Bioethical Approach Research Articles

Nanodrug research and development: a bioethical approach

Resumo Nanotecnologia é a utilização de materiais na escala nanométrica, em que estes adquirem características próprias. A área de pesquisa e desenvolvimento de novos nanomedicamentos é uma das mais promissoras atualmente, todavia essas partículas necessitam de avaliação particular e ainda não há consenso referente às testagens específicas a serem seguidas, o que dificulta a formação de uma legislação que garanta a segurança e eficácia destes medicamentos, além de um processo de registro mais eficaz. Assim, é necessária uma abordagem bioética da nanotecnologia e sua utilização em medicamentos, visando garantir que o progresso científico não acarrete impactos irreversíveis. Diante dessa problemática, busca-se promover uma discussão nanoética referente ao processo de pesquisa e desenvolvimento de nanomedicamentos, por meio de estudo qualitativo, exploratório-descritivo e de caráter analítico, utilizando revisão bibliográfica, análise documental e dados quantitativos disponíveis como técnicas de pesquisa.

Understanding and communication of neonatal palliative care: a bioethical approach

Resumo Tratar de morte e cuidados paliativos em neonatologia é desafiador para os profissionais de saúde. Esse estudo buscou conhecer a compreensão e o processo de comunicação em cuidado paliativo em neonatologia em um hospital do Sul do Brasil, e analisar os resultados sob a perspectiva da bioética, por meio de pesquisa qualitativa e descritiva de caráter retrospectivo. Foram realizadas entrevistas semiestruturadas com 14 participantes (sete mães e sete médicos) entre junho de 2021 e agosto de 2022. Para análise dos dados, foi utilizada a análise de conteúdo de Bardin e, dentre as categorias emergentes, destacam-se duas: conhecimento sobre cuidado paliativo e comunicação em cuidados paliativos. Concluiu-se que há entraves na comunicação que podem interferir na compreensão da família sobre o conceito de cuidado paliativo. É necessário maior investimento em educação sobre temas como bioética, paliatividade e comunicação de más notícias para facilitar esses processos e instrumentalizar os profissionais.

Understanding and communication of neonatal palliative care: a bioethical approach

Resumen Lidiar con la muerte y los cuidados paliativos en neonatología es un desafío para los profesionales de la salud. Este estudio buscó conocer la comprensión y el proceso de comunicación en los cuidados paliativos en neonatología en un hospital del Sur de Brasil, y analizar los resultados desde la perspectiva de la bioética utilizando investigación cualitativa y descriptiva retrospectiva. Se realizaron entrevistas semiestructuradas a 14 participantes (siete madres y siete médicos) entre junio de 2021 y agosto de 2022. Se utilizó el análisis de contenido de Bardin para analizar los datos y, entre las categorías emergentes, destacan conocimiento sobre cuidados paliativos y comunicación en cuidados paliativos. Existen obstáculos en la comunicación que pueden interferir en la comprensión de la familia sobre cuidados paliativos. Hay que invertir más en temas como bioética, cuidados paliativos y comunicación de malas noticias para facilitar estos procesos y proporcionar a los profesionales las herramientas necesarias.

Produções bioéticas brasileiras acerca do suicídio: revisão sistemática

Abstract This systematic literature review mapped Brazilian academic production with bioethical approaches to suicide, aiming to contribute to the debate on the ethical conflicts involved in this phenomenon and to collaborate in its prevention. Bibliographical search was conducted on the SciELO and Google Scholar databases, as well as institutional databases of graduate programs in bioethics, using the descriptors “suicídio,” “suicídio e bioética” and “suicídio e ética.” Twenty publications met the inclusion criteria and were grouped and analyzed in three axes: general reflections on suicide stigmatization; moral dilemmas regarding suicide and bioethical principles; and ethical-political analysis of the phenomenon. The little research found on the subject is surprising given its relevance for public health and moral reflection on end-of-life.

Pesquisa e desenvolvimento de nanomedicamentos: olhar bioético

Abstract Nanotechnology consist of using materials at the nanoscale, in which they acquire specific characteristics. Nanodrug research and development is one of the most promising fields today; however, these particles require particular evaluation. Moreover, studies lack consensus on which specific tests to follow, thus hindering the elaboration of legislation that ensure their safety and efficacy, as well as a more effective registration process. Thus, a bioethical approach to nanotechnology and its use in drug development is necessary to ensure scientific progress without irreversible impacts. Given this scenario, this article proposes a nanoethics discussion regarding nanodrug research and development by means of a qualitative, exploratory and descriptive analysis, based on literature review, documental analysis and quantitative data available.

Pacjent ,,sportowiec” z bólem w szpitalnym oddziale ratunkowym

Pain management in physically active people in emergency medicine is an important but poorly studied problem. According to the Hippocratic Oath and the Code of Medical Ethics, the doctor’s task is to reduce pain and suffering. Analgesia is a common example of a bioethical approach to the patient. Violations in treatment contradict the principle of harmlessness. The right to pain relief is a basic human right. This is stated in the Tokyo Declaration, the European Convention on Human Rights, and the Constitution of the Republic of Poland. The right to pain relief is also a patient’s right. Pain is one of the most common reasons patients visit the emergency department. Rapid and effective treatment of pain should be one of the main goals of emergency medicine. Pain assessment and management in emergency are often ineffective and do not meet patient expectations. Therefore, actions aimed at eliminating or minimizing pain are an essential aspect in providing care to injured or aggrieved persons. Many factors should be taken into account when choosing painkillers: age, weight, medications, concomitant diseases, patient personality, hospitalization and surgery options, and physical activity. To effectively manage pain, one must first assess its nature, identify the cause, and then choose the appropriate treatment method. Factors such as leisure time, past sporting history and previous injuries, and their potential impact on current physical activity-related injuries, should also be taken into account. Some scientists point to the fact of lowering the pain threshold in athletes. Others prove that there is a difference in the perception of pain by women and men. Thus, we can conclude that the issue of pain is relevant both for medicine and physical culture. Solving the relevant problem requires a holistic and multifaceted approach, as well as scientifically based therapy. The rehabilitation period also matters. Among other methods, we consider it expedient to investigate art therapy, in particular, choreotherapy, which will be discussed in the next publication.

The COVID-19 Pandemic Between Bio-Ethics, Bio-Law and Bio-Politics: A Case Study on The Italian Experience of The DuPre Commission

The aim of this qualitative study was to consider the question of whether the Italian political management of the pandemic respected the European bio-ethical and bio-juridical approaches in light of the principles of autonomy, dignity, integrity and vulnerability. As no specific consolidated literature exists on the subject, the Italian situation was taken into consideration, specifically the work of a spontaneous commission (DuPre) that collected the reflections of academics and researchers interested in discussing political decisions for the management of the emergency, which was the coronavirus disease (COVID-19) pandemic. The analysis took into account the contributions of scholars during two conferences (without proceedings), which were transcribed and examined. From the texts processed with a thematic analysis, three main themes emerged: ‘pandemic as a state of exception, sovereignty and crisis of democracy’, ‘the value of doubt and refutation’ and ‘elimination of informed consent between persuasion and blackmail’. In this paper, the final bio-political considerations on the European approach and the management of the COVID-19 pandemic in Italy are presented.

Incorporando la bioética ambiental a los cuidados materno perinatales para disminuir los riesgos de la Pan-Sindemia en el proceso reproductivo.

Until now, the bioethical approach to maternal perinatal care is projected from the integral vision of bio-psycho-social health, the perspective of Human Rights and the gender perspective. In general, the ecological bioethics that arises from the perspective of environmental health has not been incorporated into maternal-perinatal care with regard to “global ethics”, environmental bioethics, the perspective of “consilience” and the importance of the healthy environment as a human right. The current global crisis situation due to the combination of the COVID 19 Pandemic and the Global Syndemic, characterized as Pan Syndemic, increases the risks and damages in the reproductive process, especially in populations violated in their rights. JUSTIFICATION It is necessary to minimize the effect of the Pan Syndemic on the human reproductive process. On the global agenda, humanity must reverse the causes of the Pan Syndemic. Meanwhile, health professionals and teams must reformulate their role when it comes to maternal-perinatal care, incorporating into the clinic the right to a healthy environment for reproduction. PERSPECTIVES Modifications in the clinical practice of sexual and reproductive health teams should be aimed at: incorporate ecological bioethics into maternal perinatal care from training to clinical practice; develop a comprehensive approach to major perinatal obstetric syndromes, prematurity and fetal growth restriction, to minimize the impact of the Pan Syndemic on the human reproductive process.

A radical embodied perspective of autism: towards ethical, and inclusive views for cognitive diversities

Autism Spectrum Disorders have been defined as a group of developmental conditions that affect the capacity to interact with the physical and social environment, among others. A core feature of autism is the presence of restricted and repetitive behaviors that vary in complexity, form, and frequency throughout life history. These core features have traditionally been defined as impairments that interfere with communication competence. From an embodied approach, however, these actions could be seen as characteristic ways of interacting with the world. In this sense, we take an enactive and embodied approach to cognition in which we conceive cognitive agents as sensorimotor systems whose perception-action occurs in terms of affordances. This framework provides an integrative view of autism considering affectivity, perception, action, exploration, and interaction within a complex and dynamic dimension. Following this, we propose different applications based on embodied, intercultural, and feminist epistemologies, to understand and participate with autistic and cognitively diverse populations. The change in theoretical and methodological paradigms within embodied cognitive science towards autism and other cognitive diversities and how they engage with the world can lead to more comprehensive, integrative, and bioethical approaches.

The structure of analogical reasoning in bioethics.

Casuistry, which involves analogical reasoning, is a popular methodological approach in bioethics. The method has its advantages and challenges, which are widely acknowledged. Meta-philosophical reflection on exactly how bioethical casuistry works and how the challenges can be addressed is limited. In this paper we propose a framework for structuring casuistry and analogical reasoning in bioethics. The framework is developed by incorporating theories and insights from the philosophy of science: Mary Hesse's ideas on horizontal and vertical relations in analogical reasoning in the sciences, Paul Bartha's articulation model of analogical reasoning and Daniel Steel's insights on mechanism-based extrapolation in biomedical research. Adopting our framework results in two practical benefits: it sets methodological standards for analogical reasoning and enables us to compare and evaluate diverging lines of analogical reasoning in a systematic way. Adopting the framework also has theoretical benefits: it helps to understand how analogical reasoning can have moral normativity; it pinpoints exactly where moral principles or theories enter analogical reasoning; and it helps to understand why casuistry is an attractive method in bioethics and in applied ethics more generally.

Disclosure Of Final Stadium Patients' Diagnosis Review From Law And Bioethics In Indonesia

The relationship between doctor-patient rights and obligations, especially in hospitals, cannot be separated from conflicts or disagreements. These conflicts usually occur in special conditions that cause dilemmas in decision-making by doctors. Disclosure of the truth of the diagnosis in terminal patients or those suffering from end-stage disease is an ethical and legal issue that often occurs in health services. Problems occur, where on the one hand if the doctor tells the truth (reveals the truth) regarding the diagnosis/disease and on the other hand the doctor is worried that revealing the truth will have an impact that can worsen the patient's condition such as making the patient more depressed so that the patient can refuse further treatment. . But on the other hand, patients have the right to know information related to their illness. This research was conducted with a normative review approach. The results of this study found that disclosure of the truth about the end-stage disease can cause disturbances in psychological aspects and can potentially affect the patient's quality of life. The legal approach in disclosing the truth of end-stage disease through Law Number 36 of 2009 concerning health, Law Number 44 of 2009 concerning hospitals, and Law Number 29 of 2004 concerning medical practice is not fully the basis for the implementation of doctors in conveying the truth. Therefore, the bioethical aspect approach in this case through the principles of non-maleficence and respect for autonomy, truth disclosure can be done ethically and can minimize the negative impact of truth disclosure.

The birth of the "digital turn" in bioethics?

The so-called "empirical turn" in bioethics gave rise to extensive theoretical and methodological debates and has significantly shaped the research landscape from two decades ago until the present day. Attentive observers of the evolution of the bioethical research field now notice a new trend towards the inclusion of data science methods for the treatment of ethical research questions. This new research domain of "digital bioethics" encompasses both studies replacing (or complementing) socio-empirical research on bioethical topics ("empirical digital bioethics") and argumentative approaches towards normative questions in the healthcare domain ("argumentative digital bioethics"). This article draws on insights taken from the debate on the "empirical turn" for sounding out perspectives for the newly developing field of "digital bioethics." We particularly discuss the disciplinary boundaries, chances and challenges, and potentially undesirable developments of the research field. The article closes with concrete suggestions on which debates need to be initiated and which measures need to be taken so that the path forward of "digital bioethics" will be a scientific success.

Informed consent of postmortem sampling: Bibliographic review.

Informed consent is based on the principle of personal autonomy, the moral conception of respect for the dignity of the human being and therefore on his freedom. The rest of the universal bioethical principles are articulated in the informed consent process: non-maleficence, justice, and beneficence. Establish the situations in which it is pertinent to apply informed consent in the taking of postmortem samples from a bioethical approach versus a legal approach. A review was carried out in: SCIELO, LILACS, IBECS, CUMED, NIH, Repository of the Pan American Health Organization; using keywords: informed consent, human rights, autonomy, bioethics, autopsy, post-mortem samples and forensic doctors and a combination of these. The inclusion criteria: articles with a maximum age of five years, in Spanish and English with free access. 113 articles were obtained using the keywords and their combinations, plus another 43 additional records identified from other sources such as laws, regulations, etc. By eliminating the sources: duplicates, not relevant, disabled, and incomplete, a total of 49 articles were worked on. There is a need to include in the national and international ethical guidelines that regulate scientific research and guidelines to follow on the completion of the informed consent process in studies that involve postmortem samples, after their primary use.

Escaping the Shadow

Escaping the Shadow

Bioethical approach: production of nursing knowledge in Brazil

Resumen Este artículo pretende contribuir a la reflexión crítica sobre la producción de conocimiento en enfermería con enfoque bioético en las publicaciones brasileñas. Se trata de una revisión bibliográfica realizada en SciELO utilizando los descriptores “enfermagem”, “bioética” y “ética” para artículos publicados entre 1999 y 2019. Los resultados identificaron 43 artículos y, después de aplicar los criterios de inclusión y exclusión, se seleccionaron 16 trabajos que abordaron temas como la enseñanza de la ética/bioética en la carrera de enfermería, los cuidados intensivos/fin de la vida, la donación de órganos y la atención/acción/cuidado en salud. Hubo una transición entre los temas emergentes considerando el contexto histórico a lo largo de los años y el interés del área.

Bioethical approach: production of nursing knowledge in Brazil

Resumo Este artigo busca contribuir para o processo de reflexão crítica sobre a produção do conhecimento em enfermagem com enfoque bioético em publicações brasileiras. Trata-se de revisão bibliográfica realizada por meio de buscas na SciELO utilizando os descritores “enfermagem”, “bioética” e “ética”, incluindo artigos publicados entre 1999 e 2019. Como resultado, identificaram-se 43 artigos e, após aplicar critérios de inclusão e exclusão, foram selecionados 16 trabalhos, cujos temas eram ensino da ética/bioética para o curso de enfermagem, seguido por terapia intensiva/ou terminalidade, doação de órgãos e atendimento/ação/cuidar em saúde. Verificou-se transição entre os temas emergentes considerando o contexto histórico no decorrer dos anos e o interesse da área.

Testing Design Bioethics Methods: Comparing a Digital Game with a Vignette Survey for Neuroethics Research with Young People

Background Over the last decades, the neurosciences, behavioral sciences, and the social sciences have all seen a rapid development of innovative research methods. The field of bioethics, however, has trailed behind in methodological innovation. Despite the so-called “empirical turn” in bioethics, research methodology for project development, data collection and analysis, and dissemination has remained largely restricted to surveys, interviews, and research papers. We have previously argued for a “Design Bioethics” approach to empirical bioethics methodology, which develops purpose-built methods for investigation of bioethical concerns. In this paper we compare a research tool created using a design bioethics approach to a “methods-as-usual” approach in empirical bioethics. Methods Our study compared dimensions of engagement with a digital game we created, called “Tracing Tomorrow,” to a standard vignette survey. The two tools investigated the same subject matter, digital phenotyping for mental health, in a sample of 301 UK adolescents. Results Participants who played the game reported a greater sense of presence, emotional engagement, cognitive absorption, and mental health ethics insight, compared to participants who completed the vignette survey. Perceived authenticity and curiosity/motivation to learn more was equivalent for both methods. Conclusion The results of this study highlights the importance of purpose-built methodology for empirical bioethics research.

Engaging Diversity

Engaging Diversity

Justification for requiring disclosure of diagnoses and prognoses to dying patients in saudi medical settings: a Maqasid Al-Shariah-based Islamic bioethics approach

BackgroundIn Saudi clinical settings, benevolent family care that reflects strongly held sociocultural values is commonly used to justify overriding respect for patient autonomy. Because the welfare of individuals is commonly regarded as inseparable from the welfare of their family as a whole, these values are widely believed to obligate the family to protect the welfare of its members by, for example, giving the family authority over what healthcare practitioners disclose to patients about their diagnoses and prognoses and preventing them from making informed decisions about their healthcare.DiscussionFamily dominance over the healthcare decisions of competent patients is ethically problematic when the family prevent healthcare practitioners from disclosing diagnoses and prognoses to patients who have the capacity to consent and make decisions in their own best interests. Thus, the author holds that sociocultural values ought to be respected only when they do not prevent competent patients from knowing their diagnoses and prognoses or prevent them from making their own decisions.ConclusionHealthcare practitioners should not allow patients’ families to control what can or cannot be disclosed to competent patients. This is particularly important when patients are approaching death so that they may address their material and spiritual wishes—among other needs—as they prepare for death. Justification for this position is drawn from the Maqasid Al-Shariah-based Islamic bioethics approach, from which it is possible to argue that the harm of withholding diagnoses and prognoses from patients who are imminently dying outweighs the potential benefits.

The sociology of rationing: Towards increased interdisciplinary dialogue ‐ A critical interpretive literature review

Since the 1990s, the sociology of rationing has developed in explicit opposition to health economic and bioethical approaches to healthcare rationing. This implies a limited engagement with other disciplines and a limited impact on political debates. To bring the sociology of rationing into an interdisciplinary dialogue, it is important to understand the disciplines' analytical differences and similarities. Based on a critical interpretive literature synthesis, this article examines four disciplinary perspectives on healthcare rationing and priority setting: (1) Health economics, which seeks to develop decision models to provide for more rational resource allocation; (2) Bioethics, which seeks to develop normative principles and procedures to facilitate a just allocation of resources; (3) Health policy studies, which focus on issues of legitimacy and implementation of decision models; and lastly (4) Sociology, which analyses the uncertainty of rationing and the resulting value conflicts and negotiations. The article provides an analytical overview and suggestions on how to advance the impact of sociological arguments in future rationing debates: Firstly, we discuss how to develop the concepts and assumptions of the sociology of rationing. Secondly, we identify specific themes relevant for sociological inquiry, including the recurring problem of how to translate administrative priority setting decisions into clinical practice.