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1.
Perspect Biol Med ; 64(4): 511-540, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34840154

RESUMO

The Ethics of Environmentally Responsible Health Care (2004) argued that the obligation to protect nature must be a core principle of bioethics and that the environmental harm of health-care practices should be taken seriously. In the two decades since, the accelerating pace of climate change and environmental decline has strengthened the moral case for reducing the environmental costs of health care. Nevertheless, mainstream bioethics has until recently neglected these vital issues. In response, a field of clinical environmental bioethics is emerging that applies concepts and measures of sustainability to such key clinical ethical issues as humanizing technology, setting limits, caring for the dying, respecting patient wishes, and allocating resources justly. Bioethical analysis of these and other issues can support just and humane health-care adaptation to climate change. Health-care adaptation in turn plays an important role in helping communities and nations adapt to the inevitable forward march of climate change. This essay offers two recommendations: (1) establish a climate transition commission for health-care adaptation to climate change with bioethics participation, and (2) strengthen advocacy for health-care reform by uniting it with climate activism.


Assuntos
Bioética , Ética Clínica , Temas Bioéticos , Mudança Climática , Ética , Humanos , Princípios Morais
2.
Biol Futur ; 72(2): 101-102, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34554474
3.
Rev Gaucha Enferm ; 42(spe): e20200172, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34524354

RESUMO

OBJECTIVE: To reflect about the do-not-resuscitation order at COVID-19 in Brazil, under bioethical focus and medical and nursing professional ethics. METHOD: Reflection study based on the principlist bioethics of Beauchamps and Childress and in professional ethics, problematizing actions, and decisions of non-resuscitation in the pandemic. RESULTS: It is important to consider the patient's clinic, appropriation of treatment goals for people with comorbidities, elderly people, with less chance of surviving to resuscitation, or less quality of life, with the palliative care team, to avoid dysthanasia, use of scarce resources and greater exposure of professionals to contamination. CONCLUSION: COVID-19 increased the vulnerabilities of professionals and patients, impacting professional decisions and conduct more widely than important values ​​such as the restriction of freedom. It propelled the population in general to rethink ethical and bioethical values ​​regarding life and death, interfering in decisions about them, supported by human dignity.


Assuntos
Temas Bioéticos , COVID-19/terapia , Reanimação Cardiopulmonar , Enfermagem de Cuidados Críticos/ética , Atenção à Saúde/ética , Cuidados Paliativos/ética , Ordens quanto à Conduta (Ética Médica)/ética , Adulto , Cuidados Críticos , Tomada de Decisões/ética , Ética Profissional , Feminino , Alocação de Recursos para a Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Qualidade de Vida , SARS-CoV-2
4.
Cuad Bioet ; 32(105): 133-139, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34543043

RESUMO

In this article we start by submitting a definition of transhumanism and then turn to the main bioethical problems that arise from it, with particular attention to the so-called human enhancement perspective. Secondly, and without being exhaustive, we shall seek to identify some of the main challenges posed by emerging sciences in the 21st century, specially with an eye to convergent technologies or NBICs (nanotechnology, biotechnology, informatics and cognitive sciences). And finally, we end up by enumerating some of the bioethical questions every researcher should take into account before considering applying any new technology on humans in the coming decades.


Assuntos
Temas Bioéticos , Biotecnologia , Humanos , Nanotecnologia
5.
Bull World Health Organ ; 99(9): 616-617, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34475598

RESUMO

Gary Humphreys talks to Kazuto Kato about the ethical and societal challenges posed by biotechnologies that allow for the editing of the human genome.


Assuntos
Temas Bioéticos , Biotecnologia/ética , Ética Médica , Edição de Genes/ética , Temas Bioéticos/história , Sistemas CRISPR-Cas , Teoria Ética , Ética Médica/história , Edição de Genes/história , História do Século XXI , Características Humanas , Humanos
7.
Bull Cancer ; 108(9): 827-836, 2021 Sep.
Artigo em Francês | MEDLINE | ID: mdl-34340841

RESUMO

The Parents and Caregivers group in the face of ethics in pediatrics of the Île-de-France Ethics Area wondered about the association of the words Disability and Cancer by focusing on the study of the course of children with intellectual disability, treated for cancer. These situations are exceptional, the number of cases in France must not be more than fifty per year. We gathered the testimony of five families of children using a semi-directive survey taking up the journey from birth, announcement of the handicap, the diagnosis of cancer and its treatment. The verbatim show that each story is unique and rich in lessons, despite the feeling of "double penalty": "He did not deserve this, a handicap plus cancer is a lot for one person", "the shot moreover." A healthcare team was also interviewed and raised an additional question: "First, the double penalty… then, what's the point?" Through these testimonies, we sought to question the ethical principles of care, which can be shaken up in these extraordinary supported.


Assuntos
Temas Bioéticos , Tomada de Decisão Clínica/ética , Crianças com Deficiência , Deficiência Intelectual , Neoplasias/terapia , Agenesia do Corpo Caloso/diagnóstico , Agenesia do Corpo Caloso/psicologia , Cuidadores , Criança , Pré-Escolar , Crianças com Deficiência/estatística & dados numéricos , Síndrome de Down/diagnóstico , Síndrome de Down/psicologia , Família/psicologia , Relações Familiares , Feminino , Síndrome do Cromossomo X Frágil/diagnóstico , Síndrome do Cromossomo X Frágil/psicologia , França/epidemiologia , Humanos , Lactente , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/psicologia , Masculino , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/psicologia , Pais/psicologia , Autonomia Pessoal , Pesquisa Qualitativa , Revelação da Verdade
9.
Cancer Radiother ; 25(6-7): 699-706, 2021 Oct.
Artigo em Francês | MEDLINE | ID: mdl-34400087

RESUMO

In 2021, the Ethics Commission of the SFRO has chosen the issue of the practice of palliative care in radiotherapy oncology. Radiation oncology plays a central role in the care of patients with cancer in palliative phase. But behind the broad name of palliative radiotherapy, we actually find a large variety of situations involving diverse ethical issues. Radiation oncologists have the delicate task to take into account multiple factors throughout a complex decision-making process. While the question of the therapeutic indication and the technical choice allowing it to be implemented remains central, reflection cannot be limited to these decision-making and technical aspects alone. It is also a question of being able to create the conditions for a singularity focused care and to build an authentic care relationship, beyond technicity. It is through this daily ethical work, in close collaboration with patients, and under essential conditions of multidisciplinarity and multiprofessionalism, that our fundamental role as caregiver can be deployed.


Assuntos
Temas Bioéticos , Tomada de Decisão Clínica/ética , Neoplasias/radioterapia , Cuidados Paliativos/ética , Radioterapia (Especialidade)/ética , Humanos , Radio-Oncologistas/ética
10.
PLoS One ; 16(7): e0253718, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34242245

RESUMO

BACKGROUND: To determine the impact of health care interruption (HCI), on clinical status of the patients reincorporated to an outpatient clinic for rheumatic diseases (OCDIR), from a tertiary care level center who was temporally switched to a dedicated COVID-19 hospital, and to provide a bioethical analysis. METHODS: From March to June 2020, the OCDIR was closed; since June, it is limited to evaluate 25% of the ongoing outpatients. This cross-sectional study surveyed 670 consecutive rheumatic outpatients between June 24th and October 31th, concomitant to the assessment of the rheumatic disease clinical status by the attendant rheumatologist, according to disease activity level, clinical deterioration and adequate/inadequate control. Multiple logistic regression analysis identified factors associated to HCI and to clinical deterioration. RESULTS: Patients were middle-aged females (86.7%), with median disease duration of 10 years, comorbidity (38.5%) and 138 patients (20.6%) had discontinued treatment. Primary diagnoses were SLE and RA, in 285 (42.5%) and 223 (33.3%) patients, respectively. There were 344 patients (51.3%) with HCI. Non-RA diagnosis (OR: 2.21, 95%CI: 1.5-3.13), comorbidity (OR: 1.7, 95%CI: 1.22-2.37), patient's need for rheumatic care during HCI (OR: 3.2, 95%CI: 2.06-4.97) and adequate control of the rheumatic disease (OR: 0.64, 95%CI: 0.45-0.9) were independently associated to HCI. There were 160 patients (23.8%) with clinical deterioration and associated factors were disease duration, substantial disease activity previous HCI, patients need for rheumatic care and treatment discontinuation. CONCLUSIONS: HCI during COVID-19 pandemic impacted course of rheumatic diseases and need to be considered in the bioethical analysis of virus containment measures.


Assuntos
Temas Bioéticos , COVID-19/epidemiologia , Atenção à Saúde/ética , Pacientes Ambulatoriais , Pandemias , Doenças Reumáticas/terapia , SARS-CoV-2 , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
11.
J Bioeth Inq ; 18(2): 195-198, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34324147
12.
Semin Nephrol ; 41(3): 253-261, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34330365

RESUMO

Across the world, challenges for clinicians providing health care during the coronavirus disease 2019 (COVID-19) pandemic are highly prevalent and have been widely reported. Perspectives of provider groups have conveyed wide-ranging experiences of adversity, distress, and resilience. In understanding and responding to the emotional and psychological implications of the pandemic for renal clinicians, it is vital to recognize that many experiences also have been ethically challenging. The COVID-19 pandemic has prompted rapid and extensive transformation of health care systems and widely impacted care provision, heightening the risk of barriers to fulfillment of ethical duties. Given this, it is likely that some clinicians also have experienced moral distress, which can occur if an individual is unable to act in accordance with their moral judgment owing to external barriers. This review presents a global perspective of potential experiences of moral distress in kidney care during the COVID-19 pandemic. Using nephrology cases, we discuss why moral distress may be experienced by health professionals when withholding or withdrawing potentially beneficial treatments owing to resource constraints, when providing care that is inconsistent with local prepandemic best practice standards, and when managing dual professional and personal roles with conflicting responsibilities. We argue that in addition to responsive and appropriate health system supports, resources, and education, it is imperative for health care providers to recognize and prevent moral distress to foster the psychological well-being and moral resilience of clinicians during extended periods of crisis within health systems.


Assuntos
COVID-19 , Nefropatias/terapia , Princípios Morais , Nefrologia , Estresse Ocupacional/etiologia , Angústia Psicológica , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto , Idoso de 80 Anos ou mais , Temas Bioéticos , Atenção à Saúde/ética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrologia/ética
14.
Ann Glob Health ; 87(1): 58, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34249620

RESUMO

Although Artificial Intelligence (AI) is being increasingly applied, considerable distrust about introducing "disruptive" technologies persists. Intrinsic and contextual factors influencing where and how such innovations are introduced therefore require careful scrutiny to ensure that health equity is promoted. To illustrate one such critical approach, we describe and appraise an AI application - the development of computer assisted diagnosis (CAD) to support more efficient adjudication of compensation claims from former gold miners with occupational lung disease in Southern Africa. In doing so, we apply a bio-ethical lens that considers the principles of beneficence, non-maleficence, autonomy and justice and add explicability as a core principle. We draw on the AI literature, our research on CAD validation and process efficiency, as well as apprehensions of users and stakeholders. Issues of concern included AI accuracy, biased training of AI systems, data privacy, impact on human skill development, transparency and accountability in AI use, as well as intellectual property ownership. We discuss ways in which each of these potential obstacles to successful use of CAD could be mitigated. We conclude that efforts to overcoming technical challenges in applying AI must be accompanied from the onset by attention to ensuring its ethical use.


Assuntos
Inteligência Artificial , Temas Bioéticos , Atenção à Saúde/ética , Silicose , Tuberculose , Humanos , Justiça Social
15.
Bull Cancer ; 108(10): 893-894, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34229855

RESUMO

A successful Hematopoietic stem cell transplantation (HSCT) is often the only hope of survival for children suffering from a range of potentially life-threatening hematological malignancies. The financial, ethical, and emotional problems faced by the matched sibling donor and their recipient siblings during the HSCT are extremely complex and challenging. Herein, the authors have attempted to pen down these in the configuration of a poem.


Assuntos
Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/ética , Poesia como Assunto , Temas Bioéticos , Criança , Comissão de Ética , Transplante de Células-Tronco Hematopoéticas/economia , Humanos , Índia , Consentimento Informado por Menores , Irmãos , Doadores de Tecidos/psicologia
17.
Bull Cancer ; 108(9): 813-826, 2021 Sep.
Artigo em Francês | MEDLINE | ID: mdl-34176585

RESUMO

AIM: The aim was to describe and to analyze the ethics of decision-making in situations involving children with intellectual disability and cancer, from the referent-doctor's point-of-view, in pediatric oncology units in France. METHODS: Pediatricians working in pediatric oncology units were interviewed through an online questionnaire and a semi-directive interview was systematically proposed. We analyzed the ethical issues that arose during the process of decision-making and we made suggestions in order to address them. RESULTS: Sixteen doctors reported twenty-one clinical cases. Of these cases, one third of the children had a change in their oncologic treatment, with a risk of pejorative outcome on the prognosis. Despite the fact that ethical issues appeared in 80 % of the cases, there were few consultations with ethical committees. Decision-making process showed no difference compared to children without intellectual disability, thus raising ethical issues in the medical team. Our study showed discrepancy between frequently reported ethical issues, high consensus rate regarding treatment decision and lack of consultation with ethical committees. DISCUSSION: We propose three steps to guide the decision-making process in situations involving children with intellectual disability and cancer: 1/deeper understanding of the child through reinforced interactions with their caregivers, 2/better cross-boundary discussions, to improve the effectiveness of the multidisciplinary staff, and 3/more systematic ethical committees consultation.


Assuntos
Tomada de Decisão Clínica/ética , Crianças com Deficiência , Pesquisas sobre Serviços de Saúde , Deficiência Intelectual , Neoplasias/terapia , Adolescente , Adulto , Temas Bioéticos , Criança , Pré-Escolar , Tomada de Decisão Clínica/métodos , Consenso , Técnicas de Apoio para a Decisão , Comitês de Ética Clínica/estatística & dados numéricos , Feminino , França , Humanos , Lactente , Deficiência Intelectual/complicações , Masculino , Neoplasias/complicações , Neoplasias/patologia , Cuidados Paliativos , Equipe de Assistência ao Paciente , Medição de Risco , Revelação da Verdade , Adulto Jovem
18.
Hastings Cent Rep ; 51(3): 3-4, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34028820

RESUMO

The Covid-19 pandemic has exposed four myths in bioethics. First, the flood of bioethics publications on how to allocate scarce resources in crisis conditions has assumed authorities would declare the onset of crisis standards of care, yet few have done so. This leaves guidelines in limbo and patients unprotected. Second, the pandemic's realities have exploded traditional boundaries between clinical, research, and public health ethics, requiring bioethics to face the interdigitation of learning, doing, and allocating. Third, without empirical research, the success or failure of ethics guidelines remains unknown, demonstrating that crafting ethics guidance is only the start. And fourth, the pandemic's glaring health inequities require new commitment to learn from communities facing extraordinary challenges. Without that new learning, bioethics methods cannot succeed. The pandemic is a wake-up call, and bioethics must rise to the challenge.


Assuntos
Temas Bioéticos/normas , COVID-19/epidemiologia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Pesquisa Biomédica/ética , Pesquisa Biomédica/organização & administração , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/normas , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/ética , Disparidades em Assistência à Saúde/normas , Humanos , Pandemias , Saúde Pública , SARS-CoV-2
19.
BMC Med Ethics ; 22(1): 56, 2021 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-33971872

RESUMO

BACKGROUND: National Ethics Committees (NECs) offer important oversight and guidance functions and facilitate public debate on bioethical issues. In an increasingly globalized world where technological advances, multi-national research collaborations, and pandemics are creating ethical dilemmas that transcend national borders, coordination and the joining of efforts among NECs are key. The purpose of this study is to take stock of the current NEC landscape, their varying roles and missions, and the range of bioethical topics on which they deliberated since their inception. METHODS: Data on the availability, functions, and ethical deliberations (publications) of NECs globally were gathered through a systematic search of NEC websites and through contacts known to the authors. The search was conducted in English, French, and Spanish. The data abstraction was done in Excel and included the NEC's country, region, functions, and deliberations on bioethical issues. Deliberation topics were classified into thematic categories through an iterative process of regrouping to arrive at the main set of themes. RESULTS: 124 NECs in 100 countries were identified. 44% of the NECs are in Europe and 47% are in high-income countries. Out of the 1108 retrieved publications, 40% were on bioethics in the context of research, followed by the clinic (28%) and public health issues (22%). The top five topics of these publications were: research ethics (124; 9%), genetics and genomics (62; 6%), organ transplantation (58; 5%), assisted reproductive technology (49; 4%), and end of life (36; 3%). CONCLUSION: Our study makes an important contribution to understanding the current interests and functions of NECs and the range of their bioethics deliberations. By making the data publicly available through this publication, it allows users to conduct tailored analyses and queries based on their interests, and to seek and strengthen collaboration and exchange. It also makes the case for the fruitfulness of developing and maintaining a global repository of current and new deliberations to more effectively advance this field for the greater good of humanity, research, and public health.


Assuntos
Bioética , Comissão de Ética , Temas Bioéticos , Ética em Pesquisa , Europa (Continente) , Humanos , Recém-Nascido
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