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Grynberg M, Sermondade N. Fertility preservation before cancer treatment: the dilemma of saying 'no' as the price of glory. Hum Reprod 2024:deae110. [PMID: 38794911 DOI: 10.1093/humrep/deae110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
A great deal of work has been carried out by professionals in reproductive medicine in order to raise awareness about fertility preservation (FP) techniques, particularly for women, and to ensure that FP is included in the care of young adults treated for cancer or a pathology requiring gonadotoxic treatment. If the importance of the development of our discipline is obvious, our militancy in favour of FP and our emotional projections must not make us forget that medical thinking must be carried out not only on a case-by-case basis, weighing up the benefit-risk balance, but also without losing sight that conceiving a child with one's own gametes is not a vital issue. The cultural importance given to the genetic link with offspring may bias patients' and physicians' decisions, while other ways of achieving parenthood exist, and are often more effective. Systematic information should be provided on the existence of FP techniques, but this should not lead to their systematic implementation, nor should it obscure that early information will also allow patients to begin projecting themselves in alternative options to become parents.
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Affiliation(s)
- Michaël Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France
- Université Paris-Sud, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Nathalie Sermondade
- Department of Reproductive Biology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Recherche Saint Antoine, Sorbonne Universités, UPMC Université Paris 6, INSERM UMRS_938, Paris, France
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Beshyah AS, Elamouri JS, Almagdub I, Abdulrahman H, Hafidh K, Beshyah SA. Burden and Patterns of Medical Emergencies during Ramadan Fasting: A Narrative Review. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2023. [DOI: 10.1055/s-0043-1764355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Abstract
Introduction Acute medical problems may occur more frequently during Ramadan fasting (RF). We aimed to provide a narrative overview of the global literature on medical emergencies during RF.
Methods This is a nonsystematic review of the international literature from one major medical online database (PubMed, National Institutes of Health, United States). The relevant literature was narrated in a concise thematic account.
Results There is a variable impact in the burden and time distribution of emergency services and hospitalization during RF that may require readjustment of resource allocation. Studies of the risk of accidents and injuries may be increased overall or at specified times, around Iftar time. A classical impact of emergencies has been the risk of worsening peptic ulcer disease. RF impacts diabetic emergencies such as severe hypoglycemia, hyperglycemia, and diabetic ketoacidosis, particularly in type 1 diabetes and poorly controlled patients. Glucocorticoid replacement therapy may represent a challenge to patients and physicians that require education and dose adjustment. Acute neurological conditions of interest include the “first day of Ramadan headache,” epilepsy, and strokes. Several studies evaluated the risk of the acute coronary syndrome and heart failure with inconsistent findings. RF may impact the renal and urological systems through stone disease, renal colic, and acute kidney. The impact on hematological conditions was mostly focused on the safety of anticoagulant therapy during Ramadan.
Conclusion The review addresses the emergency medical encounters of the fasting patient during Ramadan to allow a holistic and ethnically sensitive approach to medical care under circumstances where decisions have to be taken with no delay.
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Affiliation(s)
- Anas S. Beshyah
- Department of Gastroenterology, Wythenshawe Hospital, Manchester, United Kingdom
| | - Jamila S. Elamouri
- Nephrology Unit, Department of Internal Medicine, Tripoli Central Hospital, Tripoli, Libya
| | - Ihab Almagdub
- Department of Medicine, Sheikh Khalifa Medical City, SEHA, Abu Dhabi, United Arab Emirates
| | - Husen Abdulrahman
- Department of Medicine, Sheikh Khalifa Medical City, SEHA, Abu Dhabi, United Arab Emirates
| | - Khadija Hafidh
- Department of Medicine, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
- Department of Medicine, Dubai Medical College for Girls, Dubai, United Arab Emirates
| | - Salem A. Beshyah
- Department of Medicine, Dubai Medical College for Girls, Dubai, United Arab Emirates
- Department of Medicine, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Medicine, Yas Clinic Khalifa City, Abu Dhabi, United Arab Emirates
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Svensson A, Bremer A, Rantala A, Andersson H, Devenish S, Williams J, Holmberg M. Ambulance clinicians' attitudes to older patients' self-determination when the patient has impaired decision-making ability: A Delphi study. Int J Older People Nurs 2021; 17:e12423. [PMID: 34510764 DOI: 10.1111/opn.12423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The proportion of older people is increasing and reflects in the demand on ambulance services (AS). Patients can be more vulnerable and increasingly dependent, especially when their decision-making ability is impaired. Self-determination in older people has a positive relation to quality of life and can raise ethical conflicts in AS. Hence, the aim of this study was to empirically explore attitudes among Swedish ambulance clinicians (ACs) regarding older patients' self-determination in cases where patients have impaired decision-making ability, and who are in urgent need of care. MATERIALS AND METHODS An explorative design was adopted. A Delphi technique was used, comprising four rounds, involving a group (N = 31) of prehospital emergency nurses (n = 14), registered nurses (n = 10) and emergency medical technicians (n = 7). Focus group conversations (Round 1) and questionnaires (Rounds 2-4) generated data. Round 1 was analysed using manifest content analysis, which ultimately resulted in the creation of discrete items. Each item was rated with a five-point Likert scale together with free-text answers. Consensus (≥70%) was calculated by trichotomising the Likert scale. RESULTS Round 1 identified 108 items which were divided into four categories: (1) attitudes regarding the patient (n = 35), (2) attitudes regarding the patient relationship (n = 8), (3) attitudes regarding oneself and one's colleagues (n = 45), and (4) attitudes regarding other involved factors (n = 20). In Rounds 2-4, one item was identified in the free text from Round 2, generating a total of 109 items. After four rounds, 72 items (62%) reached consensus. CONCLUSIONS The findings highlight the complexity of ACs' attitudes towards older patients' self-determination. The respect of older patients' self-determination is challenged by the patient, other healthcare personnel, significant others and/or colleagues. The study provided a unique opportunity to explore self-determination and shared decision-making. AS have to provide continued ethical training, for example to increase the use of simulation-based training or moral case deliberations in order to strengthen the ACs' moral abilities within their professional practice. IMPLICATIONS FOR PRACTICE Ambulance services must develop opportunities to provide continued training within this topic. One option would be to increase the use of simulation-based training, focusing on ethical aspects of the care. Another option might be to facilitate moral case deliberations to strengthen the ACs' abilities to manage these issues while being able to share experiences with peers. These types of interventions should illuminate the importance of the topic for the individual AC, which, in turn, may strengthen and develop the caring abilities within an integrated care team.
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Affiliation(s)
- Anders Svensson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Department of Ambulance Service, Växjö, Sweden
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Department of Ambulance Service, Kalmar, Sweden
| | - Andreas Rantala
- Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden.,Emergency Department, Helsingborg General Hospital, Helsingborg, Sweden
| | - Henrik Andersson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Scott Devenish
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Julia Williams
- Paramedic Clinical Research Unit (ParaCRU), University of Hertfordshire, Hatfield, UK
| | - Mats Holmberg
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.,Department of Ambulance Service, Region Sörmland, Katrineholm, Sweden
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Bremer A, Holmberg M. Ethical conflicts in patient relationships: Experiences of ambulance nursing students. Nurs Ethics 2020; 27:946-959. [PMID: 32253975 PMCID: PMC7323741 DOI: 10.1177/0969733020911077] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Working as an ambulance nurse involves facing ethically problematic
situations with multi-dimensional suffering, requiring the ability to create
a trustful relationship. This entails a need to be clinically trained in
order to identify ethical conflicts. Aim To describe ethical conflicts in patient relationships as experienced by
ambulance nursing students during clinical studies. Research design An exploratory and interpretative design was used to inductively analyse
textual data from examinations in clinical placement courses. Participants The 69 participants attended a 1-year educational programme for ambulance
nurses at a Swedish university. Ethical considerations The research was conducted in accordance with the Declaration of Helsinki.
Participants gave voluntary informed consent for this study. Findings The students encountered ethical conflicts in patient relationships when they
had inadequate access to the patient’s narrative. Doubts regarding patient
autonomy were due to uncertainty regarding the patient’s decision-making
ability, which forced students to handle patient autonomy. Conflicting
assessments of the patient’s best interest added to the conflicts and also
meant a disruption in patient focus. The absence of trustful relationships
reinforced the ethical conflicts, together with an inadequacy in meeting
different needs, which limited the possibility of providing proper care. Discussion Contextual circumstances add complexity to ethical conflicts regarding
patient autonomy, dependency and the patient’s best interest. Students felt
they were fluctuating between paternalism and letting the patient choose,
and were challenged by considerations regarding the patient’s communication
and decision-making ability, the views of third parties, and the need for
prioritisation. Conclusion The essence of the patient relationship is a struggle to preserve autonomy
while focusing on the patient’s best interest. Hence, there is a need for
education and training that promotes ethical knowledge and ethical
reflection focusing on the core nursing and caring values of trust and
autonomy, particularly in situations that affect the patient’s
decision-making ability.
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Affiliation(s)
- Anders Bremer
- Linnaeus University, Sweden; Region Kalmar County, Sweden; University of Borås, Sweden
| | - Mats Holmberg
- Linnaeus University, Sweden; Uppsala University, Sweden; Region Sörmland, Sweden
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Abstract
In medical practice, the doctrine of informed consent is generally understood to have priority over the medical practitioner's duty of care to her patient. A common consequentialist argument for the prioritisation of informed consent above the duty of care involves the claim that respect for a patient's free choice is the best way of protecting that patient's best interests; since the patient has a special expertise over her values and preferences regarding non-medical goods she is ideally placed to make a decision that will protect her interests. In this paper I argue against two consequentialist justifications for a blanket prioritisation of informed consent over the duty of care by considering cases in which patients have imperfect access to their overall best interests. Furthermore, I argue that there are cases where the mere presentation of choice under the doctrine of informed consent is detrimental to patient best interests. I end the paper by considering more nuanced approaches to resolving the conflict between informed consent and the duty of care and consider the option of permitting patients to waive informed consent.
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Affiliation(s)
- Emma C Bullock
- Department of Philosophy, Central European University, Zrinyi u. 14., 4th Floor, Budapest, 1051, Hungary.
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Erbay H. Some Ethical Issues in Prehospital Emergency Medicine. Turk J Emerg Med 2016; 14:193-8. [PMID: 27437517 PMCID: PMC4909960 DOI: 10.5505/1304.7361.2014.32656] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/27/2014] [Indexed: 11/13/2022] Open
Abstract
Prehospital emergency medical care has many challenges including unpredictable patient profiles, emergency conditions, and administration of care in a non-medical area. Many conflicts occur in a prehospital setting that require ethical decisions to be made. An overview of the some of ethical issues in prehospital emergency care settings is given in this article. Ethical aspects of prehospital emergency medicine are classified into four groups: the process before medical interventions, including justice, stigmatization, dangerous situations, and safe driving; the treatment process, including triage, refusal of treatment or transport, and informed consent; the end of life and care, including life-sustaining treatments, prehospital cardiopulmonary resuscitation (CPR), withholding or withdrawal of CPR, and family presence during resuscitation; and some ambulance perception issues, including ambulance misuse, care of minors, and telling of bad news. Prehospital emergency medicine is quite different from emergency medicine in hospitals, and all patients and situations are unique. Consequently, there are no quick formulas for the right action and emotion. It is important to recognize the ethical conflicts that occur in prehospital emergency medicine and then act to provide the appropriate care that is of optimal value.
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Affiliation(s)
- Hasan Erbay
- Department of History of Medicine And Ethics, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar
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Calleja-Sordo EC, de Hoyos A, Méndez-Jiménez J, Altamirano-Bustamante NF, Islas-Andrade S, Valderrama A, García-Peña C, Altamirano-Bustamante MM. Novel ethical dilemmas arising in geriatric clinical practice. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2015; 18:229-236. [PMID: 25185872 DOI: 10.1007/s11019-014-9593-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel-patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients' life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population.
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Affiliation(s)
- Elisa Constanza Calleja-Sordo
- Grupo transfuncional en ética clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330, Col. Doctores, 06720, Mexico, D.F., Mexico
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Erbay H, Alan S, Kadioglu S. Attitudes of prehospital emergency care professionals toward refusal of treatment: A regional survey in Turkey. Nurs Ethics 2013; 21:530-9. [PMID: 24334329 DOI: 10.1177/0969733013505311] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Prehospital emergency medicine is a specific field of emergency medicine. The basic approach of prehospital emergency medicine is to provide patients with medical intervention at the scene of the incident. This special environment causes health professionals to encounter various problems. One of the most important problems in this field is ethics, in particular questions involving refusal of treatment and the processes associated with it. OBJECTIVE The objective of this study is to identify emergency health professionals' views regarding refusal of treatment. METHODS This study was conducted with 356 health professionals who were on active duty in prehospital emergency health services. The data were collected through a form which included 10 statements. The participants were asked to indicate their level of agreement with the statements given by rating them between 0 and 10. ETHICAL CONSIDERATIONS Before conducting the research, permission was received from the local ethics committee. Participants were given written information about the purpose of the study. Participants were assured that their participation was voluntary. RESULTS The healthcare professionals with fewer years of experience in the profession and female participants adopted an attitude of giving priority to providing care. Young participants, in general, respected patient autonomy. However, paradoxically, when it comes to emergency medical cases, they expressed an opinion closer to paternalism. CONCLUSIONS This study has found that prehospital emergency health professionals generally respect the patient's right to refuse treatment; however, they do not prioritize this right when there is a life-threatening situation or when the person does not have decision-making capacity. In these cases, prehospital emergency health professionals tended to adopt a more paternalistic approach.
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McMahon-Parkes K. Rationality, religion and refusal of treatment in an ambulance revisited. JOURNAL OF MEDICAL ETHICS 2013; 39:587-590. [PMID: 22593178 DOI: 10.1136/medethics-2011-100079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In their recent article, Erbay et al considered whether a seriously injured patient should be able to refuse treatment if the refusal was based on a (mis)interpretation of religious doctrine. They argued that in such a case 'what is important…is whether the teaching or philosophy used as a reference point has been in fact correctly perceived' (p 653). If it has not been, they asserted that this eroded the patient's capacity to make an autonomous decision and that therefore, in such cases, it is the role of the healthcare professional (HCP) to 'assist patients to think more clearly and rationally' (p 653). There are, however, a number of problems with the reasons why Erbay et al suggest we should help patients to rationalise their decisions and how HCPs should go about this. In this article, the author explores some of their main arguments regarding consent and rationality (particularly in relation to religious beliefs), as well as Erbay et al's normative claim that HCPs have an obligation to promote autonomy by helping patients to come to a 'rational' decision. Ultimately, the author agrees that the (temporary) solution to the dilemma presented in this scenario (which was to insert an intravenous cannula into the patient in order to allow an infusion of fluids in the event that he changed his mind) seemed both pragmatic and ethically permissible. However, it is suggested that the arguments which underpin this conclusion in Erbay et al's article are largely unsound.
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Affiliation(s)
- Kate McMahon-Parkes
- University of the West of England, Faculty of Health and Life Sciences, Alexander Warehouse, Gloucester Docks, Gloucester, GL1 2LG, UK.
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In the line of duty: a study of ambulance drivers during the 2010 conflict in Kashmir. Prehosp Disaster Med 2012; 27:381-4. [PMID: 22831921 DOI: 10.1017/s1049023x12000933] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose of this study was to identify the problems faced by ambulance drivers working in a conflict zone. METHODS This study was conducted on ambulance drivers working for the four major hospitals in Kashmir, India. The drivers were interviewed and asked a series of 30 work-related questions. The individual interviews were conducted over a three-month period in the valley of Kashmir that was affected by continuous violence, strict curfew, and strikes. RESULTS A total of 35 ambulance drivers were interviewed. Drivers worked an average of 60 h/wk, and they drove an average of 160 km/d. Twenty-nine (83%) of the drivers experienced >1 threat of physical harm; 18 (54%) experienced physical assaults; and 31 (89%) reported evidence of psychological morbidity associated with their jobs. CONCLUSIONS The atmosphere of conflict on the streets of Kashmir impacted the ambulance drivers adversely, both physically as well as mentally. The stress faced by these professionals in conflict zones during their duty hours should be recognized, and corrective measures must be put in place.
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