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PubMed2004

[Effectiveness of a training course in bioethics and of the introduction of a checklist to detect ethical problems in a home care support team].

OBJECTIVE: To study the concordance in the number of ethical problems identified in the care of the terminally ill between the members of a home care support team (HCST) and a group of experts before and after a course in bioethics and the introduction of a checklist. DESIGN: Before-and-after intervention study. SETTING: Area 7 of Primary Care, Madrid. PARTICIPANTS: Terminally ill patients attended by the HCST between November 2001 and June 2002. INTERVENTION: Bioethics course and introduction of a checklist. MAIN MEASUREMENTS: Age, sex, basic illness, number of ethical problems identified by the HCST and by the group of experts before and after the intervention. The intraclass correlation coefficient (ICC) for the number of problems identified was calculated in both groups before and after the intervention. RESULTS: 31 cases before and 29 after the intervention were studied. Before the intervention the HCST identified an average of 2.7 +/- 2.3 ethical problems per case; and the group of experts found 11.8 +/- 6.1. The ICC for the number of problems identified was 0.53 (moderate correlation). After the intervention, the HCST identified 5.9 +/- 6.5 ethical problems per case; and the group of experts, 10.7 +/- 7.9. The ICC for the number of problems identified was 0.87 (close correlation). CONCLUSIONS: The course and the introduction of a checklist helped professionals who were not experts in bioethics to detect ethical problems in treating terminally ill patients.

Aged↗
PubMed2003

[A bioethics curriculum for the pediatric residency program: experience of a university hospital].

BACKGROUND: Pediatric education should be fully committed to being humanistically as well as scientifically responsive to the needs of the times. Although interest in bioethical issues in clinical practice has increased, ethical problem solving is not usually taught in residency training programs. OBJECTIVE: To describe the implementation of a bioethics training program in our department of pediatrics. METHODS: We designed a program that took into account the difficulties that such a program might face: time constraints, inadequate training in ethics among medical staff and, sometimes, residents' attitudes towards a formal program. RESULTS: Throughout the last four years, six to seven ethics sessions per year were scheduled. The contents included traditional topics in medical ethics (i.e. treatment refusal in adolescents or clinical trials involving minors) as well as issues that confront residents during their training (informed consent, confidentiality, etc.). These ethics sessions were based on clinical cases and were integrated into the existing meetings timetable (daily meetings from Monday to Thursday between October and June) and were prepared by the residents themselves. CONCLUSIONS: The implementation of a bioethics component, using a modified case-based approach, in our pediatric residency program was satisfactory.

Bioethics↗
PubMed2003

Bioethical theory and practice in genetic screening for type 1 diabetes.

Due to the potential ethical and psychological implications of screening, and especially in regard of screening on children without available and acceptable therapeutic measures, there is a common view that such procedures are not advisable. As part of an independent research- and bioethical case study, our aim was therefore to explore and describe bioethical issues among a representative sample of participant families (n = 17,055 children) in the ABIS (All Babies In South-east Sweden) research screening for Type 1 diabetes (IDDM). The primary aim is the identification of risk factors important for the development of diabetes and other multifactorial immune-mediated diseases. Four hundred, randomly chosen, participant mothers were asked to complete a questionnaire exploring issues of information, informed consent, bio-material, confidentiality and autonomy, and of prevention/intervention. 293 completed the questionnaire, resulting in a response rate of 73.3%. The majority of questions had the form of 6-point Likert-type response scales (1-6). We found that the majority of respondents felt calm in in regard of samples and written material, and also concerning the possibility of their child in the future being identified as having high risk of developing Type 1 diabetes. An important finding concerning access and control of mainly biological data was indicated, with the respondents expressing concern for potential future use. We believe our findings indicate that this kind of empirical studies can substantially contribute to our understanding of bioethical issues of medical research involving genetics. Issues, such as safeguards ensuring the ethical criteria of autonomy and respect, were emphasised by our respondents. We believe the issues brought up may promote further discussion, and do suggest issues for consideration by, among others, researchers, bioethicists and Institutional Review Boards.

Adult↗
PubMed2000

The concealed and the revealed: bioethical issues in Europe at the end of the second millenium.

Bioethical debate in Europe is partly a reaction to political endeavors and events. In line with the political goal of a united Europe, a European regulation is being sought for medical research and medical ethics ('Convention on Human Rights and Biomedicine'). A certain degree of ambivalence has come to the fore: whilst it does seem possible to reach a consensus (albeit a merely 'diplomatic' consensus) about complicated bioethical issues at an international level when certain controversial matters are excluded or a certain vagueness maintained, new principles are also required at a national level, for example when the medical profession of one state feels obliged to assume a 'local' stance, such as in the sensitive issue of termination of treatment. The individual contributions to this publication, together with various other current fields of bioethical conflict in Europe--especially Germany--are introduced below against a common background, namely that the original dividing line between the concealed and the revealed has shifted.

Abortifacient Agents, Steroidal↗
PubMed2006

Bioethics and health and human rights: a critical view.

Recent decades have seen the emergence of two new fields of inquiry into ethical issues in medicine. These are the fields of bioethics and of health and human rights. In this critical review of these fields, the author argues that bioethics, partly because it has been construed so broadly, suffers from quality control problems. The author also argues that the field of health and human rights is superfluous because it does nothing that cannot be done by either bioethics of the law.

Attitude of Health Personnel↗
PubMedDate not supplied

Consultation-liaison psychiatrists on bioethics committees: opportunities for academic leadership.

OBJECTIVE: This article briefly reviews the history of the relationship between psychiatry and the leadership of ethics committees as a background for examining appropriate educational initiatives to adequately prepare residents and early career psychiatrists to serve as leaders of ethics committees. METHOD: A Medline review of literature on psychiatry and ethics committees and consultation as well as recent survey data from the Academy of Psychosomatic Medicine indicate that psychosomatic medicine psychiatrists are particularly qualified and interested in serving as chairs of ethics committees. The authors compare knowledge and skills obtained in psychiatric training with the Society for Heath and Human Values and the Society for Bioethics Consultation Task Force on standards for ethics consultation proposed as core competencies for ethics committee leadership. RESULTS: Psychiatric residency and fellowship training in psychosomatic medicine can provide the knowledge and skill sets to meet the standards for ethics consultation. Further professional development through pursuit of formal ethics training, advance degrees in bioethics, mentoring, and residency and felloships focus on ethics and enhance competency, confidence, and the skills required for ethics committee leadership. CONCLUSIONS: Academic psychiatrists, particularly those in psychosomatic medicine, have historically made a significant contribution as chairs of ethics committees. Continuation and expansion of this leadership may require interested psychiatrists to obtain additional training in bioethics.

Bioethics↗
PubMed2005

Ethical care of the critically ill child: a conception of a 'thick' bioethics.

In this article I argue for an interpretive approach to bioethics with critically ill children. I begin by highlighting the dominant Anglo-American bioethical framework that defines standards for ethical care in critically ill children and then outline a critique of this framework. Drawing predominantly on the ideas of Charles Taylor, Michael Walzer and Richard Zaner, I call for a reconception of bioethics and propose an interpretive 'thick' framework that is centred on culture and context. Finally, I illustrate this interpretive approach through a comparative study of two cases in pediatric intensive care: the narratives of Marc and Larry. These case studies reveal that ethical dilemmas in pediatric critical care can be traced to relational tensions over respect, trust and power rooted in the disparity of moral horizons among the persons involved.

Attitude of Health Personnel↗
PubMed1996

Why a feminist approach to bioethics?

Many have asked how and why feminist theory makes a distinctive contribution to bioethics. In this essay, I outline two ways in which feminist reflection can enrich bioethical studies. First, feminist theory may expose certain themes of androcentric reasoning that can affect, in sometimes crude but often subtle ways, the substantive analysis of topics in bioethics; second, it can unearth the gendered nature of certain basic philosohical concepts that form the working tools of ethical theory.

Clinical Trials as Topic↗
PubMedDate not supplied

[Ethical and bioethical issues disturbing nursing: REBEn's publications from 1970 to 2000].

UNLABELLED: It was studied the ethical and/or bioethical issues published in the Revista Brasileira de Enfermagem (Brazilian Nursing Journal-REBEn) that disturbed the nursing in the period between 1970 and 2000. Tha aim was to identify in articles published in the REBEn, during the mentioned period, subjects related to the ethics/bioethics. To discuss the theoretical perspectives in which the authors base their arguments. The study was quantitative and qualitative, documentary or bibliographical type. RESULTS: in the last 30 years it had gradual increase in the number of the articles that debates ethical questionings. After 1984 appear the first study, with bioethics connotation, in which the author discourses on the interventions of nursing before the patient in imminent death, with the purpose to verify the relations between the personal and professional values of the nurse. Was Valdria Lunardi who used the bioethics term for the first time in 1998.

Bibliometrics↗
PubMed2004

Transplants: bioethics and justice.

Bioethics, as a branch of philosophy that focuses on questions relative to health and human life, is closely tied to the idea of justice and equality. As such, in understanding the concept of equality in its original sense, that is, in associating it to the idea to treat "unequals" (those who are unequal or different, in terms of conditions or circumstances) unequally (differentially), in proportion to their inequalities (differences), we see that the so-called "one-and-only waiting list" for transplants established in law no. 9.434/97, ends up not addressing the concept of equality and justice, bearing upon bioethics, even when considering the objective criteria of precedence established in regulation no. 9.4347/98, Thus, the organizing of transplants on a one-and-only waiting list, with a few exceptions that are weakly applicable, without a case by case technical and grounded analysis, according to each particular necessity, ends up institutionalizing inequalities, condemning patients to happenstance and, consequently, departs from the ratio legis, which aims at seeking the greatest application of justice in regards to organ transplants. We conclude, therefore, that from an analysis of the legislation and of the principles of bioethics and justice, there is a need for the creation of a collegiate of medical experts, that, based on medical criteria and done in a well established manner, can analyze each case to be included on the waiting list, deferentially and according to the necessity; thus, precluding that people in special circumstances be treated equal to people in normal circumstances.

Bioethics↗
PubMed2004

[Bioethics on the couch: can Freud help us to deal with the uncertainties of medical ethics?].

Only recently, bioethics has crystallized into a full-fledged discipline. The aim of this article is to analyze whether Freud is competent to deal with bioethics. Freudian psychoanalysis is reviewed as a global theory that touches culture as a totality. And it is by way of a global theory of culture that Freud takes up the phenomenon of morality. Freud gives not an alternative answer to unchanged questions in bioethics, but delivers a new manner of asking moral questions. The ground rule establishes the conditions for treatment. And secondly, it is a radical elimination of any position of moral existence. Ethics is simply bracketed (put in parenthesis) in the sense that in its regard no position is taken either for or against. What is at stake is self-recognition and Freudian itinerary runs from misunderstanding to recognition. If Freud offers a technique, it is not included in the cycle of techniques of domination; it is a technique of veracity.

Bioethics↗
PubMed1998

[Teachings in bioethics from the Pontifical Academy of Theology in Cracow].

The paper consists of two parts. In part one the author outlines conditions of introducing bioethics as lectures in university faculties of medicine and theology. After a few years of intensive development of bioethics, now some stagnancy can be observed. The author analyzes reasons for slowing down the intensity of that development. In part two the author reports of teaching activities in the Institute of Bioethics of the Pontifical Academy of Theology in Cracow. The teaching is on two levels. There is a basic course and postgraduate studies for theological and philosophical students. Also courses and conferences for health care workers are held.

Bioethics↗
PubMed1998

[Bioethics in pluralistic societies--what does it all mean?].

The phrase "bioethics in pluralistic society" has recently become a common phrase. At the same time it has become so notoriously ambiguous that it is worth to ask about its various meanings in order to reveal different senses and non-senses hidden beneath it. The terms that compose this phrase have undergone critical analysis with particular emphasis put on the term "bioethics". The need for further development of bioethics as philosophical discipline, and not its various politically determined mutations, is stressed in concluding remarks.

Bioethics↗
PubMedDate not supplied

[Bioethics in the face of death].

We review death, thanatology and bioethics concepts and precepts, the value scale and hierarchization; the changes in death vision according to culture, religion and hierarchy, changes in perception of, according to culture, religion and mores in different communities and times, as well with scientific and technological advances. We analyzed patient's reactions to death, and the reactions of people close to them. We describe and analyze the principal bioethical dilemmas associated with death: therapeutic overkill or dysthanasia, passive and active euthanasia, assisted suicide, orthothanasia, and organ transplants. We discuss the relationship between death and science, bioethics and thanatology, as a necessary discipline today.

Attitude to Death↗
PubMed2002

[Why should we research in bioethics?].

This article reviews the conceptual evolution of bioethics, conditioned by cultural changes. The discipline could be strengthened with new analytical methodologies and with an empirical approach. The dangers of a purely descriptive bioethics, solely linked to practical experience are also discussed. This may cause the loss of the regulatory frame, that allows bioethics to enrich medical practice from a humane and moral viewpoint. Therefore, there is a need to find the balance between the theoretical analysis and an empirical approach, to face the growing complexity of contemporary ethical problems.

Bioethics↗
PubMed2004

The Bioethics of Children's Rights.

The Bioethics of Children's Rights are not only embedded in child development knowledge and in the laws of a particular nation or society, but also in the values, customs and practices of the culture in which they are formulated and practiced. The Bioethics of Children's Rights reflect the changing values assigned to children by adults in our society and are determined by the parents or parental adults responsible for the care and safety of children. The Bioethics of Children's Rights reflect the role of children of different ages in a particular society and community. It is difficult to conceptualize and define. It is fundamental to realize that you cannot refer to children's rights without taking into account the adults who provide them with the continuity of their affectionate, safe-guarding care. It is the parent(s) or their surrogates who have the capacity, authority and responsibility for defining those rights, and for asserting and assuring they are in the service of their children's needs and priorities. This paper, using case vignettes, is intended to heighten our consciousness that by and large children are unable to speak effectively for their rights alone. Through the voices of their parents, care-providers and the society in which they live, we can examine the voice of the child, with the child's needs and potentialities being paramount.

Adolescent↗
PubMedDate not supplied

[Bioethics and care: from human rights to quality of care].

The pluralist nature of bioethics and the fact that it spans various branches of science places it in a privileged position to tackle ethical problems that accompany human choices in situations that influence the conditions of living beings. Clearly, issues such as health and care form part of the bioethical sphere of enquiry and it is obviously of fundamental importance that these subjects receive a suitable degree of attention within a branch of science that has always drawn on the contributions of other human sciences. Bioethics looks at the great questions posed by moral principles and seeks to apply them to present concerns.

Bioethics↗
PubMed2005

Applying theological developments to bioethical issues such as genetic screening.

Catholic movements within the centre of Roman Catholic doctrine recently have discussed Trinitarian theology as applied to sciences, arts, economics, health and other social areas. We explore the possibilities Trinitarian theology offers to bioethical debate, concentrating particularly on genetic screening and testing. It is important therefore to analyse the philosophical implications of this approach onto the bioethical world, where much disagreement occurs on fundamental issues. It is Catholic basic teaching to recognize and see God's hand in plurality, not merely as a cliche and then doing what we feel is right, but to recognize how to live in a pluralistic world. We recognize, in agreement with these theologians, that in order for a Trinitarian mode of understanding to be used by those doing bioethical debate, there is a need to depart from fundamentalism.

Bioethics↗