Silvia Helena Galvis Navarrete, Fritz Eduardo Gempeler Rueda
El propósito de la presente publicación es dar a conocer la implementación del registro institucional del Servicio de Ética Clínica y presentar los análisis de los primeros datos obtenidos durante el periodo prepandemia, comprendido entre la creación del SEC en el año 2015 hasta el inicio de la pandemia en marzo de 2020.
Medical philosophy. Medical ethics, Business ethics
Yusra Elrahal, Omar F. Khabour, Karem H. Alzoubi
et al.
Abstract Background The placenta is a rich source of stem cells that can be used in scientific research and therapeutic applications. The aim of the current study was to understand the perspectives of Jordanian women on placenta donation for research purposes. Methods The study questionnaire was developed using Google Forms and distributed across social media platforms. A total of 923 women participated in the study. Results About 64.0% of women were unaware that placenta could be donated for research. Only 27.0% expressed a positive attitude toward donation, while approximately 23.2% considered placenta donation ethically acceptable. Factors associated with the management of placenta after pregnancy included the woman’s age, education level, living in a city, and pregnancy status (p < 0.05). Reasons associated with the decline in placenta donation for research included misuse of the placenta (65.6%), potential commercial use (86.5%), desire to keep it in a cell bank (52.2%), and data privacy issues (70.0%). Conclusion Awareness of placenta donation for medical research was found to be low. A small percentage of women supported the placenta use in research. The study recommends interventions and educational programs to enhance women’s awareness of placenta donation in scientific research, which can be implemented by health authorities. Moreover, fostering partnerships between the public and scientists is essential to encouraging innovation and progress in stem cell research.
Mohamed Amine Bouchlaghem, Zoé Estey-Amyot, Erika Ethier
et al.
Abstract Background The COVID-19 pandemic has led governments worldwide to make ethically controversial decisions. As a result, healthcare professionals are facing several ethical dilemmas, especially in terms of healthcare services provided to senior citizens. Thus, the aim of this review is to identify and categorize ethical dilemmas as well as propose solutions regarding health care services for elderly individuals. Methods A qualitative systematic review of the literature was undertaken in the first tier of the pandemic. All identified scientific and editorial articles published in English or French between December 2019 and October 2021 were included. An article was excluded if it was commercial, did not address an issue in the care of the elderly or present any qualitative data. Article eligibility was determined through a process of triangulation among three independent reviewers. Results Initially, 69 articles met our inclusion criteria and were selected for this review. These studies can be divided into 2 distinct categories: scientific articles (17 studies) and expert opinion articles (52 articles). However, due to the large quantity of qualitative data that was extracted, only the results from the scientific literature are presented here. The analysis of the data of 17 studies has allowed the emergence of 2 main themes of ethical dilemmas: 1) access to care (3 subthemes: A) triage decisions for admission, B) access to the intensive care unit and C) vaccine allocation) and 2) infection control decisions (2 subthemes: (D) isolation and E) autonomy). Our results also revealed 4 categories of potential solutions to the encountered ethical dilemmas, namely, optimal protocols, enhanced communication, caregiver support and technological assistance (virtual team-based, AI). Conclusions The ethical dilemmas that emerged from our results highlight the interest of a serious international discussion around the phenomena of ageism and its potential ethical implications for health care workers (be it under normal circumstances or exceptional circumstances such as those of a pandemic). We highly recommend that future research be undertaken to test the efficacy of the proposed solutions in providing age-friendly, dilemma-free health care and environments.
In parent-child communication, adolescents with depression often respond with "I don't know", a pattern that hinders interactions and creates family tension. Drawing on theories and methods from interactional linguistics and clinical psychology, this study examines the characteristics and underlying causes of the use of "I don't know" responses by patients during parent-child interactions. The findings reveal that, such responses often appear in simplified representations, lacking specific information and linguistic elaboration. Semantically, they fall into two categories: "knowing but being unwilling to express" and "genuinely not knowing". Pragmatically, they convey an avoidance of communication. These linguistic features are closely related to the cognitive patterns, behavioral traits, and psychological needs of depressed adolescents in communicative contexts.
Abstract Background This theoretical paper aims to explore empathy in the context of technologically mediated patient-provider communication, specifically within the context of video- and telehealth consultations. Over the past few decades, empathy has been recognized as a vital component of high-quality patient care, often prioritizing the cognitive over the emotional dimensions of empathy. As healthcare increasingly embraces digital communication technologies, including video consultations, the dynamics of empathy in clinical encounters are altered. With this paper we explore the pertinent question: how do new digital communication modalities impact on empathy and its different dimensions? Methods To address the above question, we move beyond clinical and applied empathy frameworks instead integrating insights from two related philosophical traditions. First, the classical phenomenological understanding of empathy (represented primarily by Edith Stein) as embodied intuition. Second, the postphenomenological philosophy of technology, represented by Don Ihde and not least inspired by Maurice Merleau-Ponty’s phenomenology of embodiment. We apply these theoretical frameworks to empirical analyses of video consultations in general practice and telemedical encounters between chronic obstructive pulmonary disease (COPD) patients and specialist telenurses. Results Our analysis demonstrates that even though video consultations do not allow for the same level of “fine-tuned” body-mediated sensory input, a whole-body empathetic experience can nevertheless be established through (1) the audio-visual sensory impressions that are being mediated by the technology, (2) our whole-body interpretations of this information and (3) our shared experiences of a lifeworld that we actively orient ourselves towards. These experiences may lead to empathetic communication and helping actions that draw on both emotional, intuitive and cognitive dimensions in a holistic manner. Conclusion Combining theoretical insights from phenomenology and postphenomenology with empirical telehealth analyses, we demonstrate how empathy is both reconfigured through technological mediation and sustained as an embodied, intersubjective practice. We thus conclude that empathetic care practices can be established in technologically mediated encounters through bodily intentionality where our bodies and minds are unified in understanding and connecting with other persons, even though we are not in the same physical space. We propose a theoretical bridge, connecting classical phenomenology and postphenomenology in the context of empathy in technologically mediated patient-provider communication. This bridge is grounded in Merleau-Ponty’s conception of whole-body perception and the lifeworld whether through physical proximity or digital interaction.
Jussara Silva Lima, João Gabriel Silva Resende Lima, Sarah Inessa Silva Resende Lima
et al.
Resumo Este estudo teórico discorre sobre a bioética no sentido de promover e assegurar a dignidade do paciente de uma forma segura, que obedeça a sua tomada de decisão, seguindo normativas e protocolos que garantam o cumprimento dessa vontade, e trazendo também segurança para equipe assistencial. A ausência de consenso no meio jurídico, por falta de regulamentações que explicitem as regras para a elaboração de um modelo de diretivas de vontade, gera insegurança nos profissionais de saúde envolvidos, familiares e paciente. Para garantir esse direito, além da normatização jurídica, é necessário que os profissionais tenham pleno conhecimento do assunto, a fim de orientar e informar corretamente seus pacientes. Não basta assegurar ao indivíduo o direito de manifestar sua vontade, é preciso ainda a certeza de que esta será cumprida. Há a necessidade de ampliar discussões acerca da temática, com ênfase na realidade brasileira.
Alice Duarte Paiva, Elisa Duarte Paiva, Paulo Henrique Sales Guimarães
et al.
Resumo O objetivo deste trabalho foi avaliar o conhecimento sobre cuidados paliativos de estudantes do quarto, quinto e sexto anos da graduação em medicina de uma faculdade particular de Belo Horizonte, bem como investigar sua percepções sobre o ensino do tema. Trata-se de estudo transversal observacional com aplicação de questionário on-line para 135 acadêmicos. Dentre os participantes, 40,7% consideram-se preparados para lidar com morte de pacientes e luto dos familiares, 80,7% classificam o próprio nível de conhecimento sobre cuidados paliativos como regular e 77% afirmam não ter recebido informações suficientes sobre o assunto. Ao avaliar conceitos, 20% tiveram desempenho insatisfatório, 48% aceitável e 3% excelente. Acadêmicos de anos mais avançados e que fizeram o internato em saúde do idoso apresentaram melhores respostas. Revelou-se que, apesar de o desempenho dos estudantes ser em geral regular, o internato em saúde do idoso tem impacto positivo na aquisição de conhecimento sobre cuidados paliativos.
Assistive systems based on Artificial Intelligence (AI) are bound to reshape decision-making in all areas of society. One of the most intricate challenges arising from their implementation in high-stakes environments such as medicine concerns their frequently unsatisfying levels of explainability, especially in the guise of the so-called black-box problem: highly successful models based on deep learning seem to be inherently opaque, resisting comprehensive explanations. This may explain why some scholars claim that research should focus on rendering AI systems understandable, rather than explainable. Yet, there is a grave lack of agreement concerning these terms in much of the literature on AI. We argue that the seminal distinction made by the philosopher and physician Karl Jaspers between different types of explaining and understanding in psychopathology can be used to promote greater conceptual clarity in the context of Machine Learning (ML). Following Jaspers, we claim that explaining and understanding constitute multi-faceted epistemic approaches that should not be seen as mutually exclusive, but rather as complementary ones as in and of themselves they are necessarily limited. Drawing on the famous example of Watson for Oncology we highlight how Jaspers’ methodology translates to the case of medical AI. Classical considerations from the philosophy of psychiatry can therefore inform a debate at the centre of current AI ethics, which in turn may be crucial for a successful implementation of ethically and legally sound AI in medicine.
Taijiquan can handle incoming forces with minimal effort and it can overcome hardness with softness. This claim is sometimes viewed suspiciously because ordinary people cannot execute the internal force of Taijiquan. Relaxation can enhance stability and rooting can help facilitate selfdefense. This claim often causes confusion because ordinary people are unfamiliar with these concepts. In the following, the author cites ancient Taijiquan Classics and reviews scientific literature to discuss a better way for Taijiquan training for health, and to help reveal an effective way of Taijiquan application for self-defense. Martial application is a complex process, and involves converting the mechanically disadvantaged systems in the human body to be more efficient and effective mechanisms. As a martial art for self-defense, Taijiquan is most challenging for practitioners when it comes to quickly receiving a strong oncoming force and effectively launching “Jin” after neutralization. The biomechanical aspects of Taijiquan martial art are evaluated in terms of motional control; the six degrees of freedom in motion; maintaining a central equilibrium; biotensegrity formation; the living fulcrum and leverage utilization; ground reaction force enhancement; and body kinetic chain manipulation. In this paper, the mysterious “Qi” and “Jin” are scientifically defined, to help users understand the essence of Taijiquan.
La epidemia causada por el Covid-19 ha alterado y redefinido la capacidad de los sistemas de salud a nivel mundial, al mismo tiempo que ha presentado un reto para los bioeticistas, que deben enfocarse en cuestiones como el proceso ético de desarrollo de las vacunas, y las estrategias que deben seguirse para garantizar una distribución justa y equitativa de ellas. Se analiza la estrategia de las pruebas de exposición directa al virus como un posible camino para acelerar la disponibilidad de las vacunas contra el Covid-19, y sus implicaciones éticas. También se exhibe la problemática global que se tendrá que enfrentar para asegurar una vacuna universal y accesible a todos, y algunas estrategias de distribución de las vacunas a nivel local, que aseguren un proceso ético y justo para todos los miembros de la sociedad. Se presentan diferentes posturas éticas en referencia a ambos problemas, exponiendo distintos argumentos y soluciones a los dilemas éticos planteados.
While there is a steadily growing literature on epistemic injustice in healthcare, there are few discussions of the role that biomedical technologies play in harming patients in their capacity as knowers. Through an analysis of newborn and pediatric genetic and genomic sequencing technologies (GSTs), I argue that biomedical technologies can lead to epistemic injustice through two primary pathways: epistemic capture and value partitioning. I close by discussing the larger ethical and political context of critical analyses of GSTs and their broader implications for just and equitable healthcare delivery. Access to basic healthcare and equal forms of medical care is considered essential on distributive theories of justice (Daniels 1979). Yet, the practice of medicine is a human affair, and humans are notoriously prone to obstinate cognitive biases (Kahneman 2013). Such biases result in medical errors that would undermine diagnosis, treatment, and care even in ideal healthcare systems. Furthermore, there is a steadily growing body of research examining how such biases give rise to medical errors that are not equally shared by all, but instead disproportionately affect the health outcomes of vulnerable medical patients and historically oppressed patient populations (Reiheld 2010; Carel and Kidd 2014; Blease et al. 2017; Maina et al. 2018, Joel Michael Reynolds is Assistant Professor of Philosophy at the University of Massachusetts Lowell and the Rice Family Fellow in Bioethics and Humanities at The Hastings Center. His areas of research include bioethics, philosophy of disability, social epistemology, and continental philosophy. He is the author of Ethics After Ableism: Disability, Pain, and the History of Morality, forthcoming with The University of Minnesota Press, and coeditor of The Disability Bioethics Reader, forthcoming with Routledge. 162 JOEL MICHAEL REYNOLDS Reynolds and Peña-Guzmán 2019). This research, which typically focuses on patterns of patient-provider communication, institutional norms, and the effects of historical and sociopolitical factors on medical practice, also makes plain how such cognitive biases are rooted in oppressive systems and processes of racism, sexism, cissexism, ableism, and classism, et al. However, there is little work on the ways in which the development and use of recent biomedical technologies themselves contribute to epistemic injustice in healthcare and beyond. In this essay, I address this lacuna by exploring the role that biomedical technologies play in harming patients in their capacity as knowers. Criticisms of new technologies, including biomedical technologies, invariably run the risk of overgeneralization. To appropriately restrict the scope of my analysis, I focus upon clinical applications of genetic and genomic sequencing technologies, including whole genome and whole exome sequencing as well as chromosomal microarray, and I do so with respect to return of results of variants of unknown or highly variable significance in prenatal and pediatric settings. I believe that my arguments extend to other sorts of technology, biomedical and otherwise, but I do not put forward the case for that extension here. For shorthand, I will refer to these jointly as genetic and genomic screening technologies (GSTs). Given the purposes at hand, I group these technologies together because of the way in which they each produce excess information beyond the discrete, animating clinical concerns in any given case and thereby produce information that can be medically unactionable or fundamentally ambiguous. My central argument is that GSTs cause epistemic injustice through what I call epistemic capture and value partitioning. Epistemic capture occurs when fundamentally ambiguous information is transformed into and treated as definite knowledge. Value partitioning occurs when variously available hermeneutical resources are restricted to an inappropriately simplistic evaluative scale or set of appraisals. In the cases of GSTs, this restriction leaves open just two possible appraisals: positive or negative. I begin by analyzing a set of qualitative research detailing the psychosocial impact of GSTs in the aforementioned clinical settings. Then, I lay out the argument that GSTs cause epistemic injustice through epistemic capture and value partitioning. I close the paper by discussing the larger ethical and political context of critical analyses of GSTs as well as the 1 Of course, the concept of value partitioning could describe a situation where the scale consists of more than two values or where a given set of appraisals operates with an intricate and far more complex relationship than that discussed here. 163 HOW BIOMEDICAL TECHNOLOGIES HARM PATIENTS AS KNOWERS broader implications of this analysis for addressing epistemic injustice in healthcare and for the practice of just and equitable healthcare delivery more generally. Three initial clarificatory comments are in order. First, my use of the term “epistemic injustice” goes beyond its typical scope in much of the literature (Fricker 2007; Hookway 2010; Kidd et al. 2017). I focus neither on harms caused by another individual such as one’s provider, nor on harms caused by institutions. Instead, I focus on harms caused by the epistemic frameworks at play in the development and use of biomedical technologies, which is to say, in the interpretation of the data and information they produce as well as in the many practices and activities such interpretations generate and shape. Put differently, my focus is on harms resulting from the specific hermeneutical resources and processes put to work by and through biomedical technologies in the sorts of cases under discussion. In this way, I hope to contribute not only to the literature on epistemic injustice, but also to the more specific project of understanding how “certain newborn screening results,” as well as pediatric screening results, “have been demonstrated to cause distress, alter behavior, and even to influence the formation of new parental and family identities” (Grob et al. 2018). I leave open for future research the extent to which this analysis applies to GSTs in different clinical contexts and cases, including returning results other than those discussed here, and I also leave open the extent to which this analysis applies to different sorts of technology. Second, when one studies biomedical technology, one is dealing with an especially complicated phenomenon. With respect to a technology like whole-genome sequencing, for example, there are hundreds, if not thousands of people who play roles in the many processes leading up to and extending through its clinical applications as they exist today, ranging from computer scientists and lab technicians to various clinicians and genetic counselors. “Biomedical technology” often functions as a synecdoche for a large and labyrinthian network of interactions between a variety of actors in biomedicine and a host of technological tools and processes. In short, this complexity makes “biomedical technology” a difficult object for epistemological inquiry, including “genomic sequencing technologies” more specifically. Speaking of the practices and concerns captured by the umbrella terms “genetics” and “genomics” as well as “postgenomics,” Colin Koopman rightly notes that “it is by no means the case that these varied scientific projects are all, at bottom, somehow the same. Rather, there is increasing complexity in the very practice of the genetic sciences” 164 JOEL MICHAEL REYNOLDS (forthcoming). One upshot of my analysis is that studies of epistemic injustice in relation to biomedical technologies may present special methodological issues and require a thoroughly interdisciplinary and transdisciplinary approach. Third, insofar as epistemic injustice contributes to distributive injustices (Coady 2017), it is a compounding form of injustice in the context of the US healthcare system, for this system is infamously unjust and inequitable both historically and today (Washington 2008). Writing about biomedical technologies is an inherently political endeavor if for no other reason than that many of the technologies discussed in journals of philosophy, sociology, anthropology, bioethics, and public policy are technologies that the majority of humans on Earth cannot access. That they cannot do so is not primarily a question of bad luck, but of histories of colonization and imperialism (Wolfe 2006). The benefits of GSTs, for instance, are typically enjoyed by a demographically small slice of the white, middleto upper-middle class in the global North. Until the profound inequality of access to such biomedical technologies is addressed, inquiries such as the one I am undertaking risk missing the actual moral and political forest for the privileged trees. I take this concern very seriously and discuss it at length in the concluding section of the paper. 1. GENETIC AND GENOMIC SEQUENCING TECHNOLOGIES GSTs have been used in clinical settings for decades. These technologies use modern computing power to analyze particular portions of the genetic material in a human organism primarily with the aim of detecting medically actionable (or potentially medically actionable) variants. Since 2010, the American College of Medical Genetics has supported chromosomal microarray as a first-tier test for individuals with several types of suspected genetic diseases (Miller et al. 2010). Whole genome sequencing (WGS) technologies, unlike chromosomal microarray and other methods that sequence individual genes or specific sets of genes, analyze the entire genome of an organism, including chromosomal as well as mitochondrial DNA. WGS 2 See “Access to Healthcare,” Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, https ://www.cdc.gov/nchs/fasta ts/accessto-health-care.htm. My thanks to Chris Lebron for graciously leading me to engage these conc
This article aims to share our experience with those who consider dedicating themselves to research. In this way, the characteristics, qualities or competences that, in our opinion, a good researcher should fulfill are listed, and therefore the keys that can help you achieve a successful research career. The intention of this article is not to simply list a series of theoretical recommendations but to share some personal suggestions based on our experience and, therefore, of an eminently practical nature. The fundamental qualities to be discussed are: Ethics and honesty. Curiosity, passion, enthusiasm and motivation. Persistence, dedication and discipline. Ambition and leadership. Compromise and responsibility. Organization and planning. Acquire knowledge of research methodology. Critical and positive attitude towards difficulties and failure. Prioritization of objectives and time management. The importance of a good mentor. Establishment of a network of collaborators and teamwork. Maintain a balance between clinical and research activity. Combine public and private investigation. Balance between professional and personal life. And, finally, humility, generosity and thanks. Research represents a fundamental pillar of medical activity and it is evident that the highest quality of care arises from the integration of excellent clinical practice and research activity. With the philosophy that most of the qualities to develop an excellent research activity depend on attitude, and can be learned, developed and improved, in this manuscript we share with the reader a series of recommendations that we consider essential to be a good researcher.
* Abbreviation: AAP — : American Academy of Pediatrics Vaccine refusal forces us to confront tensions between many values, including scientific expertise, parental rights, children’s best interests, social responsibility, public trust, and community health. Recent outbreaks of vaccine-preventable and emerging infectious diseases have amplified these issues. The prospect of a coronavirus disease 2019 vaccine signals even more friction on the horizon. In this contentious sociopolitical landscape, it is therefore more important than ever for clinicians to identify ethically justified responses to vaccine refusal. The American Academy of Pediatrics (AAP) says dismissing families who continue to refuse vaccines is an “acceptable option,”1 but some practices have gone further by not accepting vaccine refusers as patients at all.2,3 The phenomenon of nonacceptance has been underexplored; in both empirical studies and ethics analyses, researchers largely focus on dismissal.4–7 In this article, we first criticize arguments for nonacceptance that invoke a supposed right to choose one’s patients. We then argue that nonacceptance is problematic because (1) some of its motivations are intrinsically immoral, (2) it does not appear to accomplish some of its goals, and (3) even when nonacceptance does accomplish its goals, it fails to appropriately balance the various values it implicates. Throughout the article, we engage with the existing ethics literature about dismissal and conclude that even if dismissal is sometimes justifiable, nonacceptance is not. Some may argue that nonacceptance is ethically justified because they believe the clinical relationship is fundamentally a free association between clinicians and patients, as the American Medical Association Code of Medical … Address correspondence to Mark C. Navin, PhD, Department of Philosophy, Oakland University, 746 Mathematics and Science Center, 146 Library Dr, Rochester, MI 48309-4479. E-mail: navin{at}oakland.edu
Introduction Randomised controlled trials (RCTs) are widely viewed to generate the most reliable medical knowledge. However, RCTs are not always scientifically necessary and therefore not always ethical. Unfortunately, it is not clear when an RCT is not necessary or how this should be established. This study seeks to systematically catalogue justifications offered throughout the medical and ethics literature for performing randomisation within clinical trials. Methods and analysis We will systematically search electronic databases of the medical literature including MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Clinical Trials Register, Web of Science Proceedings, ClinicalTrials.gov; databases of philosophical literature including Philosopher’s Index, Phil Papers, JSTOR, Periodicals Archive Online, Project MUSE, National Reference Centre for Bioethics; the library catalogue at the University of Ottawa; bibliographies of retrieved papers; and the grey literature. We will also pursue suggestions from experts in the fields of medical ethics, philosophy and clinical trial methodology. Article screening, selection and data extraction will be performed by two independent reviewers based on prespecified inclusion/exclusion criteria. A third reviewer will be consulted to resolve any discrepancies. We will then extract the reasons given to justify randomisation using methodology established to extract data in a defensible, systematic manner. We will track the reasons given, their frequency of use and changes over time. Finally, using grounded theory, we will combine the reasons into broader themes. These themes will form the foundation of our subsequent analysis from qualitative and quantitative perspectives. This review will map existing arguments that clinicians, ethicists and philosophers use to ethically justify randomisation in clinical trials. Ethics and dissemination No research ethics board approval is necessary because we are not examining patient-level data. This protocol complies with the reported guidance for conducting systematic scoping reviews. The findings of this paper will be disseminated via presentations and academic publication. In a subsequent phase of this research, we hope to engage with stakeholders and translate any recommendations derived from our findings into operational guidelines.
Dumile Gumede, Nothando B. Ngwenya, Stella Namukwaya
et al.
Abstract Background This article discusses our reflections on ethical and methodological challenges when conducting separate interviews with individuals in dyads in the uMkhanyakude district, South Africa. Our work is embedded in an ethnographic study exploring care relationships between adolescents and their older carers in the context of a large-donor funded HIV programme. We use these reflections to discuss some of the challenges and present possible management strategies that may be adopted in conducting dyadic health research in resource-poor settings. Methods Drawing from the relational agency, three rounds of separate interviews and participant observation were undertaken with dyads of adolescents aged between 13 and 19 and their older carers aged 50+ from October 2017 to September 2018. A reflexive journal was kept to record the interviewer's experiences of the whole research process. We identified methodological and ethical challenges from these data during the thematic analysis. Results A total of 36 separate interviews were conducted with six pairs of adolescent-older carer dyads (n = 12 participants). Five themes emerged: recruitment of dyads, consenting dyads, confidentiality, conducting separate interviews with adolescents and older carers, and interviewer-dyad interaction. We also illustrated how we dealt with these challenges. Conclusions Results from this study can guide the recruitment, consenting and collecting data for health studies that employ a similar form of enquiry in LMICs. However, ethical and methodological challenges should be recognised as features of the relationships between cross-generation dyads rather than weaknesses of the method.
Available experience from Chernobyl and Fukushima clearly demonstrate that nuclear emergencies may result in low and very low exposure levels, at which psychological and social effects among the affected population will dominate over the actual biological effects of ionising radiation. International protection standards and guidelines request, that both radiological and non-radiological health consequences have to be considered in preparedness and response to an actual emergency and there is a need to broaden the radiation protection system's philosophy beyond the metrics of radioactivity and radiation dose. During the past decade a number of multidisciplinary projects were set up with the aim of evaluating management options according to social, economic and ethical criteria, in addition to technical feasibility to achieve this goal. WHO and partners from the Inter-Agency Standing Committee Task Force on Mental Health and Psychosocial Support in Emergency Settings have developed a comprehensive framework and guidelines, which can be applied to any type of an emergency or disaster regardless of its origin. There is a need to include the available scientific expertise and the technical, managerial and personal resources to be considered within a similar 'decision framework' that will apply to radiation emergencies. Key areas of the required expertise needed to develop such a framework are radiation protection, medical support (especially primary care and emergency medicine, mental health support), social sciences (anthropology, psychology, ethics) and communications experts. The implementation of such a multidisciplinary concept in the operational world requires education and training well beyond the level currently available.
The body-to-head transplant (BHT) planned to be undertaken later this year at China's Harbin Medical University by neurosurgeons Sergio Canavero and Xiaoping Ren has attracted considerable attention and criticism. The intended operation gives rise to philosophical queries about the body-brain-mind relationship and nature of the subjective self; technical and ethical issues regarding the scientific soundness, safety, and futility of the procedure; the adequacy of prior research; and the relative merit, folly, and/or danger of forging new boundaries of what is biomedically possible. Moreover, that this procedure, which has been prohibited from being undertaken in other countries, has been sanctioned in China brings into stark relief ways that differing social and political values, philosophies, ethics, and laws can affect the scope and conduct of research. Irrespective of whether the BHT actually occurs, the debate it has generated reveals and reflects both the evermore international enterprise of brain science, and the need for neuroethical discourse to include and appreciate multicultural views, values, and voices.
Hoy en día es pertinente llevar a cabo reflexiones sobre los distintos ámbitos de actuación del ser humano. Con esta premisa es oportuno examinar las interacciones que denotan la bioética en la salud pública, al examinar sus propósitos y los desafíos que surgen de esta vinculación. Las actividades que se realizan en la salud pública se deben reflexionar desde la bioética de acuerdo con múltiples factores diferenciados como son el género, la cultura, el orden social, aspectos económicos, entre otros. Este análisis se debe realizar teniendo en cuenta los derechos humanos para promover una bioética institucional y social.
Background and Objectives: Being away from the familiar surroundings and family supports, decline in capabilities and skills, and age-related failures can lead to mental problems in the elderly living in nursing homes. This study was conducted with the aim of investigating the effectiveness of spiritual-religious psychotherapy on mental distress in the elderly in nursing homes.
Methods: The study population of this semi-experimental study with control group and pretest-posttest, consisted of all elderly living in the nursing home of Bandar Abbas, southern Iran in 2016. Samples (n: 28) were selected by convenience sampling and then randomly divided into two groups, experimental and control. Experimental group received spiritual-religion psychotherapy. Data collection instrument was Depression, Anxiety and Stress Scales. Data analysis was conducted by multivariate analysis of variance in the SPSS version 22.
Results: Spiritual-religious psychotherapy had significant effect in improving depression (F=138.47, p<0.05), anxiety (F=34.57, p<0.05), and stress (F=87.30, p<0.05).
Conclusion: Spiritual-religious psychotherapy can serve as an effective approach to improve mental distress in the elderly.