Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 78
Filter
Add filters

Document Type
Year range
1.
Hastings Cent Rep ; 51(6): 2, 2021 11.
Article in English | MEDLINE | ID: covidwho-1568056

ABSTRACT

Both articles in the November-December 2021 issue of the Hastings Center Report reflect bioethics' growing interest in questions of justice, or more generally, questions of how collective interests constrain individual interests. Hugh Desmond argues that human enhancement should be reconsidered in light of developments in the field of human evolution. Contemporary understandings in this area lead, he argues, to a new way of thinking about the ethics of enhancement-an approach that replaces personal autonomy with group benefit as the primary criterion for deciding what enhancements are acceptable. In the second article, Johannes Kniess considers the many attempts within bioethics to draw on John Rawls's work to discuss health care access and social determinants of health, and he comes across as moderately optimistic that Rawls's theory of justice has ongoing relevance.


Subject(s)
Bioethics , COVID-19 , Humans , Personal Autonomy , SARS-CoV-2 , Social Justice
2.
PLoS One ; 16(3): e0249098, 2021.
Article in English | MEDLINE | ID: covidwho-1477519

ABSTRACT

BACKGROUND: Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly. METHODS: A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020. RESULTS: NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling 'trapped' between IPC and the residents' wellbeing. They witnessed the detrimental effects of the measures imposed on their residents. CONCLUSION: This study revealed the insights of residents' and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents' mental health impact and to enhance their quality of life.


Subject(s)
COVID-19/pathology , Nursing Staff/psychology , Quality of Life , Vulnerable Populations/psychology , Aged , Aged, 80 and over , Anxiety/etiology , COVID-19/virology , Depression/etiology , Female , Focus Groups , Humans , Interviews as Topic , Male , Middle Aged , Nursing Homes , Personal Autonomy , Protective Devices/supply & distribution , Quarantine , SARS-CoV-2
3.
PLoS One ; 16(10): e0257346, 2021.
Article in English | MEDLINE | ID: covidwho-1456083

ABSTRACT

Due to the COVID-19 pandemic, higher educational institutions worldwide switched to emergency distance learning in early 2020. The less structured environment of distance learning forced students to regulate their learning and motivation more independently. According to self-determination theory (SDT), satisfaction of the three basic psychological needs for autonomy, competence and social relatedness affects intrinsic motivation, which in turn relates to more active or passive learning behavior. As the social context plays a major role for basic need satisfaction, distance learning may impair basic need satisfaction and thus intrinsic motivation and learning behavior. The aim of this study was to investigate the relationship between basic need satisfaction and procrastination and persistence in the context of emergency distance learning during the COVID-19 pandemic in a cross-sectional study. We also investigated the mediating role of intrinsic motivation in this relationship. Furthermore, to test the universal importance of SDT for intrinsic motivation and learning behavior under these circumstances in different countries, we collected data in Europe, Asia and North America. A total of N = 15,462 participants from Albania, Austria, China, Croatia, Estonia, Finland, Germany, Iceland, Japan, Kosovo, Lithuania, Poland, Malta, North Macedonia, Romania, Sweden, and the US answered questions regarding perceived competence, autonomy, social relatedness, intrinsic motivation, procrastination, persistence, and sociodemographic background. Our results support SDT's claim of universality regarding the relation between basic psychological need fulfilment, intrinsic motivation, procrastination, and persistence. However, whereas perceived competence had the highest direct effect on procrastination and persistence, social relatedness was mainly influential via intrinsic motivation.


Subject(s)
COVID-19/epidemiology , Education, Distance/statistics & numerical data , Motivation , Procrastination , Universities/statistics & numerical data , Adult , Cross-Sectional Studies , Female , Humans , Male , Pandemics , Personal Autonomy , Young Adult
5.
Actas Dermosifiliogr (Engl Ed) ; 112(2): 127-133, 2021 Feb.
Article in English, Spanish | MEDLINE | ID: covidwho-1384814

ABSTRACT

Teledermatology is now fully incorporated into our clinical practice. However, after reviewing current legislation on the ethical aspects of teledermatology (data confidentiality, quality of care, patient autonomy, and privacy) as well as insurance and professional responsibility, we observed that a specific regulatory framework is still lacking and related legal aspects are still at a preliminary stage of development. Safeguarding confidentiality and patient autonomy and ensuring secure storage and transfer of data are essential aspects of telemedicine. One of the main topics of debate has been the responsibilities of the physicians involved in the process, with the concept of designating a single responsible clinician emerging as a determining factor in the allocation of responsibility in this setting. A specific legal and regulatory framework must be put in place to ensure the safe practice of teledermatology for medical professionals and their patients.


Subject(s)
Confidentiality , Dermatology , Telemedicine , COVID-19/epidemiology , Computer Security/ethics , Computer Security/legislation & jurisprudence , Confidentiality/ethics , Confidentiality/legislation & jurisprudence , Dermatology/ethics , Dermatology/legislation & jurisprudence , Emergencies , European Union , Humans , Informed Consent/legislation & jurisprudence , Insurance, Liability/legislation & jurisprudence , Pandemics , Personal Autonomy , SARS-CoV-2 , Spain , Telemedicine/ethics , Telemedicine/legislation & jurisprudence
8.
Int J Environ Res Public Health ; 18(16)2021 08 14.
Article in English | MEDLINE | ID: covidwho-1376821

ABSTRACT

This study aims to review and quantify the value of several well-established positive leadership styles for employee work engagement in organizations. We perform both a quantitative and qualitative review (k = 86). Our (moderated) meta-analysis indicates that transformational, authentic, empowering, ethical, and servant leadership all share overlap in confidence and credibility intervals, and they may result in the same effect on work engagement (general r = 0.47). Additional theoretical analysis indicated a common ground within these positive leadership styles, i.e., having a moral perspective as a leader, role-modelling behaviour, follower self-determination, and positive social exchanges with employees. Based on the studies in the sample, we also build an integrative research model with several categories of mediators and moderators that have a well-established impact on work engagement. The moderator categories were follower characteristics and team- and organizational-level moderators. The mediator categories were psychological needs, trust, resources, and organizational-level variables. The combination of a meta-analysis with systematic review and research model can facilitate future research and supports practitioners to improve leadership.


Subject(s)
Leadership , Work Engagement , Morals , Personal Autonomy , Trust
11.
Med Health Care Philos ; 24(4): 493-505, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1281315

ABSTRACT

COVID-19 has turned many ethical principles and presuppositions upside down. More precisely, the principle of respect for autonomy has been shown to be ill suited to face the ethical challenges posed by the current health crisis. Individual wishes and choices have been subordinated to public interests. Patients have received trial therapies under extraordinary procedures of informed consent. The principle of respect for autonomy, at least in its mainstream interpretation, has been particularly questioned during this pandemic. Further reflection on the nature and value of autonomy is urgently needed. Relational autonomy has been proposed as an alternative account of autonomy that can more adequately respond to contemporary ethical issues in general and to a pandemic such as the one we are currently facing in particular. As relational autonomy is an emerging notion in current bioethics, it requires further consideration and development to be properly operationalized. This paper aims to show how six different philosophical branches--namely, philosophy of nature, philosophical anthropology, existential phenomenology, discourse ethics, hermeneutics, and cultural anthropology--have incorporated the category of relation throughout the twentieth century. We first delve into primary philosophical sources and then apply their insights to the specific field of medical ethics. Learning from the historical developments of other philosophical fields may provide illumination that will enable bioethics to experience a successful "relational turn", which has been partially initiated in contemporary bioethics but not yet achieved.


Subject(s)
Bioethics , COVID-19 , Humans , Personal Autonomy , Philosophy , Relational Autonomy , SARS-CoV-2
12.
Med Teach ; 42(7): 828-829, 2020 07.
Article in English | MEDLINE | ID: covidwho-1279953

ABSTRACT

The current disruptive and abrupt transition to remote activities that educational institutions are facing represents a major challenge for the entire academic community. While most concerns have centred on how learning activities may successfully transit from face-to-face to remote delivery, little attention has been given to how educators can be supported in this new unchartered territory. In this article, we discuss the crucial role of team leaders and how their management and leadership style may have great potential to support educators' motivation. Based on Self-determination Theory, we offer a framework through which team leaders may contribute to create optimal remote working environments for educators. We argue that educators' autonomous motivation depends on how they perceive their remote work environment as supportive of their basic psychological needs of autonomy, competence and relatedness. Then, we highlight a series of practical recommendations by which team leaders may be more needs-supportive. Working from home requires space, trust, open communication and flexibility, especially considering that team members may have different clinical or personal circumstances. We therefore hope these suggestions are helpful to cultivate educators' autonomous motivation, which is beneficial not only for themselves but also for others in their institution, including their co-workers and students.


Subject(s)
Motivation , Personal Autonomy , Staff Development , COVID-19 , Humans , Learning , Pandemics
13.
Semin Nephrol ; 41(3): 262-271, 2021 05.
Article in English | MEDLINE | ID: covidwho-1275709

ABSTRACT

When providing care, nephrologists are subject to various ethical duties. Beyond the Hippocratic notion of doing no harm, nephrologists also have duties to respect their patients' autonomy and dignity, to meet their patients' care goals in the least invasive way, to act impartially, and, ultimately, to do what is (clinically) beneficial for their patients. Juggling these often-conflicting duties can be challenging at the best of times, but can prove especially difficult when patients are not fully adherent to treatment. When a patient's nonadherence begins to cause harm to themselves and/or others, it may be questioned whether discontinuation of care is appropriate. We discuss how nephrologists can meet their ethical duties when faced with nonadherence in patients undergoing hemodialysis, including episodic extreme agitation, poor renal diet, missed hemodialysis sessions, and emergency presentations brought on by nonadherence. Furthermore, we consider the impact of cognitive impairment and provider-family conflict when making care decisions in a nonadherence context, as well as how the coronavirus disease 2019 pandemic might affect responses to nonadherence. Suggestions are provided for ethically informed responses, prioritizing a patient-narrative approach that is attentive to patients' values and preferences, multidisciplinarity, and the use of behavioral contracts and/or technology where appropriate.


Subject(s)
Nephrologists/ethics , Patient Compliance , Renal Dialysis/ethics , Adult , Aged , Decision Making/ethics , Female , Humans , Male , Patient-Centered Care , Personal Autonomy
14.
JCO Oncol Pract ; 17(3): e369-e376, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1262524

ABSTRACT

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has raised a variety of ethical dilemmas for health care providers. Limited data are available on how a patient's concomitant cancer diagnosis affected ethical concerns raised during the early stages of the pandemic. METHODS: We performed a retrospective review of all COVID-related ethics consultations registered in a prospectively collected ethics database at a tertiary cancer center between March 14, 2020, and April 28, 2020. Primary and secondary ethical issues, as well as important contextual factors, were identified. RESULTS: Twenty-six clinical ethics consultations were performed on 24 patients with cancer (58.3% male; median age, 65.5 years). The most common primary ethical issues were code status (n = 11), obligation to provide nonbeneficial treatment (n = 3), patient autonomy (n = 3), resource allocation (n = 3), and delivery of care wherein the risk to staff might outweigh the potential benefit to the patient (n = 3). An additional nine consultations raised concerns about staff safety in the context of likely nonbeneficial treatment as a secondary issue. Unique contextual issues identified included concerns about public safety for patients requesting discharge against medical advice (n = 3) and difficulties around decision making, especially with regard to code status because of an inability to reach surrogates (n = 3). CONCLUSION: During the early pandemic, the care of patients with cancer and COVID-19 spurred a number of ethics consultations, which were largely focused on code status. Most cases also raised concerns about staff safety in the context of limited benefit to patients, a highly unusual scenario at our institution that may have been triggered by critical supply shortages.


Subject(s)
COVID-19 , Cancer Care Facilities , Ethics Consultation/trends , Neoplasms , Resuscitation Orders/ethics , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Renal Cell , Cardiopulmonary Resuscitation/ethics , Child , Decision Making , Ethics Committees, Clinical , Female , Health Care Rationing/ethics , Hematologic Neoplasms , Humans , Intensive Care Units , Intubation, Intratracheal/ethics , Kidney Neoplasms , Lung Neoplasms , Male , Medical Futility , Mental Competency , Middle Aged , Multiple Myeloma , New York City , Occupational Health/ethics , Patients' Rooms , Personal Autonomy , Proxy , SARS-CoV-2 , Sarcoma , Young Adult
17.
PLoS One ; 16(5): e0251352, 2021.
Article in English | MEDLINE | ID: covidwho-1225811

ABSTRACT

The sudden switch to distance education to contain the outbreak of the COVID-19 pandemic has fundamentally altered adolescents' lives around the globe. The present research aims to identify psychological characteristics that relate to adolescents' well-being in terms of positive emotion and intrinsic learning motivation, and key characteristics of their learning behavior in a situation of unplanned, involuntary distance education. Following Self-Determination Theory, experienced competence, autonomy, and relatedness were assumed to relate to active learning behavior (i.e., engagement and persistence), and negatively relate to passive learning behavior (i.e., procrastination), mediated via positive emotion and intrinsic learning motivation. Data were collected via online questionnaires in altogether eight countries from Europe, Asia, and North America (N = 25,305) and comparable results across countries were expected. Experienced competence was consistently found to relate to positive emotion and intrinsic learning motivation, and, in turn, active learning behavior in terms of engagement and persistence. The study results further highlight the role of perceived relatedness for positive emotion. The high proportions of explained variance speak in favor of taking these central results into account when designing distance education in times of COVID-19.


Subject(s)
Adolescent Health/trends , COVID-19/psychology , Education, Distance/trends , Adolescent , Adolescent Health/statistics & numerical data , Asia , Education, Distance/methods , Emotions , Europe , Female , Humans , Learning , Male , Motivation , North America , Pandemics , Personal Autonomy , Personal Satisfaction , SARS-CoV-2/pathogenicity , Surveys and Questionnaires
18.
J Aging Soc Policy ; 33(4-5): 359-379, 2021.
Article in English | MEDLINE | ID: covidwho-1219750

ABSTRACT

The Swedish response to the COVID-19 pandemic included age-based recommendations of voluntary quarantine specifically for those 70 years of age or older. This paper investigates the experiences of a sudden change of policy in the form of an age restriction that trumped the contemporary active aging ideal. A web-based qualitative survey was conducted in April 2020. Through manual coding of a total of 851 responses, six different ways of relating to the age-based recommendations were identified. The results show that age is not an unproblematic governing principle. Instead, in addition to protecting a vulnerable group, the age-based recommendation meant deprivation of previously assigned individual responsibility and, consequently, autonomy. It is shown how respondents handled this tension through varying degrees of compliance and resistance. Findings highlight the importance of continuously tracking the long-term consequences of age-based policy to avoid negative self-image and poorer health among older adults.


Subject(s)
Ageism/psychology , Aging , COVID-19 , Health Policy , Personal Autonomy , Quarantine/psychology , Aged , Female , Humans , Longitudinal Studies , Male , Qualitative Research , Surveys and Questionnaires , Sweden
19.
Int J Psychol ; 56(6): 843-852, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1210662

ABSTRACT

COVID-19 and its containment measures have uniquely challenged adolescent well-being. Following self-determination theory (SDT), the present research seeks to identify characteristics that relate to well-being in terms of positive emotion and intrinsic learning motivation under distance schooling conditions and whether SDT's core postulates hold true in this exceptional situation. Feeling competent and autonomous concerning schoolwork, and socially related to others were hypothesised to relate to positive emotion and intrinsic learning motivation. The role of self-regulated learning (SRL) as a moderator was considered. Self-reports were collected from 19,967 secondary school students in Austria (Study 1) and Germany (Study 2). In both studies, structural equation modelling revealed that all basic needs were associated with positive emotion, and that competence and autonomy were associated with intrinsic learning motivation. Moderation effects of SRL were identified in Study 1 only: The association of autonomy and both outcomes and the association of competence and intrinsic learning motivation varied with the level of SRL. The results highlight the relevance of basic psychological need satisfaction and SRL in a situation in which adolescents are confronted with a sudden loss of daily routines.


Subject(s)
COVID-19 , Pandemics , Adolescent , Emotions , Humans , Motivation , Personal Autonomy , Personal Satisfaction , SARS-CoV-2 , Students
20.
Transfus Clin Biol ; 28(3): 271-275, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1174515

ABSTRACT

Convalescent plasma therapy (CP) has long been used to prevent and treat various infectious diseases before COVID-19 such as SARS, MERS, and H1N1. Because the viral and clinical characteristics of COVID-19 share the similarities between SARS and MERS, CP treatment could be a promising treatment option to save COVID-19. With only low quality medical evidence, but massive media support and a very significant public demand for the use of convalescent plasma for COVID-19, we are now faced with an ethical dilemma. Therefore, this paper uses a structured analysis that focuses on the preferred reporting items for a systematic review of ethical issues regarding the use of Convalescent Plasma Therapy for COVID-19. The use of convalescent plasma must meet the ethical principles of autonomy; such as voluntary, informed consent, and confidentiality. Consideration of the risk-benefit ratio for potential donor recipients also needs to be considered in order to meet the beneficence and non-maleficence principles. The principle of justice also needs to be applied both to donors, donor recipients and health workers, such as determining the priority of donor recipients, due to the increasing demand for convalescent plasma amid the limited circumstances of patients who have recovered from Covid-19 who voluntarily donate.


Subject(s)
COVID-19/therapy , SARS-CoV-2 , Adolescent , Adult , Altruism , Blood Donors , COVID-19/prevention & control , Child , Confidentiality , Donor Selection/ethics , Donor Selection/standards , Health Personnel , Humans , Immunization, Passive/ethics , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Informed Consent , Personal Autonomy , Personal Protective Equipment , Risk Assessment , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Social Justice , Volunteers
SELECTION OF CITATIONS
SEARCH DETAIL
...