1
|
Linkeviciute A, Canario R, Peccatori FA, Dierickx K. Caring for Pregnant Patients with Cancer: A Framework for Ethical and Patient-Centred Care. Cancers (Basel) 2024; 16:455. [PMID: 38275896 PMCID: PMC10813952 DOI: 10.3390/cancers16020455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/13/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
(1) Background: Caring for pregnant cancer patients is clinically and ethically complex. There is no structured ethical guidance for healthcare professionals caring for these patients. (2) Objective: This concept paper proposes a theoretically grounded framework to support ethical and patient-centred care of pregnant cancer patients. (3) Methodological approach: The framework development was based on ethical models applicable to cancer care during pregnancy-namely principle-based approaches (biomedical ethics principles developed by Beauchamp and Childress and the European principles in bioethics and biolaw) and relational, patient-focused approaches (relational ethics, ethics of care and medical maternalism)-and informed by a systematic review of clinical practice guidelines. (4) Results: Five foundational discussion themes, summarising the key ethical considerations that should be taken into account by healthcare professionals while discussing treatment and care options with these patients, were identified. This was further developed into a comprehensive ethics checklist that can be used during clinical appointments and highlights the need for a holistic view to patient treatment, care and counselling while providing ethical, patient-centric care. (5) Conclusion: The proposed framework was further operationalised into an ethics checklist for healthcare professionals that aims to help them anticipate and address ethical concerns that may arise when attending to pregnant cancer patients. Further studies exploring clinicians' attitudes towards cancer treatment in the course of pregnancy and patient experiences when diagnosed with cancer while pregnant and wider stakeholder engagement are needed to inform the development of further ethical, patient-centred guidance.
Collapse
Affiliation(s)
- Alma Linkeviciute
- Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Rita Canario
- Cancer Metastasis i3S-Institute for Research & Innovation in Health, R. Alfredo Allen 208, 4200-135 Porto, Portugal;
- Research Centre, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
- ICBAS—School of Medicine and Biomedical Sciences, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Fedro Alessandro Peccatori
- Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, KU Leuven, 3000 Leuven, Belgium;
| |
Collapse
|
2
|
Rattani A. A Critique of Contemporary Islamic Bioethics. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:357-361. [PMID: 33661476 DOI: 10.1007/s11673-021-10098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
Last year marked a decade since the publication of the book "Islamic Biomedical Ethics" by religious studies professor Abdulaziz Sachedina in which he called for a critical and rigorous analytical approach to the ethical inquiry of biomedical issues from an Islamic perspective. Since the publication of this landmark work, some authors have continued to call into question the ways in which Islam as a religious tradition is engaged with in the secular bioethics literature. This paper describes common argumentative issues with current Islamic bioethics scholarship and offers general pearls and strategies to facilitate better engagement with religious approaches to bioethical issues.
Collapse
Affiliation(s)
- Abbas Rattani
- Department of Radiation Oncology, University of Louisville, 529 S Jackson St, Louisville, KY, 40202, USA.
| |
Collapse
|
3
|
Suurmond J, Lanting K, de Voogd X, Oueslati R, Boland G, van den Muijsenbergh M. Twelve tips to teach culturally sensitive palliative care. MEDICAL TEACHER 2021; 43:845-850. [PMID: 33070696 DOI: 10.1080/0142159x.2020.1832650] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
With an increasingly ageing population there will be a rising demand for palliative care, including from older migrants and ethnic minorities. While many (future) physicians are unfamiliar with specific needs of older migrants and ethnic minorities regarding care and communication in palliative care, this may be challenging for them to deal with. Moreover, even many medical teachers also feel unprepared to teach palliative care and culturally sensitive communication to students. In order to support medical teachers, we suggest twelve tips to teach culturally sensitive palliative care to guide the development and implementation of teaching this topic to medical students. Drawn from literature and our own experiences as teachers, these twelve tips provide practical guidance to both teachers and curriculum designers when designing and implementing education about culturally sensitive palliative care.
Collapse
Affiliation(s)
- Jeanine Suurmond
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Katja Lanting
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Academy of Health (AGZ), Saxion University of Applied Sciences, Enschede, The Netherlands
| | - Xanthe de Voogd
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Roukayya Oueslati
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nursing, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Gudule Boland
- Dutch Centre of Expertise on Health Disparities, Pharos, Utrecht, The Netherlands
| | - Maria van den Muijsenbergh
- Dutch Centre of Expertise on Health Disparities, Pharos, Utrecht, The Netherlands
- Department of Primary Care and Community Health, Radboud University Nijmegen, Nijmegen, The Netherlands
| |
Collapse
|
4
|
Ewuoso C, Hall S, Dierickx K. How do healthcare professionals respond to ethical challenges regarding information management? A review of empirical studies. Glob Bioeth 2021; 32:67-84. [PMID: 33897255 PMCID: PMC8023626 DOI: 10.1080/11287462.2021.1909820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim This study is a systematic review that aims to assess how healthcare professionals manage ethical challenges regarding information within the clinical context. Method and Materials We carried out searches in PubMed, Google Scholar and Embase, using two search strings; searches generated 665 hits. After screening, 47 articles relevant to the study aim were selected for review. Seven articles were identified through snowballing, and 18 others were included following a system update in PubMed, bringing the total number of articles reviewed to 72. We used a Q-sort technique for the analysis of identified articles. Findings This study reveals that healthcare professionals around the world generally employ (to varying degrees) four broad strategies to manage different types of challenges regarding information, which can be categorized as challenges related to confidentiality, communication, professional duty, and decision-making. The strategies employed for managing these challenges include resolution, consultation, stalling, and disclosure/concealment. Conclusion There are a variety of strategies which health professionals can adopt to address challenges regarding information management within the clinical context. This insight complements current efforts aimed at enhancing health professional-patient communication. Very few studies have researched the results of employing these various strategies. Future empirical studies are required to address this. Abbreviations CIOMS: Council of International Organization of Medical Sciences; WHO: World Health Organization; AMA: American Medical Association; WMA: World Medical Association; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis; ISCO: International Standard Classification of Occupations; ILO: International Labour Office; SPSS: The Statistical Package for the Social Sciences
Collapse
Affiliation(s)
| | - Susan Hall
- Center for Applied Ethics, Stellenbosch University, Western-Cape, South Africa
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Abstract
In surveying the medical literature on Islamic principles of research ethics, it is apparent that attempts to identify ethical principles are replete with issues of standards and gaps in knowledge of the uses of scriptural sources. Despite this, attempts at creating an Islamic ethical framework for research ethics may improve current practices in research in Muslim-majority countries and contribute to the growing canon of secular bioethics. This paper aims to identify principles and considerations within Islam that (1) overlap with current corpora on research ethics, and (2) further informs the current research ethics discourse.
Collapse
Affiliation(s)
- Abbas Rattani
- Stritch School of Medicine, Loyola University Chicago, 2160 S 1st Ave., Maywood, IL, 60153, USA.
| | - Adnan A Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E-8132, Baltimore, MD, 21093, USA
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore, MD, 21205, USA
| |
Collapse
|
6
|
Ohanian DM, Stiles-Shields C, Afzal KI, Bechtel Driscoll CF, Lennon Papadakis J, Stern A, Starnes M, Holmbeck GN. Cultural Considerations for Autonomy and Medical Adherence in a Young Palestinian American Muslim Female With Spina Bifida: A Longitudinal Case Study in a Research Context. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2018; 6:386-397. [PMID: 31231602 DOI: 10.1037/cpp0000250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This case study examines the unique presentation of a young Palestinian-American Muslim female, who is a part of an ongoing longitudinal study examining family and peer relationships, psychological adjustment, and neuropsychological functioning in youth with spina bifida. Throughout ten years of data collection, Palestinian-Arab culture and Islamic faith have consistently emerged as important factors that can be considered when interpreting this participant's general level of autonomy, medical autonomy, medical adherence, and psychological adjustment. This case study examines important aspects of adaptive and independent functioning for youth with spina bifida and how this family's culture interacts with these different domains of functioning. Moreover, it explores potential conflicts between an Arab collectivist family structure and Western biomedical ethics and suggests how clinicians might navigate these conflicts and bolster culturally-rooted strengths of families and patients from non-Western backgrounds.
Collapse
Affiliation(s)
- Diana M Ohanian
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Colleen Stiles-Shields
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Khalid I Afzal
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, 5841 S Maryland Ave, MC 3077, Chicago, IL 60637
| | | | | | - Alexa Stern
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Meredith Starnes
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Grayson N Holmbeck
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| |
Collapse
|
7
|
Rispler Chaim V, Duguet AM. Debates in Islamic bioethics on how to increase organ donations: Between presumed consent and explicit consent. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jemep.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Malek MM, Abdul Rahman NN, Hasan MS, Haji Abdullah L. Islamic Considerations on the Application of Patient's Autonomy in End-of-Life Decision. JOURNAL OF RELIGION AND HEALTH 2018; 57:1524-1537. [PMID: 29417395 DOI: 10.1007/s10943-018-0575-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In end-of-life situation, the need for patient's preference comes into the picture with the intention of guiding physicians in the direction of patient care. Preference in medical directive is made by a person with full mental capacity outlining what actions should be taken for his health should he loses his competency. This is based on the reality of universal paradigm in medical practice that emphasises patient's autonomy. A specific directive is produced according to a patient's wish that might include some ethically and religiously controversial directives such as mercy killing, physician-assisted suicide, forgoing life-supporting treatments and do-not-resuscitate. In the future, patient autonomy is expected to become prevalent. The extent of patient autonomy has not been widely discussed among Muslim scholars. In Islam, there are certain considerations that must be adhered to.
Collapse
Affiliation(s)
- Mohammad Mustaqim Malek
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- Centre for Science and Environment Studies, Institute of Islamic Understanding Malaysia, No. 2, Langgak Tunku, Off Jalan Tuanku Abdul Halim, 50480, Kuala Lumpur, Malaysia.
| | - Noor Naemah Abdul Rahman
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Luqman Haji Abdullah
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| |
Collapse
|
9
|
Cabiddu G, Spotti D, Gernone G, Santoro D, Moroni G, Gregorini G, Giacchino F, Attini R, Limardo M, Gammaro L, Todros T, Piccoli GB. A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology. J Nephrol 2018; 31:665-681. [PMID: 29949013 PMCID: PMC6182355 DOI: 10.1007/s40620-018-0499-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/30/2018] [Indexed: 12/15/2022]
Abstract
Kidney transplantation (KT) is often considered to be the method best able to restore fertility in a woman with chronic kidney disease (CKD). However, pregnancies in KT are not devoid of risks (in particular prematurity, small for gestational age babies, and the hypertensive disorders of pregnancy). An ideal profile of the potential KT mother includes “normal” or “good” kidney function (usually defined as glomerular filtration rate, GFR ≥ 60 ml/min), scant or no proteinuria (usually defined as below 500 mg/dl), normal or well controlled blood pressure (one drug only and no sign of end-organ damage), no recent acute rejection, good compliance and low-dose immunosuppression, without the use of potentially teratogen drugs (mycophenolic acid and m-Tor inhibitors) and an interval of at least 1–2 years after transplantation. In this setting, there is little if any risk of worsening of the kidney function. Less is known about how to manage “non-ideal” situations, such as a pregnancy a short time after KT, or one in the context of hypertension or a failing kidney. The aim of this position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology is to review the literature and discuss what is known about the clinical management of CKD after KT, with particular attention to women who start a pregnancy in non-ideal conditions. While the experience in such cases is limited, the risks of worsening the renal function are probably higher in cases with markedly reduced kidney function, and in the presence of proteinuria. Well-controlled hypertension alone seems less relevant for outcomes, even if its effect is probably multiplicative if combined with low GFR and proteinuria. As in other settings of kidney disease, superimposed preeclampsia (PE) is differently defined and this impairs calculating its real incidence. No specific difference between non-teratogen immunosuppressive drugs has been shown, but calcineurin inhibitors have been associated with foetal growth restriction and low birth weight. The clinical choices in cases at high risk for malformations or kidney function impairment (pregnancies under mycophenolic acid or with severe kidney-function impairment) require merging clinical and ethical approaches in which, beside the mother and child dyad, the grafted kidney is a crucial “third element”.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Monica Limardo
- Azienda Ospedaliera della Provincia di Lecco, Lecco, Italy
| | | | - Tullia Todros
- Department of Surgery, Università di Torino, Turin, Italy
| | - Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, Università di Torino, Turin, Italy. .,Centre Hospitalier Le Mans, Le Mans, France.
| | | |
Collapse
|
10
|
Naji Z, Zamani Z, Koutlaki SA, Salamati P. Personal autonomy in health settings and Shi'i Islamic Jurisprudence: a literature review. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2017; 20:435-441. [PMID: 27699713 DOI: 10.1007/s11019-016-9738-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Respect for personal autonomy in decision-making is one of the four ethical principles in medical circumstances. This paper aims to present evidence that can be considered good exemplars in the clarification of the ethical viewpoints of the western and Shi'i Islamic perspectives on this issue. The method followed was originally a search in international indexing services in April 2016. Our findings point towards various controversies on individuals' autonomy lead to different decision making outcomes by health workers in both different traditions. We concluded that although Shi'i Islamic jurisprudence does not seem to allow for personal autonomy in the sense it is understood in a western context, evidence indicates that Shi'i Islamic jurisprudence respects personal autonomy.
Collapse
Affiliation(s)
- Zohrehsadat Naji
- Young Researchers and Elites Club, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | | | | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
11
|
Abstract
The doctor-patient relationship is an intricate concept in which patients voluntarily approach a doctor and become part of a contract by which they tend to abide by doctor’s instructions. Over recent decades, this relationship has changed dramatically due to privatization and commercialization of the health sector. A review of the relevant literature in the database of MEDLINE published in English between 1966 and August 2015 was performed with the following keywords: doctor-patient relationship, physician-patient relationship, ethics, and Islam. The Muslim doctor should be familiar with the Islamic teachings on the daily issues faced in his/her practice and the relationship with his/her patients.
Collapse
Affiliation(s)
- Hassan Chamsi-Pasha
- Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail.
| | | |
Collapse
|
12
|
van Eechoud I, Grypdonck M, Leman J, Verhaeghe S. Perspectives of oncology health workers in Flanders on caring for patients of non-Western descent. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/29/2022]
Affiliation(s)
- I. van Eechoud
- Department of Social Work and Diversity & Intercultural Mediation; University Hospital Ghent; Ghent Belgium
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Ghent Belgium
| | - M. Grypdonck
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Ghent Belgium
| | - J. Leman
- Department of Social Sciences; KU Leuven; Leuven Belgium
| | - S. Verhaeghe
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Ghent Belgium
| |
Collapse
|
13
|
Abstract
The paper begins by asserting the need for bioethical and related philosophical considerations in the emerging subspecialty Positive Psychiatry. Further discussion proceeds after offering operational definitions of the concepts fundamental to the field – Bioethics, Positive Psychology, Positive Psychiatry and Positive Mental Health - with their conceptual analysis to show their areas of connect and disconnect. It then studies the implications of positive and negative findings in the field, and presents the Positive Psychosocial Factors (PPSFs) like Resilience, Optimism, Personal Mastery, Wisdom, Religion/Spirituality, Social relationships and support, Engagement in pleasant events etc. It then evaluates them on the basis of the 4-principled bioethical model of Beneficence, Non-malfeasance, Autonomy and Justice (Beauchamp and Childress, 2009[5], 2013[6]), first offering a brief clarification of these principles and then their bioethical analysis based on the concepts of ‘Common Morality’, ‘Specific Morality’, ‘Specification’, ‘Balancing’ and ‘Double Effects’. The paper then looks into the further development of the branch by studying the connectivity, synergy and possible antagonism of the various Positive Psychosocial Factors, and presents technical terms in place of common terms so that they carry least baggage. It also takes note of the salient points of caution and alarm that many incisive analysts have presented about further development in the related field of Positive Mental Health. Finally, the paper looks at where, and how, the field is headed, and why, if at all, it is proper it is headed there, based on Aristotle's concept of the four causes - Material, Efficient, Formal and Final. Suitable case vignettes are presented all through the write-up to clarify concepts.
Collapse
Affiliation(s)
| | - Shakuntala A Singh
- PhD. Deputy Editor, Mens Sana Monographs, Principal and Head, Department of Philosophy, Joshi-Bedekar College, Thane, Maharashtra, India
| |
Collapse
|
14
|
van Eechoud IJ, Grypdonck M, Beeckman D, Van Lancker A, Van Hecke A, Verhaeghe S. Oncology health workers' views and experiences on caring for ethnic minority patients: A mixed method systematic review. Int J Nurs Stud 2015; 53:379-98. [PMID: 26429358 DOI: 10.1016/j.ijnurstu.2015.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate what published research reveals about the views and experiences of oncology health workers when caring for ethnic minority patients. DESIGN Systematic review of qualitative and quantitative studies. DATA SOURCES The following databases were systematically screened: PubMed, CINAHL, Web of Science, and AnthroSource. Reference lists were checked for additional articles. REVIEW METHODS Empirical studies or systematic reviews (1/2000 to 12/2013) were included if they concerned the oncology setting and the views or experiences of healthcare workers and care users belonging to an ethnic or cultural minority group. The methodological quality of each individual study was assessed using the Critical Appraisal Skills Programme for Qualitative Studies and the Quality Assessment Tool for Quantitative Studies. RESULTS Eighteen publications met the inclusion criteria. Thirteen articles had a qualitative, four a quantitative, and one a mixed methods design. The results in the individual studies were heterogeneous. Most studies reported challenges or barriers when caring for ethnic minority patients, whereas fewer than half of the articles discussed facilitating factors and opportunities. Oncology health workers participating in the included studies sought to provide professional standards of care and tried to adapt care to the needs of ethnic minority patients. However, they experienced formidable communication barriers and they feared doing things that might be considered culturally insensitive. The organizational aspects of care for the oncology patient appeared to have a significant influence on how healthcare providers view and experience oncology care for ethnic minority patients. CONCLUSIONS Views and experiences of participating oncology health workers were characterized by a willingness to provide proper care for ethnic minority patients, but this was hampered by a tangle of interrelated issues such as linguistic barriers, fear and uncertainty, and assumptions about cultural matters. Organizational aspects were shown to be a strong influence on healthcare workers caring for ethnic minority patients. Due to methodological limitations of the included studies, conclusions should be viewed with caution.
Collapse
Affiliation(s)
- Ineke J van Eechoud
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Belgium.
| | - Mieke Grypdonck
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Dimitri Beeckman
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Aurélie Van Lancker
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Ann Van Hecke
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Sofie Verhaeghe
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Belgium
| |
Collapse
|
15
|
Monsudi KF, Oladele TO, Nasir AA, Ayanniyi AA. Medical ethics in sub-Sahara Africa: closing the gaps. Afr Health Sci 2015; 15:673-81. [PMID: 26124819 DOI: 10.4314/ahs.v15i2.47] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Health care providers are expected to have the skills and knowledge relevant to their field and should also be familiar with the ethical and legal expectations that arise out of the standard practices. OBJECTIVES To elucidate the practice of the health care providers in relation to healthcare ethics in Nigeria. METHODS A self-administered structured questionnaire was devised and distributed to staff of two tertiary health care facilities in Northern Nigeria. The questionnaire comprised of detailed questions regarding day-to-day aspects of Medical ethical issues. RESULTS A total of 307(76.2%) out of 403 health care providers responded to the questionnaire. The median age of the respondents was 34 years. More than half 168(54.7%) of the respondents disagreed as to whether "Ethical conduct is important only to avoid legal action. Many respondents 135 (44.0%) agreed to adhering to "patient's wishes", on the other hand over two-third of the respondents 211 (68.7%) agreed that "doctor should do what is best" irrespective of the patient's opinion. There were significant differences (p<0.05) between the perception of physicians and non-physicians on many ethical issues. CONCLUSION This study has shown gap in knowledge and practice of healthcare ethics among health care providers. There is a need for periodic education on clinical ethics in our hospitals.
Collapse
Affiliation(s)
- Kehinde F Monsudi
- Department of Ophthalmology, Federal Medical Center, Birnin Kebbi, Nigeria
| | - Tajudeen O Oladele
- Department of Psychiatric, Federal Neuropsychiatric Hospital, Kware, Nigeria
| | - Abdulrasheed A Nasir
- Department of Surgery, University of Ilorin / University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Abdulkabir A Ayanniyi
- Department of Ophthalmology, University of Abuja/ University of Abuja Teaching Hospital, Abuja Nigeria
| |
Collapse
|
16
|
Christen M, Ineichen C, Tanner C. How "moral" are the principles of biomedical ethics?--a cross-domain evaluation of the common morality hypothesis. BMC Med Ethics 2014; 15:47. [PMID: 24938295 PMCID: PMC4071216 DOI: 10.1186/1472-6939-15-47] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 06/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background The principles of biomedical ethics – autonomy, non-maleficence, beneficence, and justice – are of paradigmatic importance for framing ethical problems in medicine and for teaching ethics to medical students and professionals. In order to underline this significance, Tom L. Beauchamp and James F. Childress base the principles in the common morality, i.e. they claim that the principles represent basic moral values shared by all persons committed to morality and are thus grounded in human moral psychology. We empirically investigated the relationship of the principles to other moral and non-moral values that provide orientations in medicine. By way of comparison, we performed a similar analysis for the business & finance domain. Methods We evaluated the perceived degree of “morality” of 14 values relevant to medicine (n1 = 317, students and professionals) and 14 values relevant to business & finance (n2 = 247, students and professionals). Ratings were made along four dimensions intended to characterize different aspects of morality. Results We found that compared to other values, the principles-related values received lower ratings across several dimensions that characterize morality. By interpreting our finding using a clustering and a network analysis approach, we suggest that the principles can be understood as “bridge values” that are connected both to moral and non-moral aspects of ethical dilemmas in medicine. We also found that the social domain (medicine vs. business & finance) influences the degree of perceived morality of values. Conclusions Our results are in conflict with the common morality hypothesis of Beauchamp and Childress, which would imply domain-independent high morality ratings of the principles. Our findings support the suggestions by other scholars that the principles of biomedical ethics serve primarily as instruments in deliberated justifications, but lack grounding in a universal “common morality”. We propose that the specific manner in which the principles are taught and discussed in medicine – namely by referring to conflicts requiring a balancing of principles – may partly explain why the degree of perceived “morality” of the principles is lower compared to other moral values.
Collapse
Affiliation(s)
- Markus Christen
- University Research Priority Program Ethics, University of Zurich, Zurich, Switzerland.
| | | | | |
Collapse
|
17
|
McMahon-Parkes K. Rationality, religion and refusal of treatment in an ambulance revisited. JOURNAL OF MEDICAL ETHICS 2013; 39:587-590. [PMID: 22593178 DOI: 10.1136/medethics-2011-100079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In their recent article, Erbay et al considered whether a seriously injured patient should be able to refuse treatment if the refusal was based on a (mis)interpretation of religious doctrine. They argued that in such a case 'what is important…is whether the teaching or philosophy used as a reference point has been in fact correctly perceived' (p 653). If it has not been, they asserted that this eroded the patient's capacity to make an autonomous decision and that therefore, in such cases, it is the role of the healthcare professional (HCP) to 'assist patients to think more clearly and rationally' (p 653). There are, however, a number of problems with the reasons why Erbay et al suggest we should help patients to rationalise their decisions and how HCPs should go about this. In this article, the author explores some of their main arguments regarding consent and rationality (particularly in relation to religious beliefs), as well as Erbay et al's normative claim that HCPs have an obligation to promote autonomy by helping patients to come to a 'rational' decision. Ultimately, the author agrees that the (temporary) solution to the dilemma presented in this scenario (which was to insert an intravenous cannula into the patient in order to allow an infusion of fluids in the event that he changed his mind) seemed both pragmatic and ethically permissible. However, it is suggested that the arguments which underpin this conclusion in Erbay et al's article are largely unsound.
Collapse
Affiliation(s)
- Kate McMahon-Parkes
- University of the West of England, Faculty of Health and Life Sciences, Alexander Warehouse, Gloucester Docks, Gloucester, GL1 2LG, UK.
| |
Collapse
|
18
|
Bétrémieux P, Mannoni C. [Neonatal palliative care and culture]. Arch Pediatr 2013; 20:1000-5. [PMID: 23896086 DOI: 10.1016/j.arcped.2013.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/19/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
Abstract
The period of palliative care is a difficult time for parents and caregivers because they are all weakened by the proximity of death. First of all, because of religious and cultural differences, parents and families cannot easily express their beliefs or the rituals they are required to develop; second, this impossibility results in conflicts between the caregiver team and the family with consequences for both. Caregivers are concerned to allow the expression of religious beliefs and cultural demands because it is assumed that they may promote the work of mourning by relating the dead child to its family and roots. However, caregivers' fear not knowing the cultural context to which the family belongs and having inappropriate words or gestures, as sometimes families dare not, cannot, or do not wish to describe their cultural background. We attempt to differentiate what relates to culture and to religion and attempt to identify areas of potential disagreement between doctors, staff, and family. Everyone has to work with the parents to open a space of freedom that is not limited by cultural and religious assumptions. The appropriation of medical anthropology concepts allows caregivers to understand simply the obligations imposed on parents by their culture and/or their religion and open access to their wishes. Sometimes help from interpreters, mediators, ethnopsychologists, and religious representatives is needed to understand this reality.
Collapse
Affiliation(s)
- P Bétrémieux
- Unité de néonatalogie 2, hôpital Sud, CHU, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex, France.
| | | |
Collapse
|
19
|
Realizing good care within a context of cross-cultural diversity: an ethical guideline for healthcare organizations in Flanders, Belgium. Soc Sci Med 2013; 93:38-46. [PMID: 23906119 DOI: 10.1016/j.socscimed.2013.03.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 12/05/2012] [Accepted: 03/20/2013] [Indexed: 11/23/2022]
Abstract
In our globalizing world, health care professionals and organizations increasingly experience cross-cultural challenges in care relationships, which give rise to ethical questions regarding "the right thing to do" in such situations. For the time being, the international literature lacks examples of elaborated ethical guidelines for cross-cultural healthcare on the organizational level. As such, the ethical responsibility of healthcare organizations in realizing cross-cultural care remains underexposed. This paper aims to fill this gap by offering a case-study that illustrates the bioethical practice on a large-scale organizational level by presenting the ethical guideline developed in the period 2007-2011 by the Ethics Committee of Zorgnet Vlaanderen, a Christian-inspired umbrella organization for over 500 social profit healthcare organizations in Flanders, Belgium. The guideline offers an ethical framework within which fundamental ethical values are being analyzed within the context of cross-cultural care. The case study concludes with implications for healthcare practice on four different levels: (1) the level of the healthcare organization, (2) staff, (3) care receivers, and (4) the level of care supply. The study combines content-based ethics with process-based benchmarks.
Collapse
|
20
|
Walczak A, Butow PN, Davidson PM, Bellemore FA, Tattersall MHN, Clayton JM, Young J, Mazer B, Ladwig S, Epstein RM. Patient perspectives regarding communication about prognosis and end-of-life issues: how can it be optimised? PATIENT EDUCATION AND COUNSELING 2013; 90:307-314. [PMID: 21920693 DOI: 10.1016/j.pec.2011.08.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 08/08/2011] [Accepted: 08/15/2011] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To explore patients' perspectives across two cultures (Australia and USA) regarding communication about prognosis and end-of-life care issues and to consider the ways in which these discussions can be optimised. METHODS Fifteen Australian and 11 US patients completed individual semi-structured qualitative interviews. A further 8 US patients participated in a focus group. Interviews and focus group recordings were transcribed verbatim and interpreted using thematic text analysis with an inductive, data-driven approach. RESULTS Global themes identified included readiness for and outcomes of discussions of prognosis and end-of-life issues. Contributing to readiness were sub themes including patients' adjustment to and acceptance of their condition (together with seven factors promoting this), doctor and patient communication skills, mutual understandings and therapeutic relationship elements. Outcomes included sub themes of achievement of control and ability to move on. A model of the relationships between these factors, emergent cross cultural differences, and how factors may help to optimise these discussions are presented. CONCLUSION Identified optimising factors illustrate Australian and US patients' perspectives regarding how prognosis and end-of-life issues can be discussed with minimised negative impact. PRACTICE IMPLICATIONS Recognition of factors promoting adjustment, acceptance and readiness and use of the communication skills and therapeutic relationship elements identified may assist in optimising discussions and help patients plan care, achieve more control of their situation and enjoy an optimal quality-of-life.
Collapse
Affiliation(s)
- Adam Walczak
- Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, Australia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Prinzipien und Diskurs – Ein Ansatz theoretischer Rechtfertigung der ethischen Fallbesprechung und Ethikkonsultation. Ethik Med 2013. [DOI: 10.1007/s00481-013-0243-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Mobasher M, Salari P, Larijani B. Key ethical issues in pediatric research: islamic perspective, Iranian experience. IRANIAN JOURNAL OF PEDIATRICS 2012; 22:435-44. [PMID: 23429172 PMCID: PMC3533141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 02/12/2012] [Accepted: 03/10/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The importance of pediatric research especially in the ethically proven trials resulted in considerable legislative attempts in association with compiling ethical guidelines. Because of children's vulnerability conducting pediatric research raises different ethical issues; the two most important of which are informed consent and risk-benefit assessment. Differences in religious and socio-cultural context limit implication of ethical standards. METHODS At the aim of finding a solution we critically reviewed guidelines, and literatures as well as Islamic points in addition to comparing different viewpoints in application of ethical standards in pediatric research. FINDINGS The literature review showed that pediatric research guidelines and authors' viewpoints have the same basic ethical core, but there are some variations; depend on cultural, religious, and social differences. Furthermore, these standards have some limitations in defining informed consent according to child's age and capacity upon application. CONCLUSION In this regard Islamic approach and definition about growth development and puberty sheds light and clarifies a clearer and more rational address to the issue.
Collapse
Affiliation(s)
- Mina Mobasher
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Pooneh Salari
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
23
|
De Graaff FM, Francke AL, Van den Muijsenbergh METC, van der Geest S. Talking in triads: communication with Turkish and Moroccan immigrants in the palliative phase of cancer. J Clin Nurs 2012; 21:3143-52. [DOI: 10.1111/j.1365-2702.2012.04289.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Anneke L Francke
- EMGO+ Institute of the VU University Medical Centre Amsterdam; Amsterdam; The Netherlands
| | | | | |
Collapse
|
24
|
|
25
|
Mo HN, Shin DW, Woo JH, Choi JY, Kang J, Baik YJ, Huh YR, Won JH, Park MH, Cho SH. Is patient autonomy a critical determinant of quality of life in Korea? End-of-life decision making from the perspective of the patient. Palliat Med 2012; 26:222-31. [PMID: 21562031 DOI: 10.1177/0269216311405089] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We aimed to investigate the current practice of the involvement in decision making from the perspectives of terminal cancer patients, and to explore its possible associations with quality of life and quality of death in Korea. METHODS A multi-center, cross-sectional survey was performed on 93 terminal cancer patients. The questionnaire solicited their opinions regarding participation in treatment decision making, as well as quality of life (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire for Palliative Care) and quality of death (Good Death Inventory-Patient Version). RESULTS A total of 78.5% of the patients had awareness of their terminal status, while 21.5% did not; 42.4% stated that they knew their condition and shared the decision-making responsibility with the medical staff and their family, while 21.7% made decisions on their own, and 35.9% left the decision-making responsibility to others. Patients who were aware of their illness and who actively participated in the decision making did not score higher than others on outcome measures of quality of life and quality of death. Moreover, the former even showed lower scores in some domains, including the 'physical and psychological comfort' (4.99 versus 5.61, p = 0.03), 'environmental comfort' (5.51 versus 6.04, p = 0.08), and 'emotional functioning' (55.70 versus 71.01, p = 0.06). CONCLUSION in Korea, patient autonomy is not a universally accepted value from the perspectives of terminal cancer patients, nor is patient involvement in decision making always conducive to high quality of life or quality of death. The level of information and the pace at which it is provided should be tailored to each individual's ability, preference, need, and culture.
Collapse
Affiliation(s)
- Ha Na Mo
- National Cancer Control Institute, National Cancer Center, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
For at least 50 years informed consent in medicine has focused on the principle of autonomy. Recently, attention has been given to informed consent being a shared decision. A primary mandate to do what is in the best interest of the patient still remains. The shared view looks to expand beyond the dyadic image of doctor and patient, to acknowledge the essential contribution to be made to informed consent from the cultural, religious, and personal values. This paper explores some of the cultural aspects of Islam that should influence informed consent.
Collapse
Affiliation(s)
- Samuel Packer
- Chair, Ethics Committee, North Shore University Hospital, Long Island Jewish Medical Center, Professor of Ophthalmology, Hofstra North Shore Long Island Jewish School of Medicine, Long Island, New York
| |
Collapse
|
27
|
de Pentheny O'Kelly C, Urch C, Brown EA. The impact of culture and religion on truth telling at the end of life. Nephrol Dial Transplant 2011; 26:3838-42. [DOI: 10.1093/ndt/gfr630] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
28
|
Ko E, Lee J. Completion of Advance Directives Among Korean American and Non-Hispanic White Older Adults. Res Aging 2010. [DOI: 10.1177/0164027510377310] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines completion of advance directives, highlighting ethnic differences between Korean and non-Hispanic White older adults in relation to health beliefs and knowledge. In this study, 217 community-dwelling older adults (112 Korean Americans and 105 non-Hispanic Whites) were interviewed using structured questionnaires. As compared to only 5.4% ( n = 6) of Korean American older adults, more than half of non-Hispanic White older adults (59.2%, n = 61) had completed advance directives. Health beliefs, but not knowledge, significantly mediated the relationship between ethnicity and completion of advance directives; Korean Americans had lower levels of health beliefs toward advance care planning than non-Hispanic Whites, and this in turn led to relatively lower rates of completing advance directives. Thus, it is advised that health care practice needs to encompass older adults’ health beliefs, which may be uniquely represented among different ethnic groups.
Collapse
Affiliation(s)
- Eunjeong Ko
- San Diego State University, San Diego, CA, USA,
| | | |
Collapse
|
29
|
CQ Sources/Bibliography. Camb Q Healthc Ethics 2010. [DOI: 10.1017/s0963180110000186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
These CQ Sources were compiled by Bette Anton.
Collapse
|
30
|
Voo TC. Editorial comment: the four principles and cultural specification. Eur J Pediatr 2009; 168:1389. [PMID: 19296130 DOI: 10.1007/s00431-009-0971-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 03/03/2009] [Indexed: 10/21/2022]
Abstract
The four-principles approach of Beauchamp and Childress has had a huge influence in many areas of medicine, including Pediatrics. There is a risk that such universalist principles fail to take into account cultural differences. This is an important point but there is a need to see the more nuanced aspects of the approach.
Collapse
|