Bioethical Approach Research Articles

Legal system for the protection of life, health and welfare of animals – bioethical approach within the legal framework

Legal system for the protection of life, health and welfare of animals – bioethical approach within the legal framework

Editors' Note.

Editors' Note James M. DuBois, Ana S. Iltis, and Heidi A. Walsh This issue completes the eighth volume of Narrative Inquiry in Bioethics. The narrative symposium in this issue is edited by Kelly K. Dineen and Daniel S. Goldberg, and is titled, "Living with Chronic Pain in the Midst of the Opioid Crisis." The symposium presents a collection of stories by individuals who have struggled with or been a witness to a loved one's chronic pain at a time when the US is experiencing an opioid-addiction crisis. Prescription opioids can be effective medications for treating pain, but they are also drugs of abuse and misuse. Long term use can lead patients to develop tolerance and physical dependence. The authors describe a range of experiences. Some describe how because of opioids they are able to work, take care of their children, and live a "normal" life, while others have been under-treated or abandoned by their physicians who, due to heightened scrutiny of opioid prescribing practices or concerns about addiction, are hesitant to prescribe opioids. Many authors describe non-pharmacological approaches to treating their pain with varying success. The three commentary articles by Caroline Huang, Travis N. Rieder, and Maia Szalavitz offer insights into the authors' stories from the perspective of their personal experiences or expertise related to opioids, substance abuse, and chronic pain. Eline M. Bunnik, Frans Meulenberg, and Inez D. de Beaufort contributed a research article to the issue titled Ethical Issues in the Beauty Salon: The Development of National Ethics Guidelines for Aestheticians in the Netherlands. The article describes a novel and significant concern about beauty salons from a bioethics perspective. Aestheticians' services increasingly overlap with medical care. The demand for risky and sometimes irreversible treatments (e.g., laser hair removal, Botox injections, chemical peels) is growing. The authors conducted a study in the Netherlands to explore 17 domains of ethical issues that apply to the beauty salon environment, including age limits, vulnerable groups, informed consent, and confidentiality. The authors' work led to the development of the first national guidelines for aestheticians in the world. "Weight is the last admissible prejudice, and obese people are the targets of all kind of cruel behavior because of their size," write Lori A. Roscoe and Daniel P. Schenck in their case study, Victim of Abuse, or Bully? The Case of the 800-Pound Man. This case describes a morbidly obese patient who was taken to the hospital when he experienced difficulty breathing. His wife, son, and daughter-in-law had been taking care of him at home and continued to bring him whatever food he asked for in the hospital. The family reported giving in to his requests despite knowing the patient's weight was causing his underlying health problems because they feared his tantrums and were frightened of him due to his large size. The authors question if this patient bullied his family into getting what he wanted or whether their compliance with his requests, jeopardizing for his health and survival, made him a victim of abuse. [End Page v] News about Narrative Inquiry in Bioethics Narrative Inquiry in Bioethics aims to be the premier journal for qualitative research and narrative approaches in bioethics. For a list of current Calls for Stories and Author Guidelines, please visit http://nibjournal.org/submit/calls/. [End Page vi] Copyright © 2018 Johns Hopkins University Press

“The Doctor’s Dilemma” and Bioethics in Literature

The interface between literature and medicine has long been an area of interest for researchers. It is difficult to conceptualize any singular methodological approach for such an interdisciplinary field. However, the theoretical developments in Bioethics are promising. Besides, literary texts representing medical themes and characters have created a cultural discourse of Bioethical problems in the modern world. Borrowing its title from Shaw’s famous medical satire, The Doctor’s Dilemma, the present paper aims at exploring how far a bioethical approach—with special reference to the doctor-figures represented in some twentieth century literary works—can be helpful in delineating the complexities involved in issues like the doctor-patient relationship, medical ethics and the rapidly growing technological orientations in the modern world.

Bioethical Considerations of Advancing the Application of Marine Biotechnology and Aquaculture.

Normative ethical considerations of growth of the marine biotechnology and aquaculture disciplines in biopharming, food production, and marine products commercialization from a bioethical perspective have been limited. This paucity of information begs the question of what constitutes a bioethical approach (i.e., respect for individuals or autonomy; beneficence, nonmaleficence, and justice) to marine biotechnology and aquaculture, and whether it is one that is appropriate for consideration. Currently, thoughtful discussion on the bioethical implications of use, development, and commercialization of marine organisms or their products, as well as potential environmental effects, defaults to human biomedicine as a model. One must question the validity of using human bioethical principlism moral norms for appropriating a responsible marine biotechnology and aquaculture ethic. When considering potential impacts within these disciplines, deference must be given to differing value systems in order to find common ground to advance knowledge and avoid emotive impasses that can hinder the science and its application. The import of bioethical considerations when conducting research and/or production is discussed. This discussion is directed toward applying bioethical principles toward technology used for food, biomedical development (e.g., biopharming), or as model species for advancement of knowledge for human diseases.

Brazilian legal and bioethical approach about donation for research and patents of human body parts.

The aim of this paper is to explain why the Brazilian legal system does not accept commercialization or commodification of human body parts, including genes or cells. As a consequence, in Brazil, the donation of human body parts for research-including basic or translational-must be made altruistically. For the same reason, the Brazilian patent system cannot be applied to human parts, cells or genes. Here, we present a qualitative analysis of juridical, bioethical, and social reasoning related to the legal status of human body parts especially in biobanks, as well as a description of the Brazilian legal system for clarification. Our aim is to discuss the responsibility of researchers for making available the scientific information resulting from scientific research and biobank storage of human body parts and to ensure the free utilization of knowledge in human health research.

MORALĖS RIBOS IR PARIBIAI: NUO BIOETIKOS IKI GYVŪNŲ TEISIŲ

Straipsnyje tiriamas rūpesčio kitu konceptas, kartu parodant, kad supratimas, kokie poreikiai ir kieno teisės yra verti dėmesio, priklauso nuo kultūrinės terpės. „Kitas“ šiame straipsnyje suprantamas iš pačios plačiausios perspektyvos, kuri apima ne tik žmonės, bet ir gyvūnus, taip pat kitus biotos dalyvius. Atsiremiant į rūpesčio etikos teorijas išryškinama, kaip emocinė dimensija ir dėmesys egzistuojančioms rūpesčio kitais praktikoms gali praturtinti tradicinę bioetinę perspektyvą, išplečiant jos ribas tiek, kad ji apimtų visus žalą galinčius patirti gyvus organizmus. Tvirtinama, kad pagarbus rūpestis gyvūnais ir mus supančia aplinka yra įprotis, ne tik ugdomas nuo vaikystės, bet ir atitinkantis konkrečioje kultūroje egzistuojančias vertybes. Remiantis žymiausiomis aplinkosaugos ir gyvūnų etikos teorijomis atskleidžiama, kaip kinta vertybinis požiūris į gyvūnus bei aplinką. Šis kismas gali būti iliustruotas B. Rollino teiginiu, kad nėra jokio moraliai reikšmingo žmonių ir gyvūnų skirtumo, kuriuo remiantis gyvūnai negalėtų būti įtraukiami į etinio rūpesčio lauką. Straipsnyje siūloma moralės sferą bioetikoje išplėsti remiantis N. Noddings pasiūlytu rūpesčio konceptu, taip į šią sferą įtraukiant ne tik nežmogiškuosius gyvūnus, bet ir visą mūsų aplinką.

La cuestión del método en bioética clínica: aproximación a una metodología adaptada al contexto de la realidad mexicana

Este artículo trata la problemática del método para el abordaje bioético de los casos clínicos desde la bioética y analiza las distintas metodologías existentes, resaltando sus aportes y fortalezas, así como sus dificultades. Igualmente, se brindan herramientas de reflexión para la implementación de una metodología adaptada a la realidad mexicana, en las cuales se destacan las características propias de México en el análisis y discernimiento bioético.

THE RELEVANCE OF THE ETHICS OF VULNERABILITY IN BIOETHICS

The concept of vulnerability is central to current developments in bioethics, not only because of its analytic nature, but also due to its capacity for criticism. However, this concept has not been sufficiently developed, neither in the area of moral philosophy nor in bioethics. For this reason, it is necessary to define and analyze the conceptual framework in which the notion of vulnerability has been developed within the scope of bioethics. Thus, the purpose of this paper is to indicate how the concept of vulnerability in the field of bioethics has been developed and what the main problems that derive from this approach are. Secondly, the paper analyzes some of the main philosophical approaches that I consider should be articulated in the expansion of a critical bioethics approach focused on the notion of vulnerability. To address this issue, I analyze the reflections that we find in the work of Martha Fineman, emphasizing the main relevant aspects for bioethics. Finally, I highlight the main implications of a theory of vulnerability for bioethics.

Estudio exploratorio-descriptivo sobre las consideraciones bioéticas presentes en la intervención a personas con discapacidad psiquiátrica en los Hospitales de Día de la Región del Maule

This article relates bioethics and psychiatric disabilities. Through interviews with professional teams that representing the unit of analysis, describe the objectives of existing bioethical considerations in interventions for people with psychiatric disabilities are plotted, hoping to contribute a bioethical approach for optimizing these attentions. The research was conducted in the three Day Hospitals in the Maule Region -devices which accord preferential treatment to people with chronic psychiatric disorders- through a qualitative, exploratory and descriptive study. During the course of the study is possible to appreciate that our country is necessary to implement health care models that integrate a pragmatic concepts of justice and fairness as transverse, strongly on their own mental health care, given the particular vulnerability of those users and users; for example, through the development of a community and social bioethics. Finally, it is expected that from this work can generate lines of research that contribute to the progress in improving the quality of care for people with psychiatric disabilities.

Care ethics. A new bioethical approach to humanize the ICU

Adopting a unique Spanish perspective, this study aims to assess healthcare resource utilization (HCRU) and the costs of treating nosocomial pneumonia (NP) produced by methicillin-resistant Staphylococcus aureus (MRSA) in hospitalized adults using linezolid or vancomycin. An evaluation is also made of the renal failure rate and related economic outcomes between study groups.An economic post hoc evaluation of a randomized, double-blind, multicenter phase 4 study was carried out.Nosocomial pneumonia due to MRSA in hospitalized adults.The modified intent to treat (mITT) population comprised 224 linezolid- and 224 vancomycin-treated patients.Costs and HCRU were evaluated between patients administered either linezolid or vancomycin, and between patients who developed renal failure and those who did not.Analysis of HCRU outcomes and costs.Total costs were similar between the linezolid- (€17,782 ± €9,615) and vancomycin-treated patients (€17,423 ± €9,460) (P = .69). The renal failure rate was significantly lower in the linezolid-treated patients (4% vs. 15%; P < .001). The total costs tended to be higher in patients who developed renal failure (€19,626 ± €10,840 vs. €17,388 ± €9,369; P = .14). Among the patients who developed renal failure, HCRU (days on mechanical ventilation: 13.2 ± 10.7 vs. 7.6 ± 3.6 days; P = .21; ICU stay: 14.4 ± 10.5 vs. 9.9 ± 6.6 days; P = .30; hospital stay: 19.5 ± 9.5 vs. 16.1 ± 11.0 days; P = .26) and cost (€17,219 ± €8,792 vs. €20,263 ± €11,350; P = .51) tended to be lower in the linezolid- vs. vancomycin-treated patients. There were no statistically significant differences in costs per patient-day between cohorts after correcting for mortality (€1000 vs. €1,010; P = .98).From a Spanish perspective, there were no statistically significant differences in total costs between the linezolid and vancomycin pneumonia cohorts. The drug cost corresponding to linezolid was partially offset by fewer renal failure adverse events.Analizar la utilización de recursos sanitarios (URS) y los costes de la neumonía nosocomial por Staphylococcus aureus resistente a meticilina en adultos hospitalizados tratados con linezolid o vancomicina. También se evaluó el porcentaje de fallo renal entre dichos pacientes.Análisis post-hoc de un ensayo clínico fase iv multicéntrico, aleatorizado, doble ciego.Pacientes adultos, hospitalizados con neumonía nosocomial por Staphylococcus aureus resistente a meticilina.Pacientes tratados con linezolid (224) o vancomicina (224).Desde la perspectiva española se compararon costes y URS entre pacientes tratados con linezolid o vancomicina y entre los que desarrollaron fallo renal y los que no.Análisis de costes y URS.Los costes totales fueron similares (p = 0,69) en los pacientes tratados con linezolid (17.782 ± 9.615 €) o vancomicina (17.423 ± 9.460 €). La tasa de fallo renal fue significativamente menor en los tratados con linezolid (4 vs. 15%, p < 0,001). Los costes totales fueron mayores en aquellos que desarrollaron fallo renal (19.626 ± 10.840 € vs. 17.388 ± 9.369 €, p = 0,14). La URS (días de ventilación mecánica: 13,2 ± 10,7 vs. 7,6 ± 3,6, p = 0,21; días en UCI: 14,4 ± 10,5 vs. 9,9 ± 6,6, p = 0,30; días de hospitalización: 19,5 ± 9,5 vs. 16,1 ± 11,0, p = 0,26) y los costes totales (17.219 ± 8.792 € vs. 20.263 ± 11.350 €, p = 0,51) tendieron a ser inferiores en los pacientes tratados con linezolid que desarrollan fallo renal. Tras corregir el análisis por mortalidad, los costes diarios por paciente fueron similares (1.000 vs. 1.010 €; p = 0,98).Desde la perspectiva española, no hubo diferencias en la URS y los costes entre los pacientes con neumonía tratados con linezolid o vancomicina. El coste de linezolid fue contrarrestado por la menor incidencia de fallo renal.

Limitações Jurídicas à Experimentação no Novo Estatuto dos Animais

Este artigo apresenta os dispositivos sobre experimentação previstos no Estatuto dos Animais. Inicialmente, foi realizada uma abordagem teórica do biodireito e da bioética. A seguir, é mencionada a Lei Arouca, norma vigente que regulamenta o artigo 225 da Constituição Federal e autoriza a experimentação em animais. Posteriormente, são destacados elementos dos Projetos de Lei que visam alterar a Lei Arouca, em tramitação no Senado Federal. O objetivo é apresentar uma interpretação do caráter protetivo mais abrangente do Estatuto dos Animais quanto ao uso destes em experimentos científicos.

A single centre experience of deceased donor transplantation

In the United States, women are over-represented and Blacks are under-represented as living kidney donors. A traditional bioethics approach would state that as long as living donors believe that the benefits of participation outweigh the risks and harms (beneficence) and they give a voluntary and informed consent, then the demographics reflect a mere difference in preferences. Such an analysis, however, ignores the social, economic and cultural determinants as well as various forms of structural discrimination (e.g., racism, sexism) that may imply that the distribution is less voluntary than may appear initially. The distribution also raises justice concerns regarding the fair recruitment and selection of living donors. We examine the differences in living kidney donor demographics using a vulnerabilities analysis and argue that these gender and racial differences may not reflect mere preferences, but rather, serious justice concerns that need to be addressed at both the individual and systems level.

Care ethics. A new bioethical approach to humanize the ICU

Care ethics. A new bioethical approach to humanize the ICU

Ethico-legal issues related to ovarian tissue transplantation.

Ovarian tissue transplantation (OTT) is a promising experimental method which may soon become well-established. In cases of minor oncology, where patients' fertility is seriously threatened by treatment, it may be applied as a unique fertility preservation option. OTT has a dual nature ('organ' and 'gamete'). Many stakeholders are involved, including donor, recipient, child, health-care providers and society at large. There is considerable uncertainty about the long-term consequences of the application of OTT and OT cryopreservation (OTC). Thus, application of OTT gives rise to a number of very different ethico-legal issues and dilemmas which are hard to solve coherently through a principlism-based bioethical approach. This study focuses on such dilemmas and attempts to review them. The role of virtue ethics, which may be combined with principlism, is essential to solve such dilemmas coherently and reasonably. Dealing with conflicts of ethical principles equivalent between them, or moral dilemmas without available answers and mind-sharing in a difficult interpersonal process of decision making, requires a virtue-based ethical approach. Besides, ethico-legal issues related to OTC/OTT are complex issues requiring a multidisciplinary approach (ethical considerations, medical, psychological and social evaluations etc.). We stress the crucial role of multidisciplinary Ethics Committee which is considered indispensable for each reproductive health-care unit practicing OTC/OTT.

Vaccinate-or-mask: Ethical duties and rights of health care providers in obtaining or refusing the influenza vaccination

There is much controversy over the effectiveness of the influenza vaccination; yet, globally, many health institutions are implementing policies that require health providers to either receive the influenza vaccination or wear a surgical mask. This vaccinate-or-mask policy has caused great hullabaloo among health care providers and the institutions wherein they work. In light of the limitations to best practice evidence, we conducted an analysis of the policy and its implications based first on the bioethical principles of beneficence, nonmaleficience, respect for autonomy, and justice and then on the ethical theories of Immanuel Kant and John Stuart Mill. The most important ethical issue was threat to patient safety and welfare in the event of receiving care from a health provider who chose to forego the influenza vaccination and surgical mask requirement. We concluded that policies requiring health care providers to receive the influenza vaccination or wear a surgical mask are only partially supported by the bioethical principle approach; however, they are clearly justified from a deontological standpoint. That is, Kant would argue the rightness of the policy as a moral imperative for health care providers to not impose a health risk to those they serve and for health care institutions to ensure professional care giver vaccination. In further considering the vaccinate-or-mask policy in terms of the utilitarian “greatest good for the greatest number”, we determined that Mill would argue that this type of policy is ethically right and just, but also that policies solely requiring immunization would be ethical as public well-being is promoted.

Lifelong learning in bioethics and human rights: 10 years of the bioethics lifelong education programme in LAC

The paper introduces a methodological proposal to teach bioethics relying on the lifelong education model called pedagogy of problematization. The general methodology and its main sources at the global and the Latin American level are presented. It describes the basic educative model, its goals and its differences with the Problem Based Learning model. The requirements necessary to implement this methodology in relation to a broad approach of bioethics including social, environmental and global bioethics and not only biomedical ethics are presented. It is argued that this methodology represents a way of teaching bioethics from a broad perspective and targeting an interdisciplinary and diverse audience. Most important, the reflection-action model of education here proposed aims at a change of attitude in adult students and at transforming the reality into which the ethical problems emerge. After introducing this model, the paper, provides an account of the framework from which the Lifelong Learning Program in Bioethics (Redbioetica) in Latin America and the Caribbean has been developed, and how to use the tools necessary for making use of this methodology in a distance e-learning platform targeting adults. Finally, some of the main results of using this platform during its 10 years of existence are presented and it is showed that through this platform it has been possible involve almost 2000 participants from 26 countries in LAC.

Bioética narrativa y salud intercultural mapuche: Aportes a su fundamentación y complementación

This article aims to systematize the progress of the narrative approach in bioethics in order to propose a groundwork for intercultural health practices. Seeks propose a basis for intercultural health practices that facilitate the complementarity of the health system through the recovery of ancestral Mapuche Worldview, their roots and specificity. It will critically review the basics of narrative bioethics and its relationship with the hermeneutical currents in applied ethics and the movement of Narrative Medicine. At the same time relates the narrative approach to the intercultural paradigm in health, in order to assess its capabilities complementation and articulation. And finally it will report on the possibilities of developing an intercultural key Narrative Bioethics appropriate to the intercultural practices in health care based on the acquis of

Translational research—the need of a new bioethics approach

Translational research tries to apply findings from basic science to enhance human health and well-being. Many phases of the translational research may include non-medical tasks (information technology, engineering, nanotechnology, biochemistry, animal research, economy, sociology, psychology, politics, and so on). Using common bioethics principles to these areas might sometimes be not feasible, or even impossible. However, the whole process must respect some fundamental, moral principles. The purpose of this paper is to argument the need for a different approach to the morality in translational bioethics, and to suggest some directions that might be followed when constructing such a bioethics. We will show that a new approach is needed and present a few ethical issues that are specific to the translational research.

On Physician-Industry Relationships and Unreasonable Standards of Proof for Harm: A Population-Level Bioethics Approach.

The primary claim of this paper is that a widely used argument against obstructing, curtailing, or eliminating deep physician-industry relationships is deficient. The typical argument critiqued requires that proof that physician-industry relationships cause harm flows from randomized controlled trials. Chief among the deficiencies in this claim is the fact that this specific demand for proof of harm essentially guts the precautionary principle. In so doing, the typical argument neuters the basic justification for public health action. In place of this fallacious move, the paper argues that proof of harm can be demonstrated via evidentiary standards widely accepted within the knowledge communities of public health scientists and epidemiologists. The paper concludes by noting that while there may be good reasons to oppose curtailment of deep physician-industry relationships, the typical argument described here is not among them.

Clinical Ethics Cultural Competence and the Importance of Dialogue a Case Study

The traditional bioethical approach to addressing clinical ethical dilemmas is to apply ethical principles to analyse the dilemma to reach an ethically acceptable course of action. This paper will address the problem of what to do when the patient or patient’s proxy disagree with this advice. I will argue that ethical principles have limitations in a culturally diverse world, and that best practice guidelines whilst helpful rarely address the specifics of an individual clinical dilemma, and are often not based on robust evidence. Bioethical mediation has been proposed as an important process for clinical ethics support services. Whilst I agree with the need for this my contention is that this is not a new bioethical skill but is in fact the very core of what a good consultation consists of. I will illustrate this discussion with a general practice case study of vaccination refusal. My conclusion is that an approach that accepts and respects diversity and focusses on developing a trusting relationship is the most effective way to reach the best available resolution for clinical ethical dilemmas.