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10.
Dtsch Med Wochenschr ; 145(10): 687-692, 2020 05.
Artigo em Alemão | MEDLINE | ID: mdl-32236913

RESUMO

The COVID-19 pandemic poses unprecedented challenges for the German health care system. What is already the case in some other countries, may occur in Germany in the near future also: Faced with limited ICU resources, doctors will be forced to decide which patients to treat and which to let die. This paper examines the legal implications of such decisions. It takes up arguments from the general discussion on prioritization in medicine. A constitutional hurdle for the application of utilitarian criteria (in particular patients' age or social role) comes from the principle that every human life is of equal value and must not be traded off against others ("life value indifference"). However, the limits that the Grundgesetz (German Basic Law) sets for state actions do not apply directly to doctors. According to the Musterberufsordnung (professional code of conduct), doctors act based on their conscience and the requirements of medical ethics and humanity. The implications of this normative standard for the prioritizing in an exceptional situation as the COVID 19 pandemic have not been sufficiently clarified. This uncertainty leads to emotional and moral burdens for doctors. The authors conclude that the German law grants a limited freedom of choice that allows physicians to apply utilitarian criteria in addition to purely medical decision algorithms.


Assuntos
Infecções por Coronavirus/mortalidade , Tomada de Decisões/ética , Ética Médica , Pneumonia Viral/mortalidade , Alocação de Recursos/ética , Betacoronavirus , Infecções por Coronavirus/terapia , Efeitos Psicossociais da Doença , Assistência à Saúde/legislação & jurisprudência , Alemanha , Humanos , Legislação Médica , Pandemias , Médicos/ética , Médicos/normas , Pneumonia Viral/terapia , Alocação de Recursos/legislação & jurisprudência , Valor da Vida
11.
Recenti Prog Med ; 111(4): 184-185, 2020 04.
Artigo em Italiano | MEDLINE | ID: mdl-32319435

RESUMO

A position statement published by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) is fostering a vibrant debate, crossed by deep fears. These are recommendations addressed to ICU doctors who must decide whether to implement intensive treatments for patients who need them to survive. Specifically, the reference is to the patients to whom the CoViD-19 epidemic has compromised respiratory capacity. We still do not have clear what positive criteria can help make clinical decisions in contexts of insufficient resources that force us to make choices.


Assuntos
Infecções por Coronavirus , Tomada de Decisões , Recursos em Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Tomada de Decisões/ética , Recursos em Saúde/provisão & distribução , Hospitais de Prática de Grupo , Humanos , Consentimento Livre e Esclarecido , Direitos do Paciente , Médicos , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Índice de Gravidade de Doença
12.
Recenti Prog Med ; 111(4): 207-211, 2020 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-32319442

RESUMO

On February 21st, 2020 the first case of severe acute respiratory syndrome due to the coronavirus 2 (SARS-CoV-2) causing the CoViD-19 disease, was identified in Italy. In the following days, despite the restrictive public health measures aimed to avoid the infection's spread, the number of cases increased. As of March 8th, 2020, Italy is the 2nd most affected country in the world. As of March 6th, 2020, the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) published operational recommendations and ethical considerations to support the clinicians involved in the care of critically-ill CoViD-19 patients, in regard a probable scenario where an imbalance between supply and demand of ICU beds, is put in place by a steadily rising number of these patients.


Assuntos
Infecções por Coronavirus , Cuidados Críticos , Tomada de Decisões/ética , Recursos em Saúde , Número de Leitos em Hospital , Pandemias , Pneumonia Viral , Alocação de Recursos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/estatística & dados numéricos , Recursos em Saúde/ética , Humanos , Itália , Pneumonia Viral/epidemiologia , Alocação de Recursos/ética
14.
West J Emerg Med ; 21(3): 477-483, 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32302284

RESUMO

As clinicians and support personnel struggle with their responsibilities to treat during the current COVID-19 pandemic, several ethical issues have emerged. Will healthcare workers and support staff fulfill their duty to treat in the face of high risks? Will institutional and government leaders at all levels do the right things to help alleviate healthcare workers risks and fears? Will physicians be willing to make hard, resource-allocation decisions if they cannot first husband or improvise alternatives?With our healthcare facilities and governments unprepared for this inevitable disaster, front-line doctors, advanced providers, nurses, EMS, and support personnel struggle with acute shortages of equipment-both to treat patients and protect themselves. With their personal and possibly their family's lives and health at risk, they must weigh the option of continuing to work or retreat to safety. This decision, made daily, is based on professional and personal values, how they perceive existing risks-including available protective measures, and their perception of the level and transparency of information they receive. Often, while clinicians get this information, support personnel do not, leading to absenteeism and deteriorating healthcare services. Leadership can use good risk communication (complete, widely transmitted, and transparent) to align healthcare workers' risk perceptions with reality. They also can address the common problems healthcare workers must overcome to continue working (ie, risk mitigation techniques). Physicians, if they cannot sufficiently husband or improvise lifesaving resources, will have to face difficult triage decisions. Ideally, they will use a predetermined plan, probably based on the principles of Utilitarianism (maximizing the greatest good) and derived from professional and community input. Unfortunately, none of these plans is optimal.


Assuntos
Infecções por Coronavirus , Tomada de Decisões , Pandemias , Pneumonia Viral , Alocação de Recursos , Atitude do Pessoal de Saúde , Betacoronavirus , Comunicação , Infecções por Coronavirus/epidemiologia , Tomada de Decisões/ética , Desastres , Surtos de Doenças , Pessoal de Saúde , Humanos , Liderança , Médicos , Pneumonia Viral/epidemiologia , Alocação de Recursos/ética , Risco
15.
J Clin Ethics ; 31(1): 92-94, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32213700

RESUMO

The COVID-19 virus is severely testing the Italian healthcare system, as the requests for intensive treatment are greater than the real capacity of the system to receive patients. Given this emergency situation, it follows that citizens are limited in their freedom of movement in order to limit infection, and that in hospitals a significant number of critical situations must be faced. This brief contribution aims to offer a reflection on the public and clinical role of the bioethicist: a figure able to promote dialogue between the world of medicine and the community, and to face ethical dilemmas even in emergent clinical settings.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Tomada de Decisões/ética , Assistência à Saúde , Eticistas , Princípios Morais , Pandemias , Pneumonia Viral , Papel Profissional , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Cuidados Críticos , Assistência à Saúde/ética , Humanos , Itália , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Capacidade de Resposta ante Emergências
16.
PLoS One ; 15(3): e0229510, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32119702

RESUMO

Punishment aims to deter individuals' selfish behaviors, but it can occasionally backfire. Some scholars have proposed promoting prosocial behaviors using punishment that communicates positive social norms because it provides additional motivation. However, it is unclear which factors affect the norm expressive function of punishment. This study proposes that third-party punishment communicates more positive normative information, and thus, promotes more prosocial behavior in observers than does second-party punishment. Using dictator games, we investigated the effects of second-party punishment compared to third-party punishment of another's unfair sharing on observers' norm perceptions and subsequent sharing decision-making. Two experiments consistently found that third-party punishment was more effective than second-party punishment at inducing observers' beliefs that unfair distribution was unusual (descriptive norm) and unacceptable (injunctive norm). The altered descriptive but not injunctive norm perception further guided individuals' own sharing behaviors. Taken together, these results suggest that third-party punishment might be better than second-party punishment at decreasing selfish behaviors by shaping individuals' norm perceptions, especially descriptive norm perception, regarding the relevant behaviors.


Assuntos
Tomada de Decisões/ética , Punição/psicologia , Altruísmo , China , Feminino , Jogos Experimentais , Humanos , Masculino , Motivação/ética , Normas Sociais , Adulto Jovem
18.
PLoS One ; 15(3): e0229412, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32191721

RESUMO

Substandard drugs are a major public health issue worldwide. Key person such as the Qualified Person in China and Europe is responsible for rejecting substandard drugs during the manufacturing stage. This study applies the Hunt-Vitell ethical decision-making model to study their rejection intentions on substandard drugs. Using the experimental vignette methodology, two scenarios were developed to represent different levels of deviation from regulations in pharmaceutical manufacturing. Responses from 204 Chinese key persons show a decline in deontology, ethical judgment, and rejection intention, and an increase in teleology in the minor deviation scenario, in comparison with the major deviation scenario. The results from the two scenarios show that the Hunt-Vitell ethical decision-making model is well fitted to explain substandard drug rejection intentions. Organizational and occupational commitments have a significant positive impact on deontological evaluation. Whereas, occupational commitments have a significant negative impact on teleological evaluation. This study suggests that strengthening occupational commitment can significantly affect key person's rejection intentions of substandard drugs.


Assuntos
Tomada de Decisões/ética , Prova Pericial/normas , Intenção , Julgamento/ética , Modelos Teóricos , Controle de Qualidade , Medicamentos Fora do Padrão/provisão & distribução , Adulto , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
19.
PLoS One ; 15(2): e0228450, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32032394

RESUMO

INTRODUCTION: This study developed a new Professional Decision-Making in Medicine Measure that assesses the use of effective decision-making strategies: seek help, manage emotions, recognize consequences and rules, and test assumptions and motives. The aim was to develop a content valid measure and obtain initial evidence for construct validity so that the measure could be used in future research or educational assessment. METHODS: Clinical scenario-based items were developed based on a review of the literature and interviews with physicians. For each item, respondents are tasked with selecting two responses (out of six plausible options) that they would choose in that situation. Three of the six options reflect a decision-making strategy; these responses are scored as correct. Data were collected from a sample of 318 fourth-year medical students in the United States. They completed a 16-item version of the measure (Form A) and measures of social desirability, moral disengagement, and professionalism attitudes. Professionalism ratings from clerkships were also obtained. A sub-group (n = 63) completed a second 16-item measure (Form B) to pilot test the instrument, as two test forms are useful for pre-posttest designs. RESULTS: Scores on the new measure indicated that, on average, participants answered 75% of items correctly. Evidence for construct validity included the lack of correlation between scores on the measure and socially desirable responding, negative correlation with moral disengagement, and modest to low correlations with professionalism attitudes. A positive correlation was observed with a clerkship rating focused on professionalism in peer interactions. CONCLUSIONS: These findings demonstrate modest proficiency in the use of decision-making strategies among fourth-year medical students. Additional research using the Professional Decision-Making Measure should explore scores among physicians in various career stages, and the causes and correlates of scores. Educators could utilize the measure to assess courses that teach decision-making strategies.


Assuntos
Competência Clínica , Tomada de Decisões/ética , Educação de Graduação em Medicina/ética , Profissionalismo/tendências , Estudantes de Medicina/psicologia , Adulto , Avaliação Educacional , Feminino , Humanos , Masculino , Princípios Morais , Reprodutibilidade dos Testes , Inquéritos e Questionários
20.
Proc Natl Acad Sci U S A ; 117(5): 2332-2337, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-31964849

RESUMO

When do people find it acceptable to sacrifice one life to save many? Cross-cultural studies suggested a complex pattern of universals and variations in the way people approach this question, but data were often based on small samples from a small number of countries outside of the Western world. Here we analyze responses to three sacrificial dilemmas by 70,000 participants in 10 languages and 42 countries. In every country, the three dilemmas displayed the same qualitative ordering of sacrifice acceptability, suggesting that this ordering is best explained by basic cognitive processes rather than cultural norms. The quantitative acceptability of each sacrifice, however, showed substantial country-level variations. We show that low relational mobility (where people are more cautious about not alienating their current social partners) is strongly associated with the rejection of sacrifices for the greater good (especially for Eastern countries), which may be explained by the signaling value of this rejection. We make our dataset fully available as a public resource for researchers studying universals and variations in human morality.


Assuntos
Tomada de Decisões/ética , Princípios Morais , Cognição/ética , Cognição/fisiologia , Comparação Transcultural , Tomada de Decisões/fisiologia , Teoria Ética , Humanos , Mobilidade Social , Inquéritos e Questionários
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