Hasil untuk "Medical philosophy. Medical ethics"

Paula Yamileth Cardona Ruiz

Durante la pandemia de COVID-19, se intensificó el debate global en torno a la vacunación obligatoria. Este estudio tiene como objetivo explorar la argumentación filosófica que sustenta tal discusión, mediante una revisión cualitativa de la literatura especializada. La investigación documental se realizó en marzo de 2022, por medio de búsquedas bibliográficas en las bases de datos Scopus y Web of Science, utilizando combinaciones de términos relacionados con vacunación y ética para identificar estudios pertinentes. Se seleccionaron 30 artículos para un análisis en profundidad, empleando el método comparativo constante. Los argumentos a favor de la vacunación obligatoria se centran en la primacía del bien común, la responsabilidad moral, la necesidad de restricciones ante riesgos sociales y la utilidad pública. En cambio, las posturas en contra destacan la falta de transparencia informativa, las amenazas a la libertad individual, la posibilidad de discriminación e influencias indebidas, así como la crítica a la idea de que la vacunación constituya, por sí sola, un bien público. Desde una ética de la responsabilidad, también se cuestiona la necesidad de imponerla. El estudio concluye que la discusión sobre la obligatoriedad de la vacunación debe abordarse desde una perspectiva que equilibre los derechos individuales con las demandas colectivas, promoviendo un diálogo ético que considere la salud pública y la confianza en las instituciones. Esta reflexión resulta esencial para comprender la complejidad de las decisiones sanitarias en el contexto de una crisis global.

Seyed Abdosaleh Jafari, Behin Araminia, Hanie Tavasoli et al.

Research on human dignity is crucial for understanding the ethical foundations of human rights. Neglecting to address certain pitfalls in this area of research can lead to adverse effects, including the perpetuation of discrimination, the misrepresentation of dignity across different schools of thought, and the weakening of ethical standards in human rights discourse. The present study aims to identify such challenges by analytically examining outstanding research in this field. Our surveys have identified challenges and pitfalls that were categorized into two groups: challenges in the field of materials, and challenges in the field of methods. In terms of materials, researchers may fail to adequately consider the historical and cultural contexts that shape these views, while in terms of methods, they may overlook the diverse perspectives that contribute to a comprehensive understanding of dignity. Consequently, it is imperative for researchers to remain vigilant and avoid these pitfalls to ensure that their work upholds the true essence of human dignity and effectively advocates for the rights of all individuals, especially those from marginalized backgrounds.

Kate Kusiak

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Fatemeh Molaei Tavani, Mozhgan Behshid, Azad Rahmani et al.

Ethical decision-making and professional behavior are essential skills in nursing profession, hence educational programs should be designed to enable future nurses to tackle problems related to ethical decision-making. This descriptive, correlational and analytical study aimed at determining the ability of Iranian nursing students to make ethical decisions as well as relationship between such decisions and professional behavior. The present study used census to select 140 freshmen from the School of Nursing and Midwifery of Tabriz University of Medical Sciences, Tabriz, Iran. Data collection tools included a demographic questionnaire, the Nursing Dilemma Test (NDT) comprising two indices of “nurse’s principled thinking” and “practical consideration”, as well as the Nursing Students Professional Behaviors Scale (NSPBS). The mean scores obtained were 41.3±5.7 for “nurse’s principled thinking”, 21.3±3.7 for “practical consideration”, and 119.07±11.79 for professional behavior. Relationships of professional behavior with “nurse’s principled thinking” and “practical consideration” were insignificant (P>0.05). According to the present study’s findings, nursing students’ weakness in applying ethical concepts to decisions and professional behaviors was due to a gap between scientific material learned and clinical practice. Hence, novel training strategies and programs should be designed to reduce such theory-practice gap

Hilmi Keleş

Müslümanlar, 711'de Tarık b. Ziyad’ın (ö. 102/720) öncülüğünde İspanya’nın fethine başlamışlar, Belatüşşüheda (114/732) Savaşında Franklara yenilmeleriyle ilerlemeleri durmuş ve bu bölgede varlıklarını yaklaşık sekiz yüzyıl devam ettirmişlerdir. İspanya’da yönetime hâkim oldukları dönemde Müslümanlar eğitim-öğretime oldukça önem vermişler eğitimin bir parçası olan tıp bilimine de önemli katkılar sağlamışlardır. Temel eğitimini tamamlayan öğrencilerden tıp alanında okumak isteyenler, medreselerdeki tıp eğitimine veya müstakil olarak açılan ve ‘bimaristan’ (hastane) olarak isimlendirilen kurumlarda eğitimlerine devam etmişlerdir. Tıp alanındaki çalışmalar için günümüzün fakülte hastaneleriyle benzer özellikte kurumlar oluşturmuşlar, yine buralarda eğitim için yeterli miktarda kitaplardan oluşan kütüphaneler kurmuşlardır. Dersliklerde teorik tıp eğitimi alan öğrenciler, uzman doktorların gözetiminde düzenli olarak hastaları ziyaret etme, hekimlerle beraber ilaç hazırlama, maket, kadavra ve hayvanlar üzerinde deneyler yapma vb. etkinliklerle pratik eğitimler almışlardır. Hastaları muayene ederken onlara nasıl davranmaları gerektiği konusunda da uzman doktorlar eşliğinde uygulamalı eğitimlere katılmışlardır. Tıp alanındaki bütün eğitimlerini tamamlayan öğrenciler daha sonra doktorluk yapabilmek için imtihana tabi tutulmuşlardır. Bu şekilde tıp okuyan ve eğitiminde başarılı olanlar diploma almaya ve doktorluk mesleğini icra etmeye hak kazanmışlardır. Tıbbî sahada ortaya konulan bu eğitim ve uygulamalar Endülüs Müslümanlarının tıp alanında da ne derece üstün bir noktaya ulaştığını göstermesi bakımından dikkat çekicidir. Tıp eğitimine önem verildiği gibi, hastaların tedavi olacağı hastanelerin yapımı ve giderlerinin karşılanması konusunda da Müslüman idareciler ile zenginler gönüllü olarak adeta birbirleriyle yarışmışlardır. Hastane çalışanlarının maaşlarını, hastaların tedavi giderlerini ve hastanenin diğer masraflarını karşılamak üzere vakıflar kurmuşlar, bu vakıflar aracılığıyla hastalara din, dil, ırk, zengin-fakir ayrımı yapmaksızın ücretsiz tedavi hizmeti sunmuşlardır. Böylesine başarılı bir tıp eğitiminin verildiği ve tedavi uygulamalarının yapıldığı bu dönemde Endülüs’te tıp alanında önemli bilim insanlarının yetiştiği görülmektedir. Örneğin Ebü’l-Kâsım Halef b. Abbâs ez-Zehrâvî (ö. 404/1013) bunlardan olup onun kaleme aldığı “Kitâbü’t-Tasrîf” adlı eser geniş muhtevası ve Avrupa’da en çok rağbet gören tıp kitaplarından olması yönüyle dikkat çekicidir. Zehrâvî dışında İbn Cülcül (ö. 384/994), İbn Rüşd (ö. 595/1198) gibi önemli hekimler de burada yetişmiştir. Göz, ortopedi, dâhiliye, cerrahi gibi tıp alanlarında önemli eserler yazılmış ve bunların bir kısmı uzun yıllar Batı'daki üniversitelerde ders kitabı olarak okutulmuştur. Ayrıca bazı ailelerin (ör.: Zühr ailesi) üç dört nesil babadan oğula tıp mesleğini birbirlerine öğreterek icra ettiklerine şahit olunmaktadır. Aynı zamanda ilaç hazırlama konusunda ciddi çalışmalar yapılmış, bitkilerden yapılan karışımların hasta tedavisinde ortaya koyduğu olumlu etkiler çok önemsenmiştir. Bugün hekimlik ve eczacılık ayrı ihtisas sahaları olmasına rağmen o dönem tıp faaliyetlerinde hekimlik ile eczacılığın birleştirildiği görülmektedir. Örneğin İbn Baytar derin eczacılık bilgisiyle hekimliği bir üst seviyeye çıkaran önemli bir botanikçidir. Bu makalede Endülüslü Müslümanların tıp alanında yaptıkları çalışmalar; “Endülüs’te Tıp Bilimi”, “Endülüs’te Yetişen Hekimler ve Yaptıkları Önemli Çalışmalar”, “Botanik Bilimi ve İbn Baytar”, Endülüs’te Hastaneler” şeklinde dört ana başlık halinde ele alındı. Müslümanların eğitime verdikleri önem, tıp eğitimi alanındaki faaliyetleri, yetiştirdikleri önemli hekimler ve çalışmaları ortaya konulmaya çalışıldı. Ayrıca hastanelerin kurulması ve sunduğu hizmetler, tıp alanında oluşturdukları bilgi birikiminin Batı'ya aktarılması ve bu zaman diliminde Avrupa’nın tıp alanındaki durumu hakkında genel bir tespit ve değerlendirme yapılmıştır. Endülüslü Müslümanların bu alandaki çalışmaları daha önce de bazı yönleri ile araştırmalara konu edilmiş olmakla birlikte, tıbbî faaliyetleri ile ilgili genel ve geniş kapsamlı bir çalışma olmadığından bu çalışmamızın böyle bir boşluğu doldurma konusunda yararlı olacağını düşünmekteyiz.

Abram Brummett, Ruaim Muaygil

Abstract Background The purpose of this study is to make a philosophical argument against the phenomenological critique of standardization in clinical ethics. We used the context of clinical ethics in Saudi Arabia to demonstrate the importance of credentialing clinical ethicists. Methods Philosophical methods of argumentation and conceptual analysis were used. Results We found the phenomenological critique of standardization to be flawed because it relies on a series of false dichotomies. Conclusions We concluded that the phenomenological framing of the credentialing debate relies upon two extreme views to be navigated between, not chosen among, in the credentialing of clinical ethicists.

Sridhar Venkatapuram, Jennifer Miller, Zohar Lederman et al.

Sakir Ahmed, Latika Gupta

Social networks are now an integrated part of life in most digitally connected societies. Bringing scientific papers of interest to a defined audience using the appropriate channel might substantially contribute to the impact of a scientific discovery. Various media and metrics have come to the fore in strategizing dissemination of scientific information. This opinion piece offers insights from the social-media experience of digital editors of peer-reviewed journals from non-Anglophone countries.

Rosmari Wittmann-Vieira, José Roberto Goldim

Resumo Este estudo objetiva avaliar a percepção de coerção em adultos e idosos internados submetidos a procedimento médico invasivo. Utilizou-se método transversal quantitativo, com 300 pacientes internados após cirurgia, com escala de percepção de coerção. Compararam-se proporções e possíveis associações entre grupos, gêneros, procedimentos eletivos, de urgência e grau de complexidade. Foram realizadas análises estatísticas descritivas e inferenciais. Os resultados apontam que a maioria dos pacientes (82,7%) tem baixa percepção de coerção, independente do grau de complexidade das operações. Porém, a percepção aumenta nos procedimentos de urgência, quando comparados aos eletivos, independentemente da idade ( p <0,0001). A percepção de coerção, de modo geral, foi baixa, pois a maioria dos participantes sentiu-se envolvida na decisão de realizar o procedimento. Verificou-se respeito à autonomia dos pacientes, já que a equipe médica compartilhou com eles e a família a decisão de operar, resultado adequado do ponto de vista bioético.

Megan Yu

Photo by Wesley Tingey on Unsplash INTRODUCTION On February 18, 1999, the World Health Organization launched VISION 2020 to eliminate preventable, treatable blindness by 2020.[1] Today, low-income nations continue to lack access to prevention-based eye care.[2] The leading causes of vision impairment in 2015 were cataracts and uncorrected refractive errors, particularly in low-income nations. Currently, 123.7 million people have uncorrected refractive errors and 57.1 million people have cataracts.[3] 826 million people have uncorrected farsightedness (presbyopia), most prevalent in rural areas among low-income countries.[4] These findings suggest there may be global disparities in access to eye care resources. Preventable ocular impairment impacts quality of life immensely. For instance, people living with uncorrected refractive errors can have difficulty cooking, recognizing faces, and showering.[5] Cataracts can cause driving difficulties and increase risk of injuries.[6] Access to eye care is vital to performing activities of daily living. This paper discusses the factors that contribute to the immense burden of vision impairment among low-income nations, the impact preventable vision impairment has on societies, and some ethical issues and recommendations that should be considered when expanding eye care coverage. ANALYSIS I. Contributing Factors to the Vision Impairment Burden among Low-Income Nations Resource Availability A lack of trained ophthalmic professionals and equipment remains one of the greatest barriers to reducing the global prevalence of avoidable ocular impairment, especially in low-income nations.[7] Despite an overall increase in total ophthalmologists and optometrists, very few eye healthcare workers are available in rural settings.[8]  Over 10 percent of the world’s blind population (4.8 million blind individuals) live in Africa, where there are not enough ophthalmologists to care for them.[9] Even if there were enough ophthalmologists worldwide, there are shortages in optometrists and other allied ophthalmic personnel critical to providing comprehensive eye services.[10] Approximately one ophthalmologist is available to address the needs of 446,000 individuals in sub-Saharan Africa.[11] There are drastic differences in the distribution of eye professionals among Anglophone, Francophone, and Lusophone Africa, with the greatest number of professionals available in Anglophone Africa.[12] Many low- and middle-income nations do not have sufficient ophthalmic equipment or infrastructure. Of about 120 healthcare settings in Africa, only 38 percent had an A-scan, a device essential for cataract surgery.[13] The majority of eye services in low-income nations are offered in secondary or tertiary hospitals, which are primarily located in urban areas, fueling the inequity in rural access to healthcare resources.[14] Gender and Resource Accessibility Many demographic factors affect accessibility to eye resources. In some low-income nations, women have lower cataract surgical coverage and poorer visual outcomes than men.[15] Many factors such as “limited financial decision-making power” for women and a lower likelihood for them to travel beyond their community contribute to the gender inequity.[16] Increasing socioeconomic disadvantage, poor health literacy, and lack of knowledge on healthcare resource availability also prevent individuals from accessing eye resources.[17] Local Remedies The presence of local remedies and unlicensed health providers, such as illicit drug sellers or spiritual healers, may divert individuals from ophthalmologists and cause delays in eye treatment.[18] Couching, which is an ancient treatment for cataracts, is still widely practiced in Nigeria.[19] It involves moving the cataractous lens from the visual axis into the vitreous cavity either surgically or through non-invasive methods, such as “repeated blunt trauma” to the eye or applying a plant extract topically.[20] Individuals living in rural regions are more likely to be couched rather than visit an ophthalmologist, and only 9.7 percent of those who were couched had a good outcome.[21] Affordability Individuals with lower socioeconomic status are less likely to seek eye resources. They cannot afford to forego earnings for their basic living needs, which can explain nonattendance at eye care appointments.[22]  Costs involved in receiving eye care, transportation to appointments, and pharmaceutical interventions are common barriers to accessing eye resources. 50 percent of people in low-income nations live more than one hour from a city, making travel difficult for appointments.[23] Additionally, many adults do not have health insurance, which affects their ability to afford eye services. In Trinidad and Tobago, “private sector ophthalmologists provide 80 percent of all eye care services but less than 20 percent of the adult population has health insurance.”[24] Acceptability In some societies, eyewear is not accepted and wearing glasses is seen as a disability.[25] Indigenous populations are more likely to access eye services if they are culturally appropriate and integrated into their community-based health service.[26] II. Impact of Uncorrected Vision Impairment on Societies Uncorrected vision impairment has tremendous impact on societies. Apart from poor health, it causes increased social isolation, decreased employment, diminished educational opportunities, and increased morbidity.[27] Uncorrected refractive errors could result in a global productivity loss of US $202 billion annually; it would take US $28 billion to resolve this issue.[28] Up to 94 percent of individuals living with farsightedness in low-income nations remain uncorrected or under-corrected.[29] These findings highlight the need to propose radical solutions to achieve access to affordable corrective measures like eyeglasses and contact lenses. III. The Ethical Imperative in Eye Care Basic vision correction is life altering. Those in rural poverty in low-income countries should have access to glasses as a minimum standard of justice. Glasses could change someone’s ability to become educated, achieve job success, and reach a better standard of living. In wealthy countries like the US that do not have universal healthcare coverage, access to glasses is a priority even for the poorest people. An individual’s ability to autonomously achieve their own goals rests on the ability to correct simple vision problems. A lack of eyeglasses threatens autonomy and may require dependence on others for driving and reading. Uncorrected vision also limits job opportunities requiring manual tasks like farming, operating cash registers, managing small shops or businesses, and using computers and phones. For many women, eyeglasses are necessary for weaving, knitting, and sewing to incur income. Living without glasses could also lead to a progressive deterioration in mental health and an inability to engage in social and community activities. Ophthalmologists, optometrists, and other eye health professionals have a professional obligation to serve the needs of their patients and engage in activities that promote public awareness of eye health issues. However, all doctors are not obligated to care for those in poverty in developing countries. Justice and autonomy should compel governments, with the help of global nonprofits and health organizations to act in the best interests of their communities, to avoid preventable morbidity, and to level the playing field, and allow each person equal opportunities. They should also support transparent, equitable allocation of eye care resources, and use more effective strategies than those implemented in the VISION 2020 initiative. Governments concerned with directing resources to communities equitably should consider eyecare necessary, distribute it fairly, and serve the marginalized.  To meet the needs of the community and fully incorporate eye care in national health strategic plans, governments of low-income nations should allow their citizens to participate in determining what eye health goals should be achieved. Respecting the community’s autonomy to engage in discussions would ensure vulnerable populations can voice their concerns regarding their access to eye care resources. Distributive justice should supersede cost-benefit analysis to ensure certain interventions or subpopulations are not neglected. While scarcity leads to allocation plans that prioritize certain interventions, distributive justice is achievable. To avoid prejudice against the elderly who tend to have vision problems, eyecare plans should not depend on subjective views of quality of life or remaining years. Providers should be able to stretch resources to cover even the most marginalized by using the most economical solutions such as eyeglasses rather than laser surgery to correct vision. IV. Moving Forward to Achieve Universal Eye Care Coverage Because most eye care delivery in low-income nations is offered at secondary or tertiary hospitals and is restricted to urban settings, providing incentives to rural eye practitioners and training locals to perform eye care is imperative.[30] Enhanced training of primary health staff, training eye health professionals that are not ophthalmologists, and promotion of regular eye exams and eye safety could be effective.[31] Countries should implement programs that destigmatize eyeglasses, improve health literacy, and integrate eyecare into primary care.   To address scarcity of resources, low-income countries should “shift from out-of-pocket payments toward mandatory prepayments with pooling of funds” and prioritize vulnerable populations.[32] The median out-of-pocket spending on health constitutes more than 40 percent of healthcare spending in low-income nations, placing a tremendous financial burden on many families.[33] These nations should estimate coverage costs they cannot meet even with pooled funds and appeal to nonprofits, the international community, and the physician community to meet the costs of basic care. Alternative financial sources, including “national insurance or performance-based financing” may be helpful.[34] Overall, health systems research is important to evaluate the global prevalence of preventable visual impairment, since there is dearth of data in this area.[35] CONCLUSION Visual impairment is still prevalent in low-income nations 21 years after VISION 2020 was launched. The global community and individual governments have an ethical responsibility to reduce the tremendous burden preventable visual impairment has on people in low-income nations. New approaches are necessary to provide affordable, equitable eye care coverage. While scarce resources call for difficult choices, by prioritizing those with correctable vision loss regardless of age or income and using the least expensive solutions (like eyeglasses), countries can achieve distributive justice. Individuals able to correct their vision problems can act autonomously to access more jobs, activities, and opportunities. While global organizations are needed for research, financing, and application, strategic plans should also involve all stakeholders within the healthcare system so local government agencies, healthcare providers, patients, and communities can come together to create a solution. Regulatory frameworks should elevate the standard of living by providing access to vision care that ensures autonomy, beneficence, and justice. [1] World Health Organization, “Prevention of blindness and visual impairment,” 2020.  https://www.who.int/blindness/partnerships/vision2020/en/. [2] Healio, “Vision 2020 reaches landmark year”, January 2, 2020. https://www.healio.com/news/ophthalmology/20191226/vision-2020-reaches-landmark-year. [3] World Health Organization website. https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment  See also Flaxman, Seth et al., “Global causes of blindness and distance vision impairment 1990-2020: A systematic review and meta-analysis,” The Lancet: Global Health 5, no.12 (December 2017): e1221-e1234. https://doi.org/10.1016/S2214-109X(17)30393-5. [4] Fricke, Timothy et al., “Global prevalence of presbyopia and vision impairment from uncorrected presbyopia,” Ophthalmology 125, no. 10 (October 2018): 1492-1499. https://doi.org/10.1016/j.ophtha.2018.04.013. [5] Kandel, Himal et al., “Impact of refractive error on quality of life: A qualitative study,” Clinical & Experimental Ophthalmology 45, no. 7 (September/October 2017): 677-688. https://doi.org/10.1111/ceo.12954 [6] InformedHealth.org, “Cataracts: Overview”, October 10, 2019. https://www.ncbi.nlm.nih.gov/books/NBK390302/. [7] World Health Organization, “World report on vision”, 2019. https://www.iapb.org/wp-content/uploads/world-vision-report-accessible1.pdf. [8] World Health Organization, 2019, p. 36; World Health Organization, 2019, p. 37 [9] Gilbert, Suzanne et al., “Recruiting and distributing eye health workers,” Community Eye Health, 31, no. 102 (2018): 45-47; World Health Organization, Global Data on Health Impairments, 2010. https://www.who.int/blindness/GLOBALDATAFINALforweb.pdf [10] World Health Organization, 2019, p. 37 [11] Graham, Ronnie, “Facing the crisis in human resources for eye health in sub-Saharan Africa,” Community Eye Health, 30, no. 100 (2017): 85-87. [12] Graham, p. 87 [13] Patel, Daksha et al., “Ophthalmic equipment survey 2010: Preliminary results,” Community Eye Health 23, no. 73 (September 2010): 22-25. [14] World Health Organization, 2019, p. 37 [15] Ramke, Jacqueline et al., “Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage,” PLOS One (March 1, 2017): e0172342. https://doi.org/10.1371/journal.pone.0172342; Lewallen, S et al., “Cataract surgical coverage remains lower in women,” British Journal of Ophthalmology 93, no.3 (December 17, 2008): 295-298. http://dx.doi.org/10.1136/bjo.2008.140301 [16] World Health Organization, 2019, p. 38 [17] Ramke, p. e0172342; World Health Organization, 2019, p. 38 [18] World Health Organization, 2019, p. 38 [19] Gilbert, Clare et al., “Couching in Nigeria: Prevalence, risk factors and visual acuity outcomes,” Ophthalmic Epidemiology 17, no. 5 (October 2010): 269-275. https://doi: 10.3109/09286586.2010.508349. [20] Gilbert, p. 270 [21] Gilbert, p. 269 [22] World Health Organization, 2019, p. 38 [23] Weiss, D et al., “A global map of travel time to cities to assess inequalities in accessibility in 2015,” Nature 553 (January 10, 2018): 333-336. [24] Braithwaite, Tasanee et al., “Health system dynamics analysis of eyecare services in Trinidad and Tobago and progress towards Vision 2020 Goals,” Health Policy and Planning 33, no. 1 (January 1, 2018): 70-84. [25] World Health Organization, 2019, p. 39; Adeoti, C, “Beliefs and attitude towards spectacles,” Nigerian Journal of Clinical Practice 12, no. 4 (December 2009): 359-361; Castanon Holguin, Aaron et al., “Factors associated with spectacle-wear compliance in school-aged Mexican children,” Invest Ophthalmol Vis Sci 47, no. 3 (March 2006): 925-928. [26] Turner, Angus et al., “Eye health service access and utilization in the National Indigenous Eye Health Survey,” Clinical & Experimental Ophthalmology 39, no.7 (September/October 2011): 598-603. [27] Honavar, Santosh, “The burden of uncorrected refractive error,” Indian Journal of Ophthalmology 67, no. 5 (May 2019): 577-578. [28] Fricke, TR et al., “Global cost of correcting vision impairment from uncorrected refractive error,” Bulletin of the World Health Organization 90, no.10 (July 12, 2012): 728-738. [29] Frick, Kevin et al., “The global burden of potential productivity loss from uncorrected presbyopia,” Ophthalmology 122, no. 8 (August, 1, 2015): 1706-1710. [30] World Health Organization, 2019, p. 37 [31] World Health Organization, 2019, p. 123; World Health Organization, 2019, p. 51 [32] World Health Organization, 2019, p. 110 [33] World Health Organization, “Public spending on health: a closer look at global trends,” 2018, https://apps.who.int/iris/bitstream/handle/10665/276728/WHO-HIS-HGF-HF-WorkingPaper-18.3-eng.pdf?ua=1. [34] Blanchet, p. 1326-1327 [35] World Health Organization, 2019, p. 84; World Health Organization, “Universal eye health: A global action plan 2014-2019,” 2013, https://www.who.int/blindness/AP2014_19_English.pdf?ua=1.

Sagar Atmaram Borker

Gemma Marfany

La tecnología de la edición génica por CRISPR ha revolucionado tanto la investigación en biotecnología como en biomedicina. Esta técnica tan poderosa y versátil permite editar los genes de cualquier especie a la carta. A pesar de su potencia y efectividad, quedan muchas cuestiones para resolver y controlar su resultado final, particularmente en las aplicaciones sobre el genoma de los seres humanos. En este artículo se plantean tanto los puntos fuertes y puntos débiles de la técnica, como otras cuestiones abiertas sobre la edición génica, sobre si debe dirigirse a la terapia o a la mejora, si la modificación debe constreñirse a células somáticas o también a editar a embriones, modificando el genoma de los seres humanos del futuro.

Javier de la Torre Díaz

Helwar Hernando Figueroa S.

La exclusión social y cultural de las personas víctimas del desplazamiento forzado en Colombia obedece a la negación del conflicto por parte de la sociedad, que pareciera sentirse más cómoda con el ejercicio de una ética ciudadana indiferente ante el dolor. Una indiferencia que contribuye al irrespeto hacia los derechos humanos e impide la creación de escenarios sociales consensuados e incluyentes, como lo propone la bioética. La metodología utilizada se basó en el acompañamiento a un grupo focal, compuesto por doce abuelos afrocolombianos, habitantes del distrito de Aguablanca (Cali), desplazados del Pacífico colombiano. Esta metodología se complementó con entrevistas de profundidad. El objetivo de la investigación fue comprender cómo los desplazados recuerdan el campo desde la ciudad y, a su vez, contextualizar los relatos del desplazamiento del cual fueron víctimas. En las conclusiones se afirma que el uso de la memoria colectiva favorece la creación de una ética pluralista e incluyente, lo cual ayuda a restituir los derechos violados de la población víctima de desplazamiento forzado.

Wolpert Lewis

<p>Abstract</p> <p>Animal Models in the Light of Evolution provides persuasive evidence that animal models should be used with great caution when applying the results to human diseases. Mice and other model animals are both similar and different, in their biology, to humans.</p>

Bagshaw Sean M, McDermid Robert C

<p>Abstract</p> <p>Critical care is in an emerging crisis of conflict between what individuals expect and the economic burden society and government are prepared to provide. The goal of critical care support is to prevent suffering and premature death by intensive therapy of reversible illnesses within a reasonable timeframe. Recently, it has become apparent that early support in an intensive care environment can improve patient outcomes. However, life support technology has advanced, allowing physicians to prolong life (and postpone death) in circumstances that were not possible in the recent past. This has been recognized by not only the medical community, but also by society at large. One corollary may be that expectations for recovery from critical illness have also become extremely high. In addition, greater numbers of patients are dying in intensive care units after having receiving prolonged durations of life-sustaining therapy. Herein lies the emerging crisis – critical care therapy must be available in a timely fashion for those who require it urgently, yet its provision is largely dependent on a finite availability of both capital and human resources. Physicians are often placed in a troubling conflict of interest by pressures to use health resources prudently while also promoting the equitable and timely access to critical care therapy. In this commentary, these issues are broadly discussed from the perspective of the individual clinician as well as that of society as a whole. The intent is to generate dialogue on the dynamic between individual clinicians navigating the complexities of how and when to use critical care support in the context of end-of-life issues, the increasing demands placed on finite critical care capacity, and the reasonable expectations of society.</p>

Luís Claudio de Souza Motta, Selma Vaz Vidal, Andréia Patrícia Gomes et al.

This is a qualitative and quantitative empirical study seeking to identify and critically describe bioethical issues in primary health care from the perspective of members of Family Health Strategy (ESF) teams in a city in the mountainous region of the state of Rio de Janeiro, Brazil. It also sought to detect the degree of theoretical approximation of professionals regarding the basics of ethics and bioethics, based on principalist theory. A semi-structured questionnaire was adopted as data collection instrument. The responses were categorized into aspects related to (i) ethical/bioethical conflicts in relation to staff and users; (ii) ethical/bioethical conflicts in the process of work and coexistence among team members; and (iii) misconceptions regarding the concepts of basic (bio)ethics and deontology. Although apparently less obvious, such matters concerning the scope of primary health care compromise the work process and the promotion of comprehensive care for users of the SUS.

Débora de Oliveira Santos, Fabíola Alves Gomes, Kely Raspante Teixeira et al.

Resumo Os adolescentes são considerados grupo vulnerável e exposto a diferentes ameaças à saúde, tornando-se necessária a discussão sobre aspectos éticos relacionados a sua participação em pesquisa e prática clínica. Por meio de revisão integrativa de literatura foram selecionados estudos que abordaram aspectos bioéticos relacionados à vulnerabilidade de adolescentes nos últimos quinze anos. Nove artigos atenderam aos critérios pré-estabelecidos para o estudo e foram agrupados em três categorias: 1) trabalhos que pontuaram a compreensão psicológica e cognitiva do adolescente ao participar de pesquisa científica; 2) estudos que enfatizaram aspectos relacionados a decisões médicas; e 3) estudos que abordaram a temática da sexualidade na adolescência. Após análise dos estudos selecionados, verificou-se que não é possível chegar a consenso válido para todas as situações que envolvem adolescentes em pesquisa e prática clínica.

Adriana Vilma Scrigni, Beatriz Elida Mantese

Resumen Los tumores de tronco encefálico representan alrededor del 10% al 20% de los tumores del sistema nervioso central en niños. El glioma intrínseco difuso es el más frecuente (80% de los casos) de este grupo de tumores, que se caracterizan por la mala evolución y una sobrevida corta. El diagnóstico se puede hacer por resonancia magnética (con espectroscopía) o por biopsia estereotáxica, un método controvertido, que permite el estudio inmunohistoquímico y molecular del tumor. La reflexión moral se focaliza en la indicación de biopsia para pacientes vulnerables y con mal pronóstico. Se analiza la cirugía desde el punto de vista ético, con base en el mejor interés del niño y en la actitud altruista del paciente y su familia.