[Who is afraid of Ockham's razor? : A discourse analysis on resilience in palliative care (2000-2021)]

BACKGROUND

The concept of resilience is becoming increasingly disseminated from material science into various fields of science. It is infiltrating medical fields predominantly via psychology and is also recommended for coping with the special burdens in pain management and palliative care. A precise definition of the term and its operationalization pose problems.

AIM

A critical stocktaking of the use of this term in the discourse of palliative care research.

METHOD

Analytical discourse analysis of a text corpus from palliative medical care publications in the time period from 2000 to 2021, obtained by means of a systematic literature search.

RESULTS

In the research discourse of palliative care, resilience is a topic primarily as a strategy for self-optimization of employees (e.g., burnout prophylaxis with the aim of preserving the workforce). Only rarely does the question of whether it offers potential for patients and their families take center stage, and then more as a catchword than as a concrete concept. The reason is that there is so far no adequate operationalization of the concept of resilience. Furthermore, there is a lack of sufficient justification for the relevance of the concept in patient care of palliative medicine.

CONCLUSION

There is a lack of qualified contributions of palliative research to the metadiscourse about resilience, especially in the context of affected patients. A successful operationalization of the term requires a highly complex multidimensionality of the palliative path of an interdisciplinary approach. There is a lack of ethical standards that prevent an affirmative instrumentalizing application of the term.

How COVID-19 pandemic has shaped buyer-supplier relationships in engineering companies with ethical perception considerations: A multi-methodological study

In business-to-business (B2B) operations, prior studies have mainly explored transaction-based relationships with both buyers and suppliers opportunistic behaviors, driven largely by their intent to maximize their own benefits. These studies have also found that dependency on partners increases when supply materials are scarce. However, research is scant on how this relationship changes in the face of exogenous forces such as the COVID-19 pandemic, keeping in mind the ethical perception considerations. This study aims to bridge this gap in the literature by studying how buyers and sellers leverage collaboration and resource-sharing to tide over pandemic-like situations similar to the current COVID-19 pandemic while considering their ethical perceptions. We conduct a multi-methodological study consisting of an industrial survey and an interview-based thematic analysis. In the first phase, we collect primary data using a structured questionnaire and conduct a covariance-based structural equation modeling (CB-SEM) analysis. In the second phase, we conduct a post-hoc test. We find that non-regular suppliers will share strategic resources with buyers during uncertain times (e.g. COVID-19 pandemic) if they have a high ethical perception of the buying firm and share a candid relationship despite being their irregular customers. Our findings propose that B2B firms should maintain healthy relationships with alternative suppliers to build trust and avoid supply crises in times of disruptions.

Review of Clinical Equipoise: Examples from Oncology Trials

BACKGROUND

The current standards that govern clinical research have been shaped over the years through many historical, social, and political events. The third principle of the Belmont Report, Justice, guides the scientific community toward the equal distribution of benefits and risks in research involving human subjects. Clinical equipoise is the status of genuine uncertainty by the investigator about the superiority of one treatment arm over the other. The term clinical equipoise was proposed to provide an ethical ground to conduct randomized controlled clinical trials.

OBJECTIVE

The objective of this review is to provide the reader with an overview of the emergence of the term equipoise and its utilization in randomized controlled trials.

METHODS

In the current review article, the major oncology clinical trials and relevant patents were reviewed for the application/utilization of clinical equipoise.

RESULTS

The concept of clinical equipoise has been challenged, and different alternatives were proposed. Yet, these alternatives received numerous critiques and failed to fully replace equipoise. In addition, several patents related to anticancer agents tested in the described studies were examined. No specific reference was made as part of the patent to the status of clinical equipoise. Alternatively, a description of the study arms was provided.

CONCLUSION

There is a need for revisiting the concept of equipoise and its suggested alternatives for its ethical essence while addressing related challenges.

Reflections around ethics, human intelligence and artificial intelligence

On the internet, artificial intelligence has grown to become a program with codes and algorithms that learn and reprogram themselves to carry out pre-established tasks with greater efficiency; although this translates into improvements, the scope of the results and reprogramming are unknown to the programmer. Given the risk of deviation from pre-established objectives and ethical regulations, filters must be installed at the beginning, during and at the end of the process, as alarms for detecting deviations with bioethical implications. The interaction of human intelligence with artificial intelligence has had negative and positive disagreements. Initially, adapting regulations, labor laws and human rights was enough; now it is necessary for ethical standards to be established, such as those formulated in the Barcelona Declaration for the Proper Development and Usage of Artificial Intelligence in Europe.

The ICN code of ethics for nurses: a time for revision

Since its development in 1953, the International Council of Nursing's Code of Ethics for Nurses has been revised a number of times and adopted or adapted as a guide for nurses in many countries. The Code serves as a critical model for ethical standards in the nursing profession, stressing responsibility and advocacy for the human rights of patients, their families and communities, as well as social issues, the work of nurses within health care systems and working with other health professionals. The most recent edition of the Code (2012) is now in the process of revision by an international Steering Committee. This policy paper describes the meaning of the Code, as well as the processes in place to develop a revised Code that is better fitted for the current needs of nurses around the globe.

Preoperative informed consent for mandibular third molar surgeries: A survey analysis in a subset of dentists and oral surgeons in Saudi Arabia

Objectives

The objective of this study was to identify patterns of obtaining preoperative informed consent from patients undergoing mandibular third molar surgeries, in a subset of general dentists and oral surgeons in Saudi Arabia, and to compare the consenting patterns based on the clinician’s rank, years of experience, place of work and gender.

Methods

A prospective questionnaire based study was designed and data was obtained through an online survey from 102 participants who were selected for the study. Demographic information, clinician experience, type of informed consent obtained and information related to discussion of legal implications and complications were collected. Descriptive analysis of the obtained data and statistical comparisons using cross tabulation and Pearson Chi-Square test with a 95% significance level (P < 0.05) were done between the independents demographic variables and dependent variables pertaining to patterns of preoperative consenting.

Results

The survey response rate was 81.3% (n = 83), with 59.04% general dentists and 40.96% oral surgeons. The ratio of male to female respondents was approximately 3:1. Majority of the respondents reported a clinical experience of less than 10 years (77.11%) and were reportedly working in the private sector (73.49%). Nearly 80% of the respondents (79.52%) mentioned obtaining preoperative consent for mandibular third molar surgeries and was significantly higher (p-value – 0.018) among clinicians with more than 5 years of experience (90%). While 38.5% of the respondents indicated obtaining both a written and verbal consent, 53.01% obtained only a verbal consent. Majority of the respondents were aware of the legal implications of obtaining informed consent (81.93%) and disclosed incidental complications to their patients (91.57%). However, differences in the perceived post-operative complications associated with mandibular third molar surgeries were observed between general dentists and oral surgeons.

Conclusion

The results of this study indicate a good level of knowledge about informed consent for mandibular third molar surgery and its legal implications among the dentists and oral surgeons who were surveyed. However, to avoid painful medico-legal disputes, a written informed consent signed by patients along with a witness should be considered mandatory.

The human rights impact of gender stereotyping in the context of reproductive health care

Gender stereotypes surrounding women's reproductive health impede women's access to essential reproductive healthcare and contribute to inequality more generally. Stereotyping in healthcare settings impedes women's access to contraceptive information, services, and induced abortion, and lead to involuntary interventions in the context of sterilization. Decisions by human rights monitoring bodies, such as the Inter-American Court of Human Rights' case, IV v. Bolivia, which was a case concerned with the involuntary sterilization of a woman during childbirth, highlight how stereotypes in the context of providing health care can operate to strip women of their agency and decision-making authority, deny them their right to informed consent, reinforce gender hierarchies and violate their reproductive rights. In the present article, IV v. Bolivia is examined as a case study with the objective being to highlight how, in the context of coercive sterilization, human rights law has been used to advance legal and ethical guidelines, including the International Federation of Gynecology and Obstetrics' (FIGO) own guidelines, on gender stereotyping and reproductive healthcare. The Inter-American Court's judgment in IV v. Bolivia illustrates the important role FIGO's guidance can play in shaping human rights standards and provides guidance on the service provider's role and responsibility in eliminating gender stereotypes and upholding and fulfilling human rights.

The Philippines rolls back advancements in the postabortion care policy

In 2018, the Philippines announced a postabortion care policy that rolls back crucial safeguards aimed at protecting women who seek medical treatment for postabortion complications from discrimination and abuse. It replaces another policy that was introduced in 2016, following years of advocacy by national and international advocates who were concerned about the mistreatment of women seeking postabortion care due to discriminatory practices in the health system and abortion stigma. The new policy is narrower in scope than the previous policy and reinforces abortion stigma by emphasizing the legal prohibition on abortion, failing to clarify that women seeking postabortion care need not be reported to the authorities, and not recognizing the availability of complaint mechanisms for women who are mistreated. These and other crucial gaps put the new policy at risk of being in violation of ethical standards of medical care and guarantees of human rights.

Bone Morphogenic Protein Use in Spinal Surgery

Bone morphogenic protein (BMP) provides excellent enhancement of fusion in many spinal surgeries. BMP should be a cautionary tale about the use of industry-sponsored research, perceived conflicts of interest, and holding the field of spinal surgery to the highest academic scrutiny and ethical standards. In the case of BMP, not having a transparent base of literature as it was approved led to delays in allowing this superior technology to help patients.