Mina Mollaei, Fateme Metanat, Amirreza Rafiei Javazm
et al.
Abstract Introduction In the realm of healthcare, nurses frequently encounter complex ethical issues that demand moral courage. Nurses'moral courage is defined as the ability to act in alignment with their moral beliefs, even when faced with difficulties and dangers during ethical challenges. This study aims to explore the role of moral courage in nursing practice, highlighting its importance in maintaining patient care standards and fostering ethical decision-making. Methods This scoping review on nurses’ moral courage was conducted following Arksey and O’Malley’s five-step approach. Relevant literature was sourced from databases such as Embase, PubMed, ScienceDirect, Web of Science, PsycINFO, Scopus, and CINAHL, spanning the years 2000–2024. A total of 40 studies were selected, focusing specifically on the foundations and influences of nurses’ moral courage, with data extraction and synthesis for reporting. Results The study highlights moral courage as crucial in nursing for ethical decision-making and patient care. Global variations in moral courage are influenced by cultural, contextual, and organizational factors. Tools for measurement show score discrepancies. Nursing education shapes moral courage, necessitating tailored programs. Research explores personal and organizational influences on ethical behavior, with factors like age, work experience, and ethics training impacting moral courage. Morning shift nurses and those with official employment exhibit higher moral courage. Gender’s impact remains inconclusive, requiring further study. Training in nursing ethics enhances moral courage, emphasizing its role in care quality. Conclusion In conclusion, understanding the diverse factors shaping moral courage in nursing is vital for navigating ethical challenges and improving patient care quality. Tailored educational strategies are essential to foster moral courage among nursing professionals globally, emphasizing the need for ongoing research and interventions to enhance ethical practice and patient outcomes.
This study explores how Macao, a semi-autonomous colonial territory under Portuguese neutrality, governed epidemic crises between 1937 and 1949 through a civic-driven, multi-actor approach. It examines how local responses to epidemics were formulated and sustained amid institutional fragility, political isolation, mass refugee inflows, and in the absence of strong centralized authority. Drawing on 1036 contemporaneous reports from Overseas Chinese News, the study employs procedural grounded theory to inductively reconstruct Macao’s epidemic governance logic. The findings reveal six interrelated strategies: real-time epidemiological monitoring and disclosure, universal compulsory vaccination, cross-institutional and transregional collaboration, grassroots hygiene education, institutionalized civil society participation, and strict quarantine and sanitation enforcement.The study proposes a “Civic-Driven Epidemic Governance Framework under Neutrality”, illustrating how decentralized collaboration, institutional improvisation, and social capital compensated for limited state control. The Macao case offers a historically grounded alternative to state-centric public health models by underscoring the role of civic engagement and cross-border cooperationFinally, it highlights the media’s dual role as a platform for public communication and a driver of social mobilization. These findings contribute to broader debates on resilient, inclusive and adaptive governance in politically fragmented or fragile contexts.
History of medicine. Medical expeditions, Medical philosophy. Medical ethics
Abstract Background Although not widely known to the general public, right-to-die organisations have been active in Germany since the 1980s, similar to Switzerland. Notably, there is often a lack of focus on the volunteer members of these organisations, despite their unique perspectives on the matter. Our study aims to thoroughly investigate the experiences of members in German right-to-die organisations and thereby make a significant contribution to the ongoing debate. Methods This project was implemented through qualitative interviews conducted with active volunteer members of German right-to-die organisations, followed by a qualitative structured content analysis based on Mayring’s approach. Using a coding evaluation method, relevant aspects were extracted from the data and on one hand assigned to predetermined categories, while one the other hand, new categories emerged organically from the material. Results After conducting 13 interviews, it became clear that, while some participants were deeply impacted by the dramatic nature of the illness-related circumstances surrounding certain assisted suicides, the majority do not find the work burdensome. Instead, they view it as highly fulfilling and rewarding. In particular, interacting with the relatives of those seeking assistance and with the individuals themselves is seen as especially enriching. Furthermore, participants frequently encounter significant ignorance from large segments of the medical community and law enforcement regarding current regulations, which can lead to complications during assisted suicides. Additionally, collaboration with care facilities and senior residences presents a considerable challenge for many members, often due to religious objections. Conclusion Our study of volunteer members of right-to-die organisations is, as far as we know, the first one with active volunteers of German right-to-die organisations. The interviews thus provide new and important insights into a lived practice that has been little studied. These insights must be incorporated into the current debate on the responsible establishment of the practice of assisted suicide.
Dan Santos, Mengqi Hu, Edilene Lopes McInnes
et al.
Contemporary scientific research depends on sharing resources. Norms, cultures and infrastructures enable, incentivize or require sharing in particular ways. Commons are one type of infrastructure, and their key characteristics include the provision and governance of resources. Understanding how resources become part of a commons is critical for implementing arrangements that effectively facilitate scientific research. This article uses commons theory associated with knowledge resources to explore efforts to establish a registry for the Australian stem cell research community where registration is not a current norm. Analyzing the perspectives of stem cell researchers regarding registries, we make two contributions: (1) a conceptual contribution to the commons literature by explicating a more contingent understanding of resources, and (2) an empirical analysis of a relatively under-examined form of governance arrangement (i.e. registries). We emphasize paying close attention to the context-dependent processes through which resources are viewed as common-able and may subsequently become common-ed.
Ana Beatriz Saragossa Guerreiro, Bianca Gabriela Tavares Castiglioni, Gabriela Barszcz Parisotto
et al.
Resumo O câncer de mama, causado pelo aumento descontrolado de células anormais, representa a forma mais comum de neoplasia maligna entre mulheres. Os desafios encontrados no diagnóstico, durante o tratamento e após a remissão envolvem tanto a queda da qualidade de vida quanto transformações físicas e emocionais, as quais geram estresse psicológico e afetam principalmente a autoestima feminina. As dificuldades enfrentadas diante do diagnóstico podem ser amenizadas com a tríade espiritualidade, rede familiar e grupos de apoio, independentemente da faixa etária da mulher. Assim, este estudo tem como objetivo compreender os impactos psicossociais da neoplasia de mama na vida das mulheres. Trata-se de revisão integrada da literatura com análise de artigos publicados entre 2014 e 2024, disponíveis nas bases de dados Scientific Electronic Library Online, National Center for Biotechnology Information da National Library of Medicine e Biblioteca Virtual em Saúde Brasil.
Shaimaa Saadaldeen, Mohammed Dawood, Abdulhussein Jwery
Background: Chronic suppurative otitis media (CSOM) is a long-standing inflammation of the middle ear. Mucosal CSOM, the most prevalent form, typically causes conductive hearing loss due to perforation of the tympanic membrane. However, sensorineural hearing loss (SNHL) may also occur. This study aims to assess the frequency of SNHL in mucosal CSOM and characterize its features.Methods: A cross-sectional study was conducted from October 2024 to March 2025 at the Otolaryngology and Audiovestibular Consultation Unit, College of Medicine, Mustansiriyah University, Iraq. Sixty patients with unilateral mucosal chronic suppurative otitis media were enrolled, with the non-diseased ear serving as a control. All participants underwent tuning fork tests and pure tone audiometry.Results: Nine out of 60 patients (15%) exhibited mixed hearing loss. The degree of SNHL was moderate in 7 patients (77.8%) and mild in 2 patients (22.2%). SNHL was significantly associated with longer disease duration and the presence of active disease (p = 0.018 and 0.032, respectively). Higher-frequency hearing was more affected than speech frequencies, with significantly elevated bone conduction thresholds in the diseased ear compared to the control ear (p < 0.001).Conclusion: Mucosal CSOM may contribute to SNHL in 15% of cases, particularly among patients with longer disease duration and active discharge. Early diagnosis and appropriate management are essential to prevent permanent sensorineural hearing impairment.
History of medicine. Medical expeditions, General works
While artificial intelligence (AI) significantly enhances medical efficiency, it also raises a series of ethical concerns, including blurred clinical responsibility, imbalanced data governance, and algorithmic bias. This paper examines three major ethical tensions in intelligent healthcare: first, the integration of AI reshapes clinical decision-making structures, leading to ambiguous responsibility allocation and a weakening of physicians' subjectivity; second, algorithm-driven data governance may result in the failure of informed consent and the marginalization of patients' lived experiences; third, regional disparities embedded in technical standards exacerbate health inequalities, with algorithmic discrimination potentially entrenching imbalances in resource distribution. In response, this study proposes ethical reconstruction strategies, including the establishment of shared responsibility frameworks, enhancement of algorithmic transparency, reinforcement of data protection, and optimization of fairness mechanisms, aiming to promote the responsible development of medical AI.
Aysun Tekbaş, M. von Lilienfeld-Toal, F. Sayrafi
et al.
Abstract Purpose Engagement of healthcare professionals with patients from diverse cultural and religious backgrounds is crucial in our multicultural society, where miscommunication and errors in medical history taking can lead to incorrect treatment. In particular, Muslim patients may present unique considerations due to their specific cultural and religious beliefs, which can significantly impact treatment outcomes. This study focuses on perioperative medication therapy for patients undergoing upper and lower gastrointestinal tract and pancreatic tumor surgery, specifically examining whether Islamic beliefs were duly considered in medication selection compared to a matching patient cohort. Materials and methods Data from January 2004 to July 2023 were analyzed. Muslim patients were identified using the onomastic method and matched with non-Muslim patients at a 1:3 ratio based on age, gender, and procedure. Analysis included examination of subcutaneous, oral, and intravenous medications, with attention to ingredients and compatibility with Islamic principles. Results Among 5272 patients, only 5 met the study’s inclusion criteria as Muslim patients, undergoing procedures such as anterior rectum resection, gastrectomy, and pancreatic head resection. Their religious affiliations were not documented in the admission records. According to the matched-pair analysis, consistent treatment was performed regardless of religious beliefs. All patients received subcutaneous medication, primarily enoxaparin, instead of fondaparinux, an Islam-compliant alternative. Intravenous heparin was used once for short period. Contrary to Islamic dietary restrictions and the availability of alternatives, capsules containing animal-derived gelatin and other non-compliant medications were administered orally. Conclusion This study underscores the importance of acknowledging Muslim patients’ cultural and religious backgrounds in the perioperative setting, as failure to do so may lead healthcare professionals to overlook their potential alternative medication needs, which are essential for providing tailored medical care in modern societies. Integration of diversity-related topics into medical curricula is essential for better preparing physicians for clinical practice and ensuring patient-centered care.
AbstractWhile there has been much discussion of how the scientific establishment’s culture can engender research misconduct and scientific irreproducibility, this has been discussed much less frequently with respect to the medical profession. Here the authors posit that a lack of self-criticism, an encouragement of novel scientific research generated by the recruitment policies of the UK Royal Training Colleges along with insufficient training in the sciences are core reasons as to why research misconduct and dishonesty prevail within the medical community. Furthermore, the UK General Medical Council’s own data demonstrates a historic inattentiveness to the ease with which doctors can engage in research misconduct. Suggestions are made as to how these issues can be investigated and alternative incentives for career advancement are adumbrated.
La importancia de la toma de decisiones éticas en ciencias de la salud ha promovido la generación de esquemas que orientan este proceso. El objetivo es proponer un modelo teórico de toma de decisiones bioéticas. Se hizo una búsqueda y revisión de la literatura en bases de datos y bibliotecas electrónicas con palabras clave, se identificaron y analizaron once modelos de toma de decisiones éticas según parámetros establecidos y se incluyeron resultados de estudios sobre el tema. Los esquemas analizados plantean una toma de decisiones basada en la razón a partir de un número variable de pasos cognitivos y, en general, aportan pocos elementos para su aplicación práctica. Se planteó el Modelo de Integración Razón Emoción para la Toma de Decisiones Bioéticas en Ciencias de la Salud. Este modelo sintetiza los pasos cognitivos para tomar decisiones adecuadas, mediante la integración de la razón y la emoción, la posibilidad de aplicación de diversos marcos éticos y la puesta en juego de la competencia ética y las habilidades de pensamiento crítico.
Irene Zasimowicz Pinto Calaça, Patrícia Jorge Carneiro de Freitas, Sérgio Augusto da Silva
et al.
Las filosofías de la Pachamama y del buen vivir son puntos de referencia de los pueblos indígenas y están presentes en las constituciones de Ecuador y Bolivia, con el fin de armonizar las diferencias culturales y añadir las tradiciones a la política local. Las filosofías toman por base un mito andino: el que cree que la naturaleza es un organismo vivo y sujeto de derechos, y se abren espacio a la visión biocéntrica del mundo, compartida por la bioética global. La naturaleza ya no logra recomponerse por las innovaciones biotecnológicas impuestas por el hombre, lo que obliga a la humanidad a encontrar nuevos paradigmas, el Nuevo Constitucionalismo Latinoamericano, representado por las constituciones, es uno de ellos. En este artículo se describen y analizan críticamente estas dos constituciones, relacionándolas con la visión de mundo de la Pachamama y de la filosofía del buen vivir en el contexto de la bioética global. En este sentido, la Declaración Universal sobre Bioética y Derechos Humanos, al asociar bioética como campo normativo particular en la atención y cuidado de la vida y de la salud, con derechos humanos como campo normativo universal básico de obligaciones morales y jurídicas para todas las formas de vivir humano, presenta los valores fundamentales de una ética universal sustentada por la dignidad humana, la igualdad de derechos, la libertad, la justicia, la fraternidad y la paz, como es defendido en el artículo 17, de la protección del medio ambiente, de la biósfera y de la biodiversidad.
Conny A. M. F. H. Span-Sluyter, Jan C. M. Lavrijsen, Evert van Leeuwen
et al.
Abstract Background Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term care of patients in VS/UWS. Methods A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Results Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Conclusions Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making.
Abstract Background This article explores the reasons in favour of revising and extending the current 14-day statutory limit to maintaining human embryos in culture. This limit is enshrined in law in over a dozen countries, including the United Kingdom. In two recently published studies (2016), scientists have shown that embryos can be sustained in vitro for about 13 days after fertilisation. Positive reactions to these results have gone hand in hand with calls for revising the 14-day rule, which only allows embryo research until the 14th day after fertilisation. Main text The article explores the most prominent arguments in favour of and against the extension of the 14-day limit for conducting research on human embryos. It situates these arguments within the history of the 14-day limit. I start by discussing the history of the 14-day limit in the United Kingdom and the reasons behind the decision to opt for a compromise between competing moral views. I then analyse the arguments that those who are generally in favour of embryo research put forward in support of extending the 14-day rule, namely (a) the argument of the beneficence of research and (b) the argument of technical feasibility (further explained in the article). I then show how these two arguments played a role in the recent approval of two novel techniques for the replacement of faulty mitochondrial DNA in the United Kingdom. Despite the popularity and widespread use of these arguments, I argue that they are ultimately problematic and should not be straightforwardly accepted (i.e. accepted without further scrutiny). I end by making a case for respecting value pluralism in the context of embryo research, and I present two reasons in favour of respecting value pluralism: the argument of public trust and the argument of democracy. Conclusion I argue that 14-day limit for embryo research is not a valuable tool despite being a solution of compromise, but rather because of it. The importance of respecting value pluralism (and of respecting different views on embryo research) needs to be considered in any evaluation concerning a potential change to the 14-day rule.
Emergency medicine, both pre-hospital through emergency medical services (EMS) and in the emergency department (ED), is focused on immediate response to a variety of different illnesses and injuries. Through the Emergency Medical Treatment and Active Labor Act (EMTALA), all patients presenting to an ED are guaranteed to receive assessment and stabilizing treatment regardless of their ability to pay.[1] Thus, the ED often replaces the primary care doctor that many patients simply cannot afford. Manageable illnesses, such as hypertension and diabetes, are left to progress untreated when patients cannot afford necessary health care services and medications. When the ED functions as the primary care doctor, it is often not in a manner that promotes overall beneficence and justice. The system is broken, and patients often come to the ED with end-stage diseases that could have been prevented. Some argue that rescue resources should be withheld from patients who cannot benefit from them and that preventive medicine should be invested in further. This piece seeks to demonstrate the practical difficulties that arise in withholding care in all situations where it may be deemed futile while proposing that further emphasis should be placed on preventive medicine; EMS resources can be utilized in this process.
We shall begin with a consideration of when rescue medicine is necessary. Nancy Jecker is a Professor of Bioethics at the University of Washington and specializes in ethics and healthcare. She argues for the rule of rescue (RR), where rescue medicine should be used only in situations where patients are expected to benefit: “We ought to attempt to rescue an individual when we are reasonably confident that our efforts can help, and when the individual’s death is imminent and our failure to act is reasonably expected to result in that person’s death.”[2] The key point for Jecker is the statement that efforts must help the individual. Jecker develops this notion to argue that rescue medicine should not be offered when there is little prospect for benefit:
Clearly, if the prospect of benefit is extremely poor, so that the patient is doomed regardless of what we do, then RR does not apply and treatment should be withheld (or compassionately withdrawn if a rescue is already underway). Similarly, if the quality of outcome to be achieved falls well below a threshold considered minimal, RR does not apply and treatment should not be attempted, even if resources are abundant.[3]
Jecker argues that the resources dedicated to rescue medicine in cases with little hope for benefit (for example, resuscitating a patient in multi-organ failure) would be better withheld such that more resources can be dedicated to preventive medicine.[4] In this case, justice to the community served outweighs the small chance of benefit to “doomed” patients.
Jecker also considers the notion of spatial distance, arguing that distance should play no role in determining who gets treatment: “Fairness requires that we avoid discriminating between individuals on morally irrelevant grounds, and merely being located nearby does not seem to be a morally relevant ground.”[5]However, distance often plays a distinct role in determining whether or not a rescue attempt is futile or offers little chance of benefit. While one group of patients in need of resuscitation consists of terminal patients similar to the example of the multi-organ failure patient, another group consists of patients who could benefit from resuscitation if it is provided in a timely fashion.
EMS provides rescue medicine to patients in both urban and rural settings. Each setting provides its own unique set of challenges. For those who work in rural settings, a common challenge to rescue efforts is time. If a patient enters cardiopulmonary arrest and does not receive bystander CPR prior to the arrival of EMS, passing time amounts to brain damage. Thus, a patient less than five minutes away might be reasonably expected to benefit from resuscitation, whereas a patient twenty or thirty minutes away might be deemed a futile effort. It is unreasonable to place an EMS agency every few miles to serve a handful of homes. Yet, it is also unreasonablenot to resuscitate those patients who are farther away from the agency. While many providers feel that these efforts are often futile and lead to false hope for family members, practicality disables us from withholding these efforts. First, a set time period would have to be determined for which these efforts are futile (likely based on a whole brain death criterion).[6] Second, bystanders would have to accurately measure the time elapsing between the onset of cardiopulmonary arrest and EMS arrival. It is unlikely that bystanders would be able to accurately check for the absence of a carotid pulse and be able to accurately measure elapsing time during this chaotic circumstance. It is also incorrect to assume that a bystander would be present at the exact time of cardiopulmonary arrest. Enacting such a policy would surely continue to result in some futile resuscitations, and, more dangerously, failure to resuscitate a patient who may benefit.
The problem of futile rescue efforts may be alleviated in part by public education and preventive medicine efforts. EMS agencies have been successfully involved in public education for injury prevention, but the role of EMS in public education and prevention for medical ailments is much less common.[7] In rural and impoverished areas, public education could enable patients to understand what a resuscitation effort in terminal illness actually entails for the patients and their loved ones versus when a resuscitation effort can truly make a difference. Educating patients to discuss their wishes with their families and obtaining medical directives and orders, if necessary, can prevent some of the futile efforts that place burdens on both families and the system with no chance of benefit.
Community preventive medicine efforts should ensure that patients have access to and properly manage their medications, have follow-up visits with education on how to manage current ailments, live in environments that reduce the chance for falls, and have access to primary care physicians when needed. It must be realized that the overutilized EMS systems and overflowing EDs is a problem created by the view that rescue medicine is a right and primary care is not. The burden on these systems is created when patients need to be seen for ailments that either could be currently managed by a primary care physician or could have been prevented by prior access to a primary care physician: “In medical emergencies where simple measures could easily have prevented an emergency from occurring, the RR has run amuck. A broader view requires, for example, preventing a progressive disease that is left untreated from continuing on its present course and taking a predictable turn for the worse.”[8]Prevention entails essentially integrating the current primary care and emergency care systems to some extent.
Primary care access and expansion are necessary steps that must be taken to reduce the load on EDs and decrease hospitalizations for ailments that could have been prevented or managed through primary care. Universal health care will grant financial access to patients who cannot currently afford primary care. The expansion of primary care will allow easier spatial access to those in rural areas and allow better access for patients who need to be seen promptly in urban areas. Examples of how these improvements can reduce the load on unnecessary hospitalizations, which often involve EMS, can be seen by looking at other healthcare systems. For example, France has a universal healthcare system that is similar to a single-payer system. It also has excellent coverage of medications and greater access to primary care, and even specialists, which greatly reduces the number of unnecessary hospitalizations: “The United States has exceedingly high rates of avoidable hospitalizations compared with Britain, Germany or France. Comparing Paris and Manhattan, we have 2.5 times the rate of avoidable hospitalizations that they do in Paris.” While the loss of physician autonomy is a general fear of universal health care, the French system is not government-run and provides better overall access and primary care for patients, and greater physician autonomy. While the transition to universal health care in the United States will likely come after much debate over the best way to achieve it, the lack of access and current abuse of our emergency medicine systems demonstrates a clear need.
EMS agencies can also play a major role in community preventive medicine efforts. By diverting some resources to preventive medicine efforts, many more expensive resources will decrease in need:
Emergency services personnel currently spend much of their time reacting to cases that fall between the cracks of today’s separate and isolated public safety, health care, and public health systems…Although emergency response must remain our foundation, EMS of tomorrow will be a community-based health management system that provides surveillance, identification, intervention, and evaluation of injury and disease.[10]
By decreasing the incidence of rescue efforts for those with preventable end-stage diseases, the rescue system can be better utilized to serve those with immediate injuries and illnesses that can benefit from rescue medicine. Incorporating preventive medicine into rescue medicine can also save lives through less invasive and emergent measures with long-term benefits, instead of more emergent “life and death” measures without long-term benefits. Such an effort would prevent the need for such extreme measures in the first place and prolong the lives of patients with manageable diseases.
All things considered, rescue medicine seeks to keep the community it serves safe. However, it is important that such efforts maximize justice and benefits while minimizing risks. Emergencies requiring a large amount of resources for little benefit to those with terminal or progressed illnesses limit justice for the community as a whole. More patients with manageable diseases will become patients with end-stage diseases, and this cycle will perpetuate until patients have access to the care and medications they need. With proper preventive medicine training, EMS is uniquely equipped to integrate preventive medicine into rescue medicine and deliver it directly within the community. Some preventive medicine providers, such as Evolution Health (a national home healthcare provider) and Golder Ranch Fire District (which offers preventive care through additionally trained “community integrated paramedics”), have already had success in enacting community preventive health measures.[11] This step, combined with improved access to primary care and medications, will expand justice, beneficence, and even autonomy as patients become better equipped to understand and manage their injuries and illnesses.
References:
[1] EMTALA was passed in 1986.
[2] Nancy S. Jecker, “The Problem with Rescue Medicine,” Journal of Medicine and Philosophy 38, no. 1 (2013): 67.
[3] Jecker, “The Problem,” 71.
[4] Jecker, “The Problem,” 75.
[5] Jecker, “The Problem,” 70.
[6] The whole brain death criterion is fulfilled when the entire brain, comprised of both the higher brain and the brainstem, has experienced an irreversible cessation of function. Patients who meet this criterion are legally dead.
[7] Theodore R. Delbridge et al., “EMS Agenda for the Future: Where We Are … Where We Want to Be,” Annals of Emergency Medicine 31, no. 2 (1998): 258.
[8] Jecker, “The Problem,” 79.
[9] Victor G. Rodwin, “Health Care Abroad: France,” Interview by Anne Underwood and Sarah Arnquist, The New York Times, September 11, 2009,http://prescriptions.blogs.nytimes.com/2009/09/11/health-care-abroad-france/?_r=0.
[10] Ricardo Martinez, “New Vision for the Role of Emergency Medical Services,” Annals of Emergency Medicine 32, no. 5 (1998): 595.
[11] Joshua Hurguy, “Fire-Based Community Paramedicine: Golder Ranch Fire District’s Community Integrated Healthcare Program,” Journal of Emergency Medical Services, September 4, 2015,http://www.jems.com/articles/print/volume-40/issue-9/features/fire-based-community-paramedicine-golder-ranch-fire-district-s-community-integrated-healthcare-program.html.
Ramin Ravangard, Zahra Sajjadnia, Abdosaleh Jafari
et al.
In order to achieve success in today's competitive world, organizations should adapt to environmental changes. On the other hand, managers should have a set of values and ethical guidelines for their administrative and organizational functions. This study aimed to investigate the association between work ethics and attitudes towards organizational changes among the administrative, financial and support employees of general teaching hospitals affiliated to Shiraz University of Medical Sciences. This was an applied, cross-sectional and descriptive-analytic study conducted in 2013. A sample of 124 employees was selected using stratified sampling proportional to size and simple random sampling methods. Data were collected using 2 questionnaires measuring the dimensions of employees' work ethics (four dimensions) and attitudes towards organizational changes (three dimensions). The collected data were analyzed using SPSS 18.0 and statistical tests, including ANOVA, independent samples t-test, and Pearson's correlation coefficient. A P < 0.05 was considered statistically significant. The maximum and minimum score of work ethic dimensions were related to being cooperative (4.60 ± 0.38) and dependable (4.29 ± 0.39) respectively. On the other hand, the maximum and minimum score of attitudes towards the various dimensions of organizational changes were related to the behavioral (3.83 ± 0.70) and the affective (3.55 ± 0.88) dimensions respectively. Furthermore, there was a significant relationship between the work ethics and education levels of the employees in this study (P = 0.003). Also, among work s dimensions, only being considerate had a significant association with attitudes towards organizational changes (P = 0.014) and their cognitive dimension (P = 0.005). To improve employees' work ethics and attitudes towards organizational changes, the following suggestions can be offered: training hospitals managers in participative management style and its application, as well as the importance of meeting the employees' needs and expectations based on their characteristics; familiarizing employees with the Islamic work ethic; educating employees on the importance of being considerate towards their colleagues and subordinates in the workplace, and reinforcing this desirable quality; and finally, clarifying the need for changes in the organization for all employees.
History of medicine. Medical expeditions, Medical philosophy. Medical ethics
El texto propone la consideración de las profundas transformaciones contemporáneas del bios/zoé y las consecuencias que tienen para el debate bioético y biopolítico, donde adquiere una especial relevancia el cuerpo. Estamos asistiendo a un giro ontológico profundo en nuestro relacionamiento con la naturaleza y entre nosotros mismos, mediado por el desarrollo creciente y acelerado de la tecnociencia en un contexto de globalización, que se evidencia en las transformaciones en el interior de los laboratorios y en el despliegue de una nueva forma de producción. El cuerpo se convierte en un eje central de debate de discursos, prácticas, estrategias y mecanismos del biopoder y la bioeconomía, al mismo tiempo como ámbito de manifestación de los más sentidos gritos de transformación sociopolítica alternativa.