Bioethical Approach Research Articles

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.

FILM ART AND CONVERSATION CIRCLE AS AN LEARNING STRATEGIES IN BIOETHICS FOR COLLECTIVE SUBJECTS

Films are important tools of communication, expression, and perception of the world and important tools in the teaching and learning process. The present article aimed to analyze the discourses that emerged from the cinematographic work, having the conversation circle as a strategy for problematizing bioethics in the work process of teachers, students, and health workers. This is a descriptive study with a qualitative approach, with data collected from an interview guided by a semi-structured script. Faculty, students, and health workers participated in the study. Data analysis based on the content analysis technique, supported by the Atlas.ti version 9.0 software, enables the identification of two thematic categories: film art as a strategy for bioethical reflection and bioethical implications in teachers’ daily practices, students, and health professionals. The results revealed that the use of cinematography engenders a new formulation of the teaching-learning process, allowing participants to reflect on everyday ethical dilemmas. It’s concluded that it’s imperative to broaden debates with bioethical approaches, anchored to cinematographic art, as an effective method to stimulate reflective thinking.

Bioética de proteção: fundamentos e perspectiva

Abstract This article seeks to reflect on the perspective of bioethics of protection and explain its tools, by using a bibliographic survey based on the theorical marks of its main idealizers and the informative reading technique, which seeks to identify the thematic and the main ideas involved. To that end, we first present protection as a bioethical principle by going deeper into the origin, to the definition and the analysis of the terms “vulnerability”, “susceptibility” and “injury”. Then, we seek to present the bioethical approaches regarding the “principle of protection”. Finally, we argue that bioethics of protection works as a paradigm for the apprehension, analysis, and resolution of moral conflicts in public health, revealing itself a fundamental approach in this field, considering its challenge is facing the tension between the individual and the collective spheres.

The role of Data Transfer Agreements in ethically managing data sharing for research in South Africa

A multitude of legislation impacts the use of samples and data for research in South Africa (SA). With the coming into effect of the Protection of Personal Information Act No. 4 of 2013 (POPIA) in July 2021, recent attention has been given to safeguarding research participants’ personal information. The protection of participants’ privacy in research is essential, but it is not the only risk at stake in the use and sharing of personal information. Other rights and interests that must also be considered and safeguarded include the right to non-discrimination, the right to dignity, and the right to enjoy the benefits of scientific progress. This can be achieved by ensuring that the ethical values and universal principles that underpin the research landscape, namely equity, reciprocity, justice and solidarity, are embedded in the regulatory framework for the management and use of personal information. This paper advocates an integrated bioethics approach to the use of personal information for research in SA. A key feature in embedding such an approach is a Data Transfer Agreement (DTA) that appropriately integrates the safeguards and protections set out by our regulatory framework with bioethical rules and procedures when personal information is used and shared for research purposes. This paper thus calls for the development of a national DTA that is guided by key ethical principles when data are shared for research purposes. This paper will be followed by a webinar on 23 June 2022 hosted by the Department of Science and Innovation and the SA Medical Research Council, where the recommendations and suggestions set out herein will be unpacked, discussed and debated by relevant stakeholders.

Social group "65 plus": Pandemic's ethical dilemma

Background: The conditions of the emergency create an unprecedented, but legitimate approach, when the rights and freedoms of the individual can be limited in the public interest. From the first days of the pandemic, a special social group of the population began to stand out, with the code name "65+".
 Aim: to give an ethical assessment of the attitude of society to the population group "65+", to show the contradiction between medical and bioethical approaches to the criteria for selecting a group.
 Materials and methods: The review of fundamental and modern works in the problem field was carried out. The empirical basis of the work was the materials of a sociological survey using Google forms (N = 520).
 Results: According to the analysis of statistical indicators of employment in the Russia before the pandemic (2019), the share of employees aged 6064 years was 32,4 %, in the range of 6569 years 13,7% of the size of the age group, which indicates the high social activity of the 65+ group (approximately every third or fourth pensioner continues to work) and demonstrates the labor potential of the group. At the same time, anti-epidemic measures related to restrictions on labor and social activity primarily affected this group, which led to stigmatization based on the age criterion. The long-term confrontation with the pandemic has weakened the psychological tactics of treating older patients that have not been fully developed in the national health care, based on the ethics of care. A survey of medical students (aged 2124) conducted in March 2021 showed that the majority (82,8 %) of respondents viewed restrictions as unacceptable discrimination.
 Conclusion: The review of updated research and the analysis of the current situation have shown that the phenomenon of the aging of the nation and the vulnerability of the older age group of the population to a new coronavirus infection have led to a contradiction in approaches to the considered age group from the standpoint of medicine and bioethics. The inherently humane measure of protection for a group that is especially vulnerable in terms of medical indicators began to be perceived by the society as a reason for stigmatization. The solution to the dilemma is possible in the context of the convergence of medical and human sciences in the interdisciplinary problem field of gerontology and geriatrics.

Cripping vulnerability: A disability bioethics approach to the case of early autism interventions

The relationships between neurodivergent and disabled communities, and healthcare practices, are marked by ambivalence. While there is a history of harmful and discriminatory practices, the clinical encounter also holds beneficial and empowering potential for neurodivergent and disabled people. To address this ambivalence, this paper’s central question is whether and how bioethical decision-making in healthcare settings can become more informed by critical insights from neurodiversity and disability studies. The bioethical debate in Western countries on early interventions for young autistic children will be the case animating my theoretical propositions. I provide a working definition of such a ‘disability approach to bioethics’ and review the obstacles in both mainstream bioethics and disability studies this approach has to overcome. Then, the ethical concept of vulnerability, its feminist reinterpretation, and its potential for disability bioethics are introduced. Instead of using the concept in its traditional, problematic sense, I propose that vulnerability can be reclaimed, or cripped, by neurodiversity and disability movements to do the exact opposite: to trouble the demarcation between the vulnerable and the invulnerable, to stress structural injustices over individual deficits, and to justify solidaristic, empowering interventions over paternalist ones. Finally, this ‘cripped account of vulnerability’ will be applied to the case of early autism intervention.

Ageísmo, sindemia covídica e Bioética de Intervenção: uma concretude interdisciplinar

ABSTRACT This is a critical-reflexive theoretical study with the aim of reflecting on issues of an interdisciplinary nature: ageism in the complexity of the COVID-19 pandemic in the light of the fundamentals of Intervention Bioethics. The assumption is that complex problems require complex solutions, which a fragmented, disciplinary view is not capable of addressing. For this purpose, the essay is organized in three acts: ageism as an old and persistent phenomenon; the COVID-19 pandemic and the expansion of ageism; and the bioethical approach as an episteme and interventional tool. It is hoped that this theoretical exercise can transcend into personal, relational, and institutional daily life, where understanding the dimensions and determinants of ageism can incite creative ethical thoughts, feelings, and attitudes to mitigate age-related derogatory aspects.

Bioethics and COVID-19: Considering the Social Determinants of Health.

In this paper, we focus on a novel bioethical approach concerning the ethical implications of the Social Determinants of Health (SDs) in the time of COVID-19, offering a fresh interpretation of our agency and responsibility in the current pandemic era. Our interpretation is grounded on the idea that our health basically depends on factors that go beyond our organism. In this sense, we stress the radical importance of circumstances to ethically assess an action, in the current pandemic context. Moreover, due the centrality of the SDs in our bioethical assessments—that implies that our health does not exclusively depend on our choices, behaviors, and lifestyle—we can affirm that we are not entirely responsible for our wellness or diseases. As health depends on economic, social, cultural, and environmental factors, we argue that the analysis of personal responsibility facing personal health status should receive further consideration. In this sense, following the “social connection model,” we stress the importance of the concept of “shared responsibility” in collective decisions: if we make many decisions collectively, we are also collectively responsible of these decisions. Furthermore, to responsibly tackle the social inequalities that are the underlying cause of disparities in health outcomes, we propose two main strategies based on the Capability Approach: 1. empowering the individuals, especially the most vulnerable ones; and 2. designing preventive policies and interventions that provides an opportunity to address the disparities moving forward. This will help us going beyond the “individualistic medical ethics paradigm” and integrating our concept of health with social factors (e.g., the SDs), based on a more relational and interdependent anthropological thought.

Desafios bioéticos do uso da inteligência artificial em hospitais

Abstract This paper explores advantages and possible bioethical challenges of using artificial intelligence in hospitals. By identifying challenges both in the development of artificial intelligence systems (pre-hospital phase), its adoption, and training of healthcare teams (hospital phase), it analyzes the role of the bioethical approach in addressing this situation, especially in hospital bioethics committees. Hence, by identifying individual – related to autonomy, consent and patient privacy –, and collective challenges – how society at large should behave before new technologies –, the paper examines the role of the state in protecting patient privacy in contexts where artificial intelligence is used. In conclusion, considering the human vulnerability before technology, regulation is a tool that, anchored in bioethical principles, aims to minimize the challenges concerning artificial intelligence in hospitals.

Attitudes of the Ecuadorian University Community Toward Genetically Modified Organisms.

Introduction: The acceptance of genetically modified organisms (GMOs) by the civilian population in Ecuador is a controversial issue, where beliefs and practices are determinant. In Ecuador, the use of GMOs for research or productive purposes has been banned since 2008; however, the current position of the population toward this technology is unknown. Objective: The aim of the study was to explain the attitude toward GMOs in the Ecuadorian university population based on sociodemographic variables, knowledge, beliefs, practices, and bioethical approach. Methods: A validated survey was applied to 719 students and teachers of the Catholic University of Cuenca through Google Forms. The collected data were processed using SPSS 23.0 software. Multivariate and linear regression analyses were used to explain the attitude toward GMOs based on the variables studied. Results: Partial approval of GMO use is research-oriented, with a rejection toward food. The linear regression model explained 65% of the variance of attitude toward GMOs from the beliefs, practices, knowledge, and bioethical approach variables. The sociodemographic variables were completely excluded from the model due to the absence of statistical significance. Conclusions: The incipient acceptance of GMOs in the academic sector corroborates a transformation in the thinking of Ecuadorian civil society. Considerations on the use of GMOs are supported by a bioethical approach that leans toward a pragmatic utilitarianism based on the immediate or mediate benefits of the technology.

Bioethical aspects in the safety of cardiovascular surgery patients and their renal protection. Systematic review

Renal dysfunction is common and can be severe in patients requiring cardiac surgery. There is currently a growing international interest in the declaration of Safe Health Units, around the safety of the surgical patient. This interest is influenced at the same time by utilitarianism and the defense of the great value of human life. The general objective was to analyze, from the bioethics of health care and the contents of surgical patient safety, acute kidney injury associated with cardiac surgery. A systematic review was carried out using the PRISMA methodology in PubMed databases with articles published in the last five years. The pathophysiology of the entity studied is complex and still poorly understood. In this period, there was a great interest in investigating acute kidney injury associated with cardiac surgery, however, no other studies were found that addressed this issue from a personalist bioethical approach. High scientific quality and methodological rigor were found in the included studies, assessed by the predominance of systematic reviews, meta-analyses, and multicenter, randomized, double-blind controlled studies. An interesting and novel field is initiated, which facilitates, from perspectives with a comprehensive and more humane assessment, decision-making on acute kidney injury associated with cardiac surgery.

Global bioethics approach to public health

Global bioethics, unlike biomedical ethics, deals not only with professional standards, but with common significant global problems of mankind. Bioethical model of health is based on the fact that health is a phenomenon which is not associated solely with medicine and medical institutions. One of the key ideas of global bioethics is reforming of medical field in order to create a reliable system for the protection of public health on a global scale. The future of bioethics ideas will be certainly determined by the quality and dynamics of democratic reforms in all spheres of Ukrainian society.

Bioethics Approach to Genetic Modified Organisms

Ethics, from the ancient Greek – éthikos – accrue from ethos, usual dwelling, understood as forming habit, which can be understood as character or nature. In the same way, moral, from the Latin – morales – is better understood in the sense of habit

Biomedical Ethics for Jehovah’s Witnesses and Patient Blood Management

Jehovah’s Witnesses refuse blood transfusions according to religious beliefs, and for this reason, most hospitals and doctors have refused their treatment. There are more than 100,000 religious people in Korea, but there are few bloodless centers that can receive their treatment. So, the number of Jehovah’s Witnesses patients visiting bloodless centers in Soonchunhyang University Bucheon Hospital has been increasing every year. Despite this situation, no legal or medical countermeasure has yet been proposed against them. Therefore, I would like to take a bioethical approach based on “principles of biomedical ethics” and introduce “patient blood management” which is currently spreading in advanced medical countries.

Pogrešna medikalizacija i epistemička nepravda u psihijatriji

In this paper, my goal is to use an epistemic injustice framework to extend an existing normative analysis of over-medicalization to psychiatry and thus draw attention to overlooked injustices. Kaczmarek (2019) has developed a promising bioethical and pragmatic approach to over-medicalization, which consists of four guiding questions covering issues related to the harms and benefits of medicalization. In a nutshell, if we answer “yes” to all proposed questions, then it is a case of over-medicalization. Building on an epistemic injustice framework, I will argue that Kaczmarek’s proposal lacks guidance concerning the procedures through which we are to answer the four questions, and I will import the conceptual resources of epistemic injustice to guide our thinking on these issues. This will lead me to defend more inclusive decision-making procedures regarding medicalization in the DSM. Kaczmarek’s account complemented with an epistemic injustice framework can help us achieve better forms of medicalization. I will then use a contested case of medicalization, the creation of Premenstrual Dysphoric Disorder (PMDD) in the DSM-5 to illustrate how the epistemic injustice framework can help to shed light on these issues and to show its relevance to distinguish good and bad forms of medicalization.

Use of andragogical methods in the process of improving the bioethics competence of medical students in forming a healthy lifestyle

The article highlights the peculiarities of teaching medical students the basics of "Fundamentals of Bioethics and Biosafety" using andragogic models of the educational process and interactive principles of learning, such as dialogic interaction, cooperation and collaboration, active-role (playing) participation, as well as organization of training to improve communication skills in combating bad habits and maintaining a healthy lifestyle.Aim. To reveal the possibilities of andragogical methods of teaching "Fundamentals of Bioethics and Biosafety" in considering the issues of bioethical aspects of health, the formation of a professional approach and critical attitude of medical students to bad habits, motivation for a healthy lifestyle.Conclusion. The introduction of interactive methods of andragogy in the educational process deepens the knowledge and forms skills of medical students in the educational component "Fundamentals of Bioethics and Biosafety", actualizes the problem of bad habits as a leading threat to health, promotes awareness of the role of future health professionals in promoting healthy lifestyle on the ground of knowledge and bioethical approaches to the factors of negative and positive effects on health.

The war of ethical worlds: why an acceptance of Posthumanism on Mars does not imply a follow up on Earth

Space bioethics, or the bioethical approach to space exploration, is still a very limited field that mostly spins off from debates that we are having on Earth already. When discussing hypothetical scenarios such as that of colonizing Mars or other planets we tend to filter such conceptualizations through the eyes of our earthly standpoint. Yet, by looking into some of the approaches that various Posthumanist scholars with different levels of space exploration enthusiasm propose, we should resist the temptation to establish or reinforce a continuity between the ethical standards applied on Earth and Mars (or other planets or contexts in Space that substantially differ from Earth). This temptation is indeed very strong in the current literature; hence it needs to be addressed so to help us not being deviated from understanding what Mars or space colonization might indeed imply for humanity. This paper wants to introduce to a wider audience the concern that it is of crucial importance to acknowledge that the exceptionality of the conditions occurring in space should not be used as a tool to lower our guard towards a mass implementation of societal, biological and ethical revolutions on this planet and our world as the result of maladapting states of exceptionality that might work well in space but have a much weaker ethical legitimacy on Earth.

The Sociotechnical Ethics of Digital Health: A Critique and Extension of Approaches From Bioethics.

The widespread adoption of digital technologies raises important ethical issues in health care and public health. In our view, understanding these ethical issues demands a perspective that looks beyond the technology itself to include the sociotechnical system in which it is situated. In this sense, a sociotechnical system refers to the broader collection of material devices, interpersonal relationships, organizational policies, corporate contracts, and government regulations that shape the ways in which digital health technologies are adopted and used. Bioethical approaches to the assessment of digital health technologies are typically confined to ethical issues raised by features of the technology itself. We suggest that an ethical perspective confined to functions of the technology is insufficient to assess the broader impact of the adoption of technologies on the care environment and the broader health-related ecosystem of which it is a part. In this paper we review existing approaches to the bioethics of digital health, and draw on concepts from design ethics and science & technology studies (STS) to critique a narrow view of the bioethics of digital health. We then describe the sociotechnical system produced by digital health technologies when adopted in health care environments, and outline the various considerations that demand attention for a comprehensive ethical analysis of digital health technologies in this broad perspective. We conclude by outlining the importance of social justice for ethical analysis from a sociotechnical perspective.

Foundational Elements of an Ethical Decision-Making Model Applied in the Biopharmaceutical Context

"We previously described an applied values-based decision-making model and reported on its use in biopharmaceutical research and development (R&D)*. The model, known by the acronym “TRIP &TIPP”, uses company values along with framing questions as part of a five-step process to guide decisions to complex questions. The employees are engaged as moral agents applying values and principles. Their moral intuition is guided by systematic use of explicit framing questions to increase the understanding and clarity of the values and contextual questions to facilitate the practical implementation of solutions. Sometimes these solutions lead to the creation of internal guidelines in the company. The ethical norms for biopharmaceutical R&D are shaped by the interaction between ethical reasoning and the context of the situation. Several levels of context are relevant here. First, that of the company within society, which is represented by the stakeholders in our model. This societal context is dynamic as societal expectations change over time. Second, the context of the employees within the company: how the company is organized, its mission, vision and values, as well as the capabilities, experiences and beliefs of the employees. Third, the specifics of the R&D question itself, which requires a pragmatic, solution-oriented, bioethical approach. Finally, ethical deliberation leads to evolving company practices addressing science, technology and society changes. "