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At least 127 records · Page 7Linked to original sources
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↗
PubMed2006

Euthanasia: an overview and the jewish perspective.

BACKGROUND: End-of-life care poses fundamental ethical problems to clinicians. Defining euthanasia is a difficult and complex task, which causes confusion in its practical clinical application. Over the course of history, abuse of the term has led to medical atrocities. Familiarity with the relevant bioethical issues and the development of practical guidelines might improve clinical performance. OBJECTIVE: To define philosophical concepts, to present historical events, to discuss the relevant attitudes in modern bioethics and law that may be helpful in elaborating practical guidelines for clinicians regarding euthanasia and end-of-life care. Concepts found in the classic sources of Jewish tradition might shed additional light on the issue and help clinicians in their decision-making process. METHODS: An historical overview defines the concepts of active versus passive euthanasia, physician-assisted suicide and related terms. Positions found in classical Jewish literature are presented and analyzed with their later interpretations. The relevance and application in modern clinical medicine of both the general and Jewish approaches are discussed. RESULTS: The overview of current bioethical concepts demonstrates the variety of approaches in western culture and legal systems. Philosophically and conceptually, there is a crucial distinction between active and passive euthanasia. The legitimacy of active euthanasia has been the subject of major controversy in recent times in various countries and religious traditions. CONCLUSION: The historical overview and the literature review demonstrate the need to provide clearer definitions of the concepts relating to euthanasia, for in the past the term has led to major confusion and uncontrolled abuse. Bioethical topics should, therefore, be included in medical training and continuing education. There are major debates and controversies regarding the current clinical and legal approaches. We trust that classical Jewish sources might contribute to the establishment of clinical definitions, meaningful approaches and practical guidelines for clinicians.

Attitude to Health↗
PubMed2001

End-of-life care in the pediatric intensive care unit: attitudes and practices of pediatric critical care physicians and nurses.

OBJECTIVE: To determine the attitudes and practices of pediatric critical care attending physicians and pediatric critical care nurses on end-of-life care. DESIGN: Cross-sectional survey. SETTING: A random sample of clinicians at 31 pediatric hospitals in the United States. MEASUREMENTS AND MAIN RESULTS: The survey was completed by 110/130 (85%) physicians and 92/130 (71%) nurses. The statement that withholding and withdrawing life support is unethical was not endorsed by any of the physicians or nurses. More physicians (78%) than nurses (57%) agreed or strongly agreed that withholding and withdrawing are ethically the same (p < .001). Physicians were more likely than nurses to report that families are well informed about the advantages and limitations of further therapy (99% vs. 89%; p < .003); that ethical issues are discussed well within the team (92% vs. 59%; p < .0003), and that ethical issues are discussed well with the family (91% vs. 79%; p < .0002). On multivariable analyses, fewer years of practice in pediatric critical care was the only clinician characteristic associated with attitudes on end-of-life care dissimilar to the consensus positions reached by national medical and nursing organizations on these issues. There was no association between clinician characteristics such as their political or religious affiliation, practice-related variables such as the size of their intensive care unit or the presence of residents and fellows, and particular attitudes about end-of-life care. CONCLUSIONS: Nearly two-thirds of pediatric critical care physicians and nurses express views on end-of-life care in strong agreement with consensus positions on these issues adopted by national professional organizations. Clinicians with fewer years of pediatric critical care practice are less likely to agree with this consensus. Compared with physicians, nurses are significantly less likely to agree that families are well informed and ethical issues are well discussed when assessing actual practice in their intensive care unit. More collaborative education and regular case review on bioethical issues are needed as part of standard practice in the intensive care unit.

Adult↗
PubMedDate not supplied

An acute-care model in the management of end-of-life issues.

Healthcare professionals who provide direct patient care have the knowledge and skill to discuss the biophysiologic aspects of a patient's condition, but the discussion of the management of end-of-life and bioethical issues is often problematic. In this article, we discuss practices and procedures that have proved helpful in encouraging open discussion of end-of-life issues, as well as appropriate management.

Acute Disease↗
PubMed1999

The medical futility controversy: bioethical implications for the critical care nurse.

Medical futility is a recent, complex bioethical issue. There is disagreement about how futility should be defined and who should be involved in futility decisions when an impasse exists between the patient/family and the physician. Bioethical discussions about Quinlan and Cruzan of the past have been replaced with the Wanglie, Baby K, and Linares cases--all of which involved critical care settings. Nurses often are involved in the debate and encounter ethical conflicts. Cost-containment, managed care, scarce resource allocation, and care due the elderly have fueled the debate. Key issues and their importance for critical care nurses will be reviewed.

Conflict, Psychological↗
PubMed1998

Bioethics in pediatric neuromuscular disease.

The increasing frequency with which bioethical issues arise in the medical care of pediatric patients with neuromuscular disease suggests a need for a working knowledge of the field for the clinical physician, Institutional Bioethics Committees are multidisciplinary groups that include medical, nursing, social service, legal, religious or chaplaincy, and community representation. The role and functioning of these committees vary widely according to institution. Inherent in the process of consent is that it must be an Informed consent. This requires that the person consenting has been given adequate information to understand and to appreciate the benefits and risks of the treatment. There are some instances in which consent by minor patients is necessary.

Adolescent↗
PubMed2006

Social science and bioethics: the way forward.

It is no surprise that bioethics and sociology developed an adversarial relationship: bioethicists value the clear descriptions of ethically charged situations provided by social scientists, but doubt the ability of those trained in social science to logically derive and discern 'the good'. For their part, social scientists - experts in observing and collecting data about the way the world is- find bioethicists ignorant of the ways elegantly crafted solutions to ethical problems get altered when incarnated in varied social and cultural settings. This discipline-centred self-affirmation can be a satisfying exercise, but it offers nothing to the project of promoting more moral medicine and health care. The articles collected in this volume demonstrate the value of collaboration between social scientists and bioethicists. Focusing on four themes found in recent sociological research in bioethics - ethics of research, the creation of moral boundaries, bioethics and social policy, and the bioethical imagination - this anthology offers practical models of co-operative work where the strengths of each discipline are brought together to advance our understanding of bioethical issues and to show the way toward just and effective social policy.

Bioethics↗
PubMed2002

Debating ethics and public policy: the Nuffield Council on Bioethics.

Concerns about bioethical issues raised by scientific developments in genetics are a common feature of both public and policy debates in the UK. This article sets out how one such body, the Nuffield Council on Bioethics, contributes to public and policy debates, and provides information about similar bodies in the UK and around the world.

Advisory Committees↗
PubMed1999

Law and ethics in emergency medicine.

Ethical issues in emergency medicine often are accompanied by legal issues. Although the legal aspects of an ethical problem are important factors to take into consideration, the law may not directly address the problem, and following the law does not always ensure an ethical outcome. Emergency physicians should have an understanding of ethics and law, understand the legal aspects of bioethical issues in emergency medicine, and finally have a guide to analyze ethical issues, including the consideration of legal issues that may have an impact on the case.

Confidentiality↗
PubMed1994

Ethics in Japanese health care: a perspective for clinical nurse specialists.

Bioethical issues relevant to nurses in Japan are described in this article. Significant Japanese values and behavior patterns, the impact of religion on ethical concerns, patient and family roles in illness, and relationships with the physician are described. Within this context, Japanese nursing involvement in ethics and selected ethical issues are explored with examples.

Attitude to Health↗
PubMed2001

Some speculations on matters of touch.

In this essay, I examine the question of whether it is possible that the encounter with the other could be mediated such that the interval of distance would lose its determining power. I reflect on some instances of extraordinary corporeality, most particularly the phenomenon of conjoined twins, in order to problematize the relation between subjects as they are embodied. Where the normative body is supposedly marked out by the closed boundaries of the skin, the figuration of the anomalous body as potentially leaky and contaminatory positions it as being of prime concern to both medical and cultural discourse. Within those paradigms there are of course many pressing bioethical issues to debate, but my intention is to draw back from a problem-based scenario in order to consider the threshold of ethics in the self/other relation itself.

Bioethics↗
PubMed1995

Medical decisions at the end-of-life: lessons from America.

Bioethical issues that deal with medical decisions at the end of life are as interesting as they are contentious. Daily, we confront questions of health care rationing, medical futility, euthanasia, or the use of advanced directives and ethics committees. There is present-day mainstream thinking on these bioethical themes and more important, under-emphasized and controversial aspects of dying in America.

Bioethics↗
PubMed1998

[Information retrieval on ethical problems by online consultation of bioethics bibliographic data bases].

In an age when the ever-expanding limits of sciences are requiring an adjustment of moral principles and values, the Bioethics file is an essential tool for those who are in need of updated guidelines on bioethical issues. This database--produced by the Kennedy Institute of Ethics (KIE) in collaboration with the National Library of Medicine (NLM)--is distributed online by different hosts and is also available in print version and on CD-ROM. Structure and contents of the online version of the Bioethics file searchable through MEDLARS are described in details.

Bioethics↗
PubMed2005

Analysis of some Filipino perspectives on ethical issues in multi-country collaborative research: a case of deep listening.

The discussion on ethical issues, it is said, should not be confined to experts but should be extended to patients and local communities, because of the real need to engage stakeholders and non-stakeholders alike not only in carrying out any biomedical research project, but also in the drafting and legislation of bioethics instruments. Several local and inter-country consultations have already been conducted in furtherance of this goal, but there is much left to be desired in them. The consultations may have helped in articulating local principles, but not in making the instruments embody these principles. As such, instruments turn incompossible, i.e. the principles and actions they legitimate are not performable. In an ethnographic study conducted in the Philippines, for example, paragraphs 29 and 30 of the Declaration of Helsinki and CIOMS guidelines 8 and 15 are construed as not only contradictory to one another but also to local principles. This problem can be solved by taking deliberate steps to ensure that consultations are grounded in ethnographic data about local principles, which the instruments would embody. A steering committee can be of help in gathering ethnographic data, in conducting consultations at the local level, and in providing a venue for discourse on various bioethical issues.

Anthropology, Cultural↗
PubMed1995

The teaching of bioethics to the health care team: the neurologist's role.

The term 'bioethics' connotes not only the complexity of the subject but also the importance of adopting an interdisciplinary approach to it. Any given bioethical issue should be considered from a biological as well as anthropological and social perspective. Treating and evaluating ethical ideas without regard for these three aspects means diminishing and limiting them. Owing to the progress in intensive care and thanks to our increased sensitivity towards patients affected by irreversible diseases, many ethical problems have emerged relating to new conditions (for instance persistent vegetative state) or to already known ones (for example the later stages of amyotrophic lateral sclerosis or dementias). In future, it is likely that neurologists will be called upon to address an increasing number of ethical concerns, as primary care givers, consultants or members of ethics consultative teams, given that they are the most qualified to throw light on individual cases with regard to their diagnostic and prognostic, as well as on ethical, rational and emotional aspects. Neurologists are eminently suitable to play a crucial part in medical decision making regarding issues such as the administration or withdrawal of life-sustaining treatment. Furthermore, neurologists have much to contribute to the education of the health care team. This is because they are used to formulating judgments grounded on their professional experience in dealing with problems both physical and psychological. On the basis of these considerations, the author believes that neurologists are among the most qualified to bridge the gap between the two major components of bioethics: natural and human science. These components should find their synthesis and completeness in the bioethical debate.

Coma↗
PubMed1980

Euthanasia: a social work perspective.

As one of the many bioethical issues arising from new scientific and medical control over the processes of life and death, euthanasia raises some of the most difficult dilemmas to confront social workers in health care. In addition to exploring these dilemmas, this article points out the need to involve social workers in developing policy to address them.

Bioethics↗