consentimento dos Pais/ética , Patient Self-Determination Act , Autonomia Pessoal , Procurador/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Estados Unidos
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