1
|
Mlambo VC, Keller E, Mussatto C, Hwang G. Development of a Medical Social Media Ethics Scale and Assessment of #IRad, #CardioTwitter, and #MedTwitter Posts: Mixed Methods Study. JMIR Infodemiology 2024; 4:e47770. [PMID: 38536206 PMCID: PMC11007602 DOI: 10.2196/47770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 04/13/2024]
Abstract
BACKGROUND Social media posts by clinicians are not bound by the same rules as peer-reviewed publications, raising ethical concerns that have not been extensively characterized or quantified. OBJECTIVE We aim to develop a scale to assess ethical issues on medical social media (SoMe) and use it to determine the prevalence of these issues among posts with 3 different hashtags: #MedTwitter, #IRad, and #CardioTwitter. METHODS A scale was developed based on previous descriptions of professionalism and validated via semistructured cognitive interviewing with a sample of 11 clinicians and trainees, interrater agreement, and correlation of 100 posts. The final scale assessed social media posts in 6 domains. This was used to analyze 1500 Twitter posts, 500 each from the 3 hashtags. Analysis of posts was limited to original Twitter posts in English made by health care professionals in North America. The prevalence of potential issues was determined using descriptive statistics and compared across hashtags using the Fisher exact and χ2 tests with Yates correction. RESULTS The final scale was considered reflective of potential ethical issues of SoMe by participants. There was good interrater agreement (Cohen κ=0.620, P<.01) and moderate to strong positive interrater correlation (=0.602, P<.001). The 6 scale domains showed minimal to no interrelation (Cronbach α=0.206). Ethical concerns across all hashtags had a prevalence of 1.5% or less except the conflict of interest concerns on #IRad, which had a prevalence of 3.6% (n=18). Compared to #MedTwitter, posts with specialty-specific hashtags had more patient privacy and conflict of interest concerns. CONCLUSIONS The SoMe professionalism scale we developed reliably reflects potential ethical issues. Ethical issues on SoMe are rare but important and vary in prevalence across medical communities.
Collapse
Affiliation(s)
| | - Eric Keller
- Division of Interventional Radiology, Stanford Health Care, Stanford, CA, United States
| | - Caroline Mussatto
- School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Gloria Hwang
- Division of Interventional Radiology, Stanford Health Care, Stanford, CA, United States
| |
Collapse
|
2
|
Aldridge Z, Harrison Dening K. Risk management and decision-making in dementia care. Nurs Older People 2024:e1460. [PMID: 38504558 DOI: 10.7748/nop.2024.e1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 03/21/2024]
Abstract
What constitutes a risk for a person living with dementia may be perceived and prioritised differently by nurses from varying clinical backgrounds. Furthermore, risk may be perceived differently according to the context. This article outlines some of the social, psychological and physical risk factors relevant to people living with dementia across the life course of the condition. It is important that nurses understand their role in identifying, assessing and managing risk and are aware of the resources, policies, legislation and processes designed to support decision-making and minimise the risk of harm to people living with dementia, their families and carers. The authors hope that this article will support nurses to become more confident in identifying risk while encouraging them to adopt a proactive and person-centred approach to risk assessment and management.
Collapse
|
3
|
Khattab SMAK, Abdelaliem SMF. Investigating the relationship between nurses' workplace behaviour and perceived levels of ethical leadership in managers. Nurs Manag (Harrow) 2024:e2104. [PMID: 38501169 DOI: 10.7748/nm.2024.e2104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND There is increasing research interest in the relationship between ethical leadership and deviant workplace behaviour. Ethical leadership encompasses altruism, courage, ethical orientation, integrity and fairness. Examples of deviant workplace behaviours include theft, fraud, sabotage, assault, abuse, manipulation and bullying. It appears that when leaders are fair and emphasise ethical conduct, followers are less inclined to engage in deviant workplace behaviour. AIM To investigate the relationship between nurses' self-rated levels of deviant workplace behaviour and perceived levels of ethical leadership in managers. METHOD For this descriptive correlational study, 355 nurses from one university hospital in Egypt responded to an online questionnaire comprising the Ethical Leadership Scale and the Workplace Deviance Behavior Scale. Descriptive and inferential statistics were used to explore results and examine the relationships between study variables. RESULTS There was a statistically significant negative relationship between respondents' self-rated levels of deviant workplace behaviour and their perceptions of levels of ethical leadership in managers. The results appeared to confirm previous research. Nurses who feel that they are treated fairly by their managers tend to have positive attitudes towards work, colleagues and management. CONCLUSION Ethical leadership on the part of managers is a significant determinant of nurses' behaviour in the workplace and should therefore be fostered by healthcare organisations.
Collapse
|
4
|
Pritchard J. Using therapeutic lies - an ethical challenge for nurses when caring for people with dementia. Nurs Older People 2024:e1468. [PMID: 38444165 DOI: 10.7748/nop.2024.e1468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 03/07/2024]
Abstract
People living with dementia can become vulnerable when experiencing symptoms such as memory loss and disorientation, as well as stigma attached to the condition. The care of people with dementia is fraught with ethical dilemmas and challenges regarding how nurses should respond to situations that put patients at risk of distress. For example, if a person with dementia asks to see a deceased relative, a nurse may have to decide whether to tell the truth, or a 'white lie' to avoid distress. This article examines the debates around the use of such 'therapeutic lying' when caring for people with dementia and provides guidance on how nurses could use this technique while protecting the individual's best interests.
Collapse
|
5
|
Malhotra J, Devi MG, Patil M. Best Practice Recommendations for Infertility Management. J Hum Reprod Sci 2024; 17:S1-S240. [PMID: 38495807 PMCID: PMC10942128 DOI: 10.4103/jhrs.jhrs_isar_ifs] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Aim The objective of this document is to provide guidance to the infertility specialist, gynecologist, embryologist, and counselors on the management of sub-fertility and brief them with the recent advances in the field. These recommendations will aid the aforementioned healthcare professionals in everyday clinical decisions about appropriate and effective care of their patients with the best available evidence. Participants Extensive deliberations, discussion, and brainstorming was done between different reproductive medicine (RM) specialists, to develop the recommendations. Evidence A systematic review of the literature published up to June 2019 was carried out using PubMed and Cochrane Collaboration Library. International guidelines, cohort studies, case series, observational studies, and randomized controlled trials currently available in the literature were reviewed. Indian data whatever available was also reviewed. Process Primary meetings were held with leading reproductive medicine specialists. Each topic was brainstormed on by a group of reproductive medicine experts, who then prepared the first draft of the recommendation. These recommendations then were reviewed by Dr. Jaideep Malhotra, Dr. Gouri Devi, and Dr. Madhuri Patil along with the chief co-ordinator of each consensus to finalize the final draft. Conclusions From the literature and discussion of the available evidence, several topics were identified for which evidence is inconsistent, insufficient, or non-existing. For the benefit of couples undergoing several treatments, the working committee recommends that future research, where possible in well-designed RCTs, will help in establishing evidence for a particular practice. In the Indian context, one also needs to take into consideration facilities and options available, cost, lack of insurance coverage, experimental nature of some advanced techniques used.
Collapse
Affiliation(s)
- Jaideep Malhotra
- Managing Director - Rainbow IVF, Agra, U.P., President ISAR (2019)
| | - M. Gouri Devi
- President, Indian Fertility Society, Director, Ridge Fertility and IVF Group
| | - Madhuri Patil
- Address: No1, Uma Admirality, Bannerghatta Road, Bangalore, India
| |
Collapse
|
6
|
Braunack‐Mayer AJ, Adams C, Nettel‐Aguirre A, Fabrianesi B, Carolan L, Beilby J, Flack F. Community views on the secondary use of general practice data: Findings from a mixed-methods study. Health Expect 2024; 27:e13984. [PMID: 38361335 PMCID: PMC10869884 DOI: 10.1111/hex.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/29/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION General practice data, particularly when combined with hospital and other health service data through data linkage, are increasingly being used for quality assurance, evaluation, health service planning and research. In this study, we explored community views on sharing general practice data for secondary purposes, including research, to establish what concerns and conditions need to be addressed in the process of developing a social licence to support such use. METHODS We used a mixed-methods approach with focus groups (November-December 2021), followed by a cross-sectional survey (March-April 2022). RESULTS The participants in this study strongly supported sharing general practice data with the clinicians responsible for their care, and where there were direct benefits for individual patients. Over 90% of survey participants (N = 2604) were willing to share their general practice information to directly support their health care, that is, for the primary purpose of collection. There was less support for sharing data for secondary purposes such as research and health service planning (36% and 45% respectively in broad agreement) or for linking general practice data to data in the education, social services and criminal justice systems (30%-36%). A substantial minority of participants were unsure or could not see how benefits would arise from sharing data for secondary purposes. Participants were concerned about the potential for privacy breaches, discrimination and data misuse and they wanted greater transparency and an opportunity to consent to data release. CONCLUSION The findings of this study suggest that the public may be more concerned about sharing general practice data for secondary purposes than they are about sharing data collected in other settings. Sharing general practice data more broadly will require careful attention to patient and public concerns, including focusing on the factors that will sustain trust and legitimacy in general practice and GPs. PATIENT AND PUBLIC CONTRIBUTION Members of the public were participants in the study. Data produced from their participation generated study findings. CLINICAL TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Annette J. Braunack‐Mayer
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, Faculty of the Arts, Social Sciences and HumanitiesUniversity of WollongongWollongongNew South WalesAustralia
- Australia Health Services Research InstituteUniversity of WollongongWollongongNew South WalesAustralia
| | - Carolyn Adams
- Macquarie Law SchoolMacquarie UniversitySydneyNew South WalesAustralia
| | - Alberto Nettel‐Aguirre
- National Institute for Applied Statistics Research AustraliaUniversity of WollongongWollongongNew South WalesAustralia
| | - Belinda Fabrianesi
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, Faculty of the Arts, Social Sciences and HumanitiesUniversity of WollongongWollongongNew South WalesAustralia
| | - Lucy Carolan
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, Faculty of the Arts, Social Sciences and HumanitiesUniversity of WollongongWollongongNew South WalesAustralia
| | - Justin Beilby
- School of Health and SocietyUniversity of WollongongWollongongNew South WalesAustralia
| | - Felicity Flack
- Population Health Research NetworkUniversity of Western AustraliaPerthWestern AustraliaAustralia
| |
Collapse
|
7
|
Duffy A. Safeguarding adults at risk of abuse. Nurs Stand 2023:e12170. [PMID: 38221863 DOI: 10.7748/ns.2024.e12170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 01/16/2024]
Abstract
Safeguarding adults at risk of abuse presents complex ethical challenges. By knowing what counts as adult abuse, recognising the signs of adult abuse and appropriately addressing suspected adult abuse, nurses contribute to protecting patients' safety, well-being, autonomy and dignity. This article discusses categories and indicators of adult abuse, relevant legislation and standards, the principles of adult safeguarding and the key elements of a nursing assessment of suspected adult abuse. The author highlights that nurses need to approach safeguarding concerns sensitively and strike a balance between acting to safeguard the person and preserving their right to autonomy. There is a need for ongoing education and training to enhance nurses' understanding of safeguarding practices, legislation, policies and standards.
Collapse
Affiliation(s)
- Anita Duffy
- Our Lady's Hospice & Care Services, Dublin, Republic of Ireland; adjunct lecturer in nursing, School of Nursing, Midwifery and Health Sciences, University College Dublin, Dublin, Ireland
| |
Collapse
|
8
|
Demir Karabulut S. The use and ethical assessment of medical photos taken by physicians. Dev World Bioeth 2023; 23:312-320. [PMID: 36196741 DOI: 10.1111/dewb.12375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022]
Abstract
With the increased use of technology, the use of medical photography has also increased, especially for secondary purposes. Secondary use only results in a benefit for clinicians and is considered a one-way process. This, in turn, raises several potential ethical issues, despite the numerous benefits of medical photography. The descriptive cross-sectional study was conducted with 82 physicians who took medical photos, in Ankara, Turkey. The mean age of the participants was 44.7 years. Of the participants, 95.1% reported using their personal mobile phones for photographing and 84.1% reported taking medical photos for "use in clinical trainings (clinical seminars, student and patient trainings, etc.)". Among physicians who took photos for research purposes, 29.3% reported obtaining only verbal consent. In addition, 53.7% of physicians reported storing medical photos on their personal computers. It seems that there is no consensus among physicians regarding taking, storing, and using medical photos, and these results cause ethical problems.
Collapse
|
9
|
Jegede A, Balogun O, Olorunsogbon OF, Nichols M, Akinyemi J, Jenkins C, Ogunronbi M, Singh A, Obiako R, Wahab K, Bello A, Akpalu A, Sarfo FS, Owolabi LF, Ojebuyi B, Adigun M, Olujobi D, Musbahu R, Titiloye M, Afolami I, Calys-Tagoe B, Uvere E, Laryea R, Fakunle A, Adeleye O, Adesina D, Mensah N, Oguike W, Coleman N, Adeniyi S, Omotoso L, Asibey S, Melikam L, Yusuf J, Gbenga A, Mande A, Uthman M, Kalaria RN, Owolabi M, Ovbiagele B, Arulogun O, Akinyemi RO. Research participants' perception of ethical issues in stroke genomics and neurobiobanking research in Africa. medRxiv 2023:2023.10.03.23296473. [PMID: 37873327 PMCID: PMC10593020 DOI: 10.1101/2023.10.03.23296473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background There is a growing interest in stroke genomics and neurobiobanking research in Africa. These raise several ethical issues, such as consent, re-use, data sharing, storage, and incidental result of biological samples. Despite the availability of ethical guidelines developed for research in Africa, there is paucity of information on how the research participants' perspectives could guide the research community on ethical issues in stroke genomics and neurobiobanking research. To explore African research participants' perspectives on these issues, a study was conducted at existing Stroke Investigation Research and Education Network (SIREN) sites in Nigeria and Ghana. Method Using an exploratory design, twenty-eight Focus Group Discussions (FGDs) sessions were conducted with stroke survivors (n=7), caregivers(n=7), stroke - free controls(n=7), and Community Advisory Board members(n=7). Data were collected using an interview guide. Interviews were conducted in English and indigenous languages of the community, audio recorded, and transcribed verbatim. Data were analyzed using NVivo (March, 2020) Software. Result Results revealed that stroke genomics and neurobiobanking research in Africa require researchers' direct attention to ethical issues. Concerns were raised about understanding, disclosure and absence of coercion as components of true autonomous decision making in research participation. Participants argued that the risk and benefits attached to participation should be disclosed at the time of recruitment. Fears around data sharing were voiced as adherence to the principle of privacy and confidentiality were of paramount importance to participants. The preference was to receive the results of incidental findings with no stigma attached from society. Conclusion Research participants' perspectives are a vital aspect of community engagement in stroke genomics and neurobiobanking research. Findings from this study suggest that research participants are interested in these fields of research in Africa if their concerns about ethical issues are appropriately addressed within the research framework.
Collapse
Affiliation(s)
- Ayodele Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Olubukola Balogun
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Olorunyomi Felix Olorunsogbon
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Nigeria
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Mayowa Ogunronbi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Arti Singh
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Reginald Obiako
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Kolawole Wahab
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Abiodun Bello
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Albert Akpalu
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Fred S. Sarfo
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lukman F. Owolabi
- Neurology Unit, Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Babatunde Ojebuyi
- Department of Communication and Language Arts, Faculty of Arts, University of Ibadan, Nigeria
| | - Muyiwa Adigun
- Department of Public Law, Faculty of Law, University of Ibadan, Ibadan, Nigeria
| | - Dorcas Olujobi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Rabiu Musbahu
- Neurology Unit, Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Musibau Titiloye
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Nigeria
| | - Ibukun Afolami
- Department of Human Nutrition and Dietetics, College of Medicine, University of Ibadan, Nigeria
| | | | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Ruth Laryea
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Adekunle Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Osi Adeleye
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Deborah Adesina
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Nathaniel Mensah
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Oguike
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Nathaniel Coleman
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Sunday Adeniyi
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Lanre Omotoso
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Shadrack Asibey
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lois Melikam
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Jibril Yusuf
- Neurology Unit, Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Abdullateef Gbenga
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Aliyu Mande
- Neurology Unit, Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Muhammed Uthman
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Rajesh N. Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- School of Medicine, University of California, San Francisco, CA, USA
| | - Oyedunni Arulogun
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Rufus O. Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| |
Collapse
|
10
|
Bolino G, D’Antonio G, Sorace L, Fazio ND, Volonnino G, Russa RL, Arcangeli M, Frati P. The "Criminal Shield": Criminal Liability for Healthcare Professionals during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:2661. [PMID: 37830698 PMCID: PMC10572230 DOI: 10.3390/healthcare11192661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
The Sars-CoV-2 pandemic has had important economic, health, political, and jurisprudential implications all over the world. According to innovations already introduced by Law 24/2017, with Decree Law no. 44 of 1 April 2021 and the subsequent conversion law no. 71 of 2021, Italy is the only country in which ad hoc rules have been introduced to limit the professional liability of healthcare professionals during the health emergency. The "criminal shield" can be defined as the Legislator response to the extreme pressure on healthcare professionals during the pandemic.
Collapse
Affiliation(s)
- Giorgio Bolino
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy; (G.B.); (G.D.); (L.S.); (G.V.); (P.F.)
| | - Gianpiero D’Antonio
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy; (G.B.); (G.D.); (L.S.); (G.V.); (P.F.)
| | - Letizia Sorace
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy; (G.B.); (G.D.); (L.S.); (G.V.); (P.F.)
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy; (G.B.); (G.D.); (L.S.); (G.V.); (P.F.)
| | - Gianpietro Volonnino
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy; (G.B.); (G.D.); (L.S.); (G.V.); (P.F.)
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Mauro Arcangeli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy; (G.B.); (G.D.); (L.S.); (G.V.); (P.F.)
| |
Collapse
|
11
|
TAJUDEEN RAJI, SILAIGWANA BLESSING, YAVLINSKY ALEXEI, EDWARDS SARAHJL. Research ethics during infectious disease outbreaks: A survey of African research stakeholders using the Ebola virus disease outbreak as a case. J Public Health Afr 2023; 14:1632. [PMID: 37881726 PMCID: PMC10594595 DOI: 10.4081/jphia.2023.1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Conducting research during disease outbreaks can be ethically challenging as evidenced in the 2014-2016 Ebola outbreak in West Africa and COVID-19 pandemic. Yet, there has been little empirical research conducted for understanding the views and perspectives of different stakeholders regarding ethical issues in conducting research during disease outbreaks. This preliminary study was conducted to empirically explore African public health research stakeholders' views about research ethics issues during infectious disease outbreaks in Africa. We conducted an online survey of 330 participants attending the International Conference on Re-emerging and Emerging Infectious Disease (ICREID) meeting that took place from 13-15 March 2019 in Addis Ababa, Ethiopia to elicit their views on various research ethics complexities experienced in the 2014 Ebola outbreak. Study results revealed some divergent views on several ethical themes including: ethics of using unregistered interventions in outbreaks; acceptable study design; ethics review processes; risks-benefit assessment; exclusion of pregnant women and children; and biological sample and data sharing. Majority (76.3%) of respondents felt that in the absence of available standard treatments or prevention modalities, the use of investigational interventions can be ethically justifiable if there is a strong scientific rationale and favorable risk-benefit ratio. Regarding conventional placebo-controlled trials during outbreaks with high case fatality rates, respondents that considered this unethical were more than three times those that felt such design were ethically justifiable. We were somewhat surprised that a majority (almost 60%) of respondents were satisfied with the exclusion of pregnant women and children in clinical trials during outbreaks. All respondents concurred with the prioritization of informed consent for research during an outbreak. Based on our findings, research ethics guidance is needed to equip research stakeholders in dealing with ethical complexities arising in the conduct of research during emerging disease outbreaks-especially regarding using experimental interventions; placebo trial design; inclusion or justified exclusion of pregnant women and children; and biological sample/data sharing. The findings will be used in ongoing efforts of developing a consultative and coherent African-centric framework to support ethical conduct of research for future emerging infectious disease outbreaks in Africa.
Collapse
Affiliation(s)
- RAJI TAJUDEEN
- African Union, Africa CDC, Division of Public Health Institutes and Research, Addis Ababa, Ethiopia
| | - BLESSING SILAIGWANA
- NIHR Group Tackling Infections to Benefit Africa (TIBA), University of Edinburgh
| | - ALEXEI YAVLINSKY
- University College London, Institute of Health Informatics, London, London NW1 2DA
| | - SARAH JL. EDWARDS
- University College London, Science & Technology Studies, Bloomsbury, London WC1H 0AW, UK
| |
Collapse
|
12
|
Güth U, McMillan S, Battegay E. Medical Aid in Dying: Europe's Urgent Medico-Ethical Challenge. Int J Public Health 2023; 68:1606538. [PMID: 37732328 PMCID: PMC10507858 DOI: 10.3389/ijph.2023.1606538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Uwe Güth
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Breast Surgery, Brust-Zentrum Zürich, Zurich, Switzerland
| | - Shaun McMillan
- Department of Breast Surgery, Brust-Zentrum Zürich, Zurich, Switzerland
| | - Edouard Battegay
- International Center for Multimorbidity and Complexity in Medicine (ICMC), University of Zurich, Zurich, Switzerland
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Merian Iselin Klinik Basel, Basel, Switzerland
| |
Collapse
|
13
|
Fithriyyah YN, Alda AK, Haryani H. Trends and ethical issues in nursing during disasters: A systematic review. Nurs Ethics 2023; 30:753-775. [PMID: 36974633 DOI: 10.1177/09697330231155602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND During a disaster, nurses face complex ethical challenges because of risky situations. It is necessary to identify trends and ethical issues of nurses in disasters to improve the quality of care and impact for nurses. METHOD This systematic review enrolled in the international registration with PROSPERO: CRD42022350765. We searched the following databases: PubMed, EBSCO MEDLINE, SCOPUS, ProQuest, ScienceDirect, and Sage Pub. The inclusion criteria were developed according to PICO and D; are Population (F): involving nurses; intervention/Exposure (I): disaster, Comparison (C): none; outcome (O): ethical practice. And Design (D): qualitative, quantitative, and mixed methods. Years of publication were 2012-2022, with full text in English. The quality of study assessment used was The Joanna Briggs Institute (JBI) Critical Appraisal tool and Mixed Methods Appraisal Tool (MMAT) version 2018. Analysis used PICO synthesis. RESULTS There were 15 studies reviewed from 2093 results, including cross-sectional (4/15, 26.6%), qualitative (9/15, 60%), and mixed methods (2/15, 13.3%) studies. The types of disasters were: COVID-19 (7/15, 46.6%), infectious (4/15, 26.6%), and all disaster events (4/15, 26.6%). The main themes were: (1) ethical issues in disasters have the potential to address ethical dilemmas, (2) factors applying nursing ethics to support ethical decision-making in disasters, (3) strategies for applying ethics and dealing with ethical issues in disasters, and (4) the impact of applying ethics in disasters. CONCLUSION Applying ethics nursing in a disaster is influenced by various factors. This framework for ethical nursing in disasters aims to help nurses, educational institutions, and policymakers develop schemes or scenarios to enhance responsible ethical decisions in disasters.
Collapse
|
14
|
Devi S, Bongale AM, Tefera MA, Dixit P, Bhanap P. Fresh Umbilical Cord Blood-A Source of Multipotent Stem Cells, Collection, Banking, Cryopreservation, and Ethical Concerns. Life (Basel) 2023; 13:1794. [PMID: 37763198 PMCID: PMC10533013 DOI: 10.3390/life13091794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/02/2023] [Accepted: 05/25/2023] [Indexed: 09/29/2023] Open
Abstract
Umbilical cord blood (UCB) is a rich source of hematopoietic cells that can be used to replace bone marrow components. Many blood disorders and systemic illnesses are increasingly being treated with stem cells as regenerative medical therapy. Presently, collected blood has been stored in either public or private banks for allogenic or autologous transplantation. Using a specific keyword, we used the English language to search for relevant articles in SCOPUS and PubMed databases over time frame. According to our review, Asian countries are increasingly using UCB preservation for future use as regenerative medicine, and existing studies indicate that this trend will continue. This recent literature review explains the methodology of UCB collection, banking, and cryopreservation for future clinical use. Between 2010 and 2022, 10,054 UCB stem cell samples were effectively cryopreserved. Furthermore, we have discussed using Mesenchymal Stem Cells (MSCs) as transplant medicine, and its clinical applications. It is essential for healthcare personnel, particularly those working in labor rooms, to comprehend the protocols for collecting, transporting, and storing UCB. This review aims to provide a glimpse of the details about the UCB collection and banking processes, its benefits, and the use of UCB-derived stem cells in clinical practice, as well as the ethical concerns associated with UCB, all of which are important for healthcare professionals, particularly those working in maternity wards; namely, the obstetrician, neonatologist, and anyone involved in perinatal care. This article also highlights the practical and ethical concerns associated with private UCB banks, and the existence of public banks. UCB may continue to grow to assist healthcare teams worldwide in treating various metabolic, hematological, and immunodeficiency disorders.
Collapse
Affiliation(s)
- Seeta Devi
- Department of Obstetrics and Gynecological Nursing, Symbiosis College of Nursing, Symbiosis International (Deemed University), Lavale, Pune 412 115, Maharashtra, India;
| | - Anupkumar M. Bongale
- Department of Artificial Intelligence and Machine Learning, Symbiosis Institute of Technology, Symbiosis International (Deemed University), Lavale, Pune 412 115, Maharashtra, India
| | | | | | - Prasad Bhanap
- HoD OBG Department, Symbiosis Medical College for Women (SMCW), Symbiosis International (Deemed University), Lavale, Pune 412 115, Maharashtra, India
| |
Collapse
|
15
|
Lanyi Y, Xiaomei Z. Oocyte cryopreservation for non-medical reasons: Ethical and regulatory concerns in China. Dev World Bioeth 2023. [PMID: 37555748 DOI: 10.1111/dewb.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023]
Abstract
Assisted reproductive technology is a complex medical intervention with many potential social sensitivities. Within this domain, oocyte cryopreservation has emerged as an important research area for preserving female fertility. Against the backdrop of the hotly debated first legal case in China of a single woman wishing to freeze her eggs, and the implementation of the 'three-child policy' in China, there is an urgent need to evaluate policies and address ethical considerations surrounding oocyte cryopreservation for non-medical reasons. This review examines current policies, explores China's practices and research, and examines the latest ethical challenges surrounding non-medical oocyte cryopreservation. It develops strategies and recommendations that will be relevant in China and other developing countries seeking to navigate this complex landscape.
Collapse
|
16
|
Abstract
BACKGROUND The field of nursing has long been concerned with ethical issues. The history of the nursing profession has a rich legacy of attention to social justice and to societal questions regarding issues of fairness, access, equity, and equality. Some nurses have found that their clinical experiences spur an interest in ethical patient care, and many are now nurse bioethicists, having pursued additional training in bioethics and related fields (e.g., psychology, sociology). PURPOSE The authors describe how the clinical and research experiences of nurses give them a unique voice in the field of bioethics. RESULTS Authors present reasons for the relative invisibility of nurse bioethicists, compared with physician, theologian, or philosopher bioethicists, as well as current efforts to increase the visibility of nurse bioethicists. They also describe four specific areas where nurse bioethicists have made and continue to make important contributions: as ethics consultants to colleagues in hospitals and other settings; as bioethics researchers or as advisers to researchers conducting trials with human subjects; as educators of trainees, patients and families, healthcare providers, and the public; and in helping to draft humane and ethical policies for the care of vulnerable patients and underserved populations. CONCLUSION Nurse bioethicists are central to the future goals of healthcare bringing a unique perspective to the day-to-day ethical challenges of both clinical care and research, as well as to the education of health professionals and the public.
Collapse
|
17
|
Policiuc L, Nutu A, Zanoaga O, Mehterov N, Braicu C, Berindan-Neagoe I. Current aspects in biobanking for personalized oncology investigations and treatments. Med Pharm Rep 2023; 96:235-245. [PMID: 37577017 PMCID: PMC10419688 DOI: 10.15386/mpr-2647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023] Open
Abstract
Background/Aim A biobank is an organization that gathers, refines, preserves and provides access to biospecimens along with relevant clinical data that can be used in applied or clinical research. Biobanking is a critical component of the scientific foundation for personalized medicine; this implies the accessibility of high-quality human biospecimens, such as blood, tissue, and other body fluids, along with the patient clinical data that goes with them. Methods This paper summarizes the function of biobanks in oncology and the requirements for biobank development in translational and clinical research. Results Biobanks raise numerous ethical issues that government agencies address by enacting particular laws. To develop personalized medicine, biobanks are crucial, given that the availability of an extensive collection of patient samples with thoroughly annotated clinical and pathological data is an essential necessity. Also, data related to biobanking raises complex ethical, legal, and social issues, particularly concerning the protection of donor privacy and the appropriate use of collected samples. International standards have been developed to address these issues to ensure biobanking practices' quality, safety, and integrity. Conclusions Biobanking is vital in advancing biomedical research, supporting clinical applications, and enhancing our understanding of human health and disease. Using real-world data and biobanking can accelerate medical research, support personalized medicine initiatives, and improve patient care.
Collapse
Affiliation(s)
- Liliana Policiuc
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andreea Nutu
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Oana Zanoaga
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nikolay Mehterov
- Research Institute, Medical University of Plovdiv, Plovdiv, Bulgaria
- Department of Dental Prosthetics, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cornelia Braicu
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
18
|
Schulz I, O'Neill J, Gillam P, Gillam L. The scope of ethical dilemmas in paediatric nursing: a survey of nurses from a tertiary paediatric centre in Australia. Nurs Ethics 2023; 30:526-541. [PMID: 36877536 DOI: 10.1177/09697330231153916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND No previous study has provided evidence for the scope and frequency of ethical dilemmas for paediatric nurses. It is essential to understand this to optimise patient care and tailor ethics support for nurses. RESEARCH AIM The aim of this study was to explore the scope of nurses' ethical dilemmas in a paediatric hospital and their engagement with the hospital clinical ethics service. RESEARCH DESIGN This study used a cross-sectional survey design. PARTICIPANTS AND RESEARCH CONTEXT Paediatric nursing staff in a tertiary paediatric centre in Australia completed an online survey asking about their exposure to a range of ethical dilemmas and their knowledge of the clinical ethics service. Analysis used descriptive and inferential statistics. ETHICAL CONSIDERATIONS Ethical approval was granted from the hospital research committee. The survey was anonymous, and no identifying details of participants were collected. RESULTS Paediatric nurses experienced a wide range of ethical dilemmas frequently, both in the intensive care and general areas. Knowledge and use of the clinical ethics service was poor and the most frequent challenge for nurses in managing dilemmas was feeling powerless. CONCLUSION There is a need to recognise the moral burden of ethical dilemmas for paediatric nurses in order to foster ethical sensitivity, and to provide adequate support to improve care and mitigate nursing moral distress.
Collapse
Affiliation(s)
- Ingrid Schulz
- The Victorian Paediatric Palliative Care Program, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Jenny O'Neill
- The Department of Nursing Research, The Royal Children's Hospital, Melbourne, VIC, Australia; Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; The Children's Bioethics Centre, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Peter Gillam
- Department of Psychology, The University of Melbourne, Melbourne, VIC, Australia
| | - Lynn Gillam
- The Children's Bioethics Centre, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
19
|
Beretta G, Marelli L. Fast-tracking development and regulatory approval of COVID-19 vaccines in the EU: A review of ethical implications. Bioethics 2023; 37:498-507. [PMID: 36905651 DOI: 10.1111/bioe.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/28/2022] [Accepted: 02/09/2023] [Indexed: 05/20/2023]
Abstract
The rapid spread of SARS-CoV-2 worldwide has triggered intense activity in the field of biotechnology, leading to the development and regulatory approval of multiple COVID-19 vaccines in less than 1 year while raising sustained scrutiny as to the ethical issues associated with this process. This article pursues a twofold objective. First, it reconstructs and provides a thorough overview of the different steps, from clinical trial design to regulatory procedures, underpinning the "fast-tracking" of COVID-19 vaccine R&D and approval. Second, drawing on a review of published literature, the article identifies, outlines, and analyzes the most ethically challenging aspects related to such process, including concerns around vaccine safety, issues in study design, the enrollment of study participants, and the challenges in obtaining valid informed consent. By scrutinizing relevant aspects of COVID-19 vaccine development and regulatory processes leading to market authorization, this article ultimately aims to provide a comprehensive overview of the regulatory and ethical issues underpinning the roll-out of this key pandemic-containment technology worldwide.
Collapse
Affiliation(s)
- Giorgia Beretta
- Department of Oncology and Hemato-Oncology, Univeristy of Milan, Milan, Italy
| | - Luca Marelli
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Centre for Sociological Research, KU Leuven, Leuven, Belgium
| |
Collapse
|
20
|
Alahmad G, Althagafi NA. Attitudes toward Medical Ethics among Obstetricians and Gynecologists in Saudi Arabia: An Exploratory Survey. Healthcare (Basel) 2023; 11:healthcare11101394. [PMID: 37239680 DOI: 10.3390/healthcare11101394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Ethics is an important aspect of medical care. The purpose of this study was to investigate the attitudes of obstetricians and gynecologists towards various ethical issues and ethical principles, and their satisfaction with their knowledge, understanding, and problem-solving skills regarding ethical issues. Methods: A cross-sectional survey was conducted among the working OB/GYNs in Saudi Arabia from various hospitals in Saudi Arabia between May 2020 and August 2020. A link to the three-point Likert scale questionnaire was mailed to 1000 OB/GYNs working in various hospitals. The data were analyzed using inferential statistics. The quantitative data were expressed as absolute numbers and percentages. Results: A total of 391 out of 1000 OB/GYNs responded. Most of the respondents were female OB/GYNs (65%), most of them were working in tertiary government hospitals (63%), and most were educated in bioethics (62%). About 80.3% of the respondents considered ethics important, and there was a low satisfaction rate with their knowledge (26%), understanding (38.6%), and problem-solving skills (35.8%) related to ethical issues. Conclusions: The obstetricians and gynecologists considered ethics an important aspect of daily practice but lacked the skills and knowledge to deal with ethical issues. The level of satisfaction with practice ethics was very low. Despite the fact that most of them had undergone bioethics education, most of them expressed the need for ethics training. Theoretical ethics education seemingly did not increase competence in resolving ethical issues, whereas experience did. The workplace had a strong correlation with the employee's attitude toward ethical issues, principles, and satisfaction with their knowledge and skills in resolving ethical issues. The ethics curriculum needs to be structured in a more effective way to improve competence in dealing with ethical challenges in daily practice.
Collapse
Affiliation(s)
- Ghiath Alahmad
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
| | - Nuha Abed Althagafi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- Department of Obstetrics and Gynecology, King Fahad National Guard Hospital, Riyadh 11426, Saudi Arabia
| |
Collapse
|
21
|
Vaughan J. Ethical decision-making in the administration of 'as required' antipsychotics to people with dementia in care homes. Nurs Older People 2023:e1440. [PMID: 37161545 DOI: 10.7748/nop.2023.e1440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/11/2023]
Abstract
Antipsychotic medicines are often prescribed 'as required' to manage behavioural and psychological symptoms of dementia, despite evidence that these medicines have little benefit for people with dementia and have numerous adverse side effects, including sedation. It is the nurse's role to decide if and when to administer antipsychotic medicines that have been prescribed on an as required basis. This decision-making is underpinned by complex ethical considerations such as mental capacity, chemical restraint, quality of life and autonomy. Adopting a person-centred approach and considering the ethics, guidelines and legislation related to such decisions can support nurses to act in patients' best interests. This article uses two ethical frameworks - the four principles of biomedical ethics and the 'four quadrants' approach - to examine this complex issue and to demonstrate their use in the context of ethical decision-making in nursing practice.
Collapse
Affiliation(s)
- Jessica Vaughan
- Adult Nursing BSc (hons), Coventry University, Coventry, England
| |
Collapse
|
22
|
Faggion CM. Transferring rejected manuscripts to other journals: A good practice? Account Res 2023:1-2. [PMID: 37015897 DOI: 10.1080/08989621.2023.2199930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
- Clovis Mariano Faggion
- Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University Hospital Münster, Münster, Germany
| |
Collapse
|
23
|
Peel M. Understanding the nurse's role as a professional witness. Nurs Stand 2023; 38:29-34. [PMID: 36620950 DOI: 10.7748/ns.2023.e11978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 01/10/2023]
Abstract
Nurses working in any setting may be required to assist the courts or coroners by preparing statements or giving evidence in court. Nurses can act as 'professional witnesses' who provide evidence of something they have seen, heard or been involved with as part of their professional duties. This article outlines how nurses should respond to requests for written statements and suggests a format for providing such statements. It also explains the typical approach to providing oral evidence in court and how nurses should prepare and present themselves in the witness box.
Collapse
|
24
|
Abstract
Background During pandemics, there are considerable ethical dilemmas. It is imperative that nurses are involved in ethical decision-making bringing nursing theory, practice and perspectives to better advocate for patients. In order to prepare nurses to be partners in ethical dilemma decision-making during pandemics, it is vital to understand the extent that nurses are involved in such decision-making during the COVID-19 pandemic. Aim The purpose of this concept analysis is to identify nurse involvement in ethical decision-making during pandemics. Method Concept analysis methodology based on literature searches used bibliographic databases: PubMed - 20 papers; Google Scholar - 8120 papers; EMBASE - 25 papers; Science Direct - 246 papers and hand searches. Results Nurse involvement in ethical decision-making during pandemics focused on nurses' physical and emotional stress, communication challenges, saturation and collapse of limited resources and allocation of scarce resources. Additional dilemmas included, changing nature of nurses' relationships with patients and families, questionable ethical equipoise preforming COVID-19 research, triage patient decisions receiving scarce resources, partner participation during labour and delivery and end-of-life decisions. Conclusion In order to protect and sustain nurses' well-being and competency, nurses should establish a framework for nurses' involvement in ethical policy development in emergencies, pandemics, education and preparedness and decision-making to be able to deal with public health emergencies.
Collapse
Affiliation(s)
- Eman Alshawish
- Assistant Professor, Faculty of Medicine and Health Sciences, An-Najah National University Palestine, Nabulus, Palestine
| | - Julie Benbenishty
- Julie Benbenishty, Nursing Administration, Hadassah Hebrew University Medical Center, Hadassah Hospital PO Box 12000 Ein Kerem Jerusalem 91120, Israel.
| |
Collapse
|
25
|
Gao Y, Xue T, Chen B, Yang H, Wei L. Ethical issues raised by uterus transplantation: A report from the People's Republic of China. Dev World Bioeth 2023; 23:34-40. [PMID: 35187771 DOI: 10.1111/dewb.12346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
The recent advances in assisted reproductive technology, such as hormonal stimulation, IVF, and intracytoplasmic sperm injection (ICSI), have made it possible to circumvent many causes of male and female factor infertility. However, uterine infertility is still considered an ''unconditionally infertile'' condition. Owing to the continued advances in organ transplantation, microvascular anastomosis techniques, and immunosuppressive medicine, the transplantation of organs is no longer restricted to the ones necessary for continued life. Quality-of-life enhancing types of transplantation, such as uterine transplantation, in recent years, have also entered the clinical arena. This undoubtedly brings new hope to such women, but also creates ethical challenges. Selection of the donor, the impact on the recipient and offspring, as well as challenges to moral and social norms are issues that cannot be ignored. In the present review, the ethical issues of transplantation of the uterus will be discussed in light of recent progress in the procedure.
Collapse
|
26
|
Kurjak A, Stanojević M, Barišić P, Ferhatović A, Gajović S, Hrabar D. Facts and doubts on the beginning of human life - scientific, legal, philosophical and religious controversies. J Perinat Med 2023; 51:39-50. [PMID: 36087294 DOI: 10.1515/jpm-2022-0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/23/2022] [Indexed: 01/17/2023]
Abstract
It is very complicated to give correct answer to the question "How to define human life?" Nowadays dilemmas consider the respect of human life from the birth to death involve not just biology but also other sciences like philosophy, theology, sociology, psychology, law and politics. These sciences evaluate the topic from different points of view. Integration of all of these perspectives could result with a proper definition. The principal purpose of this paper is to try to determine when a human individual begins. If this proves to be too difficult, we might have to settle for a specific stage in the reproductive process before which it would be impossible to say with any plausibility that a human individual exists. It is necessary to return the moral dimension of observation to the science of life. The point is to reconcile the universal ethical principles concerning the absolute value of life with the everyday challenges and dilemmas. It is our deepest conviction that life has an absolute value and that there always remains something indestructible and substantial in life, which may neither be evaluated by anything final, nor completely reduced to the material biological equivalent and the genetic substratum.
Collapse
Affiliation(s)
- Asim Kurjak
- Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
- Medical School Universities of Zagreb and Sarajevo, Zagreb, Croatia
| | - Milan Stanojević
- Department of Obstetrics and Gynecology, Medical School University of Zagreb, Clinical Hospital "Sveti Duh" Zagreb, Zagreb, Croatia
| | - Pavo Barišić
- Faculty of Philosophy, University of Zagreb, Zagreb, Croatia
| | - Amila Ferhatović
- Faculty of Law, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Srećko Gajović
- Department of Histology and Embryology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Dubravka Hrabar
- Faculty of Law, Family Law Department, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
27
|
Gandhi P, Petropanagos A, Popescu A, Bugaresti D, Nitti T, Chauhan N, Chidwick P, Oliver J. Ethical Issues in Long-term Care in Low-, Middle- and High-Income Countries During the COVID-19 Pandemic. Gerontol Geriatr Med 2023; 9:23337214221146660. [PMID: 36644688 PMCID: PMC9836839 DOI: 10.1177/23337214221146660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/07/2022] [Accepted: 12/04/2022] [Indexed: 01/12/2023] Open
Abstract
Long-term care (LTC) centers experienced an unprecedented emergency involving exponential mortality during the COVID-19 pandemic. Individuals residing in long-term care were particularly vulnerable to the effects of COVID-19, placing residents, staff, families, and organizations in a precarious position. Complex issues surrounding how to manage vulnerable populations during the pandemic have highlighted the importance of gathering information on ethical issues that require effective policy and decision-making. This project sought to identify the ethical issues faced in long-term care by residents, families, staff, and organizations from stakeholders themselves. A total of 305 participants from 45 countries responded, highlighting numerous ethical issues in long-term care during COVID-19. While numerous issues were mentioned, there was an overlap in the themes of responses between stakeholders. Visitation, isolation, harm, staff well-being, and the overall enforcement of policies during the pandemic represented the most often discussed issues. As a preliminary study of this issue, future research is necessary in order to effectively guide pandemic policymaking moving forward.
Collapse
Affiliation(s)
- Preet Gandhi
- University of British Columbia, Vancouver, Canada,Preet Gandhi, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
| | | | | | | | | | - Nipa Chauhan
- William Osler Health System, Brampton, ON, Canada
| | | | - Jill Oliver
- William Osler Health System, Brampton, ON, Canada
| |
Collapse
|
28
|
Rizzo ML, Turco S, Spina F, Costantino A, Visi G, Baronti A, Maiese A, Di Paolo M. 3D printing and 3D bioprinting technology in medicine: ethical and legal issues. Clin Ter 2023; 174:80-84. [PMID: 36655649 DOI: 10.7417/ct.2023.2501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract There has been a surge of interest in new technologies in medicine because of their promising clinical applications. Extensive research on additive manufacturing and its applications in the medical field has been carried out with good results and very high expectations. Due to their disruptive nature and potential, 3D printing and even more 3D bioprinting raise many ethical and safety concerns that need to be adequately addressed to provide good regulation before entering clinical practice. This article aims to highlight the general ethical concerns associated with the use of additive manufacturing in medicine and the lack of current international regulatory directives to guide these experiments. Transparency about how these new medical devices are regulated and approved is a fundamental requirement to promote and improve public trust, efficiency, safety and quality.
Collapse
Affiliation(s)
- M L Rizzo
- Interdepartmental Centre for Research in the History of law and in Computer Science and Law, (CIRSFID), University of Bologna, Bologna, Italy
| | - S Turco
- Department of Legal Medicine, Azienda ULSS 2 Marca Trevigiana, Italy
| | - F Spina
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
| | - A Costantino
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
| | - G Visi
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
| | - A Baronti
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
| | - A Maiese
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
| | - M Di Paolo
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
| |
Collapse
|
29
|
Suwalowska H. The invisible body work of 'last responders' - ethical and social issues faced by the pathologists in the Global South. Glob Public Health 2022; 17:4183-4194. [PMID: 35587285 PMCID: PMC9901416 DOI: 10.1080/17441692.2022.2076896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This paper utilises empirical data to explore the value of 'body work' performed by last responders charged with the duty of dead body management, with a focus on the Global South. While frontline staff work to save lives, little is known about the experiences and roles of those who care for the dead in global health in times of crises and even during normal times. This paper discusses ethical and socio-cultural challenges pathologists face in 'working on the bodies of others' while conducting any form of post-mortem procedures - necessary for ascertaining and recording the causes of death. Identifying and reporting the cause of death have significant public health benefits and provide closure for bereaved families. Despite the foregoing, the pathology field does not attract funding from governments or donors, and it is overlooked compared to other disciplines. Autopsy procedure bears social stigma - as it is associated with body mutilation and therefore disrespecting the dead; certain cultural beliefs or taboos about impurity and death persist, further raising some social and ethical tensions. As a result, the dearth of autopsy procedures contributes to the cause of death uncertainty in global health.
Collapse
Affiliation(s)
- Halina Suwalowska
- Nuffield Department of Population Health, Ethox Centre, Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK, Halina Suwalowska Old Road Campus, Oxford OX3 7LF, UK
| |
Collapse
|
30
|
Geissmann H. Voluntary Assisted Dying Act 2021 (Qld): Conscientious Objection Controversies. J Law Med 2022; 29:1150-1167. [PMID: 36763023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The right to conscientious objection has been reflected in multiple Australian jurisdictions for different purposes. The Voluntary Assisted Dying Act 2021(Qld) provides for conscientious objection and the scope of these provisions has proved a contentious topic. Through applying casuistical approaches and a rights-based ethical perspective, this article seeks to determine whether the referral requirement for objecting practitioners appropriately infringes on a practitioner's right of conscientious objection; whether the scope of professionals eligible to object conscientiously has been appropriately formulated; and whether an obligation to refer without a penalty for failure is a sufficient patient safeguard. The discussion concludes with possible considerations for future amendments to the Voluntary Assisted Dying Act.
Collapse
Affiliation(s)
- Halie Geissmann
- Acting Manager, Strategic Policy and Legislation, Department of Communities, Housing and Digital Economy
| |
Collapse
|
31
|
Spilsbury JC, Hernandez E, Kiley K, Hinkes EG, Prasanna S, Shafiabadi N, Rao P, Sahoo SS. Social Service Workers' Use of Social Media to Obtain Client Information: Current Practices and Perspectives on a Potential Informatics Platform. J Soc Serv Res 2022; 48:739-752. [PMID: 38264161 PMCID: PMC10805449 DOI: 10.1080/01488376.2022.2148037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
To gain insight into current use of social-media platforms in human services delivery, we systematically surveyed 172 social-service workers from six agencies in a Midwest US city to gather data about social-media usage among social-service providers, potential challenges and benefits of using social media, and whether a social-media-based informatics platform could be valuable. Quantitative analyses showed that approximately half of participants have used social media to collect client-related information; nearly one-quarter indicated "often" or "nearly daily" use. Adjusting for the effects of worker characteristics, social-media use was associated with the type of agency involved and with increased tenure in social services. Adjusted results also showed that participants' comfort with using the potential application was greater in those agencies substantially involved with investigative/legal work. However, trust in the information collected by the potential application was a stronger, independent predictor of comfort using the tool. Qualitative analyses identified numerous challenges and ethical concerns, and positive and negative aspects of a social-media-based informatics platform. If the platform is to be created, work must be done carefully, fully considering ethical issues rightly raised by social service workers, existing agency policies, and professional standards. Future research should investigate ways to negotiate these complex challenges.
Collapse
Affiliation(s)
- James C. Spilsbury
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Estefania Hernandez
- Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Shivika Prasanna
- Department of Electrical Engineering & Computer Science, University of Missouri, Columbia, MO, USA
| | - Nassim Shafiabadi
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Praveen Rao
- Department of Electrical Engineering & Computer Science, University of Missouri, Columbia, MO, USA
- Department of Health Management & Informatics, University of Missouri, Columbia, MO, USA
| | - Satya S. Sahoo
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
32
|
Coulson J. Understanding the role of genomics in nursing practice. Nurs Stand 2022; 37:e12053. [PMID: 36408613 DOI: 10.7748/ns.2022.e12053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Genomic testing can support the identification of abnormalities and developmental changes in patients' genes. Advances in technology and national infrastructure have led to increased access to genomic testing that can inform decisions about patient care. Care pathways are becoming increasingly personalised based on genomic information and nursing practice has evolved in line with these developments. All nurses should have sufficient knowledge about genomics to perform their role effectively. This article aims to enhance nurses' understanding of genomics and explains its benefits in healthcare practice.
Collapse
Affiliation(s)
- Jodie Coulson
- Department of Health Sciences, University of York, Heslington, England
| |
Collapse
|
33
|
Caldarelli V, Porcaro F, Filippo PD, Attanasi M, Fainardi V, Gallucci M, Mazza A, Ullmann N, La Grutta S. Long-Term Ventilation in Children with Medical Complexity: A Challenging Issue. Children (Basel) 2022; 9:1700. [PMID: 36360427 PMCID: PMC9688784 DOI: 10.3390/children9111700] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/11/2022] [Accepted: 10/28/2022] [Indexed: 12/09/2023]
Abstract
Children with medical complexity (CMCs) represent a subgroup of children who may have congenital or acquired multisystemic disease. CMCs are frequently predisposed to respiratory problems and often require long-term mechanical ventilation (LTMV). The indications for LTMV in CMCs are increasing, but gathering evidence about indications, titration, and monitoring is currently the most difficult challenge due to the absence of validated data. The aim of this review was to examine the clinical indications and ethical considerations for the initiation, continuation, or withdrawal of LTMV among CMCs. The decision to initiate long-term ventilation should always be based on clinical and ethical considerations and should be shared with the parents.
Collapse
Affiliation(s)
- Valeria Caldarelli
- Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Federica Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Paola Di Filippo
- Department of Pediatrics, SS Annunziata Hospital, University of Chieti, 66100 Chieti, Italy
| | - Marina Attanasi
- Department of Pediatrics, SS Annunziata Hospital, University of Chieti, 66100 Chieti, Italy
| | - Valentina Fainardi
- Cystic Fibrosis Unit, Department of Paediatrics, Parma University Hospital, 43126 Parma, Italy
| | - Marcella Gallucci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, 40126 Bologna, Italy
| | - Angelo Mazza
- Department of Pediatrics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Stefania La Grutta
- Institute of Traslational Pharmacology IFT, National Research Council, 90146 Palermo, Italy
| |
Collapse
|
34
|
Johnson M, Mortimore G. Genetic haemochromatosis: diagnosis and treatment of an iron overload disorder. Nurs Stand 2022; 37:77-82. [PMID: 36124694 DOI: 10.7748/ns.2022.e11896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 06/15/2023]
Abstract
Genetic haemochromatosis is a potentially serious iron overload disorder, yet there is a lack of awareness of the condition among the public and many healthcare professionals. In the UK, around one in 150 people have the genetic mutations that cause the condition, meaning that they are at increased risk of developing iron overload. If undiagnosed, prolonged iron overload can lead to liver, heart and endocrine failure and may be fatal; however, early diagnosis, treatment and maintenance can enable patients to have a normal lifespan. This article provides an overview of genetic haemochromatosis, including its types, origins, signs and symptoms, diagnosis, screening and treatment.
Collapse
Affiliation(s)
- Martin Johnson
- School of Health and Society Nursing, University of Salford, Salford, England
| | - Gerri Mortimore
- School of Nursing and Midwifery, University of Derby, Derby, England
| |
Collapse
|
35
|
Schou-Juul F, Nørgaard S, Lauridsen SMR. Ethical issues in dementia guidelines for people with dementia and informal caregivers in Denmark: A qualitative thematic synthesis. Dementia (London) 2022; 22:28-45. [PMID: 36205646 DOI: 10.1177/14713012221131856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Numerous dementia-specific guidelines are offered to support people with dementia and their informal caregivers in dealing with dementia. However, the extent to which such guidelines address ethical issues and provide guidance for dealing with the issues has not yet been assessed. This study investigates the extent to which ethical issues are addressedin those guidelines, which ethical themes are considered and whatrecommendations are offered. We analysed Danish collected via onlinesearch engines and manual contact with relevant governmental, municipal and patient organisations from November 2020 to January 2021. To assess the scope of ethical issues in such guidelines, we devised an analytical framework using Beauchamp and Childress's four principles of biomedical ethics and a data-processing method inspired by systematic reviews. We collected a total 653 dementia guidelines and screened them using formal inclusion criteria, such as publication year, target group and public availability. The guidelines that satisfied these criteria were screened for content related to ethical issues and recommendations. The guidelines that addressed ethical issues were then coded in NVivo 12 and analysed using thematic text analysis. In total, 59 guidelines satisfied the formal inclusion criteria. Among these guidelines, 15 addressed ethical issues, which fell into four transversal themes: (1) being open about the disease, (2) accepting help, (3) the line between dignified behaviour and overstepping boundaries and (4) decision-making and autonomy. The ethical issues addressed in Danish dementia-specific guidelines were diverse. However, the addressed issues did not represent a comprehensive spectrum of ethical issues as identified in relevant literature, and only a few guidelines contained substantial ethical content. In conclusion, this study indicates that the need for guidance on ethical issues is not being met by dementia-specific guidelines and that further research is required to provide additional ethical guidance that benefits people with dementia and their informal caregivers.
Collapse
Affiliation(s)
- Frederik Schou-Juul
- National Institute of Public Health, 6174University of Southern Denmark, Copenhagen, Denmark
| | - Signe Nørgaard
- National Institute of Public Health, 6174University of Southern Denmark, Copenhagen, Denmark
| | | |
Collapse
|
36
|
Zakerabasali S, Ayyoubzadeh SM. Internet of Things and healthcare system: A systematic review of ethical issues. Health Sci Rep 2022; 5:e863. [PMID: 36210869 PMCID: PMC9528947 DOI: 10.1002/hsr2.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/16/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Aims The Internet of Things (IoTs) is a set of connected objects and devices that share data and pursue a common goal in different areas. IoT technology can significantly help the healthcare system by enabling the monitoring of elderly and chronic disease patients. Along with the growth of this technology, its challenges and limitations such as Connectivity, Compatibility, Standards, cost, legal, and ethical also increase. One of the most critical and challenging issues in the IoT is ethical issues. This study aims to explore the key ethical aspects of the IoT and Categorize them based on the executive phases of IoT in healthcare. Methods The current study was conducted in two phases using the mixed‐method approach. In the first phase, a systematic review was conducted in relevant databases to identify ethical issues of the IoT. In the second phase, a focus group discussion was conducted to classify the extracted data elements based on executive phases of IoT by medical informatics experts and computer engineerings. Results Among the 138 papers retrieved through the search strategy, 11 articles were selected, and 12 ethical issues related to IoT were identified. The obtained results revealed the importance of ethical issues of IoT, including security, confidentiality, privacy, anonymity, freedom to withdraw, informed consent, integrity, availability, authorization, access control, censoring, and eavesdropping. They were classified into five main categories of executive phases of IoT based on the five experts’ opinions affiliated with SUMS, including data collection, data storage, data process, data transmission, and data delivery. Conclusion Because of the key role of the IoT in disease prevention, real‐time tele‐monitoring of patient's functions, testing of treatments, health management, and health research, considering the risks relating to Health care and patient data is essential. Moreover, health policymakers should be aware of the ethical commitment to using IoT technology.
Collapse
Affiliation(s)
- Somayyeh Zakerabasali
- Department of Health Information Management, Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information SciencesShiraz University of Medical SciencesShirazIran
| | - Seyed Mohammad Ayyoubzadeh
- Department of Health Information Management, School of Allied Medical SciencesTehran University of Medical SciencesTehranIran
| |
Collapse
|
37
|
Azul D, Zimman L. Innovation in speech-language pathology research and writing: Transdisciplinary theoretical and ethical perspectives on cultural responsiveness. Int J Speech Lang Pathol 2022; 24:460-471. [PMID: 35730181 DOI: 10.1080/17549507.2022.2084160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this paper, we offer three paths for the development of innovation in speech-language pathology (SLP), which enhance the discipline's capacity to address issues of diversity, inclusion and cultural responsiveness: transdisciplinary theoretical research, researcher reflexivity, and changes in ethical standards. First, we engage in a reflective conversation to identify facilitators and barriers to innovation we have encountered as academics who speak and write from personal and professional positionings that move between the privileged and the marginalised. Second, we present the results of a critical discourse analysis of the 2020 revisions to Speech Pathology Australia's Code of Ethics and characterise recent changes in the field's expanding understanding of ethical research and clinical practices. Third, we discuss how speech-language pathologists might reconsider their modes of engagement with clients and research populations in our shared area of specialisation-transgender voice. Together, these insights can support speech-language pathologists in further developing a contemporary, self-reflective, culturally humble and responsive professional culture.
Collapse
Affiliation(s)
- David Azul
- Discipline of Speech Pathology, Rural Department of Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia, and
| | - Lal Zimman
- Department of Linguistics, University of California, Santa Barbara, CA, USA
| |
Collapse
|
38
|
Johnstone R, Edwards P. Supporting nurse leaders to recognise and mitigate the effects of moral injury. Nurs Manag (Harrow) 2022; 30:e2067. [PMID: 36128731 DOI: 10.7748/nm.2022.e2067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
The concept of moral injury has been around for several decades, yet its effect on nurses remains under-recognised. Moral injury is defined as the biopsychosocial harm that arises from a violation of one's moral code, meaning that a person is powerless to uphold and enact what they believe is morally right. The coronavirus disease 2019 (COVID-19) pandemic has brought the issue of moral injury into focus because many nurses and other healthcare professionals have encountered potentially morally injurious events, resulting in increased pressure and emotional demands. It is essential that nurse leaders recognise moral injury if its effects are to be addressed. This article describes moral injury and its effects on nurses, and offers nurse leaders a practical framework for mitigating this issue. The framework aims to support nurse leaders to increase their understanding of moral injury, address any ethical challenges, ensure they are adequately prepared to provide support to nurses, and enhance their awareness of various interventions that can mitigate moral injury.
Collapse
|
39
|
Ogston-Tuck S. Access to pain management from a legal and human rights perspective. Nurs Stand 2022; 37:75-79. [PMID: 35968629 DOI: 10.7748/ns.2022.e11897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
Patients who experience pain require adequate pain management provided by healthcare professionals who have access to pain relief medicines and are trained in the assessment and treatment of pain. Patients also need their pain to be acknowledged, understood and believed. These patient needs in relation to pain management can be considered from a legal and human rights perspective. This article describes human rights legislation in the UK, how it affects healthcare practice and what it means for healthcare professionals. It discusses barriers to pain management, the concept of pain management as a human right, the obligation of healthcare organisations to provide pain management and the limits to patients' rights to pain management. Finally, it proposes strategies that nurses can use to uphold a patient's human rights in relation to pain management.
Collapse
Affiliation(s)
- Sherri Ogston-Tuck
- Institute of Health and Society, University of Worcester, Worcester, England
| |
Collapse
|
40
|
Holt J. Ethical issues arising from the assisted dying debate. Nurs Stand 2022; 37:28-34. [PMID: 35694834 DOI: 10.7748/ns.2022.e11879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 11/09/2022]
Abstract
The assisted dying debate is complex, with confusion over definitions and the stance taken by professional bodies. It can also be challenging to make sense of the claims made by those who support changes in the law regarding assisted dying. End of life care is an important aspect of a nurse's role and therefore understanding the ethical issues arising from the debate is useful for nurses in clinical practice. This article outlines the legal position in the UK and the bills currently before the Westminster and Scottish parliaments proposing changes in the law. It also considers major ethical issues arising from the debate, along with the nurse's role in caring for patients requesting assisted dying.
Collapse
Affiliation(s)
- Janet Holt
- School of Healthcare, University of Leeds, Leeds, England
| |
Collapse
|
41
|
Abstract
The ethical climate is the perception of health professionals about the work environment, meaning the reflection on care practices and ethical-related decisions. There are extensive studies in the international literature about the ethical climate, but there are still theoretical gaps about it in health services. In this reflection article, the objective was to explore conceptual components about the ethical climate, proposing new elements of analysis of the construct. The starting point was the accumulated knowledge itself, the possibilities for expansion, and the conceptual progress emerging from contributions from studies on nursing ethics. It was understandable that the ethical climate is considered in its procedural model and cyclically, being articulated with organizational elements, as established in the literature, and, expanding the concept, with the worker's health and the ethical expressiveness at work. Regarding this last contribution, the suggestion is to think about the potential for work to allow, limit, or favor professionals to express their ethical and esthetic values in the most daily decisions and relationships, in care, management, and education. The conceptual framework of this study progressed by addressing the ethical climate as a process articulating several concepts and elements regarding the organizational aspect, ethics, and the workers' well-being.
Collapse
|
42
|
Naik N, Hameed BMZ, Shetty DK, Swain D, Shah M, Paul R, Aggarwal K, Ibrahim S, Patil V, Smriti K, Shetty S, Rai BP, Chlosta P, Somani BK. Legal and Ethical Consideration in Artificial Intelligence in Healthcare: Who Takes Responsibility? Front Surg 2022; 9:862322. [PMID: 35360424 PMCID: PMC8963864 DOI: 10.3389/fsurg.2022.862322] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/18/2022] [Indexed: 01/04/2023] Open
Abstract
The legal and ethical issues that confront society due to Artificial Intelligence (AI) include privacy and surveillance, bias or discrimination, and potentially the philosophical challenge is the role of human judgment. Concerns about newer digital technologies becoming a new source of inaccuracy and data breaches have arisen as a result of its use. Mistakes in the procedure or protocol in the field of healthcare can have devastating consequences for the patient who is the victim of the error. Because patients come into contact with physicians at moments in their lives when they are most vulnerable, it is crucial to remember this. Currently, there are no well-defined regulations in place to address the legal and ethical issues that may arise due to the use of artificial intelligence in healthcare settings. This review attempts to address these pertinent issues highlighting the need for algorithmic transparency, privacy, and protection of all the beneficiaries involved and cybersecurity of associated vulnerabilities.
Collapse
Affiliation(s)
- Nithesh Naik
- Department of Mechanical and Manufacturing Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
- International Training and Research in Uro-Oncology and Endourology Group, Manipal, India
| | - B. M. Zeeshan Hameed
- International Training and Research in Uro-Oncology and Endourology Group, Manipal, India
- Department of Urology, Father Muller Medical College, Mangalore, India
| | - Dasharathraj K. Shetty
- Department of Humanities and Management, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Dishant Swain
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Milap Shah
- International Training and Research in Uro-Oncology and Endourology Group, Manipal, India
- Robotics and Urooncology, Max Hospital and Max Institute of Cancer Care, New Delhi, India
| | - Rahul Paul
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Kaivalya Aggarwal
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Sufyan Ibrahim
- International Training and Research in Uro-Oncology and Endourology Group, Manipal, India
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Vathsala Patil
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Komal Smriti
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Suyog Shetty
- Department of Urology, Father Muller Medical College, Mangalore, India
| | - Bhavan Prasad Rai
- International Training and Research in Uro-Oncology and Endourology Group, Manipal, India
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University in Krakow, Kraków, Poland
| | - Bhaskar K. Somani
- International Training and Research in Uro-Oncology and Endourology Group, Manipal, India
- Department of Urology, University Hospital Southampton National Health Service (NHS) Trust, Southampton, United Kingdom
| |
Collapse
|
43
|
Jensen CS, Eg M. Confidentiality breaches in hospital: the experiences of young people and parents. Nurs Child Young People 2022; 34:22-27. [PMID: 35253412 DOI: 10.7748/ncyp.2022.e1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Healthcare professionals, including nurses, have a vital role in protecting patient confidentiality. However, evidence shows that breaches of confidentiality are common in hospitals for various reasons, including the ward design and issues related to healthcare staff's professionalism. The situation can be complicated further in paediatric care because of the age range of patients and their associated needs and rights about information sharing, confidentiality and consent. AIM To explore the views and experiences of young people admitted to hospital, and their parents and related caregivers, about the effects of confidentiality breaches. METHOD A descriptive questionnaire-based survey was conducted in 2018 in two regional hospitals in Denmark over two weeks. A total of 214 surveys were completed by parents and related caregivers (n=173) and by young people (n=41). FINDINGS Many parents and young people reported that they had overheard healthcare professionals discussing care, including information about named patients, test results, personal disclosures and various comments or opinions. In many cases these breaches of confidentiality affected patients' overall experience of hospital and led some to withhold important information. CONCLUSION This study demonstrates the challenges of preserving confidentiality in children's wards. Situations in which confidentiality breaches were reported appear to have been affected by the physical environment, such as ward design, as well as staff behaviour and attitudes. Therefore, nurses and other healthcare professionals need to enhance their understanding of issues related to confidentiality and pay attention to how and where information about patients is shared.
Collapse
Affiliation(s)
| | - Marianne Eg
- Paediatrics and Adolescents, Viborg Regional Hospital, Viborg, Denmark
| |
Collapse
|
44
|
Abstract
The intent of the Pharmacists' Patient Care Process (PPCP) is to provide a comprehensive approach to team-based, comprehensive patient-centered care. Consideration of potential ethical issues is a necessary component of comprehensive care provision and is a requirement of accreditation standards, but there is no specific mention of ethics in any of the phases of the PPCP. A more explicit incorporation of ethical decision-making into the PPCP should help faculty involved in teaching ethics and students who need to incorporate ethical considerations into the PPCP to provide optimal patient care. The aims of this commentary are to provide faculty with a foundational introduction to ethics and an explicit approach for incorporating ethical decision-making into the PPCP.
Collapse
Affiliation(s)
- Brian L Erstad
- University of Arizona, College of Pharmacy, Tucson, Arizona
| |
Collapse
|
45
|
Erstad BL, Stratton TP. The Importance of Teaching Ethics in Pharmacy Education. Am J Pharm Educ 2022; 86:ajpe8503. [PMID: 35228198 PMCID: PMC8887056 DOI: 10.5688/ajpe8503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/23/2021] [Indexed: 06/14/2023]
Abstract
All pharmacy faculty members should have a general understanding of the field of ethics, regardless of whether they have received any formal training, since instruction and training in ethical decision-making is an accreditation expectation. Additionally, whether they recognize it or not, pharmacy faculty members are involved in ethical decision-making on an almost daily basis. The aims of the current commentary are to expand on a basic approach to ethical decision-making using examples involving students or faculty members in each of the triad areas of teaching, research, and service, and serve as a starting point to enable all faculty to teach students how to work through an ethical dilemma. This commentary will focus on the initial steps involved in determining whether an ethical dilemma exists, determining the facts related to the dilemma by identifying technical facts and legal constraints, and identifying the principles and values that play a role in the situation and decide which are in conflict. References are provided for more in-depth review of ethics subject matter beyond the scope of this commentary.
Collapse
Affiliation(s)
- Brian L Erstad
- University of Arizona, College of Pharmacy, Tucson, Arizona
| | | |
Collapse
|
46
|
Abstract
The coronavirus crisis is causing considerable disruption and anguish. However, the COVID-19 pandemic and consequent explosion of telehealth services also provide an unparalleled opportunity to consider ethical, legal, and social issues (ELSI) beyond immediate needs. Ethicists, informaticians, and others can learn from experience, and evaluate information technology practices and evidence on which to base policy and standards, identify significant values and issues, and revise ethical guidelines. This paper builds on professional organizations' guidelines and ELSI scholarship to develop emerging concerns illuminated by current experience. Four ethical themes characterized previous literature: quality of care and the doctor-patient relationship, access, consent, and privacy. More attention is needed to these and to expanding the scope of ethical analysis to include health information technologies. An applied ethics approach to ELSI would addresses context-specific issues and the relationships between people and technologies, and facilitate effective and ethical institutionalization of telehealth and other health information technologies.
Collapse
|
47
|
Zahedi F, Kadivar M, Khanali Mojen L, Asadabadi M, Tajalli S, Ilkhani M, Barasteh S, Elahikhah M, Larijani B. The ethical challenges of palliative care from the perspectives of pediatricians: A qualitative study in Iran. Front Pediatr 2022; 10:928476. [PMID: 36105856 PMCID: PMC9464941 DOI: 10.3389/fped.2022.928476] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adherence to ethical principles is a requirement for palliative care delivery to children and a main concern of healthcare providers. Physicians usually face ethical challenges during their daily practice in hospitals and need adequate skills and the ability to identify and manage them. This study sought to explore the ethical challenges of palliative care from the perspectives of pediatricians. METHODS This qualitative study was conducted between April and July 2019 using the content analysis approach. Participants were fifteen pediatric medical residents, specialists, and subspecialists purposively recruited from pediatric hospitals in Tehran, Iran. Data were collected using in-depth semi-structured interviews and were analyzed using Graneheim and Lundman's approach to conventional content analysis. Trustworthiness was ensured through the four criteria proposed by Guba and Lincoln. RESULTS Participants' experiences of the ethical challenges of palliative care for children were grouped into two main categories, namely "bewilderment in dealing with children and their families" (with two subcategories) and "conflicts in decision making" (with three subcategories). The final five subcategories were: (a) inability to effectively communicate with children and their families, (b) inability to tell the truth about the disease, (c) physician-parent conflicts, (d) parent-child conflicts, and (e) physician-physician conflicts. CONCLUSION The main ethical challenges of palliative care from the perspectives of Iranian pediatricians are the inability to effectively communicate with children and their families, the inability to tell them the truth, and the inability to manage physician-parent, parent-child, and physician-physician conflicts. Identification and management of these challenges may help improve the quality of pediatric palliative care in Iran. Further studies are needed to confirm these findings in other settings.
Collapse
Affiliation(s)
- Farzaneh Zahedi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maliheh Kadivar
- Division of Neonatology, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Khanali Mojen
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Asadabadi
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleheh Tajalli
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran
| | - Mahnaz Ilkhani
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Elahikhah
- Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Medical Ethics and History of Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
48
|
Cleary JP, Janvier A, Farlow B, Weaver M, Hammel J, Lantos J. Cardiac Interventions for Patients With Trisomy 13 and Trisomy 18: Experience, Ethical Issues, Communication, and the Case for Individualized Family-Centered Care. World J Pediatr Congenit Heart Surg 2021; 13:72-76. [PMID: 34919485 DOI: 10.1177/21501351211044132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report is informed by the themes of the session Trisomy 13/18, Exploring the Changing Landscape of Interventions at NeoHeart 2020-The Fifth International Conference of the Neonatal Heart Society. The faculty reviewed the present evidence in the management of patients and the support of families in the setting of trisomy 13 and trisomy 18 with congenital heart disease. Until recently medical professionals were taught that T13 and 18 were "lethal conditions" that were "incompatible with life" for which measures to prolong life are therefore ethically questionable and likely futile. While the medical literature painted one picture, family support groups shared stories of the long-term survival of children who displayed happiness and brought joy along with challenges to families. Data generated from such care shows that surgery can, in some cases, prolong survival and increase the likelihood of time at home. The authors caution against a change from never performing heart surgery to always-we suggest that the pendulum of intervention find a balanced position where all therapies including comfort care and surgery can be reviewed. Families and clinicians should typically be supported and empowered to define the best care for their children and patients. Key concepts in communication and case vignettes are reviewed including the importance of supportive relationships and the fact that palliative care may serve as an additional layer of support for decision-making and quality of life interventions. While cardiac surgery may be beneficial in some cases, surgery should not be the primary focus of initial family education and support.
Collapse
Affiliation(s)
- John P Cleary
- 20209Children's Hospital of Orange County, Orange, CA, USA.,University of California Irvine, Irvine, CA, USA
| | - Annie Janvier
- 5622Université de Montréal, Montréal, QC, Canada.,CHU Sainte-Justine, Clinical Ethics Unit, Unité de recherche en éthique et partenariat famille, Montreal, QC, Canada
| | - Barbara Farlow
- The deVeber Institute for Bioethics and Social Research, North York, ON, Canada
| | - Meaghann Weaver
- 20635Children's Hospital and Medical Center Omaha, Omaha, NE, USA
| | - James Hammel
- 20635Children's Hospital and Medical Center Omaha, Omaha, NE, USA
| | - John Lantos
- 4204Children's Mercy Kansas City and University of Missouri School of Medicine, Kansas City, MO, USA
| |
Collapse
|
49
|
Stone BM. The Ethical Use of Fit Indices in Structural Equation Modeling: Recommendations for Psychologists. Front Psychol 2021; 12:783226. [PMID: 34887821 PMCID: PMC8650002 DOI: 10.3389/fpsyg.2021.783226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/19/2021] [Indexed: 11/21/2022] Open
Abstract
Fit indices provide helpful information for researchers to assess the fit of their structural equation models to their data. However, like many statistics and methods, researchers can misuse fit indices, which suggest the potential for questionable research practices that might arise during the analytic and interpretative processes. In the current paper, the author highlights two critical ethical dilemmas regarding the use of fit indices, which are (1) the selective reporting of fit indices and (2) using fit indices to justify poorly-fitting models. The author highlights the dilemmas and provides potential solutions for researchers and journals to follow to reduce these questionable research practices.
Collapse
Affiliation(s)
- Bryant M Stone
- Department of Psychology, Southern Illinois University Carbondale, Carbondale, IL, United States
| |
Collapse
|
50
|
Abstract
Authority and freedom are connected, and both have external and internal forms. External authority, political or institutional, can impinge on internal freedom in ways that matter to psychoanalysts. Internal freedom requires an internal authority that can be trusted. The superego is an external authority masquerading as an internal one. The ego, with its compliance toward the id, the superego, and external reality, operates like a false self in the psyche. In Lacanian terms, it is of necessity alienated from itself. By contrast, the true self as described by Winnicott, and the "subject" as theorized especially in French psychoanalysis, represent an authentic conscience that allows us to become the authors of our at one's authority. This implies two sorts of freedom: freedom from narcissistic self-investment, and the forward-looking freedom of psychic growth. The latter occurs only in a context of relatedness to others, and it entails caring for the interests of others-if necessary at one's own expense. This vision of human beings as having an innate impetus toward psychic growth makes psychoanalysis a fundamentally optimistic endeavor. Clinical and nonclinical examples show, however, that it demands a perpetual readiness to let go of apparent certainties.
Collapse
|