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1.
Hastings Cent Rep ; 50(5): 17-19, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33095490

RESUMO

The Covid-19 pandemic has brought about renewed conversation about equality and equity in the distribution of medical resources. Much of the recent conversation has focused on creating and implementing policies in times of crisis when resources are exhausted. Depending on how the pandemic develops, some communities may implement crisis measures, but many health care facilities are currently experiencing shortages of staff and materials even if the facilities have not implemented crisis standards. There is a need for shared conversation about equality and equity in these times of contingency between conventional and crisis medicine. To respond well to these challenges, I recommend that institutions rely on policy, professional education, and ethics consultation. As is the case with crisis policies, creating contingency policies requires that health care professionals decide on how, specifically, to achieve equity. A policy is only as effective as its implementation; therefore, institutions should invest in context-specific education on contingency policies. Finally, ethics consultation should be available for questions that contingency policies cannot address.


Assuntos
Infecções por Coronavirus , Medicina de Desastres , Alocação de Recursos para a Atenção à Saúde , Equidade em Saúde , Recursos em Saúde/provisão & distribuição , Disparidades em Assistência à Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Medicina de Desastres/ética , Medicina de Desastres/normas , Consultoria Ética , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/métodos , Política de Saúde , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Alocação de Recursos , SARS-CoV-2
2.
In. González Menéndez, Ricardo Ángel; Donaire Calabuch, Isabel de los Ángeles. La relación de ayuda en situaciones de desastres. La Habana, Editorial Ciencias Médicas, 2020. .
Monografia em Espanhol | CUMED | ID: cum-76627
3.
In. González Menéndez, Ricardo Ángel; Donaire Calabuch, Isabel de los Ángeles. La relación de ayuda en situaciones de desastres. La Habana, Editorial Ciencias Médicas, 2020. , tab.
Monografia em Espanhol | CUMED | ID: cum-76626
4.
In. González Menéndez, Ricardo Ángel; Donaire Calabuch, Isabel de los Ángeles. La relación de ayuda en situaciones de desastres. La Habana, Editorial Ciencias Médicas, 2020. , tab.
Monografia em Espanhol | CUMED | ID: cum-76625
5.
In. González Menéndez, Ricardo Ángel; Donaire Calabuch, Isabel de los Ángeles. La relación de ayuda en situaciones de desastres. La Habana, Editorial Ciencias Médicas, 2020. , tab.
Monografia em Espanhol | CUMED | ID: cum-76624
6.
In. González Menéndez, Ricardo Ángel; Donaire Calabuch, Isabel de los Ángeles. La relación de ayuda en situaciones de desastres. La Habana, Editorial Ciencias Médicas, 2020. .
Monografia em Espanhol | CUMED | ID: cum-76623
7.
In. González Menéndez, Ricardo Ángel; Donaire Calabuch, Isabel de los Ángeles. La relación de ayuda en situaciones de desastres. La Habana, Editorial Ciencias Médicas, 2020. .
Monografia em Espanhol | CUMED | ID: cum-76621
9.
Crit Care Clin ; 35(4): 717-725, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31445616

RESUMO

Emergency and critical care medicine are fraught with ethically challenging decision making for clinicians, patients, and families. Time and resource constraints, decisional-impaired patients, and emotionally overwhelmed family members make obtaining informed consent, discussing withholding or withdrawing of life-sustaining treatments, and respecting patient values and preferences difficult. When illness or trauma is secondary to disaster, ethical considerations increase and change based on number of casualties, type of disaster, and anticipated life cycle of the crisis. This article considers the ethical issues that arise when health providers are confronted with the challenges of caring for victims of disaster.


Assuntos
Medicina de Desastres/ética , Desastres , Prioridades em Saúde/ética , Cuidados Críticos/ética , Planejamento em Desastres , Humanos , Obrigações Morais , Triagem/ética
10.
Artigo em Inglês | MEDLINE | ID: mdl-30832448

RESUMO

In October 2018, at Asia Pacific Conference for Disaster Medicine (APCDM), an expert meeting to identify key research needs was organized by the World Health Organization (WHO) Centre for Health Development (WHO Kobe Centre (WKC)), convening the leading experts from Asia Pacific region, WHO, WHO Thematic Platform for Health Emergency and Disaster Risk Management (Health-EDRM) Research Network (TPRN), World Association for Disaster and Emergency Medicine (WADEM), in collaboration with Asia Pacific Conference for Disaster Medicine (APCDM) and Japan International Cooperation Agency (JICA). International experts, who were pre-informed about the meeting, contributed experience-based priority issues in Health-EDRM research, ethics, and scientific publication. Two moderators, experienced in multi-disciplinary research interacted with discussants to transcribe practical issues into related methodological and ethical issues. Each issue was addressed in order to progress research and scientific evidence in Health-EDRM. Further analysis of interactive dialogues revealed priorities for action, proposed mechanism to address these and identified recommendations. Thematic discussion uncovered five priority areas: (1) the need to harmonize Health-EDRM research with universal terms and, definitions via a glossary; (2) mechanisms to facilitate and speed up ethical review process; (3) increased community participation and stakeholder involvement in generating research ideas and in assessing impact evaluation; (4) development of reference materials such as possible consensus statements; and (5) the urgent need for a research methods resource textbook for Health-EDRM addressing these issues.


Assuntos
Medicina de Desastres/normas , Planejamento em Desastres/normas , Medicina de Emergência/normas , Projetos de Pesquisa/normas , Medicina de Desastres/ética , Medicina de Desastres/organização & administração , Planejamento em Desastres/organização & administração , Medicina de Emergência/ética , Medicina de Emergência/organização & administração , Guias como Assunto , Humanos , Agências Internacionais/organização & administração , Cooperação Internacional , Japão , Organização Mundial da Saúde/organização & administração
12.
Disaster Med Public Health Prep ; 12(5): 657-662, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29094662

RESUMO

In a disaster, physicians are forced to make challenging and heartbreaking ethical decisions under conditions of physical and emotional exhaustion. Evidence shows that the conditions of stress that mark disasters can undermine the process of ethical decision-making. This results in biased allocation of scarce resources, fewer utilitarian and altruistic decisions, and a wider variation in decisions. Stress also predisposes clinicians to decision strategy errors, such as premature closure, that lead to poor outcomes. The very ability to make sound and ethical decisions is thus a scarce resource. Ethical frameworks underpinning disaster protocols enumerate many physician obligations, but seldom articulate the risk posed by having decisions made ad hoc by decision-makers who are compromised by the stress of the concurrent crisis. We propose, therefore, that a "duty of mind"-the obligation to make critical decisions under the clearest possible state of thought-be added to ethical frameworks for disaster response. Adding the duty of mind to the pillars on which planning is based would force attention to a moral imperative to include decision support tools in disaster planning. By moving the consideration of possible choices to a moment when time and consultation facilitate clear and considered thought, the duty of mind is upheld. (Disaster Med Public Health Preparedness. 2018;12:657-662).


Assuntos
Tomada de Decisões , Medicina de Desastres/ética , Ética Médica , Técnicas de Apoio para a Decisão , Serviços Médicos de Emergência/ética , Serviços Médicos de Emergência/métodos , Alocação de Recursos para a Atenção à Saúde/ética , Humanos , Alocação de Recursos/ética , Alocação de Recursos/métodos
15.
Bioethics ; 29(9): 653-61, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26481207

RESUMO

Disaster research has grown in scope and frequency. Research in the wake of disasters and during humanitarian crises--particularly in resource-poor settings--is likely to raise profound and unique ethical challenges for local communities, crisis responders, researchers, and research ethics committees (RECs). Given the ethical challenges, many have questioned how best to provide research ethics review and oversight. We contribute to the conversation concerning how best to ensure appropriate ethical oversight in disaster research and argue that ethical disaster research requires of researchers and RECs a particular sort of ongoing, critical engagement which may not be warranted in less exceptional research. We present two cases that typify the concerns disaster researchers and RECs may confront, and elaborate upon what this ongoing engagement might look like--how it might be conceptualized and utilized--using the concept of real-time responsiveness (RTR). The central aim of RTR, understood here as both an ethical ideal and practice, is to lessen the potential for research conducted in the wake of disasters to create, perpetuate, or exacerbate vulnerabilities and contribute to injustices suffered by disaster-affected populations. Well cultivated and deployed, we believe that RTR may enhance the moral capacities of researchers and REC members, and RECs as institutions where moral agency is nurtured and sustained.


Assuntos
Medicina de Desastres/ética , Comitês de Ética em Pesquisa , Ética em Pesquisa , Desastres , Terremotos , Análise Ética , Ética , Comitês de Ética em Pesquisa/organização & administração , Inundações , Humanos
17.
Prehosp Emerg Care ; 19(2): 302-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25290737

RESUMO

Since 2009, the seminal text in emergency medical services (EMS) medicine has been used to guide the academic development of the new subspecialty but direct application of the material into EMS oversight has not been previously described. The EMS/Disaster Medicine fellowship program at our institution scheduled a monthly meeting to systematically review the text and develop a study guide to assist the fellow and affiliated faculty in preparation for the board examination. In addition to the summary of chapter content, the review included an assessment of areas from each chapter subject where our EMS system did not exhibit recommended characteristics. A matrix was developed in the form of a gap analysis to include specific recommendations based on each perceived gap. Initial review and completion dates for each identified gap enable tracking and a responsible party. This matrix assisted the fellow with development of projects for EMS system improvement in addition to focusing and prioritizing the work of other interested physicians working in the system. By discussing expert recommendations in the setting of an actual EMS system, the faculty can teach the fellow how to approach system improvements based on prior experiences and current stakeholders. This collaborative environment facilitates system-based practice and practice-based learning, aligning with ACGME core competencies. Our educational model has demonstrated the success of translating the text into action items for EMS systems. This model may be useful in other systems and could contribute to the development of EMS system standards nationwide.


Assuntos
Competência Clínica/normas , Medicina de Desastres/educação , Medicina de Desastres/ética , Educação Médica Continuada/métodos , Serviços Médicos de Emergência/normas , Currículo , Humanos , Modelos Educacionais , Médicos , Serviços Urbanos de Saúde
18.
Curr Psychiatry Rep ; 16(8): 457, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24912607

RESUMO

Disaster behavioral health is increasingly regarded as a central part of disaster preparedness, response and recovery. Legal and ethical issues have received relatively little attention and have sparked divergent opinions. Optimally, understanding and applying legal and ethical considerations requires an understanding of the evolution of the disaster behavioral health field and the context of disaster response and recovery. In addition, there are many legal and ethical questions identified for consideration, and many ways to approach reaching understanding and consensus. Traditionally, discussions of disaster behavioral health, including legal and ethical issues, have not included understanding decision making processes that occur in extreme circumstances. Models which interpret disaster response operations as complex adaptive systems are presented for consideration as useful tools for preparing mental health workers for effectively delivering services in acute disaster response environments.


Assuntos
Medicina do Comportamento , Medicina de Desastres , Planejamento em Desastres , Serviços de Saúde Mental , Medicina do Comportamento/ética , Medicina do Comportamento/legislação & jurisprudência , Medicina de Desastres/ética , Medicina de Desastres/legislação & jurisprudência , Planejamento em Desastres/legislação & jurisprudência , Planejamento em Desastres/métodos , Ética Médica , Humanos , Serviços de Saúde Mental/ética , Serviços de Saúde Mental/legislação & jurisprudência
19.
West J Emerg Med ; 15(2): 231-40, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24672618

RESUMO

"Humanitarian catastrophes," conflicts and calamities generating both widespread human suffering and destructive events, require a wide range of emergency resources. This paper answers a number of questions that humanitarian catastrophes generate: Why and how do the most-developed countries-those with the resources, capabilities, and willingness to help-intervene in specific types of disasters? What ethical and legal guidelines shape our interventions? How well do we achieve our goals? It then suggests a number of changes to improve humanitarian responses, including better NGO-government cooperation, increased research on the best disaster response methods, clarification of the criteria and roles for humanitarian (military) interventions, and development of post-2015 Millennium Development Goals with more accurate progress measures.


Assuntos
Desastres , Altruísmo , Medicina de Desastres/ética , Medicina de Desastres/legislação & jurisprudência , Planejamento em Desastres , Genocídio , Saúde Global , Humanos , Pandemias , Refugiados , Valores Sociais , Guerra
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