Hasil untuk "Medical philosophy. Medical ethics"

Furkan Kül

Bu makalede, Esra Atmaca tarafından kaleme alınan Kara Veba: Memlükler’de Salgın ve Toplum (749/1348-49) adlı eser tanıtılmaktadır. Kitap, XIV. yüzyılda Memlükler döneminde yaşanan kara veba salgınının toplumsal, kültürel, ilmî ve idari yapılar üzerindeki etkilerini çok boyutlu bir yaklaşımla incelemektedir. Dört ana bölümden oluşan eser, Memlük topraklarında salgının yayılış sürecinden sosyal hayat üzerindeki yıkıcı etkilerine, bilimsel faaliyetlerin duraksamasından devlet idaresindeki aksamalara kadar pek çok konuyu tarihî kaynaklara dayanarak ele almaktadır. Yazar, veba sürecinin halkın dinî yaşantısındaki değişimlere, ekonomik yapıya ve nüfus hareketlerine etkilerini birincil kaynaklarla ortaya koyarak eseri akademik anlamda değerli kılmıştır. Ayrıca kitapta salgının sadece Avrupa ile sınırlı kalmadığını vurgulayan bakış açısı, İslâm tarihi açısından önemli bir katkı sunmaktadır. Bu tanıtım yazısı, eserin kapsamını ve bilimsel katkılarını özetlemeyi, tarih ile tıp tarihi alanlarında çalışan araştırmacılar için önemini vurgulamayı amaçlamaktadır. Sonuç olarak, Kara Veba: Memlükler’de Salgın ve Toplum (749/1348–49) adlı eser, tarih, İslâm medeniyeti ve tıp tarihi araştırmaları açısından kıymetli bir başvuru kaynağıdır. Eserde kullanılan birincil kaynaklar, açıklayıcı dipnotlar ve yalın üslup, çalışmayı akademik olduğu kadar erişilebilir kılmaktadır. Neticede bu eser, geçmişte yaşanan salgınları analiz etmek ve günümüz krizlerini tarihsel bir perspektiften değerlendirmek isteyen araştırmacılar ve okuyucular açısından nitelikli bir başvuru kaynağı niteliği taşımaktadır

Bernard Rabwoni

El sector de seguros de salud de Uganda sigue estando subdesarrollado, con baja cobertura y una fuerte dependencia de los pagos directos. Este documento explora los desafíos éticos de los modelos de seguros de salud de Uganda, centrándose en la equidad, el acceso y la sostenibilidad. Utilizando principios bioéticos, marcos de derechos humanos y la perspectiva moral Ubuntu, examina cuestiones como la asequibilidad, la exclusión de poblaciones vulnerables y la deficiente supervisión regulatoria. Las soluciones clave incluyen la implementación de un Sistema Nacional de Seguro de Salud (SNHS), el fortalecimiento de los seguros comunitarios, la mejora de la regulación, la garantía del compromiso político y el aumento de la transparencia y la rendición de cuentas. Basándose en la literatura existente y los análisis de políticas, este estudio destaca la urgente necesidad de reformas éticas y políticas para crear un sistema de seguros de salud inclusivo y sostenible. Abordar estos desafíos impulsará la cobertura sanitaria universal, mejorará los resultados de salud y contribuirá al desarrollo social y económico mediante un enfoque colaborativo y basado en la justicia.

Ben Green

Abstract This paper explores public perceptions of the Hippocratic Oath (Physician’s Oath) in the U.K. Results of a questionnaire administered online to 106 adults indicated that the majority were of the opinion that their primary and secondary health care doctors had taken the Oath (88% and 86% respectively). A majority thought that nurses, paramedics, psychotherapists and graduate scientists and researchers should also take some form of professional oath. Elements of the Oath which were deemed most important included that it is a sworn oath, that doctors should not harm patients, act in the best interests of patients, abide by the principles of autonomy and informed consent and maintain patient confidentiality. A significant proportion - about 20% - of the UK public felt that doctors had forgotten their Hippocratic Oath during COVID-19 lockdowns and associated vaccination programme, suggesting that recent history may have damaged the public faith in the medical profession.

Anuradha Sharma

Iva Rincic, Amir Muzur, Cristina Richie

Abstract Background In 1926, Fritz Jahr described bio-ethics (German: bio-ethik) as “the assumption of moral obligations not only towards humans, but towards all forms of life.” Jahr summarized his philosophy by declaring, “Respect every living being on principle as an end in itself and treat it, if possible, as such!.” Bioethics was thus originally an ethical system concerned with the “problems of interference with other living beings… and generally everything related to the balance of the ecosystem” according to the 1978 Encyclopedia of Bioethics. This definition was predicated on the work of Fritz Jahr, Menico Torchio, and Van Rensselaer Potter. Methods In order to proceed with depthful analysis of the origin and major bioethical flare up, we will use critical analysis of existing literature, followed by a study trip to relevant bioethical localities (collecting photo and other documentations regarding Menico Torchio). Results While Jahr and Potter are typically given intellectual credit for developing the field of bioethics, the eco-ethical contributions of Menico Torchio have been forgotten.This article will first trace the origins of “bioethics” – now commonly bifurcated into “biomedical ethics” and “environmental bioethics.” The former was developed by Tom Beauchamp from the Philosophy Department and James Childress of the Religious Studies department at Georgetown University and is based on principlism, with a narrow focus on medical settings. The latter addresses the environmental impact of the medical industry and climate change health hazards. Second, we will present a panorama of Torchio’s significant intellectual contribution to bioethics. Menico Torchio’s concept of bioethics synthesized work of both Jahr and Potter, advocating “the need to expand our ethical obligations and embrace the most developed groups of animals, not only physically but also psychologically.” Third, we will reflect on the lasting legacy of “bioethics” on biomedical and environmental bioethics today. Thematic elements such as interconnectedness of planetary health and human health, dedication to living in harmony with nature, and emphasis on systems and symbiosis remain unchanged from the legacy of Tochio onward. Conclusion Our conclusion will underscore the necessity of understanding the connections between planetary, environmental, and human health.

Limbanazo Matandika, Kate Millar, Eric Umar et al.

Abstract Background Research ethics is intertwined with and depends on building robust and responsive research governance systems alongside researchers. Globally there has been substantial investment in agriculture, nutrition, and health (ANH) research motivated by the need to improve health outcomes, such as micronutrient deficiencies in Sub-Saharan Africa. Although there has been a notable focus on ethical issues inherent in ANH studies, there has been scanty research examining researchers’ attitudes related to ANH research. This study was conducted to explore the perspectives of researchers who conducted an agronomic biofortification study in Malawi. Methodology In-depth interviews were conducted with a purposive sample of ten ANH researchers. Interviews were conducted online via Zoom, audio-recorded, transcribed verbatim, and thematically analysed using the Leadership, Ethics, Governance and Systems Framework. Results Four core aspects emerged: Leadership: The relevance of building ethics leadership and ethical competence among researchers. Ethics: There is a need to develop a framework that operationalises core ethical values that can guide the implementation of ANH research. Governance: Research guidelines were perceived to be too generic to guide ANH research. Systems: Researchers’ recommended the establishment of a specialised ANH research ethics committee. Conclusions The findings highlight the significance of building ethics leadership and supporting ethical competency amongst researchers. Researchers recommended the development of tailored approaches rather than utilising generic governance systems and frameworks that are drawn from medical research and thus not fit for purpose in this field. In Malawi, specialised ethics review committees are needed to guide ANH research.

Marzieh Azadian, Tahereh Nasrabadi, Abbas Ebadi et al.

Role modeling is one of the most influential components of teaching professional behaviors to nursing students. The Role Model Apperception Tool (RoMAT) was designed in the Netherlands to measure role modeling behaviors in clinical educators. The aim of this study was assess the psychometrics of the Persian version of this tool.In a methodological study, the Persian version of the RoMAT tool was developed using the forward-backward translation method. Face validity was confirmed through cognitive interviews, and content validity was done by a panel of 12 experts. Construct validity was assessed through exploratory factor analysis (n = 200), and confirmatory factor analysis (n = 142) was evaluated after the tool was completed online by undergraduate nursing students. Reliability was confirmed using internal consistency and test and retest methods. Furthermore, ceiling and floor effects were assessed.The two components of "professional competencies" and "leadership competencies" emerged with a cumulative variance of 62.01%, a reliability with Cronbach's alpha of 0.93 and 0.83, and an intraclass correlation of 0.9 and 0.78, respectively. It was concluded that the Persian version of the Role Model Apperception Tool is a valid and reliable tool and can be used to investigate the role modeling behaviors of clinical instructors of nursing students.

Jesper Ahlin Marceta

Luis Guillermo Bastidas-Goyes, Efraín Méndez-Castillo, Claudia Marina Bonilla-Estévez

En un contexto globalizado, donde el mundo convencional se expande a lo virtual, se desarrolla un análisis ético y jurídico del turismo médico en Colombia mediante la identificación de riesgos potenciales en la instrumentalización comunicativa. La oferta y demanda de cirugía estética acompañada del marketing, como un reflejo del deseo, lo bello y el maquillaje, promueven tensiones éticas latentes. La incertidumbre jurídica que gravita alrededor del flujo transfronterizo e indeterminación de los distintos sistemas jurídicos exterioriza varios frentes susceptibles de abordaje y que a su vez se erigen como desafíos. El trasfondo de las reflexiones que se divisan hace imprescindible reivindicar prerrogativas fundamentales, inherentes a los seres humanos, que parecen desvanecerse ante inserciones cada vez más frecuentes y penetrantes provenientes de realidades construidas y enraizadas en el vaivén de los precios.

Vittorio Bufacchi

The principle of non-maleficence, primum non nocere, has deep roots in the history of moral philosophy, being endorsed by John Stuart Mill, W. D. Ross, H. L. A. Hart, Karl Popper and Bernard Gert. And yet, this principle is virtually absent from current debates on social justice. This article suggests that non-maleficence is more than a moral principle; it is also a principle of social justice. Part I looks at the origins of non-maleficence as a principle of ethics, and medical ethics in particular. Part II introduces the idea of non-maleficence as a principle of social justice. Parts III and IV define the principle of justice as non-maleficence in terms of its scope and coherence, while Part V argues that the motivation of not doing harm makes this principle an alternative to two well-established paradigms in the literature on social justice: justice as mutual advantage (David Gauthier) and justice as impartiality (Brian Barry).

Erik Gustavsson, Giovanni Galvis, Niklas Juth

Abstract Background Genetic testing is moving from targeted investigations of monogenetic diseases to broader testing that may provide more information. For example, recent health economic studies of genetic testing for an increased risk of breast cancer suggest that it is associated with higher cost-effectiveness to screen for pathogenic variants in a seven gene panel rather than the usual two gene test for variants in BRCA1 and BRCA2. However, irrespective of the extent to which the screening of the panel is cost-effective, there may be ethical reasons to not screen for pathogenic variants in a panel, or to revise the way in which testing and disclosing of results are carried out. Main text In this paper we discuss the ethical aspects of genetic testing for an increased risk of breast cancer with a special focus on the ethical differences between screening for pathogenic variants in BRCA1/2 and a seven gene panel. The paper identifies that the panel increases the number of secondary findings as well as the number of variants of uncertain significance as two specific issues that call for ethical reflection. Conclusions We conclude that while the problem of handling secondary findings should not be overstated with regard to the panel, the fact that the panel also generate more variants of uncertain significance, give rise to a more complex set of problems that relate to the value of health as well as the value of autonomy. Therefore, it is insufficient to claim that the seven gene panel is preferable by only referring to the higher cost effectiveness of the panel.

Franck L. B. Meijboom, Elzbieta Kostrzewa, Cathalijn H. C. Leenaars

Abstract Background Current policies regulating the use of animals for scientific purposes are based on balancing between potential gain of knowledge and suffering of animals used in experimentation. The balancing process is complicated, on the one hand by plurality of views on our duties towards animals, and on the other hand by more recent discussions on uncertainty in the probability of reaching the final aim of the research and problems of translational failure. Methods The study combines ethical analysis based on a literature review with neuropsychiatry-related preclinical research as a case study. Results Based on the analysis and the case study we show that neuropsychiatry-related preclinical research is an especially interesting case from an ethical perspective. The 3R principles (Replacement, Reduction and Refinement) are used to minimize the negative consequences for the animals used in research. However, neuropsychiatric research is characterized by specific challenges in assessing the probability of success of reaching the final aim, due to our limited mechanistic knowledge of human neuropsychiatric illness. Consequently, the translational value of the currently used animal models may be difficult to prove, which undermines the validity of these models and complicated the ethical assessment. Conclusions We conclude that a combined approach that deals with both science and the ethical dimensions is necessary to address the problems of validity and translation in neuropsychiatry-related preclinical research. We suggest this approach to comprise first, improved experimental methods, e.g. by using systematic reviews, second, a more patients-based approach that leads to models that reflect interindividual variation better, and third, more interdisciplinary cooperation.

Munamato Chemhuru

Esther Arroyo Amayuelas

En las páginas que siguen se ilustran las tendencias que existen en Europa en materia de protección de adultos y el impacto que ha tenido el Convenio de Nueva York de 2006, sobre los derechos de las personas con discapacidad, en los sistemas jurídicos nacionales. Más concretamente, se analiza el sistema legal de protección en Cataluña, denominado "assistència", que es una institución adecuada para una multitud de casos, pero especialmente apta para aquellas personas frágiles que, debido a su avanzada edad, sufren un deterioro físico y/o mental o intelectual. La conclusión es que esta institución debe sustituir a aquellas otras que implican una limitación judicial de la capacidad de obrar y convertirse en una institución de aplicación general no sólo en Cataluña, sino también en todo el territorio español.

Indu Priya, Sakshi Sharma, Isar Sharma et al.

The following article has been retracted from publication in the Taylor & Francis journal New Genetics and Society. I. Priya, S. Sharma, I. Sharma, R. Mahajan and N. Kapoor, A review of 45 candidate genes: association of single nucleotide polymorphism to schizophrenia risk, New Genetics and Society https://doi.org/10.1080/14636778.2018.1481740. Version of Record published online 13 July 2018. The editorial office of the journal inadvertently processed the paper through the online submission system without proper peer review or requisite checks. This has now been remedied and the journal and publishers apologise to the authors that this occurred. Journal processes and checks have now been reviewed and updated so that all best efforts are made to ensure this does not occur again. © Taylor & Francis/Journal owner

Dr. med. G. Neitzke, Univ.-Prof. Dr. med. H. Burchardi, Univ.-Prof. Dr. jur. G. Duttge et al.

MedKlin IntensivmedNotfmed2019 ·114:46–52 https://doi.org/10.1007/s00063-018-0514-y Published online: 30 November 2018 © The Author(s) 2018 G. Neitzke · H. Burchardi · G. Duttge · C. Hartog · R. Erchinger · P. Gretenkort · A. Michalsen · M. Mohr · F. Nauck · F. Salomon · H. Stopfkuchen · N. Weiler · U. Janssens 1 Institute for Medical History, Ethics and Philosophy, Hannover Medical School, Hannover, Germany 2 Bovenden, Germany 3 Institute for Criminal Sciences—Department for Criminal Medicaland Biolaw, Georg-August-University Göttingen, Göttingen, Germany

N. Emmerich

Making particular use of Shale’s analysis, this paper discusses the notion of leadership in the context of palliative medicine. Whilst offering a critical perspective, I build on the philosophy of palliative care offered by Randall and Downie and suggest that the normative structure of this medical speciality has certain distinctive features, particularly when compared to that of medicine more generally. I discuss this in terms of palliative medicine’s distinctive morality or ethos, albeit one that should still be seen in terms of medical morality or the ethos of medicine. I argue that, in the context of multi-disciplinary teamwork, the particular ethos of palliative medicine means that healthcare professionals who work within this speciality are presented with distinct opportunities for leadership and the dissemination of the moral and ethical norms that guide their practice. I expand on the nature of this opportunity by further engaging with Shale’s work on leadership in medicine, and by more fully articulating the notion of moral ethos in medicine and its relation to the more formal notion of medical ethics. Finally, and with reference to the idea of medical education as both on going and as an apprenticeship, I suggest that moral and ethical leadership in palliative medicine may have an inherently educational quality and a distinctively pedagogical dimension. The nature of palliative medicine is such that it often involves caring for patients who are still receiving treatment from other specialists. Whilst this can create tension, it also provides an opportunity for palliative care professionals to disseminate the philosophy that underpins their practice, and to offer leadership with regard to the moral and ethical challenges that arise in the context of End of Life Care.

Anne Kerr

Yrrah H. Stol, Eva C. A. Asscher, Maartje H. N. Schermer

Abstract Background Health checks or health screenings identify (risk factors for) disease in people without a specific medical indication. So far, the perspective of (potential) health check users has remained underexposed in discussions about the ethics and regulation of health checks. Methods In 2017, we conducted a qualitative study with lay people from the Netherlands (four focus groups). We asked what participants consider characteristics of good and bad health checks, and whether they saw a role for the Dutch government. Results Participants consider a good predictive value the most important characteristic of a good health check. Information before, during and after the test, knowledgeable and reliable providers, tests for treatable (risk factors for) disease, respect for privacy, no unnecessary health risks and accessibility are also mentioned as criteria for good health checks. Participants make many assumptions about health check offers. They assume health checks provide certainty about the presence or absence of disease, that health checks offer opportunities for health benefits and that the privacy of health check data is guaranteed. In their choice for provider and test they tend to rely more on heuristics than information. Participants trust physicians to put the interest of potential health check users first and expect the Dutch government to intervene if providers other than physicians failed to do so by offering tests with a low predictive value, or tests that may harm people, or by infringing the privacy of users. Conclusions Assumptions of participants are not always justified, but they may influence the choice to participate. This is problematic because choices for checks with a low predictive value that do not provide health benefits may create uncertainty and may cause harm to health; an outcome diametrically opposite to the one intended. Also, this may impair the relationship of trust with physicians and the Dutch government. To further and protect autonomous choice and to maintain trust, we recommend the following measures to timely adjust false expectations: advertisements that give an accurate impression of health check offers, and the installation of a quality mark.

U. Gantenbein