Hasil untuk "Medical philosophy. Medical ethics"

Jaime Junyent, Gabriel Muñoz Cordal, Francisca Jimena Junyent Echenique

El trabajo pretende exponer sobre la inteligencia artificial y sus sesgos relacionados con la salud y particularmente con las listas de espera en Chile. Los hallazgos apuntan a ciertos desafíos regulatorios y vacíos existentes, mostrando algunas propuestas para intentar abordar coherentemente la complejidad de sus problemas.

Deep Shah

Antonio Blanco Portillo, Rebeca García-Caballero, Diego Real de Asúa et al.

Abstract Background The differences in clinical bioethics between the Mediterranean and Latin American cultures have not been analyzed. The objective of the study is to compare the ethical conflicts that internists in Spain, Mexico and Argentina have. Methods Cross-sectional observational study through a survey directed at internists from Spain, Argentina and Mexico. The survey was administered to affiliated members of the National Societies of Internal Medicine across three countries via an online platform. Results 762 internists participated, 261 from Spain, 154 from Argentina and 347 from Mexico. The main ethical conflicts that internists in Spain, Argentina and Mexico have are related (in order) to the end of life, to the clinical relationship and to the patient’s autonomy. Withholding and withdrawing life-sustaining treatment is the most frequent conflict in Spain and Argentina and the second in Mexico. Conclusions Internists from Spain and Argentina identify very similar ethical conflicts. Furthermore, they consider them more frequent and difficult than in Mexico. In Argentina they are less satisfied with the way they are resolved. To explain these differences, socio-cultural factors are postulated, among others: paternalism, individualism, masculinity, organization of the health system, formal training in bioethics and assessment of death.

Thomas Milovac

Roxana Nayeli Guerrero Sotelo, José Eduardo Orellana Centeno, Melecio Honorio Juárez Pérez et al.

El objetivo de la investigación es identificar los problemas epistemológicos que surgen en el conocimiento y praxis de la Bioética en contextos pluriculturales y multiétnicos como es la Sierra Sur de Oaxaca México, y determinar su relación con los derechos humanos específicamente con el Enfoque de salud basado en los Derechos Humanos (EBDH). El método es el realismo epistemológico pragmático de Jürgen Habermas. Los resultados muestran dos tipos de problemas: el primero, es el tipo de relación sujeto-objeto de conocimiento en el que el Otro es subjetivado como objeto e instrumentalizado; y el segundo, el reduccionismo metodológico y por tanto las formas de verificación de las proposiciones verdaderas. Por cuanto hace a los derechos humanos vinculados a los problemas epistemológicos son principalmente colectivos y secundariamente individuales, en tanto que el proceso de conocimiento es un fenómeno social, comunal e histórico. Concluimos que la pluriculturalidad es un fenómeno que complejiza y enriquece la labor de la Bioética con una realidad múltiple de tipo sensible, inteligible y valorativo, este nexo muestra la necesidad de desarrollar abordajes inter o transdisciplinarios que aminoren tanto los problemas epistemológicos como la incidencia en la violación de derechos humanos.

Philip Osarobu Isanbor

Situation ethics is aimed at regulating human actions and values based on the prevailing and forcible circumstances that may determine what should be valued as morals, Such “ethics of living” is necessary for the sake of the common or greater good. In most cases, the situations determine the survival of a greater number of persons, irrespective of the nature of causality that may be impeded. With situation ethics, Fletcher advocates that a human person is an agent of a conscious being. These human actions in society cannot be free from moral implications when the sense of common goodness prevails. Adopting expository and descriptive methods of inquiry, the essay examines Fletcher’s situation ethics in relation to the possibilities of moral order in our world that has been bedeviled by erotic and erratic actions, ideologies, interests, and values without meaningful responsibility that can guarantee authentic and integral living. The paper highlights the moral thrusts for one’s actions and choices not to be judged or evaluated at face value, but to consider the possible rationality based on the situations in which actions are expressed and choices are made. The objective of the paper is hinged on the indispensability of one’s situation as a conscientious determinant of one’s moral responsibility and interest. The paper concludes that Fletcher’s situation ethics will remain ever relevant in the face of other ethical theories, principles, movementsor ideologies, as it can lead the human persons and their world to an enduring possibility of peace and tranquility, and then, guarantees the sustainability of moral order when the principle of love and care is generally adopted to regulate the contents of human freedom and conscience. 

S Singh

Ethical guidance in research is underpinned by the need to show respect for study participants by upholding autonomy in participant decision-making, and confidentiality and protection of individual rights, privacy and interests, yet decision-making could also be influenced by the participant’s sociocultural and belief systems. This calls for a more Africanised approach to research ethics where these values and beliefs are upheld. While national and international ethics guidelines do exist, there is little evidence that such a paradigm shift in research ethics is adequately interrogated in the teaching and learning curricula in higher education, where research skills are developed and nurtured. Critical reflection is used to highlight opportunities to stimulate learning and debates underpinned by humanised pedagogy in higher education.

Laiane Moraes Dias, Mirella Rebello Bezerra, Williams Fernandes Barra et al.

Resumo O planejamento antecipado de cuidados é um processo de discussões entre profissionais de saúde e pacientes que permite a tomada de decisão compartilhada quanto a objetivos de cuidados de saúde, atuais e/ou futuros, com base nos desejos e valores do paciente e em questões técnicas do cuidado. É considerado fundamental na prestação de cuidados de excelência em fim de vida, permitindo que profissionais de saúde alinhem os cuidados prestados com o que é mais importante para o paciente. Apesar de seus benefícios, ainda é muito pouco realizado na prática clínica, especialmente no Brasil. Considerando a necessidade de guias práticos de planejamento antecipado de cuidados adaptados à realidade brasileira, pautados em estratégias de comunicação empática, este estudo é uma proposta de guia baseada em revisão integrativa da literatura (PubMed e SciELO), com recomendações de evidências atuais, incluindo instrumentos validados para o português (Brasil), para facilitar sua implementação na prática clínica.

Anca-Cristina Sterie, Ralf J. Jox, Eve Rubli Truchard

Abstract Background Health decisions occur in a context with omnipresent social influences. Information concerning what other patients decide may present certain interventions as more desirable than others. Objectives To explore how physicians refer to what other people decide in conversations about the relevancy of cardio-pulmonary resuscitation (CPR) or do-not-attempt-resuscitation orders (DNAR). Methods We recorded forty-three physician–patient admission interviews taking place in a hospital in French-speaking Switzerland, during which CPR is discussed. Data was analysed with conversation analysis. Results Reference to what other people decide in regards to CPR is used five times, through reported speech. The reference is generic, and employed as a resource to deal with trouble encountered with the patient’s preference, either because it is absent or potentially incompatible with the medical recommendation. In our data, it is a way for physicians to present decisional paths and to steer towards the relevancy of DNAR orders (“Patients tell us ‘no futile care’”). By calling out to a sense of membership, it builds towards the patient embracing norms that are associated with a desirable or relevant social group. Conclusions Introducing DNAR decisions in terms of what other people opt for is a way for physicians to bring up the eventuality of allowing natural death in a less overt way. Formulating treatment choices in terms of what other people do has implications in terms of supporting autonomous and informed decision making, since it nudges patients towards conformity with what is presented as the most preferable choice on the basis of social norms.

Parham Pooladgar, Shabnam Bazmi

: Medical futility is one of the most common controversial topics in medicine, medical ethics, and philosophy of medicine. Every day, doctors are dealing with patients who are in a condition that must have a decision about requested futile treatment with their own beliefs, opinions, and different demands. This is an important issue that must be taught during teaching courses. Therefore, it is good to provide general policies for teaching how to make the best decision, establishing better communication between doctors and patients, and maintaining their Autonomy. On the other hand, with the interference and expansion of humanistic and holistic attitudes in the treatment of patients, it must be considered that at all treatment levels, especially decisions related to end-of-life, it is better to involve this point of view in our policies. In the present article, we tried to give a general conclusion of general policy and present standards for a humanistic policy by analyzing various countries’ policies and expressing their bugs.

Leah Teresa Rosen

Abstract Epistemic injustice sits at the intersection of ethics, epistemology, and social justice. Generally, this philosophical term describes when a person is wrongfully discredited as a knower; and within the clinical space, epistemic injustice is the underlying reason that some patient testimonies are valued above others. The following essay seeks to connect patterns of social prejudice to the clinical realm in the United States: illustrating how factors such as race, gender identity, and socioeconomic status influence epistemic credence and associatively, the quality of healthcare a person receives. After describing how epistemic injustice disproportionately harms already vulnerable patients, I propose a narrative therapy intervention. This intervention can help providers re-frame their relationships with patients, in such that they come to view patients as valuable sources of unique knowledge. Though I identify this intervention as a valuable step in addressing clinical epistemic injustice, I call upon medical educators and practitioners to further uplift the voices, perspectives, and stories of marginalized patients.

Eduardo Sánchez de la Iglesia

El presente artículo analiza la importancia de la bioética y la educación ambiental como herramientas indispensables para la conservación del medio ambiente. Una educación ambiental que ha sido infravalorada en muchos ámbitos y que se establece como vehículo fundamental para asentar la conciencia ambiental en todos y cada uno de los estamentos sociales. Además, se discurre acerca de las problemáticas existentes que se suceden a partir de actitudes negacionistas, falta de consenso unánime y déficit de profesionales especializados en transmitir los conocimientos científicos y valores ambientales.

Dorit Barlevy, Sarah Werren, Vardit Ravitsky

In an Israeli qualitative study with adolescent cancer survivors and parents who had considered fertility preservation, practically all participants could not recall any discussions with healthcare providers about plans for cryopreserved biological materials in the case of death. This finding is surprising given recent court struggles in Israel over the posthumous use of cryopreserved sperm. In interviews with these adolescent survivors and their parents, intended future use of cryopreserved biological materials is directed for affected individuals’ reproductive purposes later in life, with hardly any consideration of others' use of these materials for posthumous reproduction. To avoid future ethical and legal quagmires, healthcare professionals should have frank discussions with adolescents and their parents about what to do with such materials in the case of death. This paper discusses the socio-cultural and legal Israeli context and considers the ethical implications of using minors’ biological materials for posthumous assisted reproduction in Israel.

Kristin Klomstad, Reidar Pedersen, Reidun Førde et al.

Abstract Background Many of the elderly in nursing homes are very ill and have a reduced quality of life. Life expectancy is often hard to predict. Decisions about life-prolonging treatment should be based on a professional assessment of the patient’s best interest, assessment of capacity to consent, and on the patient’s own wishes. The purpose of this study was to investigate and compare how these types of decisions were made in nursing homes and in hospital wards. Methods Using a questionnaire, we studied the decision-making process for 299 nursing home patients who were treated for dehydration using intravenous fluids, or for bacterial infections using intravenous antibiotics. We compared the 215 (72%) patients treated in nursing homes to the 84 (28%) nursing home patients treated in the hospital. Results The patients’ capacity to consent was considered prior to treatment in 197 (92%) of the patients treated in nursing homes and 56 (67%) of the patients treated in hospitals (p < 0.001). The answers indicate that capacity to consent can be difficult to assess. Patients that were considered capable to consent, were more often involved in the decision-making in nursing homes than in hospital (90% vs. 52%). Next of kin and other health personnel were also more rarely involved when the nursing home patient was treated in hospital. Whether advance care planning had been carried out, was more often unknown in the hospital (69% vs. 17% in nursing homes). Hospital doctors expressed more doubt about the decision to admit the patient to the hospital than about the treatment itself. Conclusions This study indicates a potential for improvement in decision-making processes in general, and in particular when nursing home patients are treated in a hospital ward. The findings corroborate that nursing home patients should be treated locally if adequate health care and treatment is available. The communication between the different levels of health care when hospitalization is necessary, must be better. Trial registration ClinicalTrials.gov NCT01023763 (12/1/09) [The registration was delayed one month after study onset due to practical reasons].

O. Muramoto

The aim of this essay is to elaborate philosophical and ethical underpinnings of posthumous diagnosis of famous historical figures based on literary and artistic products, or commonly called retrospective diagnosis. It discusses ontological and epistemic challenges raised in the humanities and social sciences, and attempts to systematically reply to their criticisms from the viewpoint of clinical medicine, philosophy of medicine, particularly the ontology of disease and the epistemology of diagnosis, and medical ethics. The ontological challenge focuses on the doubt about the persistence of a disease over historical time, whereas the epistemic challenge disputes the inaccessibility of scientific verification of a diagnosis in the past. I argue that the critics are in error in conflating the taxonomy of disease (nosology) and the act of diagnosing a patient. Medical diagnosis is fundamentally a hypothesis-construction and an explanatory device that can be generated under various degrees of uncertainty and limited amount of information. It is not an apodictic judgment (true or false) as the critics presuppose, but a probabilistic (Bayesian) judgment with varying degrees of plausibility under uncertainty. In order to avoid this confusion, I propose that retrospective diagnosis of a historical figure be syndromic without identifying underlying disease, unless there is justifiable reason for such specification. Moreover it should be evaluated not only from the viewpoint of medical science but also in a larger context of the scholarship of the humanities and social sciences by its overall plausibility and consistency. On the other hand, I will endorse their concerns regarding the ethics and professionalism of retrospective diagnosis, and call for the need for situating such a diagnosis in an interdisciplinary scope and the context of the scholarship of the historical figure. I will then enumerate several important caveats for interdisciplinary retrospective diagnosis using an example of the retrospective diagnosis of Socrates for his life-long intermittent neurologic symptoms. Finally, I will situate the present argument in a larger context of the major debate among the historians of medicine and paleopathologists, and discuss the similarities and differences.

Navjeevan Singh

Satya loved to tell his stories. As often happens, as he grew older, his own children grew weary of them. Being around more often than they were, I heard many; all but his last one. In retrospect I wish I had listened more carefully. Kept notes perhaps. You don’t realize the worth of these things until you no longer have them.

S. Birch, Amani Magid, A. Weber

L. Sher

C. Bernard

medical men. The editors are, however, commendably cautious as to the possible existence and viability of a philosophy ofmedicine as an independent enterprise akin to the philosophy of science, which is an established discipline like the philosophy of biology. They do believe, nevertheless, that common ground exists between physicians and philosophers, and that, as Temkin has suggested, there is room for a consideration of medical logic, medical ethics, and medical metaphysics. But as well as a philosophy of medicine there is need for a philosophy in medicine: a critical analysis of basic concepts and presuppositions in medicine, and of its significance and limitations. This book deals with some of these and discusses models of explanation and systems of value in the biomedical sciences. Although most of the papers should be read by historians of medicine, those of greatest interest to them will be Lester King's, 'Some basic explanations of disease: an historian's viewpoint', Chester Bums', 'Diseases versus healths: some legacies in the philosophies of modem medical science', and Engelhardt's, 'The concepts of health and disease', all ofwhich are excellent contributions. Toulmin on 'Concepts offunction and mechanism in medicine and medical science', given as a tribute to Claude Bernard, is also outstanding. The Round-Table Discussion is likewise profitable to historians. In fact they should all possess a copy of this book, although the price will probably be the usual deterrent. The symposiasts concur that the philosophy ofand in medicine are legitimate topics ofstudy, for as Dr. E. D. Pellegrino concludes: ". . . Indeed without the engagement and the conjunction of medicine and philosophy, no viable or understandable image of man can be synthesized for our times. And, the absence of such a synthesis is a major deficit in contemporary culture." (p.234). We can look forward to further volumes in this series, which are planned to encompass the analysis of philosophical problems pertinent to medicine, and we can congratulate the editors, the contributors and the publishers for what they have achieved so far.

Hathout Leith

<p>Abstract</p> <p>This commentary examines the incursion on the neutrality of medical personnel now taking place as part of the human rights crises in Bahrain and Syria, and the ethical dilemmas which these incursions place not only in front of physicians practicing in those nations, but in front of the international community as a whole.</p> <p>In Bahrain, physicians have recently received harsh prison terms, apparently for treating demonstrators who clashed with government forces. In Syria, physicians are under the same political pressure to avoid treating political demonstrators or to act as informants against their own patients, turning them in to government authorities. This pressure has been severe, to the point that some physicians have become complicit in the abuse of patients who were also political demonstrators.</p> <p>This paper posits that physicians in certain countries in the Middle East during the “Arab Spring,” specifically Syria and Bahrain, are being used as both political pawns and political weapons in clear violation of Geneva Convention and World Medical Association guidelines, and that this puts them into the most extreme sort of “dual loyalty” dilemma. They are being forced to choose between their own safety and well-being and that of their patients – a negative sum scenario wherein there is no optimal choice. As such, an international call for a United Nations inquiry must be made in order to protect the neutrality of medical care and personnel during times of armed conflict.</p>