Hasil untuk "Medical philosophy. Medical ethics"

Swapnil Paralikar

Abdullah Mijwil, Wafa Jasim

Background: Diabetes mellitus is rapidly becoming one of the main health issues and problem in the 21st century among humans, the number of patients with diabetes mellitus is steadily increasing both in developed and developing countries. Diabetes mellitus is a major health problem that results in serious consequences on global health and its economy. This study aimed to assess the diabetic attitude regarding their nutritional status in Kirkuk city.Methods: A descriptive design study started from 12 November 2023 and ended at 28 March 2024 in three places in Kirkuk city in Iraq, with a non–random sample collection of (425) diabetic patients who were diagnosed with diabetes mellitus.Results: The mean age of the patients was 50.47 ± 16.24 years. Of them, 49.6% were men compared to 50.4% female. Additionally, 318 (74.8%) of participants had accompanying diseases, including diabetes. Conclusion: There was a high level of attitude among diabetic patients regarding their nutritional status in Kirkuk City.

Chao Zhang, Xiujuan Xue, Junrong Tao et al.

Abstract Background The aging population and advancements in medical technology have intensified the emotional complexities faced by physicians and nurses in making decisions regarding life-sustaining treatment (LST). Aim This study explores healthcare professionals’ emotional and cognitive experiences in decisions to withdraw LST for ICU patients, identifies the factors influencing such decisions, and provides evidence-based recommendations to enhance their effective involvement in end-of-life decision-making. By addressing key challenges in this process, the findings aim to offer actionable insights and practical guidance for medical practitioners, policymakers, and healthcare institutions, particularly within the Chinese cultural context, to improve patient-centered care in end-of-life scenarios. A phenomenological qualitative approach was employed, utilizing convenience sampling of ten nurses and ten physicians from a tertiary ICU in China. Participants engaged in face-to-face, semi-structured interviews, which were transcribed verbatim and analyzed using Colaizzi’s method to identify and code themes. Findings Healthcare professionals’ experiences in withdrawing LST for ICU patients were classified into three primary themes and eight subthemes: perceptions of LST (professional and humanitarian perspectives); factors influencing decision-making (personal factors of healthcare professionals, family and societal culture, lack of preparedness, and ethical dilemmas); and differing viewpoints of nurses and physicians regarding the execution of LST. Conclusion The decision to withdraw LST presents multifaceted challenges, including conflicts arising from personal and professional differences among healthcare providers and the emotional complexities intrinsic to the process. Nurses, often constrained by clinical hierarchies and professional limitations, frequently have minimal influence in decision-making teams. Furthermore, communication between healthcare professionals and patients remains insufficient. To enhance the efficacy of decision-making in end-of-life care, improving interdisciplinary collaboration and fostering patient-centered trust are critical.

Lasse Benzinger, Jelena Epping, Frank Ursin et al.

Abstract Background Artificial intelligence (AI) has revolutionized various healthcare domains, where AI algorithms sometimes even outperform human specialists. However, the field of clinical ethics has remained largely untouched by AI advances. This study explores the attitudes of anesthesiologists and internists towards the use of AI-driven preference prediction tools to support ethical decision-making for incapacitated patients. Methods A questionnaire was developed and pretested among medical students. The questionnaire was distributed to 200 German anesthesiologists and 200 German internists, thereby focusing on physicians who often encounter patients lacking decision-making capacity. The questionnaire covered attitudes toward AI-driven preference prediction, availability and utilization of Clinical Ethics Support Services (CESS), and experiences with ethically challenging situations. Descriptive statistics and bivariate analysis was performed. Qualitative responses were analyzed using content analysis in a mixed inductive-deductive approach. Results Participants were predominantly male (69.3%), with ages ranging from 27 to 77. Most worked in nonacademic hospitals (82%). Physicians generally showed hesitance toward AI-driven preference prediction, citing concerns about the loss of individuality and humanity, lack of explicability in AI results, and doubts about AI’s ability to encompass the ethical deliberation process. In contrast, physicians had a more positive opinion of CESS. Availability of CESS varied, with 81.8% of participants reporting access. Among those without access, 91.8% expressed a desire for CESS. Physicians' reluctance toward AI-driven preference prediction aligns with concerns about transparency, individuality, and human-machine interaction. While AI could enhance the accuracy of predictions and reduce surrogate burden, concerns about potential biases, de-humanisation, and lack of explicability persist. Conclusions German physicians frequently encountering incapacitated patients exhibit hesitance toward AI-driven preference prediction but hold a higher esteem for CESS. Addressing concerns about individuality, explicability, and human-machine roles may facilitate the acceptance of AI in clinical ethics. Further research into patient and surrogate perspectives is needed to ensure AI aligns with patient preferences and values in complex medical decisions.

Linnet Ongeri, Miriam Nyawira, Symon M. Kariuki et al.

Background Little is known about the reasons for suicidal behaviour in Africa, and communities’ perception of suicide prevention. A contextualised understanding of these reasons is important in guiding the implementation of potential suicide prevention interventions in specific settings. Aims To understand ideas, experiences and opinions on reasons contributing to suicidal behaviour in the Coast region of Kenya, and provide recommendations for suicide prevention. Method We conducted a qualitative study with various groups of key informants residing in the Coast region of Kenya, using in-depth interviews. Audio-recorded interviews were transcribed and translated from the local language before thematic inductive content analysis. Results From the 25 in-depth interviews, we identified four key themes as reasons given for suicidal behaviour: interpersonal and relationship problems, financial and economic difficulties, mental health conditions and religious and cultural influences. These reasons were observed to be interrelated with each other and well-aligned to the suggested recommendations for suicide prevention. We found six key recommendations from our thematic content analysis: (a) increasing access to counselling and social support, (b) improving mental health awareness and skills training, (c) restriction of suicide means, (d) decriminalisation of suicide, (e) economic and education empowerment and (f) encouraging religion and spirituality. Conclusions The reasons for suicidal behaviour are comparable with high-income countries, but suggested prevention strategies are more contextualised to our setting. A multifaceted approach in preventing suicide in (coastal) Kenya is warranted based on the varied reasons suggested. Community-based interventions will likely improve and increase access to suicide prevention in this study area.

Seyed-Mahdi Esmaeili, Mahdi Sadeghi, Mohammad Abbasi et al.

Background and Objectives: Emergency medical technicians (EMTs), as the front line of dealing with patients with COVID-19, are exposed to the intensification of stress caused by these conditions, and it is essential to identify related factors, such as resilience and spiritual intelligence in this context. This study was conducted to determine the relationship between perceived stress, spiritual intelligence, and resilience of EMTs during the COVID-19 pandemic. Methods: This cross-sectional study was conducted on 108 EMTs in Shahroud in 2021. Data collection tools included the demographic checklist, Cohen’s perceived stress questionnaire, King’s spiritual intelligence questionnaire, and Conrad Davidson’s questionnaire (CD-RISC). To analyze the data, descriptive and inferential (independent t-test, Pearson correlation, and multiple regression) statistics were used. Results: The mean scores of perceived stress and resilience of employees were at medium and high levels, respectively. There was no significant relationship between perceived stress and spiritual intelligence (r=-0.49, P=0.24), but there was a meaningful negative correlation between perceived stress and resilience (r=-0.31, P=0.002). A positive and significant relationship was observed between perceived stress score and age and work experience. Conclusion: Considering the significant relationship between perceived stress and resilience in the present study, it is suggested that the administrators provide solutions such as creating training courses to manage stress and increase resilience in EMTs.

Lucas Martins Teixeira, Luiz Ayrton Santos Junior, Renato Soleiman Franco

Nas últimas décadas, a Medicina convive com o aumento de denúncias éticas e processos judiciais. Este artigo avaliou as sindicâncias apreciadas pelo Conselho Regional de Medicina do Piauí, de 2001 a 2016. Foram incluídas 1011 sindicâncias, totalizando 1073 médicos implicados. Houve significativo crescimento da quantidade de médicos denunciados em função do tempo (p<0,001). O principal denunciante foi o próprio paciente ou seu familiar/representante legal (54,15%), com a queixa principal de negligência (31,87%). Os denunciados mais frequentes foram do sexo masculino (77,45%). O artigo discute fatores associados ao crescimento das denúncias, como distanciamento da relação médico-paciente e represálias ao erro médico.

Pedro César Cantú-Martínez

El propósito de este estudio es describir las condiciones sociales del adulto mayor en México, a la luz del pronunciamiento de la Organización Mundial de la Salud de un envejecimiento saludable. México cuenta con aproximadamente 15.1 millones de personas con 60 años y más, que configura el 12% de la población del país. Esto tendrá derivaciones en el entorno social, como también en las estructuras del Gobierno para adjudicar acciones en favor de apoyar una atención adecuada de los adultos mayores, en el marco de los derechos humanos. Al respecto, en México existe un gran compromiso por fortalecer la política pública en esta materia. No obstante, aún existen adultos mayores —mujeres y hombres— en condiciones alejadas de un envejecimiento saludable.

Rwamahe Rutakumwa, Jantina de Vries, Michael Parker et al.

Previous research has consistently highlighted the importance of stakeholder engagement in identifying and developing solutions to ethical challenges in genomic research, especially in Africa where such research is relatively new. In this paper, we examine what constitutes good ethical practice in research, from the perspectives of genomic research participants in Uganda. Our study was part of a multi-site qualitative study exploring these issues in Uganda, Ghana and Zambia. We purposively sampled various stakeholders including genomic research participants, researchers, research ethics committee members, policy makers and community members. This paper presents the findings from in-depth interviews with 27 people with diabetes who had participated in a diabetes genomic study. Data were collected using semi-structured interviews. Manual thematic content analysis was conducted using a framework approach. Findings indicate three key requirements that research participants see as vital for genomic research to be more responsive to research participants’ needs and contextual realities: (1) de-emphasising the role of experts and institutions in the consenting process, (2) clarity about the timing and nature of feedback both of findings relevant to the health of individuals and about the broad progress of the study, and (3) more effective support for research participants during and after the study.

Sweta Bhoopatiraju

Jesuit universities often espouse a goal of care for the entire person’s mind, body, and spirit. However, some Jesuit institutions contradict this goal, since they do not currently provide contraceptives and birth control prescriptions for pregnancy prevention, and some do not provide contraceptive educational resources for students. Despite the merits of some arguments that requiring Jesuit universities to provide on-campus contraception violates religious freedom, Jesuit universities should provide on-campus contraception. The high rates of unintended pregnancies in college-aged students, women’s generally positive perceptions of contraception, the need to combat discrimination against women, and women’s rights as detailed by international treatises all necessitate such a decision. Even though Jesuit universities’ health insurance plans abide by the Patient Protection and Affordable Care Act’s (PPACA’s) Contraceptive Mandate, which requires employers and health insurers to cover contraceptive costs within insurance plans, some universities’ policies prevent students from reaping the plan’s benefits on campus. These policies can be better understood through the example of Saint Louis University’s (SLU) on-campus contraception policies, since SLU is a Jesuit university. For example, SLU’s Student Health Center claims to abide by “Jesuit Catholic beliefs regarding family planning” and does not provide contraceptives or prescription medication for pregnancy prevention. If a student wishes to receive birth control for pregnancy prevention, the person must obtain it off-campus. Even if a student is interested in obtaining birth control off-campus, however, the person often cannot receive on-campus education on proper birth control use or options. For example, the SLU Wellness Initiative is prohibited from providing information about contraception. By denying students on-campus access to contraceptive services, Jesuit universities deny students full bodily autonomy and restrict their ability to act upon decisions they feel will enhance their bodily and mental health, both of which are central to core Jesuit principles. Unintended pregnancies are prevalent in college-aged women, constituting 58.5% of all pregnancies for women aged 20-24. College-aged women also have the highest rates of abortions (Henshaw 1998). However, as access to contraceptives increased in recent years, unintended pregnancy rates declined, implying that increased contraceptive usage may play a role in successfully preventing pregnancies. One study concluded that to decrease the abortion rate, access to contraception should be promoted (Henshaw 1998). The Catholic background of Jesuit universities sanctifies the life of the unborn and condemns abortion. Pope Francis, leader of the Catholic Church, stated that birth control, when compared to abortions, is “the lesser of two evils” and “not an absolute evil.” If Jesuit universities seek to lower the abortion rate in their student populations, they should make contraception and more accessible to students. Apart from easily accessible birth control, education on birth control is fundamental for effective use and lower unintended pregnancy and abortion rates. One study showed that 65% of unplanned pregnancies occurred when contraception was used. Reasons for this included contraception misuse or failure to withdraw (Bajos, Leridon, Goulard, Oustry, & Job-Spira 2003). If university programs that are effective in their outreach, like the SLU Wellness Initiative, provide education on birth control, then students might become aware of resources available to them so that they can make informed decisions about their bodies, curbing abortion rates. Like all universities, Jesuit universities have an obligation to serve the interests of their students and provide for their well-being. Women, who university contraception policy disproportionately affects, generally share positive attitudes about contraception. Women feel that bodily and reproductive control are important to some degree and should be available to women. This sentiment may explain why women report more benefits of condom use and costs of unprotected sex than vice versa (Parsons, Halkitis, Bimbi, & Borkowski 2000). Also, students at universities whose college health centers provide emergency contraceptive pills (ECPs) praised these services and expressed gratitude to the clinical staff, noting the convenience and inexpensiveness of the on-campus services. Though it is true that sexually active female students are less likely to use contraception if they are religious, many religious college-aged women still feel that reproductive control is important to some degree and should be available to women. Among religious female students, 48% chose abortions as a solution to an unwanted pregnancy (Notzer, Levran, Mashiach, & Soffer 1984). Thus, allowing access to birth control will allow Jesuit universities to better serve their students. Even though Jesuit universities’ Catholic principles and ideals focus on serving the most vulnerable and marginalized communities, some on-campus contraception policies discriminate disproportionately against women and even more harshly against vulnerable groups of women, including those with disabilities. Women with invisible and/or visible disabilities face difficulties when seeking contraceptive care and report a lack of access to health information. This lack of access can impact these women’s ability to obtain appropriate birth control, especially since they live in a culture that questions their sexuality, as well as their capacity and desire for sexual activity (Kaplan 2006). Additionally, people with disabilities face barriers, physical and otherwise, that make receiving contraception and information at farther off locations inconvenient. On-campus contraception, however, might make contraception more accessible and convenient for students. This policy would be less discriminatory towards students with disabilities. By not providing contraception on campus, universities also discriminate against women of lower socioeconomic status, many of whom are women are color. These women have a higher risk than others of contraceptive misuse and nonuse, since they are less likely to have received proper education of birth control options and methods and are less likely to have afforded and used contraception previously. They are also more likely to receive abortions. Increasing access to and promoting long-acting reversible contraceptives, however, have been effective in lowering fertility and abortion rates among young women of low socioeconomic status (Forrest 1994). The women involved in programs promoting contraceptive use expressed a higher level of well-being, noting improved ability to continue and complete their education and obtain jobs without having to care for children (Forrest 1994). If Jesuit universities wish to achieve their ideals and combat systemic disadvantages women of color and low socioeconomic status face in both higher education and the job market, they must provide resources like birth control and birth control education so that these women can reap the value of their education and better control their futures. Providing contraceptives and contraceptive education also protects the religious freedoms of students who may not identify with the Christian faith. Jesuit universities are often diverse communities of people from different religious and nonreligious backgrounds. Preventing easy access to birth control and appropriate education permits the more powerful administration to force its religious views onto less powerful students and deny them useful services they might have otherwise utilized. To truly embrace and serve their diverse student body, universities must protect the religious freedoms of its less powerful students and allow them to act according to their own beliefs in choosing to use or not use contraception (Corbin & Smith 2013). It does not suffice that some students seeking to obtain contraception have the means to obtain it off-campus and have costs covered by insurance. Denying service to someone based on that person’s identity is humiliating, frustrating, and dehumanizing, all of which are characterizations of discrimination (Lim & Melling 2014). The remedy for this sort of injustice, then, is recognition rather than redistribution. In the context of Jesuit universities’ contraception policy, women are discriminated against. Refusal to provide contraception and educational resources through campus directives can be humiliating to the lifestyle choices of women, whose sexual and reproductive health needs have historically been neglected. Instead of denying services on-campus and simply providing birth control elsewhere (a policy that stigmatizes a woman’s choice to use contraceptives by limiting its accessibility), universities must recognize the dignity in a woman’s choice to control her body and offer contraceptives on-campus. In considering the rights of vulnerable groups, it is also important to consider the conclusions of revered international organizations like the United Nations. The United Nations’ Convention on the Elimination of All Forms of Discrimination Against Women of 1979 and the United Nations’ International Conference on Population and Development of 1994 both responded to historical and systemic discrimination against women globally (Shalev 2000). They identified women’s rights as human rights and stressed the importance of rights to easy access to contraception, access to health care and education, and rights to liberty and foundation of families (Cook 1993). The refusal of some universities to not provide on-campus contraceptives for pregnancy prevention limits contraception accessibility and prohibits preventative family planning measures and contraceptive education, which are central to the United Nations’ conclusions. Thus, the historical and systemic discrimination against women is perpetuated through some Jesuit universities’ refusal to provide on-campus contraception. Additionally, while it is true that Jesuit universities’ missions and goals are grounded in and shaped by Jesuit principles and ideals, the institutions do not function primarily as a space for people to express their religion through community, as is done in houses of worship like churches and mosques. The university consists of students and staff from diverse religious (or nonreligious) backgrounds, and SLU’s main purpose is to provide students with an education in exchange for their money. Thus, Jesuit universities arguably function more like corporations than houses of worship, and their religious freedom is not violated under the Religious Freedom and Restoration Act (RFRA), a federal law that protects interests in religious freedom. This is because only individuals can have substantial burden of religious conscience (Corbin & Smith 2013). This interpretation is supported by the Supreme Court, which has repeatedly ruled that First Amendment rights of corporations differ from those of humans. For example, even though the Supreme Court ruled in Citizens United v. FEC that the Free Speech Clause protects corporate speech, it did so to affirm people’s right to hear all points of view regardless of source—not because corporations have a First Amendment-protected right to speak (Corbin & Smith 2013). Also, corporations and owners are separate legal entities, as ruled in Cedric Kushner Promotions, Ltd. v. King (Corbin & Smith 2013). This implies that the Catholic founders of Jesuit universities and the university itself are different legal entities, and that because of this, its founders cannot speak on behalf of the institution. The university’s rights are not the founders’ or administration’s rights. Thus, because universities function less like houses of worship and more like corporations, which cannot experience substantial burden of religious conscience, accessibility to on-campus contraception does not violate religious freedom protected by the RFRA. Requiring on-campus accessibility to contraceptives and contraceptive education is necessary for Jesuit universities to ensure that all students are treated fairly and that their needs are attended to. While it is true that some Catholic beliefs clash with modern mainstream feminism, values like serving the most vulnerable populations and working towards the greater good, seem to connect well with feminism. As the Catholic Church slowly embraces increasingly modern interpretations of Catholic theology, Jesuit schools must reevaluate their commitments and policies and understand that the manifestation of the Jesuit goal of care for the entire person can be different for everyone. Bibliography Bajos, Nathalie, Henri Leridon, Helene Goulard, Pascale Oustry, Nadine Job-Spira. “Contraception: from accessibility to efficiency,” Human Reproduction 18, no. 5 (May 2003): 994-999 https://doi.org/10.1093. Cook, Rebecca. “International Human Rights and Women's Reproductive Health,” Studies in Family Planning 24, no. 2 (1993): 73-86. https://doi.org:10.2307/2939201. Corbin, Caroline Mala and Steven D. Smith. “Debate: The Contraception Mandate and Religious Freedom,” University of Pennsylvania Law Review Online 161, no. 261 (2013). Forrest, Jacqueline Darroch. “Epidemiology of unintended pregnancy and contraceptive use,” American Journal of Obstetrics & Gynecology 170, no. 5 (1994): 1485-9. https://doi.org/10.1016/S0002-9378(12)91804-9. Henshaw, Stanley K. “Unintended Pregnancy in the United States,” Family Planning Perspectives 30, no. 1 (1998): 24-29. Kaplan, Clair. “Special Issues in Contraception: Caring for Women with Disabilities,” Journal of Midwifery & Women’s Health 51, no. 6 (2006): 450-456. Lim, Marvin and Louise Melling. “Inconvenience or Indignity Religious Exemptions to Public Accommodations Laws,” Journal of Law and Policy 22, no. 2 (2014): 705-726. Miller, Laura. “Emergency Contraceptive Pill (ECP) Use and Experiences at College Health Centers in the Mid- Atlantic United States: Changes Since ECP Went Over-the-Counter,” Journal of American College Health 59, no. 8 (2001): 683-689. Notzer, Notzer, David Levran, Shlomo Mashiach, Sarah Sqffer. “Effect of religiosity on sex attitudes, experience and contraception among university students,” Journal of Sex and Marital Therapy 10, no. 1 (2008): 57-62. https://doi.org/10.1080/00926238408405790. Parsons, Jeffrey, Perry Halkitis, David Bimbi, Thomas Borkowski. “Perceptions of the benefits and costs associated with condom use and unprotected sex among late adolescent college students,” Journal of Adolescence 23, no. 4 (2000): 377-391. Shalev, Carmel. “Rights to Sexual and Reproductive Health: The ICPD and the Convention on the Elimination of All Forms of Discrimination against Women,” Health and Human Rights 4, no. 2 (2000): 38-66. https://doi.org/10.2307/4065196.

Mohammad Torabi, Fariba Borhani, Abbas Abbaszadeh et al.

Abstract Background Emergency care providers regularly deal with ethical dilemmas that must be addressed. In comparison with in-hospital nurses, emergency medical service (EMS) personnel are faced with more problems such as distance to resources including personnel, medico-technical aids, and information; the unpredictable atmosphere at the scene; arriving at the crime scene and providing emergency care for accident victims and patients at home. As a result of stressfulness, unpredictability, and often the life threatening nature of tasks that ambulance professionals have to deal with every day, ethical decision-making (EDM) has become an inevitable challenge. Methods The content analysis approach was used to conduct the present qualitative study in Iran. The participants consisted of 14 EMS personnel selected through purposive sampling, which continued until the data became saturated. Data were collected using semi-structured interviews and analyzed concurrently with their collection through the constant comparison method. Results The process of data analysis resulted in the emergence of 3 main categories “respecting client’s values”, “performing tasks within the professional manner”, “personal characteristic”, and the emergence of eight (8) sub-categories signifying participants’ experiences with regard to EDM. Conclusion According to the results, when EMS personnel are faced with ethical dilemmas, they consider the client’s values and professional dignity, and perform the assigned tasks within the framework of the regulation. The findings also suggest that pre-hospital care providers assess legal consequences before making any decision. Further studies should be conducted regarding the experiences of the subordinates and other related parties.

Ames Dhai

Rodrigo Arcila Gómez

Reconociendo la importancia de la Revista Latinoamericana de Bioética y con el fin de difundir en este medio científico el avance que ha alcanzado la industria farmacéutica nacional, binacional y multinacional colombiana firmando y sacando adelante un código de autorregulación para todo el sector de la salud queremos compartir con sus lectores los beneficios que traerá está implementación para todo el sector de la salud. El pasado mes de junio la  Cámara de la Industria farmacéutica de la ANDI  presentó   el Código de ética y transparencia, un manual de comportamiento para los agentes de la Industria Farmacéutica que beneficia principalmente a los pacientes, convirtiéndose en un mecanismo de autorregulación e incentivo de participación ciudadana.

Ricardo García Manrique

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Michael Conway Stacey

M Kusunose, F Nagamura, K Muto

Informed consent (IC) is an essential requirement of ethical research involving human participants, and usually is achieved by providing prospective research participants (PRPs) with a document that explains the study and its procedures. However, results of a series of IC workshops held in Tokyo during 2014 indicate that consent forms alone are not enough to achieve full IC in regenerative medicine research due to the necessity of long-term patient-safety observations to meet the ethical challenges of such research. Adequate training of the people who are responsible for obtaining IC (elucidators) is also necessary to ensure full IC. Elucidators must be able to provide PRPs with sufficient information to assure adequate comprehension of the study and its potential aftereffects; judge PRPs’ voluntariness and eligibility; and establish/maintain partnerships with PRPs. The workshops used role-playing simulations to demonstrate how to effectively obtain fuller IC to members of several Japanese research groups preparing for clinical stem cell trials. Workshop results were correlated with the results of a 2013 workshop on what information is patients want when considering participation in iPSC research. The correlated results showed the need for continuous training and education of elucidators in order to have them acquire and maintain IC competency.Â

Mahomed Sathar

Justice, sovereignty and self-determination for all human beings are fundamental foundations for healthcare and human rights. In any civilised society, the balance between medical ethics and human rights is critical for the delivery of healthcare. War is a deeply ethical issue. Combatants, whose violations of international conventions, laws and codes of ethics during war and political conflict are detrimental to civilian non-combatants, including healthcare workers, commit crimes against humanity. The war in Gaza is a humanitarian crisis.

Denys Damiaan

<p>Abstract</p> <p>In their recent paper, Natalie Banner and Tim Thornton evaluate seven volumes of the Oxford University Press series “International Perspectives in Philosophy and Psychiatry,” an international book series begun in 2003 focusing on the emerging interdisciplinary field at the interface of philosophy and psychiatry. According to Natalie Banner and Tim Thornton, the series represents a clear indication that the interdisciplinary field of philosophy of psychiatry has been flourishing lately. Philosophers and psychiatrists face a “new philosophy of psychiatry”. However, the optimism which the “new” philosophy of psychiatry celebrates is precisely the exiling of philosophy from the foundations of psychiatry. The 150 year old belief that psychopathology cannot do without philosophical reflection has virtually disappeared from common psychiatric education and daily clinical practice. Though the discipline of psychiatry is particularly suited to contributions from philosophy, the impact of philosophy on psychiatry nowadays remains limited. With some exceptions, philosophical papers are embedded in a philosophical context inscrutable to ordinary psychiatrists. Much current philosophical work is perceived by psychiatrists as negativistic. I would encourage the field of psychiatry to incorporate once again basic philosophical attitudes which render possible true dialogue with philosophy and enrich both disciplines. The views developed here should not discredit the value and importance of Natalie Banner and Tim Thornton’s paper and the excellent series “International Perspectives in Philosophy and Psychiatry.” As Jaspers said “Everybody inclined to disregard philosophy will be overwhelmed by philosophy in an unperceived way”.</p>

Fabíola Alves Alcântara

Resumo O objetivo do estudo é investigar a percepção de fisioterapeutas sobre aspectos bioéticos que envolvem o atendimento a pacientes sem possibilidades terapêuticas de cura. Trata-se de estudo transversal, descritivo, com profissionais do Conselho Regional de Fisioterapia e Terapia Ocupacional da Primeira Região. Foi aplicado questionário tipo survey , baseado nos princípios de autonomia, beneficência, não maleficência e justiça. Os resultados mostraram que a maioria dos profissionais atua com pacientes sem possibilidade terapêutica de cura, considera extremamente relevante o processo de tomada de decisão durante o atendimento, respeita a vontade do paciente, busca defender o princípio da beneficência e reconhece a importância da bioética e das discussões éticas na formação acadêmica. Conclui-se que os fisioterapeutas buscam tomar decisões de modo ético, mas há conflito de valores no que se refere a princípios como autonomia e beneficência.

Danielle Yuri Takauti Saito, Elma Lourdes Campos Pavone Zoboli

Resumo O envelhecimento da população aumentou a incidência de doenças crônicas, demandando a inserção dos cuidados paliativos (CP) em diferentes níveis da rede, incluindo a atenção primária à saúde (APS). Isso poderá interferir nas questões éticas da APS. A presente pesquisa teve como objetivo identificar, na visão dos profissionais de saúde, os problemas éticos decorrentes da prática dos CP na APS. Fez-se revisão sistemática nas bases PubMed, Embase, Lilacs, CINAHL, com os descritores “ética”, “bioética”, “atenção primária à saúde” e “cuidados paliativos”. Localizaram-se 3.915 artigos, restando 16, após a análise. Os problemas éticos detectados foram: escassez de recursos; desconhecimento sobre CP; falta de habilidades comunicacionais; dificuldade de estabelecer limites na relação clínica; sobrecarga de trabalho; falta de apoio dos serviços de referência. Na abrangência, esses problemas assemelham-se aos vividos na APS, com diferenças nas situações específicas. Para incorporar os CP na APS, são necessárias normatizações e formação específicas, além da cultura do cuidado compartilhado e corresponsável.