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1.
BMC Med Educ ; 24(1): 737, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38982353

RESUMO

BACKGROUND: The importance of including bioethics in the medical curricula has been recognized globally. Certain countries including Pakistan continue to lag behind although some developments have occurred recently. OBJECTIVES: The research aimed to provide a snapshot of bioethics education in undergraduate medical colleges in Karachi, Pakistan. The secondary objectives included identifying factors promoting or inhibiting integration of bioethics into the curriculum. METHODS: A two-pronged strategy was used to collect data including a website review of medical colleges, in existence for more than ten years, recognized by the Pakistan Medical and Dental Council (PMDC), the regulating body for undergraduate medical education in Pakistan. The other arm employed in-depth interviews with medical educationists in colleges fulfilling inclusion criteria. Data from the website was analyzed and presented as frequencies. Qualitative data was analyzed using content analysis method which involved coding of transcripts, multiple readings and arriving at subthemes and themes iteratively. RESULTS: Thirteen medical colleges were included for the website review, of which four were from public sector. Three medical colleges used the word "ethics" in their vision and mission statement and four had provided a detailed curriculum for ethics on their website. Thematic framework included four broad themes: 1) Need for Bioethics Education, 2) Current Status of Bioethics Education 3) Challenges in integration of bioethics in medical curriculum and 4) Recommendations for integration of bioethics in the Curriculum. Participants were in agreement that bioethics was important in development of future physicians. Participants identified various challenges, foremost being shortage of trained faculty, lack of institutional buy-in and overcrowded curriculum. CONCLUSION: The study identified sporadic inclusion of bioethics in undergraduate medical curricula, left to the discretion of individual institutions. Since Karachi is a cosmopolitan city, the findings may reasonably reflect the situation in other parts of the country. While bioethics is recognized as an important field, it will continue to remain an orphan subject in the curricula unless the regulatory and accreditation bodies make it compulsory for institutions to include ethics in their curricula.


Assuntos
Bioética , Currículo , Educação de Graduação em Medicina , Paquistão , Humanos , Bioética/educação , Pesquisa Qualitativa
2.
Salud Colect ; 20: e4821, 2024 06 05.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-38961602

RESUMO

The purpose of this paper is to delve into the ethical aspects experienced by the healthcare team when they receive the directive to limit therapeutic effort or a do-not-resuscitate order. From an interpretative, qualitative paradigm with a content analysis approach, a process based on three phases was conducted: pre-analysis in which categories were identified, the projection of the analysis, and inductive analysis. During 2023, interviews were conducted in the clinical setting of a high-complexity hospital in Chile with 56 members of the healthcare teams from critical and emergency units, from which four categories emerged: a) the risk of violating patients' rights by using do-not-resuscitate orders and limiting therapeutic effort; b) the gap in the interpretation of the legal framework addressing the care and attention of patients at the end of life or with terminal illnesses by the healthcare team; c) ethical conflicts in end-of-life care; and d) efficient care versus holistic care in patients with terminal illness. There are significant gaps in bioethics training and aspects of a good death in healthcare teams facing the directive to limit therapeutic effort and not resuscitate. It is suggested to train personnel and work on a consensus guide to address the ethical aspects of a good death.


El propósito de este trabajo es profundizar en los aspectos éticos que experimenta el equipo de salud cuando reciben la indicación de limitar el esfuerzo terapéutico o la orden de no reanimar. Desde un paradigma interpretativo, cualitativo y con un enfoque de análisis de contenido, se realizó un proceso basado en tres fases: preanálisis en el que se identificaron las categorías, la proyección del análisis y el análisis inductivo. Durante 2023, se realizaron entrevistas en el entorno clínico de un hospital de alta complejidad en Chile a 56 miembros de equipos de salud de unidades críticas y urgencias, de las que emergieron cuatro categorías: a) riesgo de vulnerar los derechos de los pacientes al utilizar la orden de no reanimar, y limitación del esfuerzo terapéutico; b) brecha en la interpretación del marco legal que aborda la atención y cuidado de pacientes al final de la vida, o con enfermedades terminales por parte del equipo de salud; c) conflictos éticos de la atención al final de la vida; y d) el cuidado eficiente o el cuidado holístico en pacientes con enfermedad terminal. Existen brechas importantes en la formación en bioética y aspectos del buen morir en los equipos de salud que se enfrentan a la orden de limitar el esfuerzo terapéutico y no reanimar. Se sugiere capacitar al personal, y trabajar una guía de consenso para abordar los aspectos éticos del buen morir.


Assuntos
Equipe de Assistência ao Paciente , Pesquisa Qualitativa , Ordens quanto à Conduta (Ética Médica) , Assistência Terminal , Humanos , Chile , Ordens quanto à Conduta (Ética Médica)/ética , Ordens quanto à Conduta (Ética Médica)/legislação & jurisprudência , Equipe de Assistência ao Paciente/ética , Assistência Terminal/ética , Direitos do Paciente/ética , Feminino , Masculino , Atitude do Pessoal de Saúde , Entrevistas como Assunto
3.
Hastings Cent Rep ; 54(3): 55-56, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38842885

RESUMO

This commentary responds to Moti Gorin's article "What Is the Aim of Pediatric 'Gender-Affirming' Care?" We argue that Gorin's case against pediatric gender-affirming care rests upon numerous false conceptual binaries: female/male, public/private, objective/subjective, and medically necessary/elective. Drawing on feminist bioethics, we show how such dichotomous thinking is both inaccurate and marginalizing of gender minorities.


Assuntos
Feminismo , Humanos , Bioética , Feminino , Pessoas Transgênero , Masculino , Pediatria/ética , Minorias Sexuais e de Gênero , Identidade de Gênero , Assistência à Saúde Afirmativa de Gênero
6.
Ethics Hum Res ; 46(4): 47-51, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38944881

RESUMO

In an earlier essay, I advocated that translational bioethics uses the public's values, determined through social science, in its analysis of translational science technologies. It may be unclear what those values might be, and whether such a translational ethics would necessarily conclude that cutting edge technologies should not be developed. In this essay, I show the public's values relevant to human brain organoids and argue that a translational bioethics analysis using these values would support continued organoid research.


Assuntos
Encéfalo , Organoides , Pesquisa Translacional Biomédica , Humanos , Pesquisa Translacional Biomédica/ética , Tomada de Decisões/ética , Bioética , Valores Sociais
7.
Theor Med Bioeth ; 45(3): 183-197, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38789700

RESUMO

The COVID-19 pandemic has provoked new interest in the notion of vulnerability and in identifying alternative approaches for responding to vulnerable patients and populations during health emergencies. In this paper, I argue that the autonomy-based approach (the most dominant approach in bioethics) to responding to vulnerability during health emergencies is deficient because it focuses only on the interests, values, and decisions of the individual patient. It overly emphasizes respect for autonomy and not respect for the patient as it does not consider the patient as a social and relational agent. Indeed, relational approaches to autonomy like the feminist and indigenous sub-Saharan African ethical approaches are promising alternatives. In this essay, I use the indigenous African relational approach to autonomy as an example of an alternative method which can be used to respond to vulnerability during a global health emergency like COVID-19.


Assuntos
COVID-19 , Autonomia Pessoal , SARS-CoV-2 , Populações Vulneráveis , Humanos , COVID-19/epidemiologia , Bioética , Pandemias/ética , África Subsaariana/epidemiologia , África/epidemiologia , Temas Bioéticos
8.
Bioethics ; 38(6): 578-580, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38768385
9.
J Law Med Ethics ; 52(1): 183-187, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38818592

RESUMO

This commentary takes up a challenge posed by Franklin Miller in a 2022 essay in Bioethics Forum. Dr. Miller queried whether bioethicists could be useful in public health policy contexts and while he refrained from issuing an ultimate opinion, did identify several challenges to such utility. The current piece responds to the challenges Dr. Miller identifies and argues that with appropriate training, public health ethicists can be of service in virtually any context in which public health policies are deliberated and decided.


Assuntos
Política de Saúde , Formulação de Políticas , Saúde Pública , Humanos , Saúde Pública/ética , Eticistas , Estados Unidos , Bioética
10.
Acta Ortop Mex ; 38(2): 101-104, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-38782475

RESUMO

INTRODUCTION: it is estimated that 302 million people worldwide are affected by osteoarthritis, corresponding to 60% osteoarthritis (OA) of the knee, which responsible 80% of disability in older adults, hence the importance of the association of the sign with the early inflammatory process in OA. OBJECTIVE: to determine the association of digital pressure sign in patients with and without osteoarthritis of the knee. MATERIAL AND METHODS: this was an observational, comparative cross-sectional study, carried out in patients with and without a diagnosis of knee OA, to whom the digital pressure sign was determined. The sample was calculated with the formula for two proportions, obtaining a total of 40 participants per group, obtained by non-probabilistic sampling for convenience. The statistical analysis included frequencies, percentages, 2 and OR. The bioethics regulations in force were respected. RESULTS: the study included 80 participants, with a median age of 48.9 years (RQI 46-53.7), 73.1% were predominantly female sex (38), and a statistically significant association was found between patients with OA and the presence of digital pressure sign, 2 4.62 and p value = 0.41, OR of 2.65. CONCLUSIONS: the presence of digital pressure sign increases the probability of having OA 2.65 times more.


INTRODUCCIÓN: se estima que 302 millones de personas en el mundo son afectadas por osteoartritis, correspondiendo 60% a osteoartritis (OA) de rodilla, causante de 80% de discapacidad en adultos mayores, de ahí la importancia de la asociación del signo de digito-presión con el proceso inflamatorio temprano en OA. OBJETIVO: determinar la asociación del signo de digito-presión en pacientes con y sin osteoartritis de rodilla. MATERIAL Y MÉTODOS: estudio observacional, transversal comparativo, realizado en pacientes con y sin diagnóstico de OA de rodilla, a quienes se les determinó el signo de digito-presión; la muestra se calculó con la fórmula para dos proporciones que determinó un total de 40 participantes por grupo, obtenidos por muestreo no probabilístico por conveniencia; el análisis estadístico incluyó frecuencias, porcentajes, 2 y OR. Se respetó la reglamentación de bioética vigente. RESULTADOS: el estudio incluyó a 80 participantes, con una mediana de edad de 48.9 años (RIQ 46-53.7), predominó el sexo femenino en 73.1% (38). Se encontró asociación estadísticamente significativa entre pacientes con OA y la presencia del signo de digito-presión, 2 4.62 y p = 0.41, OR de 2.65. CONCLUSIONES: la presencia del signo de digito-presión aumenta 2.65 veces más la probabilidad de tener OA.


Assuntos
Osteoartrite do Joelho , Pressão , Humanos , Feminino , Estudos Transversais , Masculino , Osteoartrite do Joelho/patologia , Pessoa de Meia-Idade , Dedos , Idoso
11.
J Clin Ethics ; 35(2): 142-146, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38728699

RESUMO

AbstractA long-standing tenet of healthcare clinical ethics consultation has involved the neutrality of the ethicist. However, recent pressing societal issues have challenged this viewpoint. Perhaps now more than ever before, ethicists are being called upon to take up roles in public health, policy, and other community-oriented endeavors. In this article, I first review the concept of professional advocacy and contrast this conceptualization with the role of patient advocate, utilizing the profession of nursing as an exemplar. Then, I explore the status of advocacy in clinical ethics and how this conversation intersects with the existing professional obligations of the bioethicist, arguing that the goals of ethics consultation and ethical obligations of the clinical ethicist are compatible with the role of professional advocate. Finally, I explore potential barriers to professional advocacy and offer suggestions for a path forward.


Assuntos
Eticistas , Defesa do Paciente , Humanos , Bioética , Negociação , Consultoria Ética , Obrigações Morais , Ética Clínica
12.
AMA J Ethics ; 26(5): E429-433, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38700527

RESUMO

This essay plays out a few ethics reasons we have to reconsider what's really being marketed to us in some free offers that distract us from questions of ethical, cultural, and clinical importance, for example. Possible points of focus for bioethics as a field are related to antimicrobial resistance and stewardship.


Assuntos
Sciuridae , Humanos , Animais , Gestão de Antimicrobianos/ética , Publicidade/ética , Bioética
13.
Cuad Bioet ; 35(113): 15-26, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38734920

RESUMO

This article tries to set up the epistemological bases of the science of ″human ecology″. This term has started to be used as a synonymous of morality, especially in the Catholic moral social doctrine that used for the first time to justify its marriage prospectives. We look at both terms together (human plus ecology) and we propose that human ecology should be a discipline that in the first time study human behavior and population (objective) using the postulates of the science of ecology (method) and then, once a conceptual framework for social sciences disciplines such as bioethics can be settle, could be used as a way to support or not moral postulates in the name of ecology. We conclude by defining which should be the methods of knowledge acquisition, the limits and the validity of what should be considered ″Human ecology″, that is to say, the ecology of the humans.


Assuntos
Bioética , Ecologia , Conhecimento , Ecologia/ética , Humanos , Princípios Morais
14.
BMC Med Ethics ; 25(1): 62, 2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38773588

RESUMO

BACKGROUND: Respect for human rights and bioethical principles in prisons is a crucial aspect of society and is proportional to the well-being of the general population. To date, these ethical principles have been lacking in prisons and prisoners are victims of abuse with strong repercussions on their physical and mental health. METHODS: A systematic review was performed, through a MESH of the following words (bioethics) AND (prison), (ethics) AND (prison), (bioethics) AND (jail), (ethics) AND (jail), (bioethics) AND (penitentiary), (ethics) AND (penitentiary), (prison) AND (human rights). Inclusion and exclusion criteria were defined and after PRISMA, 17 articles were included in the systematic review. RESULTS: Of the 17 articles, most were prevalence studies (n.5) or surveys (n.4), followed by cross-sectional studies (n.3), qualitative studies (n.1), retrospective (n.1) and an explanatory sequential mixed-methods study design (n.1). In most cases, the studies associated bioethics with prisoners' access to treatment for various pathologies such as vaccinations, tuberculosis, hepatitis, HIV, it was also found that bioethics in prisons was related to the mental health of prisoners, disability, ageing, the condition of women, the risk of suicide or with the request for end-of-life by prisoners. The results showed shortcomings in the system of maintaining bioethical principles and respect for human rights. CONCLUSIONS: Prisoners, in fact, find it difficult to access care, and have an increased risk of suicide and disability. Furthermore, they are often used as improper organ donors and have constrained autonomy that also compromises their willingness to have end-of-life treatments. In conclusion, prison staff (doctors, nurses, warders, managers) must undergo continuous refresher courses to ensure compliance with ethical principles and human rights in prisons.


Assuntos
Direitos Humanos , Prisioneiros , Prisões , Humanos , Respeito , Temas Bioéticos , Bioética , Acessibilidade aos Serviços de Saúde/ética
15.
Pan Afr Med J ; 47: 91, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38799186

RESUMO

To inform public health policymakers that the generation of local evidence-based knowledge is key. Research capacity in low- and middle-income countries (LMIC) to generate medical knowledge is often weak and insufficiently resourced and efforts to tackle these challenges are not standardized. Continuous research training can equip researchers with the required knowledge and research skills, but its effectiveness largely depends on the quality and pertinence of the training methods used. We aim to assess the effectiveness of the Cameroon HIV/AIDS Research Forum (CAM-HERO) 2022 Research Methodology and Bioethics Training with the objective to describe the knowledge gained and the self-efficacy of health professionals and clinical scientists. A survey was conducted during the one-day training among health professionals and clinical scientists. Participants took an online self-administered questionnaire before and after the training related to the topics taught. The questionnaire consisted of two parts: 1) 18 Multiple Choice Questions (MCQs) to assess knowledge and 2) Nine items to evaluate self-efficacy using a five-point Likert scale. Mean scores were calculated, analysed, and compared using paired t-test for the pre- and post-test results. A total of 30 participants (57% women) completed the socio-demographic form. The median age (IQR) of participants was 33.5 (13.3) years. We registered 38 respondents for the pre-test and 33 respondents for the post-test. There was a rise in knowledge mean score from 13.0 to 14.8 (p=0.001) and an improvement in the perception of self-efficacy with a mean score increase from 2.9 to 3.7 (p < 0.001). Knowledge and perception of self-efficacy on research methodology improved among participants after the training. These results suggest that the CAM-HERO 2022 training had an immediate positive impact on skills and self-efficacy. Hence, we recommend the implementation of this training on a larger scale, periodically, and with long-term follow-up to evaluate its impact.


Assuntos
Bioética , Infecções por HIV , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Pesquisadores , Autoeficácia , Humanos , Camarões , Feminino , Masculino , Inquéritos e Questionários , Adulto , Pessoal de Saúde/educação , Pesquisadores/educação , Bioética/educação , Pessoa de Meia-Idade , Síndrome da Imunodeficiência Adquirida , Adulto Jovem , Pesquisa Biomédica/educação
16.
BMC Med Ethics ; 25(1): 64, 2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38783289

RESUMO

BACKGROUND: Intersectionality is a concept that originated in Black feminist movements in the US-American context of the 1970s and 1980s, particularly in the work of feminist scholar and lawyer Kimberlé W. Crenshaw. Intersectional approaches aim to highlight the interconnectedness of gender and sexuality with other social categories, such as race, class, age, and ability to look at how individuals are discriminated against and privileged in institutions and societal power structures. Intersectionality is a "traveling concept", which also made its way into bioethical research. METHODS: We conducted a systematic review to answer the question of where and how the concept of intersectionality is applied in bioethical research. The PubMed and Web of Science databases were systematically searched and 192 articles addressing bioethical topics and intersectionality were finally included. RESULTS: The qualitative analysis resulted in a category system with five main categories: (1) application purpose and function, (2) social dimensions, (3) levels, (4) health-care disciplines and academic fields, and (5) challenges, limitations, and critique. The variety of academic fields and health-care disciplines working with the concept ranges from psychology, through gynaecology to palliative care and deaf studies. Important functions that the concept of intersectionality fulfils in bioethical research are making inequities visible, creating better health data collections and embracing self-reflection. Intersectionality is also a critical praxis and fits neatly into the overarching goal of bioethics to work toward social justice in health care. Intersectionality aims at making research results relevant for respective communities and patients, and informs the development of policies. CONCLUSIONS: This systematic review is, to the best of our knowledge, the first one to provide a full overview of the reference to intersectionality in bioethical scholarship. It creates a basis for future research that applies intersectionality as a theoretical and methodical tool for analysing bioethical questions.


Assuntos
Bioética , Humanos , Feminino , Feminismo , Temas Bioéticos
17.
BMC Med Educ ; 24(1): 385, 2024 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-38589869

RESUMO

BACKGROUND: The undergraduate bioethics curriculum introduced in a private medical college in Pakistan in 1988 and revised in 2009 has evolved over time to incorporate globally relevant innovations, including integration of bioethics spirally within an existing problem-based learning curricular framework. The present evaluation study shares the results of this integrated bioethics curriculum delivered for 10 years across the five-year undergraduate medical curriculum. The study assessed the effectiveness of the curriculum in terms of student achievement, appropriateness of course contents and efficiency of instructional methods. METHODS: The study utilized a mixed method sequential explanatory design. The quantitative method was used in the first phase to gather data by utilizing a structured online questionnaire. This was followed by the second phase of qualitative methods to explain the findings of the first phase and enrich the data gathered. This phase was based on focus group discussions and document review. RESULTS: Student and faculty responses showed the curriculum contents to be relevant, informative, and appropriate as per learning objectives and student achievement. Multi-modal instructional methods used were stated to be effective and engaging; small group teaching and shorter sessions suggested to be preferable for fostering discussion and maintaining student engagement and attention. Large class formats were stated to be less effective. Students affirmed the contribution of bioethics education to their personal and professional development and ethical positioning. The majority of students agreed that the curriculum contributed to their knowledge acquisition (60.3-71.2%), skill development (59.41-60.30%) and demonstration of ethical/professional behavior (62.54-67.65%). The ranges indicate agreement with related sets of questions. Participants suggested that the curriculum could be further strengthened by better integration in clinical years, role modelling and providing opportunities for application in clinical health care settings. Moreover, topics like ethical issues related to the use of social media, public health ethics and ethics and law were suggested as additions to the existing curriculum. These findings have regional and global relevance for the development and assessment of effective bioethics curricula. CONCLUSION: An effective bioethics curriculum for undergraduate medical education should run longitudinally across the 5 year curriculum and be integrated in the modules and clerkships. Basic acquisition of knowledge and skills takes place in Years 1 & 2 with reinforcement and application in Years 3-5. Learning embedded in an integrated curriculum can help students recognize, critically analyze and address ethical dilemmas. Involvement and commitment of the clinical faculty is essential for reinforcing the ethical principles and concepts learnt in the earlier years.


Assuntos
Bioética , Educação de Graduação em Medicina , Estudantes de Medicina , Humanos , Bioética/educação , Currículo , Aprendizagem
18.
19.
Perspect Biol Med ; 67(1): 63-72, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38662063

RESUMO

This article presents a case for transforming traditional bioethics into "Bios-ethics." This exposition relies on three propositions: (1) the climate emergency is the "Bios emergency"; (2) in the Bios emergency, bioethics must be replaced by Bios-ethics; and (3) the top and overwhelming priority of Bios-ethics is to address the Bios emergency. Biocentrism, habitat, and environmental ethics are discussed in light of their contribution to the development of Bios-ethics, and potential lines of research in Bios-ethics are outlined. The urgency of undertaking substantive conceptual and practical innovations in response to our current danger is emphasized throughout.


Assuntos
Bioética , Humanos , Mudança Climática , Ecossistema , Temas Bioéticos , Emergências
20.
Perspect Biol Med ; 67(1): 166-179, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38662071

RESUMO

The relationship between philosophy and bioethics remains a matter of perennial debate, but there does appear to be a consensus on one issue: whatever bioethics might want to borrow from philosophical ethics, it won't be normative theories. This essay argues that theories can have an important role to play in bioethics, though it might not be the one traditionally assumed by philosophers.


Assuntos
Bioética , Teoria Ética , Humanos , Filosofia , Temas Bioéticos
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