Acta Bioethica

Revisiting the Conceptual Aspects of Humanization and Dignified Treatment in Healthcare from an Ethical Perspective: A systematic review of the literature

Paola Andreucci-Annunziata — 2024-09-25

Background: The attainment of humanization and dignified treatment in healthcare has proven to be a challenging endeavor, notwithstanding the advancements made in initiatives aimed at their implementation. One approach to addressing this issue is to direct reflection towards its ethical and conceptual foundations, as well as exploring the potential integration of the various dimensions involved in its management and approach. Objectives: The aim of this study is to conduct a systematic review of original articles focusing on humanization and dignified treatment in healthcare from an ethical and bioethical standpoint, with two specific research objectives: 1. To identify key conceptualizations related to humanization and dignified treatment, taking into account the perspectives of the various stakeholders at contextual, institutional, interpersonal, and personal levels. 2. To propose a relational model that facilitates the visualization of the dimensions, agents, and practices involved in humanization. Methods: A systematic search was performed in the Web of Science (WoS) database, following bibliometric procedures and the PRISMA methodology. Results: A total of 8 articles were selected from the WoS indexing categories of “Ethics” and “Religion,” published between 2010 and 2022. The analysis revealed that ethics and bioethics play a fundamental role in shaping the discourse on humanization and dignified treatment in healthcare. Key themes included respect for individuals' integrity, relational ethics, associated ethical principles, and concrete institutional practices. Discussion: The implications of considering ethical notions as foundations for humanization and dignified treatment in healthcare, as well as the proposal of a relational model in humanization applicable to healthcare practices, are discussed.

Exploring ethical principles and values in the surgical care of the geriatric patient: a humanized and emergent approach

Anderson Díaz Pérez — 2024-09-25

The objective of this research is to describe the meanings and practices from the values and principles that emerge during the humanized care provided by the surgical team to the geriatric patient scheduled for surgery. Through the qualitative and interpretive paradigm, and from an objectivist and methodological epistemic framework, the perception existing among surgeons on how humanized care should be towards the elderly is reflected. Ten surgeons were interviewed through semi-structured sessions, and the analysis was carried out using the matrix of categories with the support of the ATLAS Ti 8.0 ® program. The perception of surgeons regarding humanized care considers that care is strengthened during the higher education they receive at the university and is fortified through the norms that govern the profession, in the sense of always aiming for the well-being and respect for the dignity of patients, especially the most vulnerable.

Comprehensive Methodology for Ethical-Clinical Analysis (CMECA): A new paradigm for resolving end-of-Life dilemmas

Anderson Díaz Pérez — 2024-09-25

End-of-life care management presents significant ethical challenges, especially in complex clinical cases such as that of a patient with severe head trauma and multiple complications. Ethical decision-making involves considering the rights, dignity, and preferences of the patient and his or her family, as well as quality of life and relief from suffering. The objective of this research is to design and implement a comprehensive methodology to provide a care plan that respects the dignity and improves the quality of life of patients at the end of life, aligned with their wishes and those of their family. The approach used was the Comprehensive Methodology of Clinical-Ethical Analysis (CMECA), which included a continuous evaluation, pain and symptom management, supportive care, limitations of medical interventions, and preparation for the end of life, with the active participation of the family from a palliative care approach. The resolution of the case was achieved through a shared decision between the parents and the medical team, proceeding with a gradual disconnection of life support. The importance and relevance of the Comprehensive Methodology of Ethical-Clinical Analysis (CMECA) is highlighted, due to its comprehensive approach focused on the patient and in accordance with medical ethics. This method stands out for considering legal and ethical aspects, empathy, and respect for human dignity at all times.

The right to be forgotten regarding genetic data: A legal and ethical analysis

Mónica Correia — 2024-09-25

This article investigates an under-discussed provision of the European Union's (EU's) General Data Protection Regulation (GDPR) regarding genetic data, i.e., the right to be forgotten. The debate on this right came from the commerce-related side of data protection instead of the medical side. Thus, this article addresses the implications of the RTBF for the lawful processing of familial genetic data. The article develops a normative, ethically focused principles argument about interpreting genetic data’s right to be forgotten. It gives due consideration to autonomy, privacy, and human dignity. It argues that the individualistic approach of genetic privacy materialised through the extreme solution of data erasure is challenging to combine with familial and scientific research interests. The article suggests an interpretation of the GDPR according to bioethical principles and the inclusion of a specific exception regarding genetic data to prevent patients from claiming the right to be forgotten. Keywords: bioethics, data protection, genetic data, privacy, right to be forgotten.

What “evidence” does Evidence-Based Medicine (EBM) refer to?

Karina Ordóñez Torres — 2024-09-25

This article examines the use of the concept of “evidence” in the current movement known as “Evidence-Based Medicine” (EBM). The article includes some historical milestones of the concept, in which Aristotle, André Lalande and Michel Foucault are the main references. Then, the process through which EBM was born is reviewed, going through Cochrane, Guyatt, Sackett and Woolf. It is explained that EBM understands evidence as facts, where controlled and randomized clinical studies, as well as systematic reviews, are the most appropriate means to obtain evidence. We propose that EBM may not be aware that the concept of “evidence” used is crypto-normative, which makes this concept contain a strong axiological load. The article does not intend to simply dismiss the concept of “evidence”, but rather to review its univocality and open it to an analogous understanding that could improve clinical practices and the theoretical scope that serve as their foundation. A central part of the arguments used in this paper consists of reviewing the supposed epistemic neutrality of EBM, which is a movement in formation that requires various adjustments. Among them, an in-depth review of the concept that gives it its name and meaning, for the benefit of the generators and users of EBM (clinicians and patients).

Ethical aspects in telemedicine. Literature review

Francisco Rosero-Villarreal — 2024-09-25

This paper analyzes the ethical aspects related to telemedicine. A literature search on the topic was conducted, based on a systematic review of the specific ethical aspects of telemedicine using thirteen articles selected from the Web of Science and PubMed databases. The findings were grouped into the following categories: access; principles; quality of care; privacy, confidentiality, cybersecurity; commercialization, conflict of interest; trust and doctor-patient relationship; education, training and licensing; professional malpractice, telenegligence; virtual prescription of medications; shared decisions, patient empowerment; informed consent; governance and policies. The ethical aspects of telemedicine are important not only for adequate health care, but also for the construction of adequate public policies.

Computing addiction: Epistemic injustice challenges in the culture of computational psychiatry

Min Wang — 2024-09-25

Computational psychiatry (CP), based on artificial intelligence technology, plays an increasingly important role in scientific research and medical diagnosis. Epistemic concerns in the ethics of artificial intelligence have also been at the center of debate in CP, but the different epistemic forms of injustice caused by the internal cultures of CP remain unexplained. We distinguish between data-driven and theory-driven cultures and their research purposes via practical examples of CP models deployed in addiction. A data-driven culture may advance medical understanding of biological categories of mental illness, whereas a theory-driven culture provides better explanatory mechanisms between symptoms and biology. We discuss testimonial injustice caused by the silencing of patient voices in a data-driven culture, and hermeneutic injustice caused by the non-sharing of hermeneutic resources in theory-driven culture based on Miranda Fricker's account of epistemic injustice. We analyze the factors underlying nuances in epistemic forms between the two, such as naturalistic-dominated medical understanding and the system's epistemic privileging. The above epistemic risks all indicate the intricacies of mental disorders and require that success be assessed in terms of actual benefit to patients. Finally, we emphasize the importance of the patient's phenomenology and call for greater inclusion of patients in psychiatric decision-making processes.

Evaluation of moral intelligence in prehospital emergency healthcare employees: The case of Bolu-Düzce

Ramazan Güneşer — 2024-09-25

Prehospital emergency healthcare employees are frequently faced with ethical problems. Moral intelligence, which is seen as a rising value in the field of health, is very important for prehospital emergency health employees to choose the best and right action ethically. This study aims to evaluate the moral intelligence of prehospital emergency healthcare employees and to determine whether moral intelligence parameters differ according to various socio-demographic characteristics. This study was conducted with 261 emergency medical personnel working in the ambulance service between November 2021 and February 2022. Participants showed high sensitivity to equality, empathy, moral intelligence, justice, tolerance, self-control, and kindness in the delivery of healthcare services. There were no significant differences between the groups in the scale dimensions in terms of gender, educational level, working hours, working systems, income level and having children. Single/widowed/divorced/separated participants had significantly higher levels of empathy (p=0.004), justice (p=0.039) and self-control (p=0.009) than married participants. The self-control levels of paramedics were found to be higher than those of health officers/nurses/midwives/others (p=0.015). The high sensitivity of employees towards moral intelligence parameters can play an effective role in solving both ethical issues and problems related to other moral intelligence parameters in the field of prehospital healthcare.

Bioethics in public university education in health sciences in Perú

Ana Alondra Paredes Cohaila — 2024-09-25

The purpose of this research lies in evaluating the current state of higher university education about bioethics studies in the faculties of health sciences in the Peruvian territory. The methodological design adopts a descriptive level with a mixed approach that is divided into two stages: The first consists of a qualitative theoretical-analytical-rational analysis, followed by a subsequent empirical analysis with a quantitative, descriptive, and cross-sectional approach. The main discoveries refer to the existence of nineteen licensed public universities in Peru that offer the Human Medicine degree. However, it was found that the Bioethics course is only available in nine of these institutions. In summary, it can be affirmed that in the educational programs of careers related to health sciences, attempts are made to address ethical principles from different perspectives, for example, through courses on general ethics or deontology. However, this strategy is not considered adequate. In addition, it is imperative to promote an educational policy within the faculties of health sciences that mandates the mandatory inclusion of a bioethics course in the curricula of health sciences programs.

The use of informed consent in dental practice in southern Peru

Astridh Semiramis Quenaya Garay — 2024-09-25

The objective of this research is to determine how informed consent is used in dental practice in southern Peru in the year 2023. The methodological design adopts a descriptive level with a mixed approach that is divided into two stages: The first consisted of a qualitative theoretical-analytical-rational analysis, followed by a subsequent empirical analysis with a quantitative, descriptive and cross-sectional approach. The study was carried out in a population of dentists who practice the dental profession in southern Peru in the year 2023 with a non-probabilistic convenience sample of 131 dentists. The main results were that the use of informed consent (14.5%) states that they do not use it in their daily consultation and (59.5%) use it in an erroneous way, due to different factors that influence this procedure and that the non-use of informed consent in its highest percentage arguing "lack of time" on the part of dentists It was concluded that there is a high rate of dental professionals who do not use informed consent in their professional practice, even more so that there is a high percentage that does not use consent correctly reported as an ethical-legal document.

Temporal and spatial changes and equity of nursing human resources configuration in Sichuan province, China

Huan Yang — 2024-09-25

This research aims to analyze the configuration, distribution, and equity of nursing human resources in Sichuan Province, China, providing a reference for the future development of nursing care in the region. A descriptive analysis was conducted to describe the configuration of nursing human resources in 2010, 2015, and 2020. The Lorenz curve, Gini coefficient, health resource density index, and distribution density maps were used as resources and methodology to evaluate the changes and equity in the configuration of nursing human resources. The result of this research determined that the nurse-to-population ratio was 1.17, 2.09, and 3.42 in 2010, 2015, and 2020, and nursing staff accounted for 24%, 49%, and 35% of technical health personnel. The nurse-to-physician ratio was 1:0.72, 1:1.05, and 1:1.22 in the three years. The Gini coefficients of nursing resource allocation for permanent population and area were 0.24, 0.20, and 0.12 and 0.74, 0.72, and 0.72, respectively. The nursing resource density index was 0.50, 0.91, and 1.42, respectively. In conclusion, the study shows that the equity of nursing resources based on population increased, while the equity based on region still showed disparity, with a sustained increase in nursing human resource density from 2010 to 2020. However, it is necessary to continue increasing the number of nurses and improving the geographical accessibility of nursing care.

Brazilian physicians' attitudes and feelings towards palliative care in pediatrics

Anderson de Almeida Rocha — 2024-09-25

The aim of the article is to evaluate and understand the feelings and attitudes of Brazilian physicians regarding the implementation of palliative care in pediatric patients. Between July 2018 and December 2019, 236 questionnaires were sent to physicians on the National Academy of Palliative Care roster. The data collected through the planned questionnaires were analyzed using the IRAMUTEQ programs (Interface de R pour les Analyzes Multidimensionnelles de Textes et de Questionnaires). From the analysis performed by IRAMUTEQ, a dendrogram containing words with p<0.05 was obtained. Feelings of sadness, anguish, relief, regret and fulfillment were perceived as relevant. Attitudes such as understanding, communication, instructing, treating well, strategy, and multiprofessional conferences were also described. Thus, it was observed that these professionals experience different contradictory feelings and make use of different strategies so that they do not harm the treatment carried out, in addition to maintaining a good relationship with the patient's family. In the present study, we demonstrate that there are intrinsic characteristics of pediatric palliative care that are a source of mixed feelings for medical professionals. In this context, challenges still exist and it is essential to conduct new studies that address this issue. Paying attention to these feelings promotes better management of palliative care in pediatrics.

Humanización, humanismo, ética

Fernando Lolas Stepke — 2024-09-25

HERREROS, BENJAMÍN. Filosofía y Medicina. Una historia de amor

Fernando Lolas Stepke — 2024-09-25

PIÑAS-MESA, A. y POVEDA GARCÍA-NOBLEJAS, B. (eds). Juan Rof Carballo. Medicina, Psicología, Antropología

Nunzio Bombaci — 2024-09-25

Desafíos en la especialización para gestión de datos de investigación en un contexto ético

Ricardo Hartley Belmar — 2024-09-25

Este comentario explora los desafíos éticos y bioéticos asociados con la gestión responsable de datos de investigación en Chile, en el contexto de la implementación de regulaciones europeas como el Reglamento General de Protección de Datos (GDPR) y los principios FAIR (Findability, Accessibility, Interoperability, and Reusability). Se comentan los esfuerzos de instituciones chilenas y regionales, como La Referencia, CLACSO y UNESCO, en la promoción de prácticas de gestión de datos que se alinean con los criterios europeos, y se explicitan recomendaciones para integrar de mejor forma la gestión responsable de los datos en el contexto de la investigación.

Octaviano Humberto Domínguez Márquez: incansable defensor de la dignidad de la vida

Octavio Márquez Mendoza — 2024-09-25

12 Congreso Internacional de Educación en Ética: Desarrollo Sostenible y Ecología Integral

David Cerdio-Domínguez — 2024-09-25