Bioethical Dilemmas Research Articles

Cytokine storm secondary to coronavirus disease-19 pneumonia in a preterm pregnancy: A management and bioethical dilemma

A 27-year-old primigravida at 26 weeks' age of gestation presented with difficulty of breathing, nonproductive cough, and generalized body malaise. Coronavirus disease-19 (COVID-19) infection was confirmed by a positive reverse transcription-polymerase chain reaction. She was diagnosed with severe COVID-19 pneumonia with progressive oxygen desaturation requiring intubation and intensive care unit admission. The management and bioethical dilemma involved the use of investigational therapeutic interventions for compassionate use, with unknown effects to the fetus, namely remdesivir, tocilizumab, dexamethasone, and hemoperfusion to manage the cytokine storm and prolong pregnancy or to terminate the pregnancy hoping that it might improve the deteriorating condition of the patient. A multidisciplinary approach and family conference to solve the dilemma resulted in a successful outcome.

The bioethical committee as an institute for social control of technological innovations in medicine: law analysis

The article provides a general description and classification of bioethical committees from the point of view of the subject and goals of their activities, the nature of their authority, legal status, organizational and legal foundations of their activity. The bioethical committee is interpreted as a special institutional form of organizing scientific (interdisciplinary) and public understanding of moral and legal problems in the field of medicine, generated by technological innovations. In the system of social control the bioethical committee is a social institution that is either integrated into the system of public administration, or creates its own channels of influence on the position of the professional medical community and public opinion. From this point of view the article analyzes foreign and Russian history of bioethics committees institutionalization. The author interprets bioethics as a field of scientific and practical activity, the social purpose of which is to translate actual bioethical dilemmas, unsolvable on the basis of abstract principles, into the communicative space, where a consensus can be based on common moral intuitions. The article substantiates the thesis that the main intention of bioethics and bioethics committees, as an expression of its practical function, is to find a legal solution to problems. The author made proposals for improving the legal support for the creation and operation of bioethical committees in Russia.

A narrative review of the challenges, ethical frameworks, and guidelines in the setting of COVID-19 healthcare and research.

The coronavirus disease (COVID)-19 pandemic has ever since its outbreak been perplexing healthcare generally at all levels. There is a need to identify, analyze and address the bioethical dilemmas that have emerged during the pandemic. This paper presents a narrative review of the published literature on the ethical issues, frameworks, and guidelines in COVID-19-related healthcare and research. An electronic search was conducted on PubMed, Google Scholar, and Science Direct using the search terms “COVID- 19” [AND] ethical issues, clinical trials, resource allocation, ethical guidelines, vaccine allocation. Articles between 2019 and 2020 focusing on ethics were included and analyzed. Fifteen full-text articles in English, one workshop summary, and 5 guidelines were identified and are discussed under the following themes: global response to the pandemic, allocation of resources, conduct of clinical trials, and fair distribution of vaccines and individual patient care. Despite the global and collaborative response to guide the healthcare sector throughout the pandemic, there have been some worrying repercussions in the form of increased vulnerabilities, precarious imbalances in resources, priority settings, exclusion of individuals or groups, exhaustions of healthcare professionals, impaired individual patient care, slowing down of non-covid research as well as scientific, ethical and logistic challenges in COVID and non-COVID research. These can be ethically justifiable only considering the seriousness and urgency of the pandemic. This paper presents some tenacious challenges that must be addressed if ethical reflection is to be effectively implemented in response to this pandemic.

Http://habibiaislamicus.com/index.php/hirj/article/view/193

Euthanasia is bioethical dilemma. Different countries are struggling for its legalization. The Proponents consider that Euthanasia is against the dignity of human being and everyone has right to relief his pain. They think that human beings have to live a life which is according to the standard of humanity but when a person suffers from a disease which is incurable, his standard of life goes down to a level which is not suitable for a human being. So in such condition they should have the right to end their lives with dignity. This paper basically deals with what is the concept of euthanasia? What is its history and what rationale does its proponents and opponents presents? This research is historical, analytical and descriptive. The views of both parties have been analyzed. The research shows that it is not a new phenomenon. Its roots are found in Greek period. Its proponents take it as a savior of human dignity and freedom. It’s the basic right of every human to decide about the end of his life. On the other side the opponents think that it is unethical and we don’t have a right to end our life as we are a part of big plan of God.

Bioethical aspects in type I neurofibromatosis

Type I neurofibromatosis is one of the most common monogenic disorders, being caused by abnormalities of the neurofibromin gene on chromosome 17. About half of the cases are inherited, respecting the autosomal dominant inheritance criteria, the rest are de novo cases. The clinical manifestations are multisystemic and are progressively installed, presenting inter- and intra-familial variability of clinical expression. The hereditary nature, impaired quality of life and lethal potential identify numerous and various ethical dilemmas in the diagnosis, monitoring and treatment of neurofibromatosis type 1. Variable expressiveness and multisystemic clinical manifestations determine the unpredictable evolutionary character, associating bio-ethical dilemmas necessary to be managed in the clinical context of the disease. As a clinical applicability, we conclude that some of these problems could be avoided by informing and educating affected families about the disease, by increasing confidence in specialized services and by using molecular techniques in order to know as accurately as possible the genotype-phenotype correlation.

Evolving an ethical framework for Covid-19 management in India.

The Covid-19 pandemic has caused millions of cases and deaths worldwide and has caused a massive global economic contraction. Governments, policymakers, and medical professionals have been confronted with several complex bioethical dilemmas during these exceptional circumstances. In developing countries like India, having a large population base, inadequate preexisting public health infrastructure, and a multi-level government system with complex administrative mechanisms imposes enormous barriers and challenges in the effective and ethical management of the pandemic. Furthermore, endemic corruption, limited bureaucratic and organisational accountability, and weak oversight, especially among stakeholders in the vast private and non-government health and allied services sector, complicate the assessment of their adherence to ethical public health practices.

Етичний компас медичних рішень під час пандемії COVID-19

The article actualizes and structures significant problems of the medical sphere that arise in the context of the COVID-19 pandemic, in terms of the relations vectors: global world – state – person, state – clinic – society, clinic – doctor (medical staff), clinic – patient, doctor (medical staff) – the patient. The authors presented the evolutionary context of the norming process of medical resources and emphasized the hierarchical scheme of the regulation process of scarce resources norming in the health care system under the pandemic crisis conditions. The paper substantiates approaches to making medical decisions on “sorting” and applying a number of its forms depending on various regional, national, religious, and local models of the ethical values system formation. Emphasis is placed on American and European models of bioethics. The authors consider the utilitarian approach to preparing medical solutions of “clinical sorting” to level ethical catastrophes in a pandemic based on Catholic ethics. The issues of regulated norming of scarce medical resources and the “clinical triage” of patients during the COVID-19 pandemic in Ukraine have been investigated. The main bioethical dilemma of the COVID-19 pandemic is outlined. The authors actualize criteria and models of ethical medical solutions for equitable allocation of scarce medical resources in the context of the COVID-19 pandemic. These criteria and models are defined in the Ethical Guidelines for Responding to COVID-19 of the Bioethics Committee at the Council of Europe, the US Department of Health and Human Services; in normative documents in the field of ethics of medical decisions during the COVID-19 pandemic of the National Medical Associations, chambers, centres of bioethics of Italy, Hungary, USA, Great Britain; in the guidelines of national, religious and local institutions for the preparation of medical decisions for the levelling ethical catastrophes during the pandemic and the studies of international bioethics experts. The paper identified the need to formalize the fair distribution of scarce resources during the COVID-19 pandemic in Ukraine. The authors suggested recommendations for the implementation of ethical values and priorities for their application in critical conditions of shortage of medical resources and personnel in the COVID-19 pandemic in the health care system of Ukraine.

Conscientious objection

Conscientious objection is a means of exercising freedom of belief, conscience and ethical convictions in the face of legal orders that could collide with their principles by excessively invading their autonomy. Although this right corresponds to every person, the health field is one of the most frequent to invoke it, generating bioethical dilemmas at the time of its exercise.

Bioethics in the face of the COVID-19 pandemic.

The year 2020 has marked a major change in our daily lives. The COVID-19 pandemic has presented challenges for governments, professionals, and society in general, mainly in health care. In this context, the presence of bioethical dilemmas has been inevitable, for this reason we analyse some of the dilemmas that have arisen in healthcare and biomedical research.

First person profile: Ezekiel "Zeke" Emanuel, MD, PhD: Bioethics pioneer leads multiple efforts to improve US and global health care.

First person profile: Ezekiel "Zeke" Emanuel, MD, PhD: Bioethics pioneer leads multiple efforts to improve US and global health care.

Stem Cells: A Historical Review about Biological, Religious, and Ethical Issues.

Stem cells can be used to replace damaged cells or regenerate organs and have broadened our knowledge of the development and progression of certain diseases. Despite significant advances in understanding stem cell biology, several problems limit their use. These problems are related not only to the growth of tumors in animal models and their rejection in transplant cases but also to ethical and social issues about the use of embryonic cells. The ethical-scientific debate on this type of cells has taken on great interest both for their application in regenerative medicine and for the potential possibilities in the field of cell and gene therapy. Different points of view often have the expression of a perception that depends on scientific goals or opportunities or on religious traditions and beliefs. Therefore, as the questions and doubts about when life begins, so do the answers for the use of these cells as therapy or otherwise. So, in addition to the origin of stem cells, there are currently some social bioethical (such as political and legislative issues) and religious dilemmas. The purpose of the study is aimed at being a narrative on the history of stem cells and the evolution of their use to date, as well as to clarify the bioethical position of the various religions today in comparison with the social ones regarding the research and use of embryonic and adult ones. Hence, their biological hypostasis regarding the concepts of “conception” and “fertilization” and their development and therapeutic use compared to those of the main theological doctrines.

Η μάταιη θεραπεία (futile treatment): Ιατρική και θεολογική προσέγγιση

This is a medical and theological approach of Futile Treatment, an issue that raises severe medical and bioethical dilemmas. We discuss the difficulties in establishing objective criteria to discontinue treatment and present the theological views on the subject with emphasis to orthodox theology. This paper aims to contribute to the subject and also rise a debate in Greece.

The Bioethical Dilemma of Gender-Affirming Therapy in Children and Adolescents.

This article examines GAT, the paradigm used in treating individuals identifying as transgender, through the lens of an EDMF. Each stage of this widely proposed treatment - social affirmation, pubertal blockade, administration of cross-sex hormones, and sex reassignment surgery - poses harms and risks that are not fully disclosed to minors and families, creating a bioethical dilemma. Dialogue utilizing science and reasoning must be encouraged to assist individuals who experience a gender identity that rejects their biological sex. This approach would also contribute to the well-being of society.

Neonatal Intensive Care: Is professional Status Related to Critical Bioethical Decision-Making?

The bioethical dilemmas that arise concerning the provision of intensive care to premature or diseased neonates are among the ten most important ethical challenges in the field of health...

The Debate on the Concept of the Person in Bioethics

This article endeavours to sketch the debate about the concept of a person in the realm of bioethics. Initially, it sets out three understandings of the issue, namely the concept of a person in naturalistic philosophy, in the current of communitarianism and in one of the humanistic positions. The analysis of these approaches lead to the conclusion that a human person is perceived either as an empirical and psychological entity or as a free subjectivity creating him/herself. This thesis provides stimulation for further research. In order to avoid a kind of dualism in the perception of a person stemming from the stances outlined above, the personalistic approach is developed. This points out that a human being should be depicted as one indivisible entity unifying in itself more strictly its self, a subjective aspect of the person, with nature-body aspect which is an objective facet of being human. Given this personalistic perspective, a person comes out as an embodied subjectivity formed by the unique personal act of existence. In this article, such a concept of a person is argued as a vital support in the complex field of bioethical dilemmas.

Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?-A Scoping Review With Paradigmatic Cases-Based Analysis.

Ethical issues that arise during the care of a pregnant woman with cancer are challenging to physicians, policymakers, lawyers, and the bioethics community. The main purpose of this scoping review is to summarize existing literature regarding the bioethical dilemmas when a conflict arises in the maternal-fetus dyad, like the one related to cancer and pregnancy outcomes. Moreover, we illustrate the decision-making process of real-life case reports. Published data were searched through the PubMed and Google Scholar databases, as well as in grey literature, using appropriate controlled keywords in English and Portuguese. After identification, screening, eligibility and data extraction from the articles, a total of 50 was selected. There are several established ethical frameworks for conflict resolution and decision-making. Pragmatic theoretical approaches include case-based analysis, the ethics of care, feminist theory, and traditional ethical principlism that scrutinizes the framework of autonomy, justice, beneficence, and non-maleficence. In addition, society and practitioner values could mediate this complex ethical interplay. The physician must balance autonomy and beneficence-based obligations to the pregnant woman with cancer, along with beneficence-based obligations to the fetus. Ethical challenges have received less attention in the literature, particularly before the third trimester of pregnancy. Best, unbiased and balanced information must be granted both to the patient and to the family, regarding the benefits and harms for the woman herself as well as for the fetal outcome. Based on a previously validated method for analyzing and working up clinical ethical problems, we suggest an adaptation of an algorithm for biomedical decision-making in cancer during pregnancy, including recommendations that can facilitate counseling and help reduce the suffering of the patient and her family.

Polish Catholic Magazines and Bioethical Dilemmas: A Critical Discourse Analysis

Abstract This article presents a cad-based analysis of Polish Catholic newspaper discourse regarding bioethical dilemmas. The study corpus consists of materials published by four weekly magazines – Gość Niedzielny, Niedziela, Przewodnik Katolicki, and Tygodnik Powszechny – between 2005 and 2015. The author took into consideration articles that were fully devoted to abortion, in vitro fertilization, or euthanasia. The research methodology was based on critical discourse analysis and delivered both quantitative and qualitative results. The findings suggest that even though all magazines touched on bioethical dilemmas and conjured up similar topics, their discourses were different. It transpired that the key variable was the magazines’ affiliations. Titles directly connected to the Catholic Church (Gość Niedzielny, Niedziela, Przewodnik katolicki) produced different discourses than Tygodnik Powszechny, which has no official bonds with the Catholic Church. Given the structure of the discourses, the author suggests division into two categories: inward-oriented and outward-oriented.

Bioethical Aspects of Human Geneticization

Human geneticization, discussed in the following text, is usually associated with the bio-medical practices aimed at human improvement, with the use of genetic enhancement, also understood as genetic improvement or genetic correction. Despite the wide range of benefits claimed by scientists (including biotechnologists and geneticists), these practices undoubtedly generate a number of ethical and legal problems. They concern, among other things, the legitimacy of conducting research in the field of biotechnology or genetics, including reprogenetics, its possible direction, projections related to the development of the research, as well as the methods and means used to control the aforementioned research, or even the problem of both the legislative and moral validity of its further practical implementation. This can be seen, for example, in the ongoing discussion on the geneticization of human life, and in the broader context of its progressive biomedicalization. In view of the considerable breadth and complexity of the issue of geneticization, this text focuses primarily on a closer examination of the possibilities that genetic enhancements, supported by the potential which genetic engineering might bring, followed by due consideration of selected bio-ethical dilemmas that may arise from the application of such enhancements.

Η επανασύνδεση με ένα αγαπημένο πρόσωπο που έχει αποβιώσει, μέσω της εικονικής πραγματικότητας. Απόψεις και προβληματισμοί ενώπιον πρωτοφανούς προκλήσεως

A team of documentary producers and computer programmers, while they were in a laboratory creating a virtual reality environment, could never have imagined how much impact their project would have not only to the family involved but also to a large percentage of humanity and other scientific fields. In particular, they created a virtual park and a virtual girl, who in real life had died, and, through the special equipment, they placed the living mother in this environment. The mother ‘‘met’’ her daughter, ‘‘touched’’ her, ‘‘talked’’ to her, they celebrated her daughter’s birthday together’’ and, at the end, they ‘‘said goodbye’’ to each other.This endeavor was the result of a combination of techniques and elements of various sciences. Of course it is admirable, but at the same time it raises doubts, intense concerns and many questions such as: ‘‘What are the limits of the technological applications?’’; ‘‘What aspects and at what extent of the human existence can they involved?’’; ‘‘How is the human existence affected?”; Can an application play with human emotions and, specifically, with the pain and misery of a human, in this case of a mother mourning her child?’’ The issue is difficult and even more difficult the moral and bioethical dilemmas that arise.All the above-mentioned will be presented and studied in this present article. In particular, initially reference will be made to the definition of virtual reality, to the means which lead to the achievement of a completely operational system, as well as to the areas of application of its systems. Therefore, the way of creation and the context of the documentary will be presented, to be followed by a very short reference to the thoughts that the mother of the girl had expressed. Afterwards various opinions will be presented, questions and dilemmas arising by the documentary will be mentioned and commented and alongside some questions will be asked for reflection. The conclusions will complete this present article.

A Multisystemic Approach to Psychosocial Evaluations of Vascularized Composite Allotransplantation Candidates

This report seeks to shed light on multisystem domains of interest in vascularized composite allotransplantation (VCA) to improve patients’ psychosocial assessment and candidacy, to decrease environmental barriers to transplant success, and to add to the discussion concerning bioethical dilemmas associated to VCA. Psychosocial assessment tools cover availability, accessibility, and common sense of the treatment at microsystem and individual levels. However, macro-, exo-, and mesosystem risk factors remain unevaluated. Readers are invited to expand and complement the factors described in the review. Psychosocial assessment of individual and microsystem domains in VCA is not enough for patients in developing countries where higher contextual barriers to treatment adherence are expected. To expand contextual domains of interest, Bronfenbrenner’s social-ecological theory and Ungar’s multisystemic social-ecological theory of resilience are taken into consideration.