Hasil untuk "Medical philosophy. Medical ethics"

Editta Buttura da Prato, Hugues Cartier, Andrea Margara et al.

Abstract This article addresses some critical aspects of the relationship between aesthetic medicine (AM) and ethics and proposes a possible deontological ethical line to pursue based on current practices. The role of AM has always been controversial and suffers from unclear practical and moral boundaries, even within academic settings, since it aims to improve the appearance of individuals, not to cure a disease. Today, it is essential and pertinent to discuss these issues, as AM specialists are dealing with a growing and increasingly demanding patient population that has undergone profound evolution in recent years. Current challenges within the field of AM include a lack of global uniformity concerning the education of AM specialists, an increasing number of physicians practicing AM with diverse training backgrounds, the spread of AM being practiced outside of medical practice or hospital settings, and the influence of social media where the success is modelled and dictated by the identification of a youthful appearance). By the field of action enriched by technologies that aim not only at enhancement per se but also at the preservation and regeneration of tissues, it is necessary to establish an active multidisciplinary discussion on the definition of shared ethical limits. This discussion would allow AM to fully reclaim its identity as a specialty that aims to improve patient well-being whilst maintaining respect for patient aesthetic harmony, the expertise of specialists who practice AM, the essential role of safety, and awareness of the importance of a confidential doctor−patient relationship.

Gabriel Andrade, Eid AboHamza, Yasmeen Elsantil et al.

Abstract Xenotransplantation has great potential as an alternative to alleviate the shortage of organs for donation. However, given that the animal most suited for xenotransplantation is the pig, there are concerns that people in Muslim countries may be more hesitant to morally approve of these procedures. In this study, the moral approval of xenotransplantation was assessed in a group of 895 participants in Egypt. The results showed that religiosity itself does not predict moral approval of xenotransplantation, but religious identity does, as Muslims are less likely to approve of xenotransplantation than Christians. However, the strongest predictor of moral approval of xenotransplantation was gender, with women displaying less approval. A partial mediating factor in this association was concern for animal welfare. Based on these results, some implications for public policy are discussed.

Hoda Ahmari Tehran, Sareh Bakouei, Nahid Mehran

Background and Objectives: The emotional relationship between a mother and her fetus is considered one of the stages of the mother’s adaptation to facing pregnancy anxiety. It seems that maternal-fetal attachment behaviors are different in various cultures and religions. This study aimed to examine the effect of training maternal-fetal attachment behaviors based on Iranian-Islamic culture on anxiety in pregnant women referred to health centers in Qom City, Iran. Methods: This quasi-experimental research included 84 singleton primigravida pregnant mothers aged 30 to 34 years who were selected by convenience sampling method and randomly assigned to the experimental and control groups. The Spielberger state-trait anxiety inventory (STAI) and Cranley’s maternal-fetal attachment scale (MFAS) were administered at both pre- and post-intervention weeks in both groups. In addition to the usual care, the experimental group received training on maternal-fetal attachment behaviors based on Iranian-Islamic culture in eight 30-minute sessions over four weeks. Data were analyzed by SPSS software version 26 using the independent t-test and paired t-test. Results: No statistically significant difference was observed between the two groups’ average anxiety scores before the intervention (P=0.67). After the intervention, a statistically significant difference was observed between the two groups’ mean anxiety scores (P=0.002). Conclusion: Training in maternal-fetal attachment behaviors based on Islamic-Iranian culture reduced the anxiety of pregnant mothers. This training serves as a foundation for strengthening trust and hope in God, leading to a calmer mental and spiritual state for the mother. Healthcare providers are encouraged to recommend these training sessions.

B. Hofmann

Disease radically changes the life of many people and satisfies formal criteria for being a transformative experience. According to the influential philosophy of Paul, transformative experiences undermine traditional criteria for rational decision-making. Thus, the transformative experience of disease can challenge basic principles and rules in medical ethics, such as patient autonomy and informed consent. This article applies Paul’s theory of transformative experience and its expansion by Carel and Kidd to investigate the implications for medical ethics. It leads to the very uncomfortable conclusion that disease involves transformative experiences in ways that can reduce people’s rational decision-making ability and undermine the basic principle of respect for autonomy and the moral rule of informed consent. While such cases are limited, they are crucial for medical ethics and health policy and deserve more attention and further scrutiny.

T. Browne, E. Kendal, T. Sudenkaarne

frontiers of human reproduction: Conceptual differences and potential implications. Journal of Medical Ethics 44 (11):751–5. doi:10.1136/medethics-2018-104910. Romanis, E. C. 2019. Artificial womb technology and the significance of birth: Why gestatelings are not newborns (or fetuses). Journal of Medical Ethics 45 (11):728–31. doi:10.1136/medethics-2019-105723. Thomson, J. J. 1971. A defense of abortion. Philosophy and Public Affairs 1 (1):47–66. Wozniak, P. S., and A. K. Fernandes. 2021. Conventional revolution: The ethical implications of the natural progress of neonatal intensive care to artificial wombs. Journal of Medical Ethics 47 (12):e54. doi:10.1136/ medethics-2020-106754.

Patricia Sorokin, María Angélica Sotomayor, Agueda Muñoz del Carpio Toia et al.

En la capital de un país de América Latina y el Caribe, en una institución de salud muy prestigiosa, con investigadores acreditados, con comité de ética que revisa y aprueba o rechaza los protocolos, con innumerables documentos nacionales e internacionales, con la presencia de una autoridad regulatoria de las investigaciones; algo sucedió sin que nadie lo notara… hasta que una persona fue reclutada de modo solapado y sintió que no quería ser “un número y algo más”.

E. Pellegrino, D. Thomasma

Salik Ansari

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Michele Farisco, Cyriel Pennartz, Jitka Annen et al.

Abstract Background Assessing consciousness in other subjects, particularly in non-verbal and behaviourally disabled subjects (e.g., patients with disorders of consciousness), is notoriously challenging but increasingly urgent. The high rate of misdiagnosis among disorders of consciousness raises the need for new perspectives in order to inspire new technical and clinical approaches. Main body We take as a starting point a recently introduced list of operational indicators of consciousness that facilitates its recognition in challenging cases like non-human animals and Artificial Intelligence to explore their relevance to disorders of consciousness and their potential ethical impact on the diagnosis and healthcare of relevant patients. Indicators of consciousness mean particular capacities that can be deduced from observing the behaviour or cognitive performance of the subject in question (or from neural correlates of such performance) and that do not define a hard threshold in deciding about the presence of consciousness, but can be used to infer a graded measure based on the consistency amongst the different indicators. The indicators of consciousness under consideration offer a potential useful strategy for identifying and assessing residual consciousness in patients with disorders of consciousness, setting the theoretical stage for an operationalization and quantification of relevant brain activity. Conclusions Our heuristic analysis supports the conclusion that the application of the identified indicators of consciousness to its disorders will likely inspire new strategies for assessing three very urgent issues: the misdiagnosis of disorders of consciousness; the need for a gold standard in detecting consciousness and diagnosing its disorders; and the need for a refined taxonomy of disorders of consciousness.

Rehan Gul, Hamid Saeed, Zikria Saleem et al.

Abstract Background In Pakistan, drug promotion practices, ethical or unethical, have rarely been in the spotlight. We aimed to assess the perception and barriers of medical representatives (MRs) and doctors (MDs) regarding ethical promotion of pharmaceuticals in Pakistan. Methods A cross sectional survey was conducted in seven major cities of Pakistan for 6-months period. Self-administered questionnaire was used for data collection. Logistic regression and five-point Likert scale scoring was used to estimate the perceptions and barriers. Results Compared to national companies (NCs), the medical representatives (MRs) of multinational companies (MNCs) strongly believed that their companies follow World Health Organization (WHO) (OR; 5.31, p = 0.0005), International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) (OR; 6.45, p = 0.0005) and national codes of ethics (OR; 5.84, p = 0.0005). MNCs trained their MRs (OR; 6.68, p = 0.0005), provide accurate and valid scientific data (OR; 4.01, p = 0.007) with adequate system of accountability and controls on product samples (OR; 1.96, p = 0.047), while, NCs sponsor social or entertainment activities, seminars and conferences, and all sort of facilitation in form of gifts of their choice and clinic renovation for medical doctors (MDs). MDs perceptions were similar to MRs mentioned above, yet strongly agreed that companies offer cash payments or equivalents to MDs. The MRs of NCs/MNCs and MDs agreed/strongly agreed that no external accountability, profiteering, pressure on sale targets, job insecurity, condoning unethical promotion by high-ups’ and business promotion by junior MDs were the predominant barriers. Conclusion In conclusion, MRs of MNCs and MDs believed that MNCs follow certain codes of ethics in the promotion of pharmaceuticals, while NCs tend to be more profit oriented and even condone unethical promotion. All stakeholders, MRs, MDs and companies, might pose certain barriers, intentionally or unintentionally, in ethical promotion.

Javier Gonzalez

Ante la preocupación por el desarrollo de argumentos que soportan estrategias de protección animal, en este artículo se identifican y analizan distintos discursos sobre derechos de los animales que pronuncian documentos de los poderes ejecutivo, legislativo y judicial de Colombia. Se encontraron discursos tergiversados para promover prácticas de maltrato animal y otros cuya falta de rigor argumentativo no permite que se les pueda caracterizar propiamente como derechos de los animales. Esta situación plantea la necesidad de revisar las herramientas conceptuales en particular de quienes participan activamente en la defensa de los animales no humanos.

Janaína Oliveira Barbosa Franco, Rosa Silva Batistão, Denise Cristina Santos et al.

Objetiva-se compreender a síndrome de Münchhausen a partir da descrição das suas causas, dos critérios de identificação, dos sinais clínicos, do diagnóstico e do tratamento, bem como das assistências realizadas pela Enfermagem e pela equipe interdisciplinar com interface da Bioética. Trata-se de uma revisão narrativa de literatura de caráter exploratório reflexivo, com abordagem qualitativa. Realizaram-se buscas de estudos em periódicos publicados entre 2009 e 2019; a amostra final constituiu-se por 30 artigos, além de livros, manuais e normativas. Os resultados apresentados evidenciam o conhecimento da quinta edição do Manual Diagnóstico e Estatístico de Transtornos Mentais, no qual a expressão “síndrome de Münchhausen imposto a si próprio” foi substituída por “transtorno factício autoimposto”, e a “síndrome de Münchhausen por procuração” foi alterada para “transtorno factício imposto a outro”, quanto à bioética. Indivíduos com o distúrbio factício tendem a buscar tratamento para si mesmo ou para outro. O comportamento desses pacientes aumenta a probabilidade de terem realmente uma doença física e até mesmo ir a óbito, causado pelo excesso de uso de medicações e pelos diversos procedimentos invasivos. Portanto, conclui-se que identificar o quadro clínico pode ser uma das primeiras iniciativas para a detecção e a prevenção. O tratamento deve se concentrar no manejo, com a possibilidade do uso da psicoterapia e de antidepressivos, antipsicóticos e ansiolíticos. A equipe de enfermagem e a multiprofissional devem estar atentas a sinais e sintomas para uma intervenção precisa e precoce, pois desempenham importante papel na identificação adequada do diagnóstico.

Javier Sádaba Garay

El artículo expone, en síntesis, el estado de la cuestión del campo de la bioética. Trata del vínculo indisoluble con la ética y presenta una propuesta epistemológica para el ámbito de conocimiento de la bioética.

Tien Dung Ha

Pablo Enguer Gosálbez, Francisca Ramón Fernández

Este trabajo analiza algunos problemas jurídicos y bioéticos que no están resueltos por la legislación aplicable a la reproducción asistida, uno de los campos más controvertidos de la medicina y la biotecnología humana. Se centra especialmente en el ámbito de los nuevos modelos familiares heterosexuales y homosexuales, así como el caso de parejas que tengan una enfermedad preexistente, la controversia referente a la selección de embriones no portadores de enfermedades en el caso del diagnóstico genético preimplantatorio, la selección del sexo, la fecundación in vitro mixta, procreación post mortem, entre otros. En definitiva, se presta atención al modo como se ha efectuado la regulación y a las valoraciones éticas, con el propósito de alcanzar conclusiones después de conocer los argumentos emitidos por la doctrina y reflexionar acerca de los aspectos mejorables de nuestra legislación, con propuestas concretas de lege ferenda.

Chris Gilmartin, Edward H. Arbe-Barnes, Michael Diamond et al.

Abstract The 2018 Varsity Medical Ethics debate convened upon the motion: “This house believes that the constant monitoring of our health does more harm than good”. This annual debate between students from the Universities of Oxford and Cambridge is now in its tenth year. This year’s debate was hosted at the Oxford Union on 8th of February 2018, with Oxford winning for the Opposition, and was the catalyst for the collation and expansion of ideas in this paper. New technological devices have the potential to enhance patient autonomy, improve patient safety, simplify the management of chronic diseases, increase connectivity between patients and healthcare professionals and assist individuals to make lifestyle changes to improve their health. However, these are pitted against an encroachment of technology medicalising the individual and home, an exacerbation of health inequalities, a risk to the security of patient data, an alteration of the doctor-patient relationship dynamic and an infringement on individual self-identity. This paper will draw upon and develop these concepts, while contending arguments for and against constant health monitoring. This is not a review of medical devices and health monitoring, but a reflective development and more detailed elaboration of the main points highlighted in the 2018 Varsity Medical Ethics debate.

Michael Quante

Jorge Luis Rivera-Agosto

On January 23, 2017, President Trump signed a Presidential Memorandum reinstating the so-called Mexico City Policy. The Memorandum conditions U.S. global health and family planning assistance to a strict rule that precludes foreign non-governmental organizations (also known as “NGOs”) from promoting or performing abortion as a method of family planning. Also known as the “global gag rule,” this policy represents a blow specifically to women’s health worldwide. Thanks to this new action, it will become harder, like in past years when it was in effect, to have resources to support family planning and reproductive health services, such as “family counseling, contraceptive commodities, condoms, and reproductive cancer screenings.” Even though the U.S. government won’t retract from the Memoranda until this Administration ceases, global efforts should be made to ameliorate the negative effects the new policy will cause. The Mexico City Policy was first enacted by President Reagan in 1984 – and at the time, it represented an expansion of existing legislative restrictions of the use of U.S. funds for abortions internationally. It was then rescinded by President Clinton in 1991; reinstated by President Bush in 2001; rescinded by President Obama in 2009; and reinstated and expanded by President Trump in 2017. The policy requires foreign NGOs “to certify that they will not perform or actively promote abortion as a method of family planning, using funds from any source (including non-U.S. funds), as a condition for receiving U.S. government global family planning assistance and any other U.S. global health assistance.” The reason given to enact such policy was that the U.S. did not consider abortion as an acceptable element of family planning; thus, it was no longer going to contribute to it – no other evidence nor reason were presented. The problem with this line of thinking was that it did not conform to declared national interests, U.S. foreign policy, foreign aid policy, nor foreign assistance programs. Furthermore, the policy directly contravened (and continues to) the role and scope of the U.S. support for global health. In addition, the morally relevant issue at stake is the undermining of women’s rights and their health. When the Mexico City Policy is in place, it has been found that in sub-Saharan African countries, the rate of abortion rates increases; precisely because foreign NGOs that depend on U.S. funding, but declined it because of the policy, do not have the additional resources to provide family planning services such as contraception. Also, they lack general essential services, that empower women and their families and produce better health outcomes, because they do not have the money – provided by U.S. aid – to provide such services. Moreover, the Mexico City Policy erodes the fine work made by gender equality movements and contravenes treaties ratified by the United States –such as the United Nations Charter, the Universal Declaration of Human Rights, and the International Covenant on Civil and Political Rights– because it takes away from women their right to choose, eliminates access to health care, and it directly impairs general well-being for all. Finally, the new policy frustrates free speech and thwarts U.S. efforts to bring about democracy for developing countries; specifically, because the global gag rule takes money away from NGOs that are mostly the contributors and the only viable openers of power restructuring and democratic participation in those countries. It can be argued in turn that the U.S. has the power to tie certain restrictions to the money it provides. But what this line of thought misses is that any good and workable framework to address issues of global health should undertake the essential health benefits to create a positive impact on well-being – because the underlying causes of poor health are directly dealt with. In that sense, abortion restrictions cannot be rationally achieved by restricting access to essential health benefits through money restrictions – for the effect on health care and well-being in general is disastrous for all, specially women in developing countries. The current Administration won’t rescind of the Mexico City Policy any time soon. It is, therefore, the duty of other developed countries to help and provide the assistance that now lacks to women and their families in developing countries. Some have taken the lead, namely The Netherlands, creating international abortion funds that ameliorate the vacuum created by the new policy/ Nonetheless more is needed, for the health of women and their families in developing countries is a morally relevant issue for all human beings and not just one country – it is part of our moral duty as people of this world. Their health is our health – and their well-being is our well-being.   References 1. The Henry J. Kaiser Family Foundation, The Mexico City Policy: An Explainer, Fact Sheet, March 2017, p. 1. 2. The Henry J. Kaiser Family Foundation, supra (note i), p. 5. 3. Policy Statement of the United States of America at the United Nations International Conference on Population (Second Session), Mexico City, Mexico, August 6-14, 1984. 4. The Henry J. Kaiser Family Foundation, The U.S. Government Engagement in Global Health: A Primer, Report, January 2017, p. 32; Congressional Research Service, International Family Planning: The “Mexico City” Policy, April 2, 2001, RL30830, p. CRS-3; Gregory H. Fox, American Population Policy Abroad: The Mexico City Abortion Funding Restrictions, 18 N.Y.U. J. Int’l. L. & Pol. 609 (1986). 5. Bill Clinton Administration, Subject: AID Family Planning Grants/Mexico City Policy, Memorandum for the Acting Administrator of the Agency for International Development, January 22, 1993. 6. George W. Bush Administration, Subject: Restoration of the Mexico City Policy, Memorandum for the Administrator of the United States Agency for International Development, March 28, 2001. 7. Barack Obama Administration, Mexico City Policy and Assistance for Voluntary Population Planning, Memorandum for the Secretary of State, the Administrator of the United States Agency for International Development, January 23, 2009. 8. White House, The Mexico City Policy, Memorandum for the Secretary of State, the Secretary of Health and Human Services, the Administrator of the Agency for International Development, Jan. 23, 2017. 9. The Henry J. Kaiser Family Foundation, supra (note i), p. 1. 10. Policy Statement of the United States…, supra (note iii); see in general: Lindsay B. Gezinski, The Global Gag Rule: Impacts of conservative ideology on women’s health, 55 Intl. Social Work 837 (2011). 11. Nina J. Crimm, The Global Gag Rule: Undermining National Interests by Doing unto Foreign Women and NGOs What Cannot Be Done at Home, 40 Cornell Int’l. L.J. 587, 609-611 (2007). 12. The Henry J. Kaiser Family Foundation, supra (note iv), pp. 10-11 13. Eran Bendavid, Patrick Avila & Grant Miller, United States aid policy and induced abortion in sub-Saharan Africa, 89 Bulletin of the World Health Organization 873 (2011); The Henry J. Kaiser Family Foundation, supra (note i), p. 5. 14. The Henry J. Kaiser Family Foundation, supra (note i), p. 5. 15. Yvette Aguilar, Gagging on a Bad Rule: The Mexico City Policy and Its Effect on Women in Developing Countries, 5 The Scholar 37, 62-64 (2002); also, see in general Sylvia A. Law & Lisa F. Rackner, Gender Equality and the Mexico City Policy, 20 N.Y.U. J. Int’l. L. & Pol. 193 (1987). 16. Sylvia A. Law & Lisa F. Rackner, supra (note xv); see in general: Patty Skuster, Advocacy in Whispers: The Impact of the USAID Global Gag Rule Upon Free Speech and Free Association in the Context of Abortion Law Reform in Three East African Countries, 11 Mich. J. Gender & L. 97 (2004); Allegra A. Jones, The “Mexico City Policy” and its effects on HIV/AIDS Services in Sub-Saharan Africa, 24 B.C. Third World L.J. 187 (2004); and Melissa Upreti, The Impact of the “Global Gag Rule” on Women’s Reproductive Health Worldwide, 24 Women’ Rts. L. Rep. 191 (2003). 17. Rachael E. Seevers, The Politics of Gagging: The Effects of the Global Gag Rule on Democratic Participation and Political Advocacy in Peru, 31 Brook. J. Int’l. L. 899, 915-927 (2006). 18. Madison Powers and Ruth Faden, Social Justice: The Moral Foundations of Public Health and Health Policy 81-82 (2006). 19. William H. Frist, Overcoming Disparities in U.S. Healthcare, 24(2) Health Affairs 445, 447 (2005). 20. Lawrence O. Gostin, Meeting the Survival Needs of the World’s Least Healthy People: A Proposed Model for Global Health Governance, 298 JAMA 225, 225-226 (2007). 21. Id. 22. Lawrence O. Gostin, Meeting Basic Survival Needs of the World’s Least Healthy People: Toward a Framework Convention on Global Health, 96 Georgetown L. J. 331, 347-352 (2008). 23. James Masters, Netherlands moves on abortion funding after Trump reinstates ‘gag rule’, CNN, January 26, 2017, accessed through http://www.cnn.com/2017/01/25/politics/netherlands-trump-global-gag-rule/. 24. Madison Powers and Ruth Faden, supra (note xviii), pp. 81-82.

Olga Cecilia Wilches Flórez, Angela María Wilches Flórez

Purpose: reflect on nursing practice, specifically on care, with the purpose of creating questions as an evaluation and auto evaluation for nursing professionals. Methods: A review of documents, taking concepts of renowned authors, is conducted and related ethical aspects concepts in nursing practice and ethical concepts of care and nursing knowledge patterns is developed; all this is argued from the theoretical but always correlating with the reality experienced by the family members of the health service. Conclusions: within the context of nursing it is noticeable that the true meaning of caring is lost, therefore the performance of the professionals in the area is not consistent with the ethical concepts and constructs that are implicit in their performance.

Loreto García Moyano, Begoña Pellicer García, Begoña Buil Tricas et al.

Se denominan “bebés medicamento” a, los niños concebidos con el propósito de que sean donantes compatibles para salvar, por medio de la determinación del antígeno leucocitario humano (HLA) de embriones, a un hermano que sufre una enfermedad congénita inmunitaria. Toda esta situación actual genera varios interrogantes éticos sobre el “uso” o “utilidad” de estas nuevas técnicas, el presente estudio pretende analizar las cuestiones bioéticas generadas más relevantes.