Principles Of Beneficence Research Articles

Ethical principles, challenges and opportunities when conducting genetic counselling for schizophrenia.

Ethical challenges of genetic counselling for schizophrenia include effective communication of critical scientific information in an easily understood manner by patients and relatives, and the ability to ensure communication is unencumbered by medical jargon. Levels of literacy in the target population may limit this process, making it difficult for patients to attain the desired levels of informed consent to make crucial decisions during genetic counselling. Multilingualism in target communities may further complicate such communication. This paper outlines the ethical principles, challenges and opportunities facing clinicians when conducting genetic counselling for schizophrenia and how these might be met, drawing on lessons from South African studies. The paper draws on reflections of clinician and researcher experiences gained from clinical practice or research on the genetics of schizophrenia and psychotic disorders in South Africa. The context of genetic studies in schizophrenia is used to illustrate the ethical challenges in genetic counselling for schizophrenia, both in clinical and research settings. Attention is also drawn to multicultural and multilingual populations, particularly where the preferred language lacks a well-developed scientific language of communication for some of the genetic concepts that have to be presented during the genetic counselling process. The authors describe the ethical challenges and how to address these to empower patients and relatives to make well-informed decisions despite these obstacles. Principles applied by clinicians and researchers during the genetic counselling are described. Potential solutions, including the establishment of community advisory boards to address potential ethical challenges inherent to the genetic counselling process, are also shared. Genetic counselling for schizophrenia still faces ethical challenges which require a balance of principles of beneficence, autonomy, informed consent, confidentiality and distributive justice, while striving to present accuracy in the science that guides the process. Evolution in language and cultural competency therefore needs to occur alongside scientific advances in genetic research. Key stakeholders need to partner and build capacity and expertise in genetic counselling through the provision of funding and resources. The goal of partnerships is to empower patients, relatives, clinicians and researchers to share scientific information in a manner guided by empathy while retaining scientific accuracy.

Decision Criteria for the Ethically Reflected Choice of a Member Check Method in Qualitative Research: A Proposal for Discussion

Methodologists recommend member checking (MC) to increase the credibility of results from qualitative studies. In this procedure, the researcher’s categories, hypotheses and interpretations can be verified or corrected by respondents, and the latter can add information. Various methods are available for conducting this procedure. However, in addition to methodological issues, MC also raises ethical questions. In this article, we investigate which member check method (MCM) is most appropriate for a particular study from an ethical perspective. Based on a literature review about ethical issues in different MCMs and ethical principles contained in guidelines for research ethics, we develop seven decision criteria that can facilitate an ethically reflected decision for a particular MCM. Accordingly, we consider the principles of beneficence, justice, scientific quality, informed consent and avoiding harm, which are widely accepted in research ethics. In addition, we recommend that participants’ wishes and concerns regarding the MC be inquired about and considered.

Ethics of Resident Involvement in Surgical Training.

After IRB approval, surgeons from three institutions were invited to participate in a pilot, survey, exploring how principles of patient autonomy, physician beneficence, nonmaleficence, and justice apply to participant opinions. Responses were transcribed and coded for quantitative and qualitative analysis. 51 attendings and 55 residents completed the survey. We identified that patient autonomy is upheld through transparent consent practices. Intraoperative supervision is a key practice that maintains the principles of physician beneficence and nonmaleficence and mitigates the risk of resident participation. Vulnerable patients were defined by respondents as those unable to participate in their own consent and those limited by social determinants of health and barriers to medical literacy. In contrast, resident participation is not limited in the care of vulnerable patients but is restricted in cases of higher complexity and those procedures deemed to have lower error margins. Although residents measure the success of their training based on their level of intraoperative independence, autonomy afforded to the resident does not only depend on objective skill. There are ethical considerations that the attending must navigate as they decide on effective teaching and safe surgical management, which is especially relevant in the care of complex cases.

Geriatric restraints as a last resort

Relying on the remaining abilities of elderly people at home, in hospital or in residential care facilities for the dependent elderly, allows them to maintain their autonomy and avoid restraints. If geriatric caregivers observe an elderly person who is agitated, at risk of falling, or putting themselves in danger, they suggest strategies to calm the person. As a last resort, physicians may prescribe an appropriate restraint. This is a deprivation of liberty. The multidisciplinary evaluation every twenty-four hours of this care is based on the principle of beneficence by re-evaluating the prescribed device.

A Framework for Personal Respiratory Ethics

The Covid-19 pandemic raises the need for an ethical framework that addresses the unique ethical challenges and questions arising from airborne infectious diseases. For example, are we ever ethically obliged to wear a face mask? If so, why and when? The Respiratory Ethics Framework (REF) herein proposes pathways to answers grounded in ethical norms and the moral principles of non-harm, beneficence and respect for personal autonomy. REF is a personal ethics wherein your ethical duty to increase your respiratory hygiene efforts—such as by donning a mask—is proportional to your estimation of an increase in the likelihood that your respiratory effluent poses a risk of harmful infection to others. REF includes illustrated decision models that instantiate a framework of proportionality between levels of risk, ethical duty and mitigation that shapes risk mitigation across domains.

Viewing Pediatric Food Oral Immunotherapy Through an Ethical Lens-A Narrative Systematic Review.

Food allergy remains a common problem and a lifelong condition for many children. In recent years food allergy management has increasingly involved conversations about food oral immunotherapy. While ethical considerations of autonomy, beneficence, non-maleficence, and justice implicitly inform these conversations, applying these principles can be complex, particularly in young children. Families of young children assume a role of surrogate decision maker and must balance immediate risks with the hope of longer-term benefits. To explore implementation of oral immunotherapy in children through an ethical lens. To evaluate OIT through an ethical lens, a literature search was conducted to explore currently published frameworks in this arena. Evaluation of the harm principle, the basic interest principle, and the best interest principle of parental decision making can be informative. Shared decision making continues to be central to the process of engaging with patient-family units to individualize the best care, at the right time, and minimize decisional discord. While OIT is well positioned to promote health and well-being, challenges to equity, sustainability, and organizational support must be considered to improve access for appropriate patients. While approaches to food OIT may be tailored to the individual context of each patient-family unit, ethical principles must guide decisions to initiate and continue therapy. Traditional ethical principles of autonomy, beneficence, non-maleficence, and justice remain cornerstones when considering the ethical context of OIT.

Reconstruction of Chemical Castration Sanctions Implementation Based on the Medical Ethics Code (Comparison with Russia and South Korea)

This study aims to reconstruct the ideal setting in the implementation of chemical castration sanctions in Indonesia based on the medical code of ethics. This research is a normative legal research, the approach used is a case approach, comparative approach and a conceptual approach, with a literature study research technique. The granting of the authority to execute chemical castration by a doctor is contrary to the principles contained in the medical code of ethics, including: First, it contradicts the principle of autonomy at the level of implementation of the principle of Autonomy which is applied in the form of the principle of "informed consent" where in carrying out his duties a doctor must first choose approval from the family and the patient for all actions that result in a decrease in the patient's physical endurance. Second, it is against the principle of non-maleficence, which prohibits actions that harm or worsen the patient's condition. Third, it is against the principle of beneficence. The rules regarding the implementation of chemical castration for perpetrators of sexual crimes against children can actually be followed by referring to the provisions for the implementation of chemical castration in Russia and South Korea, both countries whose medical profession will only serve as an advisory opinion for law enforcers who have been given special competency training.

Applying an ethical lens to the provision of care in for-profit healthcare facilities.

In early 2023, after three years of pandemic and delayed care, Ontario faced an overwhelming backlog of elective surgical procedures and unacceptable wait times. With hospitals experiencing historic health human resources shortages and critical capacity limitations, disruptive change was required. The Ontario government proposed to address these mounting access-to-care issues by paying for-profit healthcare clinics and surgi-centres to provide insured services, resulting in considerable controversy, much opposition, some praise, and many public protests. Previous experiences with for-profit independent health facilities had generated both complaints and documented problems with their operations. This article examines these concerns against the ethical principles of autonomy, beneficence, non-malfeasance, and justice. While much of this unease can be effectively addressed through collaboration and oversight, the complexity and costs involved in ensuring equity and quality may make it difficult for such facilities to maintain profitability.

To Resuscitate or Not to Resuscitate – The Crossroads of Ethical Decision-Making in Resuscitation in the Emergency Department

Emergency physicians (EPs) working in low-resource settings, where patients mainly bear healthcare delivery, face many challenges. Emergency care is patient-centered and ethical challenges are numerous in situations where patient autonomy and beneficence are fragile. This review discusses some of the common bioethical issues in the resuscitation and post-resuscitation phases of treatment, it proposes solutions and emphasizes the necessity for evidence-based ethics and unanimity on ethical standards. After consensus was reached on the article's structure, smaller groups of authors (2-3) wrote narrative reviews of ethical issues like patient autonomy and honesty, beneficence/nonmaleficence and dignity, justice, and specific practices/circumstances like family presence during resuscitation after having discussions with senior EPs. Ethical dilemmas were discussed, and solutions were proposed. The cases related to medical decision-making by proxies, financial constraints in management, and resuscitation in the face of medical futility have been discussed. Solutions proposed include involving hospital ethics committees early on, having financial mechanisms in place beforehand, and allowing some leverage on a case-to-case basis when care is futile. We recommend developing evidence-based national ethical guidelines and incorporating societal and cultural norms with autonomy, beneficence, non-maleficence, honesty, and justice principles.

Identifying abolitionist alignments in community psychology: A path toward transformation.

Psychology is grounded in the ethical principles of beneficence and nonmaleficence, that is, "do no harm." Yet many have argued that psychology as a field is attached to carceral systems and ideologies that uphold the prison industrial complex (PIC), including the field of community psychology (CP). There have been recent calls in other areas of psychology to transform the discipline into an abolitionist social science, but this discourse is nascent in CP. This paper uses the semantic device of "algorithms" (e.g., conventions to guide thinking and decision-making) to identify the areas of alignment and misalignment between abolition and CP in the service of moving us toward greater alignment. The authors propose that many in CP are already oriented to abolition because of our values and theories of empowerment, promotion, and systems change; our areas of misalignment between abolition and CP hold the potential to evolve. We conclude with proposing implications for the field of CP, including commitments to the belief that (1) the PIC cannot be reformed, and (2) abolition must be aligned with other transnational liberation efforts (e.g., decolonization).

Health professions students’ approaches towards practice-driven ethical dilemmas; a case-based qualitative study

BackgroundIn healthcare practice, ethical challenges are inevitable and their optimal handling may potentialy improve patient care. Ethical development in medical education is critical for the transition from a medical and health sciences student to an ethical healthcare practitioner. Understanding the health professions students’ approaches towards practice-driven ethical dilemmas could harness i the effective ethical development in their medical education. This study attempts to identify the health professions students’ approaches towards practice-driven ethical dilemmas.MethodsAn inductive qualitative evaluation was conducted on six recorded videos of health professions students’ case-based online group discussions, followed by a one-hour online ethics workshop. The online ethics workshop was organized with students from the College of Medicine, College of Dental Medicine and College of Pharmacy at the University of Sharjah, and the College of Medicine at the United Arab Emirates University. . The recorded videos were transcribed verbatim and imported to the qualitative data analysis software of MAXQDA 2022. Data were analyzed applying four stages of review, reflect, reduce and retrieve and two different coders triangulated the findings.ResultsSix themes emerged from the qualitative analysis of the health professions students’ approaches to the practice-based ethical dilemmas; (1) emotions, (2) personal experiences, (3) law and legal system, (4) professional background, (5) knowledge of medical research and (6) inter-professional education. In addition, during the case-based group discussions in the ethics workshop, students efficiently applied the relevant ethical principles of autonomy, beneficence, non-maleficence and justice in their reasoning process to reach an ethical decision.ConclusionThe findings of this study explained how health professions students resolve ethical dilemmas in their ethical reasoning process. This work sheds light on ethical development in medical education by gaining students’ perspectives in dealing with complex clinical scenarios. The findings from this qualitative evaluation will aid academic medical institutions in developing medical and research-based ethics curriculum to transform students to ethical leaders.

Psychological beneficence as part of the principle of beneficence in non-reconstructive aesthetic surgeries

The beneficence of the patient in non-reconstructive aesthetic surgeries must always include not only the physical well-being, but the psychological well-being of the patient as well. This issue has been proven to be effectively targeted with the use of psychological consulting in those cases where the medical team ascertains the existence of psychological alterations. In said cases, for the beneficence and best interest of the patient, the ethical and medical choice is not to undergo the surgical procedure. Applying the Principle of Beneficence in aesthetic patients with stringency demands the use of psychological treatment to target the cause of the corporal discomfort or unsatisfaction. If the wrong can be treated it must always be eliminated as the seed that causes the damage, the complex or discontent and not merely attain the effects through surgery. There has been an increase of cases where the root of the problem is not of physical nature but psychological. In these cases, the use of a scalpel would not achieve beneficence.

Decision-Making and Ethical Considerations of Tracheostomy and Chronic Mechanical Ventilation in Children With Acute Neurological Injury

The decisions around whether or not to provide tracheostomy and chronic mechanical ventilation to children with acute neurologic injury are difficult for medical providers and surrogate decision makers. Consideration of the 4 primary principles of medical ethics-autonomy, beneficence, non-maleficence, and justice-can provide a framework from which constructive discussions can form. Determination of the goals of care is a good first step in navigating these complex decisions. A shared decision model should be used, including education of decision-makers by medical providers and appropriate recommendations based on the stated goals of care. In this paper, 2 illustrative cases are discussed highlighting the utility of this decision-making framework.

Mechanical ventilator as a shared resource for the COVID-19 pandemic

COVID-19, the causative agent of which is a new type of coronavirus called SARS-CoV-2, has caused the most severe pan-demic in the last 100 years. The condition is mainly respiratory, and up to 5 % of patients develop critical illness, a situation that has put enormous pressure on the health systems of affected countries. A high demand for care has mainly been observed in intensive care units and critical care resources, which is why the need to redistribute resources in critical medicine emerged, with an emphasis on distributive justice, which establishes the provision of care to the largest number of people and saving the largest number of lives. One principle lies in allocating resources to patients with higher life expectancy. Mechanical ven-tilator has been assumed to be an indivisible asset; however, simultaneous mechanical ventilation to more than one patient with COVID-19 is technically possible. Ventilator sharing is not without risks, but the principles of beneficence, non-maleficence and justice prevail. According to distributive justice, being a divisible resource, mechanical ventilator can be shared; however, we should ask ourselves if this action is ethically correct.

Clarification of ethical principle of the beneficence in nursing care: an integrative review

BackgroundEthics-based nursing practice can transform health care practices. As the biggest human capital in the health care system, nurses are obliged to follow ethical principles in this field. One of these ethical principles; is beneficence, which is considered the core of nursing care. This study aimed to investigate clarification of the principle of beneficence in nursing care and its related challenges.MethodsThis integrative review was conducted using the Whittemore & Knafl method in 5 stages, including problem identification, searching the literature, evaluating primary sources, analyzing data, and presenting the results. Databases like SID, Irandoc, Magiran, Google Scholar, Web of Science, PubMed, and Scopus were searched using the keywords; “beneficence”, “ethic”, “nursing” and “care” in English and Persian in the time range of 2010 to 10 February, 2023. After applying inclusion criteria and assessing the articles using Bowling’s Quality Assessment Tool, finally, 16 papers were included from 984.ResultsAfter reviewing and evaluating the qualified articles, the findings were classified into four main categories: (1) nature, (2) applicability, (3) Relevant and influential factors, and (4) challenges related to the ethical principle of beneficence in nursing care.ConclusionBased on the results of this review it seems that paying attention to clarification the principle of beneficence in nursing care can provide positive outcomes for patients to benefit from this principle and finally, it leads to increasing the well-being and health of patients, reducing their mortality rate, increasing satisfaction and maintaining the respect and human dignity of patients.

Trojan technology in the living room?

Definition of the problemAssistive technologies, including “smart” instruments and artificial intelligence (AI), are increasingly arriving in older adults’ living spaces. Various research has explored risks (“surveillance technology”) and potentials (“independent living”) to people’s self-determination from technology itself and from the increasing complexity of sociotechnical interactions. However, the point at which self-determination of the individual is overridden by external influences has not yet been sufficiently studied. This article aims to shed light on this point of transition and its implications.ArgumentsThe identification of this “tipping point” could contribute to analysis of familiar issues of conflict between the ethical principles of beneficence and respect for autonomy. When using technology in the living spaces of older adults, relationships, among other factors, may play a crucial role in older adult’s self-determination. We find the tipping point to occur subjectively and variably. To this end, the article combines theoretical ethical considerations with two examples from a qualitative study illustrating the perspective of older adults aged 65–85 years.ConclusionThe study of the tipping point underscores the importance of perceiving an older person’s perspective. Particularly at the tipping point, this might be the only way to effectively identify whether the individual concerned perceives their self-determination as externally overridden. In conceptualizing the tipping point itself as well as its variability, we might create the basis for a normative call to shift the tipping point to promote self-determination and prevent overriding the will of older adults. We highlight individual, relational, and societal implications of our findings.

Ethical considerations of the vaccine development process and vaccination: a scoping review

BackgroundVarious vaccines have been developed and distributed worldwide to control and cope with COVID-19 disease. To ensure vaccines benefit the global community, the ethical principles of beneficence, justice, non-maleficence, and autonomy should be examined and adhered to in the process of development, distribution, and implementation. This study, therefore, aimed to examine ethical considerations of vaccine development and vaccination processes.MethodsA scoping review of the literature was conducted based on the Arkesy and O’Malley protocol to identify eligible studies published until November 2021. We searched Web of Science, PubMed, Scopus, and SciELO databases. The search was conducted using combinations of Medical Subject Heading (MeSH) search terms and keywords for Ethics, COVID-19, and vaccines in abstract, keywords, and title fields to retrieve potentially relevant publications. We included any study that reported one of the four principles of medical ethics: autonomy, justice, non-maleficence, and beneficence in the COVID-19 vaccine development and distribution and implementation of vaccinations. Letters, notes, protocols, and brief communications were excluded. In addition, we searched gray literature to include relevant studies (ProQuest database, conferences, and reports). Data were analyzed using framework analysis.ResultsIn total, 43 studies were included. Ethical considerations concluded two themes: (1) production and (2) distribution and vaccination. The production process consisted of 16 codes and 4 main Categories, distribution and vaccination process consisted of 12 codes and 4 main Categories. Moreover, the ethical considerations of special groups were divided into four main groups: health care workers (HCWs) (five codes), children and adolescents (five codes), the elderly (one code), and ethnic and racial minorities (three codes).ConclusionDue to the externalities of pandemics and the public and social benefits and harms of vaccination, it is not feasible to adhere to all four principles of medical ethics simultaneously and perfectly. This issue confronts individuals and policymakers with several moral dilemmas. It seems that decision-making based on the balance between social benefit and social harm is a better criterion in this regard, and the final decision should be made based on maximizing the public benefit and minimizing the public harm.

Accompagnement des transidentités aux États-Unis, avancées et reculs, impact en Europe

What is happening in the United States in terms of support for trans people, as in other areas, is regularly observed and a source of inspiration at the international level; the recent political turmoil around affirmative trans care in some States, especially for minors, has a tremendous impact in Europe, being regularly used by the "camps" that argue today on this issue. However, the political context and the organization of the health and health insurance system color this support in a very specific way in the United States, and omitting these aspects or simplifying them is a source of erroneous interpretations and misinformation. Understanding these determinants is essential to define what belongs to the medical field, and to put back at the center of the discussions the interest of the people concerned, the principles of beneficence, non-maleficence and equity. In this article, we will therefore discuss the organization of care and recommendations for good practice, but also, from "non-scientific" articles and references, the political and social climate and its impact on trans health and care, including in Europe.

The principles of bioethics in teaching: difficulties and proposal

It is common base the teaching of bioethics on the learning of the principles of autonomy, beneficence, non-maleficence and justice, widely used today. In terms of ethical practice, these principles suffer from a notable inadequacy, leaving aside their ambiguity and other problems. Nevertheless, as a teaching method, they show a special incongruity, for several reasons: a) little adequacy of the terms to the concepts that want to be expressed, b) formalism that hinders the approach to reality, c) little adaptation to the needs of the student and d) be specialized terms in a field that should be fundamentally informative. These four limitations, which advise another approach in the teaching of bioethics, are examined in detail; a final reflection is provided on the difference between the principles of bioethics and ethics.

COVID-19 PANDEMIC IN URUGUAY AND THE NEED FOR A PERSON AND SOCIAL CENTERED MEDICINE

Background: During the COVID-19 pandemic, the Uruguayan government decided to call for an attitude of responsible freedom of the population and created an Honorary Scientific Advisory Group (GACH). The intention was to report the scientific evidence available on the health situation with transparency and technical independence and to recommended interventions. This paper aims (1) to analyze the strategy to combat the COVID-19 pandemic used in Uruguay from the perspective and principles of person-centered medicine (PCM), (2) to report and examine from a broad perspective the policy regarding health authorities, scientific evidence and population, and (3) to discuss the importance of mental health and behavioral monitoring for identifying vulnerable groups that require special attention and care.
 Methods: Retrospective and narrative analysis of the creation of a socioeconomic and behavioral observatory [OSEC], critical evaluation of key data collection on population mental health, and assessment of the influence of OSEC in the context of the pandemic in Uruguay. T-test was used to assess mean differences of mental health trends in the general population using GHQ-12 panel data. The article presents the results obtained on the country’s mental health data through the analysis of a helpline consultations and a digital panel survey of a representative sample of the Uruguayan population. Screening instruments were used, which allowed for an identification of risk groups.
 Results: The evidence shows the impact of the pandemic on the emotional distress of the population, indicating that the population discomfort decreased significantly when the pandemic situation began to improve. In addition, differences according to socioeconomic status and age groups were observed, showing that the most disadvantaged had significantly higher levels of emotional distress than those of the middle and upper class, at all times of analysis.
 Conclusions: Apparently, it is possible to extend the principles of beneficence, autonomy, and justice applied at the individual level to the level of collective health policies. This is essential to achieve the active participation of the population in their self-care and to promote greater and more transparent communication with the health and scientific fields. It is also necessary to adopt a holistic, biopsychosocial perspective, which makes it possible to identify the vulnerable sectors of society and the areas in which special attention is required.