ABSTRACT
Introducción: En enfermería, la vivencia ética connota ser siempre afectivo-reflexiva, al ejercerse en contextos de fragilidad y vulnerabilidad de los pacientes, exigiendo a los profesionales del cuidado y la salud a actuar con tales criterios beneficiando a las personas cuidadas. Objetivo: Describir la racionalidad y sensibilidad ética en el cuidado de enfermería al paciente de un hospital público peruano de nivel II-2. Material y métodos: Se asumió el enfoque cualitativo, de tipo descriptivo bajo diseño de análisis hermenéutico. La muestra fue de 15 enfermeros, obtenido en muestreo no probabilístico por conveniencia, quienes trabajaron en el área de Medicina Interna del hospital público mencionado. Se recolectó la información mediante entrevista semiestructurada aplicada por medios digitales, previo consentimiento informado. Los datos se procesaron a través del análisis de contenido. Resultados: a) Disponibilidad y esfuerzo hacia un cuidado compasivo y solidario, b) Equilibrando deberes y afectos hacia el bien global del enfermo, c) Comprensión interactiva, confianza y buen trato hasta el final de la vida. Conclusión: Los resultados destacan la capacidad de la enfermera para aplicar la afectividad, la empatía, la comunicación afectiva, la mirada atenta y el contacto físico; así como la disponibilidad para oír e interpretar las necesidades, además de comprender la angustia, sufrimiento, miedos y dolor de la persona cuando está internada en un nosocomio.
Background: In nursing, the ethical experience connotes being always affective-reflexive, when exercised in contexts of fragility and vulnerability of patients, requiring care and health professionals to act with such criteria, benefiting the people cared for. Objective:To describe the rationality and ethical sensitivity in nursing care for patients in a level II-2 Peruvian public hospital. Material and methods: The qualitative, descriptive approach was assumed under hermeneutic analysis design. The sample consisted of 15 nurses, obtained through non-probabilistic convenience sampling, who worked in the Internal Medicine area of the aforementioned public hospital. Information was collected through a semi-structured interview applied by digital means, with prior informed consent. The data was processed through content analysis. Results: a) Availability and effort towards compassionate and supportive care, b) Balancing duties and affections towards the global good of the patient, c) Interactive understanding, trust and good treatment until the end of life. Conclusion: The results highlight the nurse's ability to apply affectivity, empathy, affective communication, attentive gaze and physical contact; as well as the availability to listen and interpret the needs, in addition to understanding the anguish, suffering, fears and pain of the person when they are admitted to a hospital.
ABSTRACT
Background: Clinical ethics consultation services and their methods vary and they are seldom evaluated. Only one formal system of individual clinical ethics consultation has been reported in Chile, with a ten-year registry. Aim: To evaluate the opinion of intensivist physicians about the contribution of clinical ethics consultation. Material and Methods: An anonymous and voluntary questionnaire consulting their opinion about clinical ethics consultations was sent to 38 intensivist physicians. Results: The questionnaire was answered by 28 professionals. Eighty four percent of respondents considered that ethics consultation contributed to improve patients' quality of care, 92% responded that this practice helps in decisions about limitation of treatments or life support, and 96% expressed that it also was a positive support for patients and their relatives. Seventy two percent of respondents considered that ethics consultations enhanced their ethical sensibility, 76% that they improved their understanding of clinical ethics topics, and 72% declared that it decreased their stress in complex decision-making. Conclusions: Clinical ethics consultation provides a positive support for improvements in clinical decision-making and in the quality of patients' care.
Subject(s)
Humans , Physicians , Ethics Consultation , Surveys and Questionnaires , Ethics, Clinical , MoralsABSTRACT
Background: Theoretically, the exercise of good medicine requires physicians who possess and practice virtues. There are good reasons to believe that virtue ethics would be highly appreciated by patients. Aim: To determine the importance that patients attribute to the possession virtues among physicians. Material and Methods: Patients hospitalized in a private and a public hospital were invited to answer a three-question survey. The questions were: first, what do you expect of a good physician? Second, please evaluate, in a scale from 1 to 5, the importance of physician virtues to consider him a good doctor (fidelity to trust given by the patient, benevolence, postponement of self-interests, compassion, intellectual honesty, justice and prudence). Third, among the seven former virtues, select the three more important, and then the most important of all. Results: Most patients responded that they valued that a good physician should have good communication skills, a cordial relationship, commitment to the patient and knowledge. All virtues studied were considered important or very important by almost all patients. The virtues considered the most important were intellectual honesty and fidelity to trust given by the patient. Conclusions: These results support the theoretical argument that, for patients, the practice of virtue ethics is essential for a good medical practice.
Subject(s)
Humans , Male , Physicians , Medicine , Physician-Patient Relations , Surveys and Questionnaires , Virtues , Empathy , Ethics, MedicalABSTRACT
The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.
Subject(s)
Humans , Pneumonia, Viral/therapy , Pneumonia, Viral/epidemiology , Health Care Rationing/ethics , Coronavirus Infections/therapy , Coronavirus Infections/epidemiology , Pandemics , Clinical Decision-Making/ethics , Chile/epidemiology , Practice Guidelines as TopicABSTRACT
Objetivo. Los recursos hospitalarios resultan insuficientes ante la demanda de pacientes graves con COVID-19. La adecuada gestión de recursos es esencial para brindar la mejor atención posible. Se revisaron criterios que ayuden a tomar decisiones adecuadas y oportunas, siguiendo principios éticos. La priorización del soporte ventilatorio invasivo debe hacerse de manera transparente y objetiva, evaluando integralmente al paciente y basado en criterios objetivos como escalas de pronóstico, ciclo de vida o compromiso clínico. El tratamiento sintomático (incluyendo cuidados paliativos) es indispensable en esta pandemia y la comunicación con el aciente o la familia permiten humanizar la atención del personal de salud.
Objetive. Hospital resources are insufficient given the demand for seriously ill patients with COVID-19. Proper resource management is essential to provide the best possible care. Criteria to help make appropriate and timely decisions were reviewed, following ethical principles. The prioritization of invasive ventilatory support must be done in a transparent and objective manner, comprehensively evaluating the patient and based on objective criteria such as prognostic scales, life cycle or clinical commitment. Symptomatic treatment (including palliative care) is essential in this pandemic and communication with the patient or family makes it possible to humanize the care of health personnel.
ABSTRACT
In spite of the demonstrated benefits, the question of HPV massive vaccination is still subject to intense discussions and controversies. The protection against cancer is still unproven and need more time to be accurate about the quantification of the decrease in cervical cancer. The analysis of HPV vaccine relevance is very complex due to several overlapped levels to be considered. The authors analyze many of the ethical, sociological, economic, political and finally scientific issues involved. The population trust in vaccines has been affected owing to dubious practices of many pharmaceutical companies. Faced with this manipulation of information on a worldwide scale, general practitioners have organized themselves to fight this uncertainty. Quaternary prevention, a concept supported by the World Organization of Family doctors, advocates the application of ethically acceptable procedures in health care. This opinion article addresses some of the multiple dimensions involved to encourage reflection on this issue.
A pesar de los beneficios demostrados, la cuestión de la vacunación masiva contra el VPH todavía está sujeta a intensas discusiones y controversias. La protección contra el cáncer aún no está probada y necesita más tiempo para la precisión sobre la cuantificación de la disminución del cáncer cervical. El análisis de la relevancia de la vacuna contra el VPH es muy complejo debido a varios niveles superpuestos que se deben considerar. Los autores analizan muchas de las cuestiones éticas, sociológicas, económicas, políticas y finalmente científicas involucradas en este análisis. La confianza de la población en las vacunas se ha visto afectada debido a prácticas dudosas de muchas compañías farmacéuticas. Ante esta manipulación de información a escala mundial, los médicos generales, de familia y comunidad, se han organizado para luchar contra la incertidumbre. La prevención cuaternaria, un concepto apoyado por la Organización Mundial de Médicos de Familia, aboga por la aplicación de procedimientos éticamente aceptables en la atención médica. Este artículo de opinión aborda algunas de las múltiples dimensiones involucradas para favorecer la reflexión sobre este tema.
Apesar dos benefícios demonstrados, a questão da vacinação massiva contra o HPV ainda está sujeita a intensas discussões e controvérsias. A proteção contra o câncer ainda não está comprovada e precisa de mais tempo para ser precisa sobre a quantificação da redução do câncer do colo do útero. A análise da relevância da vacina contra o HPV é muito complexa devido a vários níveis sobrepostos que devem ser considerados. Os autores analisam muitas das questões éticas, sociológicas, econômicas, políticas e, finalmente, científicas envolvidas nesta análise. A confiança da população nas vacinas foi afetada devido às práticas duvidosas de muitas empresas farmacêuticas. Diante dessa manipulação de informações em escala global, clínicos gerais, família e comunidade se organizaram para lutar contra a incerteza. A prevenção quaternária, conceito apoiado pela Organização Mundial de Médicos de Família, defende a aplicação de procedimentos eticamente aceitáveis nos cuidados médicos. Este artigo de opinião aborda algumas das múltiplas dimensões envolvidas para incentivar a reflexão sobre esta questão.
Subject(s)
Papillomaviridae , Primary Prevention , Ethics, Clinical , Papillomavirus Vaccines , Quaternary PreventionABSTRACT
RESUMO Em um dilema ético, há sempre uma conduta identificada como a melhor a ser tomada. A impossibilidade de adotar tal conduta leva o profissional a experimentar o sofrimento moral. Esta revisão objetivou definir este problema e propor estratégias para seu enfrentamento. Foram buscadas as palavras-chaves "moral distress" e "sofrimento moral" nas bases de dados internacionais MEDLINE/PubMed e SciELO, em artigos publicados entre 2000 - 2017. A revisão foi não exaustiva, contextual, enfocando definições, etiologia e métodos de resolução do problema. No cotidiano da prática em terapia intensiva, o sofrimento moral esteve comumente relacionado ao prolongamento do sofrimento do paciente e ao sentimento de impotência, bem como a dificuldades na comunicação entre os membros da equipe. As estratégias de enfrentamento para o sofrimento moral incluíram ações organizacionais, pessoais e administrativas. Foram recomendadas ações como manejo da carga de trabalho, apoio mútuo entre profissionais e desenvolvimento de técnicas para cultivar a comunicação aberta, a reflexão e o questionamento dentro da equipe multidisciplinar. Na prática clínica, os profissionais de saúde foram reconhecidos como agentes morais, tendo sido fundamental o desenvolvimento da coragem moral para suplantar os dilemas éticos e os conflitos interprofissionais. Tanto na terapia intensiva pediátrica como de adultos, os professionais encontram-se desafiados pelos questionamentos sobre sua prática e podem experimentar sofrimento moral. Este sofrimento pode ser minimizado e resolvido ao se compreender que o foco sempre é o paciente e agir com coragem moral e boa comunicação, em um ambiente de respeito mútuo.
ABSTRACT In an ethical dilemma, there is always an option that can be identified as the best one to be chosen. When it is impossible to adopt such option, the situation can lead professionals to experience moral distress. This review aims to define the issue of moral distress and propose coping strategies. Systematic searches in the MEDLINE/PubMed and SciELO databases were conducted using the keywords "moral distress" and "moral suffering" in articles published between 2000 and 2017. This review was non-exhaustive and contextual, with a focus on definitions, etiologies and methods of resolution for moral distress. In the daily practice of intensive care, moral distress was commonly related to the prolongation of patients' suffering and feelings of helplessness, as well as difficulties in communication among team members. Coping strategies for moral distress included organizational, personal and administrative actions. Actions such as workload management, mutual support among professionals and the development of techniques to cultivate open communication, reflection and questioning within the multidisciplinary team were identified. In clinical practice, health professionals need to be recognized as moral agents, and the development of moral courage was considered helpful to overcome ethical dilemmas and interprofessional conflicts. Both in pediatric and adult intensive care, professionals are challenged by questions about their practice, and they may experience moral distress. This suffering can be minimized and solved by understanding that the focus is always on the patient and acting with moral courage and good communication in an environment of mutual respect.
Subject(s)
Humans , Child , Adaptation, Psychological , Decision Making/ethics , Intensive Care Units/ethics , Patient Care Team/organization & administration , Patient Care Team/ethics , Stress, Psychological/psychology , Communication , Critical Care/methods , Critical Care/ethics , Ethics, ClinicalSubject(s)
Humans , Codes of Ethics , Ethics , Ethics, Clinical , Ethics, Institutional , Ethics, Professional , Ethics, Nursing , United States , HumansABSTRACT
Resumen
Ante el dilema de la no reanimación cardiopulmonar, mi primer cuestionamiento como profesional de enfermería en el ámbito hospitalario fue: ¿Qué hacer ante la aflicción de la madre y abuela sin confundir su percepción sobre el criterio médico de no reanimación? Y desde el punto de vista ético, ¿Cuál es la respuesta profesional de enfermería que le ayude a la madre a tomar una decisión? La premisa es que, si se reconoce el valor de la vida cuando se está frente a una situación vitalmente límite que se estima reversible, debe considerarse como una obligación médica y ética intentar la reanimación a una persona con un paro cardiorrespiratorio. Sin embargo, existe la posibilidad de que se efectúen maniobras de reanimación, pero también que se dé la instrucción de no reanimar. Dicha situación se agrava por la disparidad de criterios para enfrentar el paro cardiorrespiratorio, lo cual afecta al paciente, a su familia y al equipo de salud que lo asiste.
Abstract
Given the dilemma of no cardiopulmonary resuscitation, my first question as a nurse practitioner, in the hospital setting was: What to do in the face of the affliction of the mother and grandmother without confusing her perception of the medical criterion of non-resuscitation? And from the ethical point of view, what is the nursing professional response that helps the mother to make a decision? The premise is, if the value of life is recognized when faced with a vitally limited situation that is considered reversible, it should be considered as a medical and ethical obligation to try to resuscitate a person with cardiorespiratory arrest. However, there is the possibility that resuscitation maneuvers may be performed, but also that the non-reanimating instruction be given. This situation is aggravated by the disparity of criteria to face cardiorespiratory arrest, which affects the patient, his family and the health team that assists him.
Subject(s)
Humans , Nursing Care , Codes of Ethics , Cardiopulmonary Resuscitation , Ethics , Ethics, Clinical , Ethics, Institutional , Ethics, Professional , Ethics, Nursing , Mexico , HumansABSTRACT
PURPOSE: This study aims to investigate how competitive orientation influences unethical decision-making (UDM) through relationship conflict and the moderating effect of hostile attribution bias. METHODS: This study was conducted using a self-report questionnaire. Data were collected from 727 employees in Chinese hospitals. For each variable, measures were adopted or adapted from existing literature. Data were analyzed using descriptive statistics, correlation analysis, confirmatory factor analysis, and hierarchical regression analysis. Common method variance was established using Harman's single-factor test. RESULTS: Competitive orientation is significantly and positively associated with relationship conflict (β = .36, p < .001) and UDM (β = .35, p < .001). Relationship conflict is significantly and positively associated with UDM (β = .51, p < .001). Relationship conflict partially mediates the relationship between competitive orientation and UDM. In addition, hostile attribution bias strengthens the positive relationship between competitive orientation and UDM through relationship conflict. CONCLUSION: This study provides some implications for hospital employees to deal with ethical dilemmas in decision-making. Hospital employees including nurses, physicians, and other health-care professionals should raise awareness of competitive orientation and adopt a cooperative approach to human relations. Effective training programs should be utilized to direct all hospital employees to depress hostile attribution bias whenever possible to everything in clinical practice.
Subject(s)
Humans , Asian People , Bias , Conflict, Psychological , Decision Making , Education , Ethics, Clinical , Hostility , MethodsABSTRACT
A teleconsulta, uma ação de telessaúde, apesar de ser regulamentada em vários países, ainda não é permitida no Brasil. O presente texto explora a situação da teleconsulta na América do Norte, na Europa e em outros países, fazendo um paralelo com a situação nacional dentro da medicina e de outras profissões da saúde. Ao final, por meio do referencial utilizado, é construída uma argumentação de forma a assumir um posicionamento favorável à regulamentação da teleconsulta no país.
Teleconsultation, a telehealth action, although regulated in several countries, is still not allowed in Brazil. This text explores the topic of teleconsultation in North America, Europe and other countries, parallel to the national reality in medicine and other health professions. Finally, from the theoretical framework analyzed, an argument is built to assume a favorable position to the regulation of teleconsultation in the country.
La teleconsulta, una acción de telesalud, a pesar de ser regulada en varios países, todavía no es permitida en Brasil. El presente texto explora el tema de la teleconsulta en América del Norte, en Europa y en otros países, haciendo un paralelo con la realidad nacional en la medicina y otras profesiones de la salud. Finalmente, a partir del marco teórico analizado, se construye una argumentación para asumir un posicionamiento favorable a la regulación de la teleconsulta en el país.
Subject(s)
Brazil , Ethics, Clinical , Remote Consultation , Telemedicine , Physician-Patient RelationsABSTRACT
Resumen La ética de la investigación en salud no se agota en el marco normativo y trasciende la Resolución 8430 de 1993. Las normas constituyen una herramienta fundamental que determina los estándares mínimos de protección de los sujetos de investigación y, por lo tanto, su conocimiento y aplicación, así como la reflexión sobre ellas, son deberes de todos los investigadores en salud. En este texto se presentan y discuten desde un punto de vista analítico las normas para el ejercicio de la investigación en salud, entendiendo por salud un proceso multidimensional y por investigación en salud, un proceso multidisciplinario que trasciende este campo y abarca la investigación básica, la clínica y de salud pública, la colectiva y la de ciencias afines. Las principales categorías analíticas que se presentan se relacionan con los principios y los participantes en la investigación, las entidades reguladoras, los comités de ética y los sujetos y poblaciones especiales o vulnerables, y con los códigos de ética profesional, el consentimiento informado y el tratamiento de los datos. A pesar de los aportes de las normas éticas a la cualificación del ejercicio investigativo en salud, se concluyó que la normatividad vigente en Colombia debe actualizarse con respecto a los desarrollos técnicos y científicos y las especificidades de los diversos tipos de investigación en salud.
Abstract The scope of ethics in health research transcends its legal framework and the regulations established in Resolution 8430 of 1993. These norms represent a fundamental tool to determine the minimum protection standards for research subjects, and, therefore, they should be known, applied properly, and reflect upon by all researchers in the field. Here I present and discuss from an analytical point of view the regulations that guide research in health. In this framework, health is understood as a multidimensional process, and research in health as a multidisciplinary exercise involving basic, clinical and public health research, collective health, and other related sciences. The main analytical categories are related to the principles and actors involved in research (regulatory authorities, ethical committees, and special or vulnerable subjects and populations), and to professional ethics codes, in addition to informed consents and data management. Despite the contribution of this legislation to the qualification of health research, my conclusion is that the national legislation in ethics for health research requires updating regarding technological and scientific developments, as well as specifications from the multiple types of health studies.
Subject(s)
Animals , Humans , Public Policy/legislation & jurisprudence , Ethics, Research , Human Experimentation/legislation & jurisprudence , Policy Making , Truth Disclosure , Animal Welfare , Genetic Engineering/ethics , Risk , Colombia , Confidentiality , Personal Autonomy , Patient Rights , Ethics Committees, Research/legislation & jurisprudence , Information Dissemination/ethics , Internationality , Animal Care Committees , Vulnerable Populations , Human Experimentation/ethics , Animals, LaboratoryABSTRACT
Resumen La moderna hermenéutica se interesa por las condiciones de posibilidad de la comprensión humana. Sus aportaciones son de indudable interés para el campo de la ética biomédica, donde médico y paciente tratan de comprenderse mutuamente con el fin de concretar determinado proyecto de cuidados. Sin embargo, esta aproximación está lejos de ser aprovechable para formar una pauta concreta de cara a la toma de decisiones en este campo. La hermenéutica acierta al poner el centro de gravedad en el diálogo, en lugar de en el método, pero olvida que, en Gadamer, el diálogo está dirigido a la verdad. Esto es lo que se tratará de poner de manifiesto en este trabajo, intentado establecer la conexión de dicha noción con las de bien, historia y comunidad.
Abstract Modern hermeneutics deals with the conditions of the possibilities of human understanding. Its contributions are particularly pertinent to clinical ethics, where patient and doctor seek to mutually understand one another in order to establish a determined care plan. Nevertheless, this approach is far from useful for the formulation of a concrete standard for decision making in this area. Hermeneutics is effective in putting the focus on dialogue, rather than method. But it overlooks the fact that dialogue, according to Gadamer, is directed towards truth. The present article aims to highlight this point, and seeks to establish the connection between this notion of truth and ideas of good, history and community.
Resumo A hermenêutica moderna interessa-se pelas condições de possibilidade da compreensão humana. Indubitavelmente, os seus contributos são de interesse para a ética biomédica, na qual o médico e o paciente tratam de compreender-se mutuamente a fim de concretizar um determinado projeto de cuidados. No entanto, esta perspectiva está longe de poder ser utilizada como padrão concreto para a tomada de decisões neste campo. A hermenêutica tem razão ao colocar o centro de gravidade no diálogo e não no método, entretanto, esquece-se de que, em Gadamer, o diálogo está orientado para a verdade. É precisamente isso que se pretende evidenciar neste trabalho, procurando estabelecer-se a conexão entre a referida noção de verdade com as noções de bem, história e comunidade.
Subject(s)
Ethics, Clinical , Decision Making , HermeneuticsABSTRACT
Objective: to know the ethical problems experienced by oncology nurses. Method: descriptive and exploratory study with a qualitative approach, performed in inpatient units and in chemotherapy out-patients units that provide assistance to oncological patients in two capitals in the South region of Brazil. Eighteen nurses participated in this study, selected by snowball sampling type. For data collection, semi-structured interviews were carried out, which were recorded and transcribed, and then analyzed by thematic analysis. Results: two categories were established: when informing or not becomes a dilemma - showing the main difficulties related to oncological treatment information regarding health staff, health system, and infrastructure; to invest or not - dilemmas related to finitude - showing situations of dilemmas related to pain and confrontation with finitude. Conclusion: for the effective confrontation of the ethical problems experienced by oncology nurses to occur, it is important to invest in the training of these professionals, preparing them in an ethical and human way to act as lawyers of the patient with cancer, in a context of dilemmas related mainly to the possibility of finitude.
Objetivo: conhecer os problemas éticos vivenciados por enfermeiros oncológicos. Método: estudo exploratório e descritivo, com abordagem qualitativa, realizado em unidades de internação e em ambulatórios de quimioterapia que atendiam pacientes oncológicos em duas capitais da Região Sul do Brasil. Participaram do estudo 18 enfermeiros, selecionados mediante amostragem do tipo bola de neve. Para coleta de dados, foram realizadas entrevistas semiestruturadas, gravadas e transcritas, analisadas mediante análise temática. Resultados: foram construídas duas categorias: quando informar ou não se torna um dilema - apresentando as principais dificuldades relacionadas às informações sobre o tratamento oncológico relacionadas às equipes de saúde, sistema de saúde e infraestrutura; investir ou não - dilemas relacionados com a finitude - apresentando situações de dilemas ligados à dor e confronto com a finitude. Conclusão: para que ocorra o enfrentamento efetivo dos problemas éticos vivenciados por enfermeiros oncológicos, torna-se fundamental investir na formação desses profissionais, preparando-os de forma ética e humana a intervir como advogados do paciente oncológico, em um contexto de dilemas relacionados principalmente à possibilidade de finitude.
Objetivo: conocer los problemas éticos vividos por enfermeros oncológicos. Método: estudio exploratorio y descriptivo con enfoque cualitativo, realizado en unidades de internación y en ambulatorios de quimioterapia que atendían pacientes oncológicos en dos capitales de la Región Sur de Brasil. Participaron de este estudio 18 enfermeros, mediante un muestreo del tipo bola de nieve. Para la recogida de datos se llevaron a cabo entrevistas semiestructuradas, grabadas y transcritas, analizadas mediante análisis temático. Resultados: dos categorías fueron construidas: cuando informar o no se convierte en un dilema - presentando las principales dificultades relacionadas con las informaciones del tratamiento oncológico relacionado con los equipos de salud, sistema de salud e infraestructura; invertir o no - dilemas relacionados con la finitud - presentando situaciones de dilemas relacionados con el dolor y confrontación con la finitud. Conclusión: para que el enfrentamiento efectivo de los problemas éticos vividos por enfermeros oncológicos ocurra, es fundamental invertir en la formación de estos profesionales, preparándolos de manera ética y humana para que actuen como abogados del paciente oncológico en un contexto de dilemas relacionados principalmente a la posibilidad de finitud.
Subject(s)
Humans , Oncology Nursing/ethics , Bioethical Issues , Brazil , MoralsABSTRACT
Os cuidados paliativos (CP) apresentam-se como problema de saúde pública, devido ao substancial aumento do número de idosos e da prevalência de doenças crônico-degenerativas não transmissíveis. Evidencia-se a importância da reorganização dos serviços da atenção primária à saúde (APS) para assegurar a oferta desses cuidados. O objetivo foi identificar casos de usuários, a fim de inventariar os problemas éticos que a equipe vivencia. Estudo de caso de abordagem qualitativa, através da análise temática. Identificaram-se dois casos que revelaram, como problemas éticos, a responsabilidade da APS para com os cuidadores e famílias e a dificuldade de comunicação franca e honesta entre a equipe e a família. Os resultados indicam que a formação de recursos humanos com competência técnica e que a continuidade da assistência na transição do tratamento curativo para o paliativo são fatores propícios à integralidade e à obtenção de respostas mais adequadas aos desafios éticos que as equipes vivenciam.
Palliative Care (PC) is presented as a public health problem, due to the substantial increase in the number of elderly and the prevalence of non-communicable chronic degenerative diseases. The importance of the reorganization of Primary Health Care Services (PHCS) to ensure the provision of this care has become evident. The objective was to identify cases of users, in order to inventory the ethical problems that the team experienced. This is a case study based on a Qualitative approach, using thematic analysis. Two cases were identified, that revealed, as ethical problems, the responsibility of the PHCS towards the caregivers and families and the difficulty of frank and honest communication between the team and the family. The results indicate that the training of human resources with technical competence and the continuity of assistance in the transition from curative to palliative treatment are factors favorable to the integrality and the obtention of more adequate responses to the ethical challenges that the teams experienced.
Los cuidados paliativos (CP) se presentan como un problema de salud pública, debido al sustancial aumento del número de ancianos y de la prevalencia de enfermedades crónico-degenerativas no transmisibles. Se evidencia la importancia de la reorganización de los servicios de la atención primaria de la salud (APS) para asegurar la oferta de estos cuidados. El objetivo fue identificar casos de usuarios, a fin de enumerar los problemas éticos que el equipo vivencia. Estudio de caso con abordaje cualitativo, a través del análisis temático. Se identificaron dos casos que revelaron, como problemas éticos, la responsabilidad de la APS para con los cuidadores y familias y la dificultad de comunicación franca y honesta entre el equipo y la familia. Los resultados indican que la formación de recursos humanos con competencia técnica y que la continuidad de la asistencia en la transición del tratamiento curativo hacia el paliativo son factores propicios para la integralidad y la obtención de respuestas más adecuadas a los desafíos éticos que los equipos vivencian.
Subject(s)
Humans , Male , Female , Chronic Disease , Ethics, Clinical , Health Services , Humanization of Assistance , Integrality in Health , Palliative Care , Primary Health Care , Patient Care Team , Qualitative Research , Quality of LifeABSTRACT
En el intento de crear nuevos individuos, el transhumanismo propone profundos cambios estructurales en nuestro concepto de lo humano. Entre los cambios de mayor relevancia se encuentran los relacionados al sistema nervioso central, que serían implementados a través de diversas tecnologías. En el presente artículo, presentaremos una descripción general de dicha corriente filosófica y del concepto de Neuroética, para con ello abordar los problemas prácticos de las supuestas mejoras o enhancements neurológicos y analizar los problemas éticos derivados de dichas prácticas. Por último, estudiaremos aquello que consideramos la causa fundamental del problema: un concepto errado de Persona...
Attempting to create new people, Transhumanism advocates deep structural changes in our concept of human. Some of the most significant changes are related to the central nervous system and would be achieved through different technologies. In this paper, we present an overview of this philosophical tendency and the concept of Neuroethics, thereby presenting the practical problems of those presumed neurological enhancements and analysing the ethical issues arising from these practices. Finally, we discuss what we believe to be the fundamental cause of the problem: a misconception of Person...
Subject(s)
Humans , Male , Female , Bioethics , Technological Development , Humanism , Personality , Ethics, ClinicalABSTRACT
Methods and techniques employed in gene therapy are reviewed in parallel with pertinent ethical conflicts. Clinical interventions based on gene therapy techniques preferentially use vectors for the transportation of therapeutic genes, however little is known about the potential risks and damages to the patient. Thus, attending carefully to the clinical complications arising as well as to security is essential. Despite the scientific and technological advances, there are still many uncertainties about the side effects of gene therapy. Moreover, there is a need, above all, to understand the principles of bioethics as both science and ethics, in accordance with its socioecological responsibility, in order to prioritize the health and welfare of man and nature, using properly natural resources and technology. Therefore, it is hard to determine objective results and to which extent the insertion of genes can affect the organism, as well as the ethical implication.
Métodos e técnicas empregadas na terapia gênica são revisados em paralelo a conflitos éticos pertinentes. Intervenções clínicas com base em técnicas de terapia gênica são usadas preferencialmente em vetores para o transporte de genes terapêuticos; porém, pouco se sabe sobre os possíveis riscos e danos para o paciente, sendo necessário atender cuidadosamente às complicações clínicas resultantes, bem como à segurança. Apesar dos avanços científicos e tecnológicos relacionados à terapia gênica, ainda há muitas incertezas sobre os efeitos colaterais do uso dessa terapia. Além disso, é necessário, acima de tudo, compreender os princípios da bioética como uma ética da ciência para com a responsabilidade socioecológica, a fim de priorizar a saúde e o bem-estar do homem e da natureza, utilizando adequadamente recursos naturais e tecnologia. Portanto, é difícil afirmar qual é o rendimento real, bem como os resultados do aumento da genética inserida no organismo e as implicações éticas.
Subject(s)
Humans , Bioethical Issues , Gene Transfer Techniques , Genetic Therapy , Attitude of Health Personnel , Patient Safety , Risk Assessment/standards , Social ResponsibilityABSTRACT
Os sistemas médicos são culturalmente moldados e podem ter impactos negativos naqueles que não compartilham essas bases. Discutimos a perspectiva indígena de questões morais na relação com os serviços de saúde na região do Alto Rio Negro/Amazonas/Brasil. Trata-se de pesquisa qualitativa que utilizou como técnicas a observação participante e entrevistas em duas comunidades na região do Alto Rio Negro. A transferência para serviços de saúde em área urbana foi identificada como a principal questão moral para os indígenas na região. A diversidade de tradições, culturas e valores dos povos indígenas influenciam na sua moralidade e tomada de decisões clínicas, que eram pouco compreendidas pelos profissionais de saúde. Na relação entre profissionais de saúde e usuários indígenas ficou evidente o choque entre habitus distintos e a configuração de uma relação entre estranhos morais. Essas condições dificultam o diálogo para a resolução de conflitos...
Los sistemas médicos son culturalmente moldeados y pueden tener impactos negativos en los que no comparten estas bases. Se discute la perspectiva indígena de cuestiones morales en la relación con los servicios de salud en la región del Alto Rio Negro/Amazonas/Brasil. Fue un estudio cualitativo que utiliza las técnicas de la observación participante y entrevistas en dos comunidades de la región del Alto Rio Negro. La transferencia para servicios de salud en zona urbana fue identificada como la principal cuestión moral para los indios de la región. La diversidad de tradiciones, culturas y valores de los pueblos indígenas tienen influencia en su moralidad y la toma de decisiones clínicas que eran poco comprendidas por los profesionales de salud. En la relación entre los profesionales de salud y los usuarios indígenas se hizo evidente el choque entre los distintos habitus y la configuración de una relación entre extraños morales. Estas condiciones dificultan el diálogo para resolver los conflictos...
Medical systems are culturally adapted and may have negative impacts on those that do not share these bases. We discussed the indigenous perspective on moral issues in the relation with health services in the region of Alto Rio Negro/Amazonas/Brazil. It was a qualitative research that used participant observation and interviews in two communities in the region of Alto Rio Negro as techniques. The transfer to health services in urban areas was identified as the main moral issue for the Indians in the region. The diversity of traditions, cultures and values of the indigenous people influence their morality and clinical decisions to be made, what used to be little understood by health professionals. In the relationship between health professionals and indigenous users it was clear the shock between different habits and the configuration of a relation between moral strangers. These facts hinder the dialogue to solve conflicts...
Subject(s)
Humans , Male , Female , Bioethics , Cultural Diversity , Ethnic Violence , Ethics, Clinical , Health of Indigenous Peoples , Health Personnel , Health Services , Humanization of Assistance , Indigenous Peoples , Social Discrimination , Qualitative ResearchABSTRACT
Nos problemas éticos da clínica é preciso apreciar a situação com o uso de procedimentos sistematizados e organizados para a tomada de decisão, visando diminuir as áreas de incerteza caraterísticas dos conflitos de valores e deveres descobertos na clínica e chegar a resoluções práticas, prudentes e responsáveis. Há vários procedimentos para a tomada de decisão em bioética clínica. O artigo apresenta a casuística e a deliberação. O objetivo é descrever os métodos a partir de publicações de seus propositores. Ambos os procedimentos têm início com a compreensão do caso clínico, considerando nas resoluções as circunstâncias e peculiaridades de cada situação sem perder de vista a imagem-objetivo dos deveres éticos.
En los problemas éticos de la clínica es necesario evaluar la situación con el uso de procedimientos sistematizados y organizados para la toma de decisión, con el fin de disminuir las áreas de incertidumbre típicas de los conflictos de valores y deberes descubiertos en la clínica y llegar a resoluciones prácticas, prudentes y responsables. Existen varios procedimientos para la toma de decisión en bioética clínica. El artículo presenta la casuística y la deliberación. El objetivo es describir los métodos desde las publicaciones de sus proponentes. Ambos procedimientos comienzan con la comprensión del caso clínico, considerando en las resoluciones las circunstancias y particularidades de cada situación, sin perder de vista la imagen objetivo de los deberes éticos
In the ethical problems in clinics it is required to appreciate the situation through the use of organized and systematized procedures to assess the situation for decision-making, in order to decrease the typical uncertainty areas of the conflicts of values and duties found in clinics and to reach practical, wise and responsible resolutions. There are several procedures for decision making in clinical bioethics. The article presents the casuistry and deliberation. The aim is to describe the methods based on the publications of its proponents. Both procedures begin with the understanding of the clinical case and consider in the proposed resolution the circumstances and peculiarities of each situation without losing sight of the objective image of ethical duties.
Subject(s)
Humans , Male , Female , Bioethics , Decision Support Techniques , Ethical Analysis , Ethics Committees , Ethics, Clinical , Delivery of Health CareABSTRACT
Proporcionar una atención médica es un proceso complejo que requiere de un estricto respeto de los derechos humanos. En países como el Perú, a pesar de contar con normas y leyes específicas, el ejercicio de la autonomía del paciente no es común y, ciertamente, el paternalismo y la beneficencia son priorizados al momento de tomar decisiones médicas. En este tipo de realidad, exigir a los profesionales de la salud que se respeten los derechos fundamentales de las personas debe ser considerado crucial, mucho más que en las sociedades donde los ciudadanos están realmente empoderados. Pero para lograr el pleno respeto a los derechos humanos, especialmente en la prestación de un servicio de salud, existe la necesidad de ir mucho más allá de la defensa de una legislación apropiada y de marcos normativos. En este artículo se argumenta que la violación de ciertos derechos, como el proceso de consentimiento informado, por parte de los proveedores del cuidado de la salud, se evidencia en cómo estos profesionales, especialmente médicos formados en la tradición occidental, establecen prioridades y llegan a juicios morales. En este escenario hay que considerar la necesidad de un cambio en la manera en la que se entienden los derechos humanos para mejorar el respeto hacia ellos durante las atenciones de salud.
Providing medical care is us a complex process that requires a strict respect for human rights. In countries like Peru, despite of having regulations and specific laws, patient´s autonomy is not a common currency and certainly paternalism and beneficence generally overrule in physicians decision making. In this type of reality the requirement to health care professionals for respecting fundamental rights should be considered crucial, far more than in societies where citizens are really empowered. But to achieve the full respect of human rights, especially when providing a health care service, there is the need to go much further than just advocating for appropriate legislation and regulatory frameworks. In this article I argue that the violation of certain rights as the informed consent process by health care providers, is rooted in how these professionals, specially medical doctors trained in the western tradition, establish priorities and arrive to moral judgments. In this scenario I consider the need of a change in the way the Human Rights framework is being used to improve fundamental rights respect in health care.