Bioethical Approach Research Articles

Different approach to medical decision-making in difficult circumstances: Kittay’s Ethics of Care

The onset of the COVID-19 pandemic has necessitated advances in bioethical approaches to medical decision-making. This paper develops an alternative method for rationing care during periods of resource scarcity. Typical...

Social Isolation of Older Adults in Long Term Care as a Result of COVID-19 Mitigation Measures During the COVID-19 Pandemic

Social Isolation of Older Adults in Long Term Care as a Result of COVID-19 Mitigation Measures During the COVID-19 Pandemic

Using Artificial Intelligence for High-Volume Identification of Silicosis and Tuberculosis: A Bio-Ethics Approach.

Although Artificial Intelligence (AI) is being increasingly applied, considerable distrust about introducing “disruptive” technologies persists. Intrinsic and contextual factors influencing where and how such innovations are introduced therefore require careful scrutiny to ensure that health equity is promoted. To illustrate one such critical approach, we describe and appraise an AI application – the development of computer assisted diagnosis (CAD) to support more efficient adjudication of compensation claims from former gold miners with occupational lung disease in Southern Africa. In doing so, we apply a bio-ethical lens that considers the principles of beneficence, non-maleficence, autonomy and justice and add explicability as a core principle. We draw on the AI literature, our research on CAD validation and process efficiency, as well as apprehensions of users and stakeholders. Issues of concern included AI accuracy, biased training of AI systems, data privacy, impact on human skill development, transparency and accountability in AI use, as well as intellectual property ownership. We discuss ways in which each of these potential obstacles to successful use of CAD could be mitigated. We conclude that efforts to overcoming technical challenges in applying AI must be accompanied from the onset by attention to ensuring its ethical use.

THE RELEVANCE OF VALUES HISTORY IN ITS RELATIONSHIP WITH THE SO-CALLED “LIVING WILLS”: A RELEVANT QUESTION RAISED BY LEGAL BIOETHICS.

El presente artículo, desde una mirada centrada en la Bioética Jurídica, tiene por objetivo el estudio de la values history en su relación con los ordinariamente denominados “testamentos vitales”, materias que deben incluir en su análisis la influencia ejercida por los respectivos códigos axiológicos. De esta manera, una vez estudiada la génesis de dichas figuras, nos centramos en sus contenidos para finalmente referirnos al Proyecto de Ley sobre Muerte Digna y Cuidados Paliativos, texto actualmente en discusión en nuestro Congreso Nacional. Así, siempre desde un enfoque fundado en la Bioética Jurídica, se trata la relevancia de los valores a los que adhieren las personas con respecto a temas tan trascendentales como la enfermedad, el dolor, los tratamientos médicos y la muerte.

Aligning Medical and Muslim Morality: An Islamic Bioethical Approach to Applying and Rationing Life Sustaining Ventilators in the COVID-19 Pandemic Era

Abstract The COVID-19 pandemic has spurred policymakers and religious leaders to revisit age-old questions about the ethics of pandemic control, the just allocation of scarce resources, and preparing for death. We add to these conversations by discussing the use of mechanical ventilation for COVID-19 patients. Specifically, we address the following: For Muslim patients/families when is it permissible to forgo mechanical ventilation? For Muslim clinicians, what circumstances justify the withholding or withdrawing of mechanical ventilation from patients? And for policymakers, is there an Islamically-justifiable rubric for allocating mechanical ventilation to patients in times of scarcity? Our Islamic bioethical analyses connect biostatistical data and social contexts with ethico-legal constructs to bridge the epistemic theories of biomedicine and the Islamic legal tradition. They reveal that forgoing mechanical ventilation is permissible for Muslims, that there are several conditions that allow for Muslim clinicians to justify withholding and withdrawing mechanical ventilation, and also several policy rubrics for ventilator allocation that would be justifiable.

Conscience and conscientious objection in nursing: A personalist bioethics approach.

The ability of nurses to act as moral agents in accordance with their conscience is both an essential human freedom and an important part of professional ethics. Recent developments in Canada related to Medical Assistance in Dying have revealed new and important challenges related to conscientious objection – challenges that may require rethinking of how nurses do professional ethics. Notably, the inclusion of a personalist bioethical approach is needed to introduce and explicate what conscience is for nurses to be able to apply it to nursing practice. In this article, we explore the importance of conscience and conscientious objection as ethical concepts to support nurses in addressing issues of conscience amid ethically challenging situations. We discuss how a personalist basis for conscience can support nurses to inclusively engage with one another across diverse moral perspectives.

Shared decisions in neonatal intensive care − bioethical approach

Technological and therapeutic advances in neonatal intensive care have led to a decrease in neonatal morbidity and mortality in recent decades. Along with technical and scientific expertise, it is important to provide a holistic and comprehensive approach to the care of the newborn and family. The purpose of this review is to describe and analyze strategies to improve decision-making within a shared process between health professionals and caregivers at neonatal intensive care setting. The decision-making process is not linear or immutable over time and there is no consensus on the definition of ‘shared decision’. More unanimous is the role of communication as a atherapeutic relationship pillar. Professional ethics, bioethics, and narrative medicine should be used as tools to address the vulnerabilities of families and professionals and as a way to consolidate and structure the human relational dimension intrinsic to medical practice.

Principios y regulaciones que orientan la evaluación de ensayos clínicos patrocinados por la industria farmacéutica en Comités de Ética de Investigación en Panamá

Se presentan los resultados de una investigación multicéntrica de evaluación de los Comités de Ética de Investigación (CEI) en Panamá, la cual busca mecanismos que ayuden a fortalecer su capacidad para evaluar, desde un enfoque de bioética y derechos humanos, los protocolos de los ensayos clínicos financiados por la industria farmacéutica o por los centros extranjeros de investigación, así como monitorear la implementación de los protocolos aprobados. Se revisó documentación suficiente y se hicieron entrevistas a miembros de cuatro CEI. A partir de ahí, se concluye que en Panamá los CEI respetan las normas internacionales de funcionamiento y de revisión de protocolos, y que los problemas encontrados guardan relación con su experiencia, el contexto social y la evolución de los intereses de las compañías farmacéuticas.

The Imperative of the Bioethical Approach to the Moral and Political Problems of the Coronacrisis COVID-19

Mass diseases in the modern world, such as epidemics and even more pandemics pose global threats and risks to human civilization. Few infectious diseases known or emerging pose vital ethical problems as quickly and sharply as they did during the outbreak of the new form of the coronavirus COVID-19. The peculiarity of this epidemic is that the emergency situation in healthcare over a short period of time escalated into an economic and geopolitical crisis, which received one of its names “Corona Crisis 2020”. The World Health Organization has classified COVID-19 as a worldwide pandemic. At the time of writing this article, the epidemic has declined, but in the future, there is a threat of a “new wave” of infectious diseases. The moral and political dilemmas arising from the outbreak of the new coronavirus, among other problems, also actualize many bioethical considerations in developing methods and tactics for combating the epidemic. The limited capabilities of the healthcare system and medicine in the treatment of infections highlight the need for understanding bioethical approaches to many problems and challenges affecting the vital values and interests of the individual, medical workers and society as a whole. We attempt to identify and briefly analyze some aspects of the political and moral state of modern society, due to corona crisis COVID-19. A comparative analysis of existing concepts of bioethics with an emphasis on the need for adapting ethical standards and requirements for public health policies is given. We stress the importance of adhering to the principle of mutual moral responsibility of the state and the individual; the protection of socio-economic and political rights and freedoms of a person during the period of implementation long-term measures of isolation and long-term emergency situation. Keywords: coronavirus COVID-19, pandemics, bioethics, policy, health organization

The Person and the Right to Life – Philosophical, Bioethical and Law Approach

We live in a postmodern society, characterized by an individual morality, ethical minimalism, etc., or we could call it liquid modernity, twilight of debt or late modernity, as Jürgen Habermas stated. Considering the conditions of such a society, where even education is achieved through ICT technologies, we consider it appropriate to make a brief review of subjective civil rights. Hence, we considered it opportune to discuss non-patrimonial rights, namely those concerning the dignity and physical and moral integrity of the person.

How Should We Respond to the Global Pandemic: The Need for Cultural Change

The Covid pandemic has had a terrible effect on the world and government responses have been described as “Catastrophic Moral Failure”. The approach of bioethics of developing “normative ethics” has provided frameworks on how to act but despite the fact that we knew what to do to prevent the pandemic, we did not do it. In this paper I argue that ethics is culture bound: it is the stories that “we” live by. I illustrate this with examples of cultures with differing values that were developed as a result of the particular circumstances of those cultures. I then argue that after World War 2 in response to the risks of further large wars and atrocities, work was done to further establish a “global culture” and a detailed normative ethical framework was developed by negotiation through the United Nations for that “culture”. Whilst this approach has been necessary, it has not been sufficient. I argue that we need to reframe the approach as one of achieving cultural change rather than complying with ethical norms. Some societies that were unable to adapt to changed circumstances failed to survive, others failed to thrive. A similar fate awaits the whole planet if we cannot change the stories we live by.

Уважая автономию пациента: добровольное информированное согласие в современной медицине

The article reveals the most influential in modern bioethics approach to understanding voluntary informed consent as a way to implement the principle of respect for patient autonomy, which is determined by both legal regulation and socio-cultural factors. The authors discuss the main elements of informed consent, its specificity in clinical trials, and criteria for autonomous choice.

The Application of Maqasid-Oriented Approach in Islamic Bioethics: A Case Study on Fatwa Related to Cosmetic, Plastic and Reconstructive Surgery

INTRODUCTION: Cosmetic surgery, which is a type of elective surgery designed to alter the physical features of the human body, is currently in high demand due to a combination of several main factors; namely low self-esteem, the desire to achieve beauty standards set by society, and the ubiquity of mass media and social media influencers. As a Muslim, cosmetic surgery must be evaluated from a jurisprudential lens to determine the level of necessity of the procedure, whether it reached the stage of essential (darurah), or necessity (hajah), or complimetary (tahsinah), along with close inspection of the maslahah dan mafsadah involved with the aspect of maslahah dan mafsadah in need of further clarification. A close inspection of medical fatwas relating to cosmetic surgery reveals that procedures that are intended solely for physical beautification with no medical justification whatsoever are forbidden. MATERIALS AND METHODS: This study collect data from fatwas issued by seven fatwa institutions worldwide, will look into the application of maqasid al-shariʿa in determining the legal status of cosmetic surgery in Islam. The data was analysed thematically. RESULT: The findings from this study suggest that all fatwas pertaining to cosmetic surgery were decided based on the considerations of maqasid al-shariʿa, which will greatly aid doctors and patients in evaluating the need, or the lack thereof, to proceed with cosmetic surgery. CONCLUSION: The discussion of Islamic law or fatwa related to medicine requires synergy between sharia experts and medical doctors.

“As Long As I’m Me”: From Personhood to Personal Identity in Dementia and Decision-making

As older people begin to develop dementia, we confront ethical questions about when and how to intervene in their increasingly compromised decision-making. The prevailing approach in bioethics to tackling this challenge has been to develop theories of “decision-making capacity” based on the same characteristics that entitle the decisions of moral persons to respect in general. This article argues that this way of thinking about the problem has missed the point. Because the disposition of property is an identity-dependent right, what matters in dementia and decision-making is an individual’s personal identity with their prior self, not their moral personhood. Therefore, in considering when and how we ought to intervene in the decision-making of those with dementia, we must look to the philosophy of personal identity rather than personhood.

Virtue Ethics and the Trilemma Facing Sentiocentrism

This article aims to question the value of impartiality in environmental ethics by highlighting a problem internal to the bioethics approach known as sentiocentrism. The principle that all beings with the same degree of consciousness should receive the same moral treatment would lead to a trilemma, i.e., the need to choose among three morally unacceptable choices. I argue those problems are related to the premise, shared by Utilitarianism and rights-centered theories, that impartiality is the constitutive feature of the moral point of view. In the last part of my article, I discuss how this problem points to some advantages of a virtue ethics approach to environmental ethics.

Creating an ethical culture to support recovery from substance use disorders

There is a long-standing failure to create an ethical culture around substance use disorders (SUDs) or dependence that actively supports people’s recovery efforts. Issues which impede the development of prorecovery...

Chapitre 1. Bioética y crisis global medioambiental

We address the ethical causes of the global ecological crisis we are currently undergoing, along with the expansion of the instrumental reason that is typical of modernity and the critics arisen from ecological ethics and feminism. Helping to solve the ethical crisis found in the base of ecology, with the intention of universal rationality, is possible from bioethical approach: utilitarianism and radical neoliberalism are useless, and maybe the foundations of our ethical duties with the nature and the rest of the living creatures may be found in the proposals of the dialogic ethics, neoaristotelian perspective and personalisme.

Pandemia, bioética e distanciamento social: Relação entre interesses coletivos e individuais

This work aims to provide an ethical approach to the tension between individual and collective interests during the new coronavirus pandemics. This conflict occurs because of the State interventions through measures adopted to stem the Covid19 spread, such as isolation, lockdown, social distance, and use of masks in public places. These measures have been seen by a large number of individuals as restrictions going against personal interests, specially concerning economic interests or leisure. For this reflection, the Aristotle's conceptions of politics, eudaimonia, and common good will be rescued, and the bioethical approach of the aristotelians Pellegrino and Thomasma about the defense of the good (in this case, meaning health) over the (individual) rights will be presented.

Subsequent Curves of COVID-19 in Society

Beyond the strict biological scenarios inherent to the virus, other consequences exist that require attention due to the duration and evolving alternate implications of the pandemic in our society. The relevance of other “curves” in the Covid-19 Pandemic, related with Non Covid diseases, socio-economic issues, the wear and tear on the medical and social service infrastructure, and the physical and mental deterioration in the human resources, need a special focus in the global strategies in the management of Covid-19 pandemic. Civil rights and legal implications, are another issue to have in mind in the decisions, because these guidelines must not be the cause of social discrimination or stigma in the society. This bioethics approach is particularly targeted to those who are primarily responsible for decision making in matters with an impact on public health.

Bioethics training in reproductive health in Mexico.

Bioethical approaches to reproductive health have been of utmost importance for the last three decades in Mexico. As Mexican laws regarding abortion, assisted reproduction, and conscientious objection have been modified, a number of social actors with an interest in these areas have realized that they have to educate the different agents who take part in these procedures in a bioethical approach to reproductive health and rights. This strategy was first used in Mexico by the Catholic Church and many Catholic universities. Advocates, scientists, and feminist organizations, as well as some public universities, have also realized that a grounding in bioethics could help health providers to have an ethical frame that supports the provision of abortion services. Bioethics is also a good framework for supporting the legalization of abortion and for more liberal laws regarding assisted reproduction. So, for the last few years, one of the priorities of these two sides, Catholic and secular groups, has been to train healthcare personnel, lawyers, and members of ethics committees and members of Congress in the application of their respective bioethical perspectives.