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Tosam MJ. Autonomy-based bioethics and vulnerability during the COVID-19 pandemic: towards an African relational approach. THEORETICAL MEDICINE AND BIOETHICS 2024; 45:183-197. [PMID: 38789700 DOI: 10.1007/s11017-024-09671-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
The COVID-19 pandemic has provoked new interest in the notion of vulnerability and in identifying alternative approaches for responding to vulnerable patients and populations during health emergencies. In this paper, I argue that the autonomy-based approach (the most dominant approach in bioethics) to responding to vulnerability during health emergencies is deficient because it focuses only on the interests, values, and decisions of the individual patient. It overly emphasizes respect for autonomy and not respect for the patient as it does not consider the patient as a social and relational agent. Indeed, relational approaches to autonomy like the feminist and indigenous sub-Saharan African ethical approaches are promising alternatives. In this essay, I use the indigenous African relational approach to autonomy as an example of an alternative method which can be used to respond to vulnerability during a global health emergency like COVID-19.
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Affiliation(s)
- Mbih Jerome Tosam
- Department of Philosophy, The University of Bamenda, Bamenda, Cameroon.
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Redhead CAB, Frith L, Chiumento A, Fovargue S, Draper H. Using symbiotic empirical ethics to explore the significance of relationships to clinical ethics: findings from the Reset Ethics research project. BMC Med Ethics 2024; 25:66. [PMID: 38802832 PMCID: PMC11131179 DOI: 10.1186/s12910-024-01053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/03/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND At the beginning of the coronavirus (Covid-19) pandemic, many non-Covid healthcare services were suspended. In April 2020, the Department of Health in England mandated that non-Covid services should resume, alongside the continuing pandemic response. This 'resetting' of healthcare services created a unique context in which it became critical to consider how ethical considerations did (and should) underpin decisions about integrating infection control measures into routine healthcare practices. We draw on data collected as part of the 'NHS Reset Ethics' project, which explored the everyday ethical challenges of resetting England's NHS maternity and paediatrics services during the pandemic. METHODS Healthcare professionals and members of the public participated in interviews and focus group discussions. The qualitative methods are reported in detail elsewhere. The focus of this article is our use of Frith's symbiotic empirical ethics methodology to work from our empirical findings towards the normative suggestion that clinical ethics should explicitly attend to the importance of relationships in clinical practice. This methodology uses a five-step approach to refine and develop ethical theory based on a naturalist account of ethics that sees practice and theory as symbiotically related. RESULTS The Reset project data showed that changed working practices caused ethical challenges for healthcare professionals, and that infection prevention and control measures represented harmful barriers to the experience of receiving and offering care. For healthcare professionals, offering care as part of a relational interaction was an ethically important dimension of healthcare delivery. CONCLUSIONS Our findings suggest that foregrounding the importance of relationships across a hospital community will better promote the ethically important multi-directional expression of caring between healthcare professionals, patients, and their families. We offer two suggestions for making progress towards such a relational approach. First, that there is a change of emphasis in clinical ethics practice to explicitly acknowledge the importance of the relationships (including with their healthcare team) within which the patient is held. Second, that organisational decision-making should take into account the moral significance afforded to caring relationships by healthcare professionals, and the role such relationships can play in the negotiation of ethical challenges.
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Affiliation(s)
- Caroline A B Redhead
- Centre for Social Ethics and Policy, Department of Law, The University of Manchester, Manchester, UK.
| | - Lucy Frith
- Centre for Social Ethics and Policy, Department of Law, The University of Manchester, Manchester, UK
| | - Anna Chiumento
- School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK
| | - Sara Fovargue
- School of Law, University of Sheffield, Sheffield, UK
| | - Heather Draper
- Warwick Medical School, The University of Warwick, Warwick, UK
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Coronado-Vázquez MDV, Gómez-Trenado R, Benito-Sánchez B, Barrio-Cortes J, Gil-Salmerón A, Amengual-Pliego M, Grabovac I. Cancer prevention in people experiencing homelessness: ethical considerations and experiences from the CANCERLESS project. Front Public Health 2024; 12:1371505. [PMID: 38655508 PMCID: PMC11036339 DOI: 10.3389/fpubh.2024.1371505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
The incidence of cancer in Europe has been increasing in recent years. Despite this, cancer prevention has remained a low priority in health policies. Cancer is one of the main causes of mortality among people experiencing homelessness, who continue to have difficulties accessing prevention programs. A strategy that has been tested to favor cancer prevention is the health navigator figure. The objective of CANCERLESS project is to implement this model among populations experiencing homelessness in four European countries to foster the prevention and early detection of cancer. In this perspective, a presentation of CANCERLESS project is made, and its ethical aspects are discussed according to the ethics of public health, the ethics of care, solidarity, relational autonomy, and the social recognition of the virtue of just generosity. The ethical foundations of CANCERLESS project are rooted in social justice and in equity in access to health systems in general and cancer screening programs in particular. The ethics of public health guided by utilitarianism are insufficient in serving the interests of the most disadvantaged groups of the population. Hence, it is necessary to resort to relational bioethics that includes the ethics of care and solidarity and that recognizes the moral identity of socially excluded persons, reaffirming their position of equality in society. Relational autonomy therefore provides a broader conception by including the influence of living conditions in decisions. For this reason, the CANCERLESS project opts for a dialogue with those affected to incorporate their preferences and values into decisions about cancer prevention.
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Affiliation(s)
- María del Valle Coronado-Vázquez
- Healthcare Center Las Cortes, Gerencia 1 Healthcare Center Las Cortes, Gerencia Asistencial de Atención Primaria, Madrid, Spain
- Facultad de Medicina, Francisco de Vitoria University, Madrid, Spain
- B21-20R Group, Instituto Aragonés de Investigaciones Sanitarias, Universidad de Zaragoza, Zaragoza, Spain
| | - Rosa Gómez-Trenado
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Madrid, Spain
- Health Work Department, Complutense University of Madrid, Madrid, Spain
| | - Beatriz Benito-Sánchez
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Madrid, Spain
| | - Jaime Barrio-Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Madrid, Spain
- Faculty of Health, Camilo José Cela University, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain
| | - Alejandro Gil-Salmerón
- International Foundation for Integrated Care, Oxford, United Kingdom
- International University of Valencia, Valencia, Spain
- Complutense University of Madrid, Madrid, Spain
| | - Miguel Amengual-Pliego
- B21-20R Group, Instituto Aragonés de Investigaciones Sanitarias, Universidad de Zaragoza, Zaragoza, Spain
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria
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Inagaki N, Seto N, Lee K, Takahashi Y, Nakayama T, Hayashi Y. The role of critical care nurses in shared decision-making for patients with severe heart failure: A qualitative study. PLoS One 2023; 18:e0288978. [PMID: 37471342 PMCID: PMC10358911 DOI: 10.1371/journal.pone.0288978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023] Open
Abstract
AIM Patients with severe heart failure undergo highly invasive and advanced therapies with uncertain treatment outcomes. For these patients, shared decision-making is necessary. To date, the nursing perspective of the decision-making process for patients facing difficulties and how nurses can support patients in this process have not been fully elucidated. This study aimed to clarify the perceptions of critical care nurses regarding situations with patients with severe heart failure that require difficult decision-making, and their role in supporting these patients. METHODS Individual semi-structured interviews were conducted with 10 certified nurse specialists in critical care nursing at nine hospitals in Japan. A qualitative inductive method was used and the derived relationships among the themes were visually structured and represented. RESULTS The nurses' perceptions on patients' difficult situations in decision-making were identified as follows: painful decisions under uncertainties; tense relationships; wavering emotions during decision-making; difficulties in coping with worsening medical conditions; patients' wishes that are difficult to realize or estimate; and difficulties in transitioning from advanced medical care. Critical care nurses' roles were summarized into six themes and performed collaboratively within the nursing team. Of these, the search for meaning and value was fundamental. Two positions underpin the role of critical care nurses. The first aims to provide direct support and includes partnerships and rights advocacy. The second aims to provide a holistic perspective to enable necessary adjustments, as indicated by situation assessments and mediation. By crossing various boundaries, co-creating, and forming a good circular relationship in the search for meaning and values, the possibility of expanding treatment and recuperation options may be considered. CONCLUSIONS Patients with severe heart failure have difficulty participating in shared decision-making. Critical care nurses should collaborate within the nursing team to improve interprofessional shared decision-making by providing decisional support to patients that focuses on values and meaning.
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Affiliation(s)
- Noriko Inagaki
- Graduate School of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
| | - Natsuko Seto
- Graduate School of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kumsun Lee
- Graduate School of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Yuko Hayashi
- Graduate School of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
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Deeb M, Alameddine D, Abi Radi Abou Jaoudeh R, Laoun W, Maamari J, Honeini R, Khouri A, Abou-Mrad F, Elia N, Abi-Gerges A. Knowledge about and attitudes toward medical informed consent: a Lebanese population survey. ETHICS & BEHAVIOR 2022. [DOI: 10.1080/10508422.2022.2153681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Mary Deeb
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Dana Alameddine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | | | - Widian Laoun
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Julian Maamari
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Rawan Honeini
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Alain Khouri
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Fadi Abou-Mrad
- Faculty of Medical Sciences, Lebanese University, Lebanon; Memory Clinic, Division of Neurology, Saint Charles Hospital, Lebanon; Lebanon Memory Group for Clinical Research (GMRC-Liban), Lebanon
| | - Nassib Elia
- Faculty of Law, Sagesse University, Lebanon
- Judicial Studies Institute, Lebanese Ministry of Justice, Beirut, Lebanon
| | - Aniella Abi-Gerges
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
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Broom J, Williams Veazey L, Broom A, Hor S, Degeling C, Burns P, Wyer M, Gilbert GL. Experiences of the SARS-CoV-2 pandemic amongst Australian healthcare workers: from stressors to protective factors. J Hosp Infect 2022; 121:75-81. [PMID: 34902500 PMCID: PMC8662954 DOI: 10.1016/j.jhin.2021.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The SARS-CoV-2 pandemic has critically challenged healthcare systems globally. Examining the experiences of healthcare workers (HCWs) is important for optimizing ongoing and future pandemic responses. OBJECTIVES In-depth exploration of Australian HCWs' experiences of the SARS-CoV-2 pandemic, with a focus on reported stressors vis-à-vis protective factors. METHODS Individual interviews were performed with 63 HCWs in Australia. A range of professional streams and operational staff were included. Thematic analysis was performed. RESULTS Thematic analysis identified stressors centred on paucity of, or changing, evidence, leading to absence of, or mistrust in, guidelines; unprecedented alterations to the autonomy and sense of control of clinicians; and deficiencies in communication and support. Key protective factors included: the development of clear guidance from respected clinical leaders or recognized clinical bodies, interpersonal support, and strong teamwork, leadership, and a sense of organizational preparedness. CONCLUSIONS This study provides insights into the key organizational sources of emotional stress for HCWs within pandemic responses and describes experiences of protective factors. HCWs experiencing unprecedented uncertainty, fear, and rapid change, rely on clear communication, strong leadership, guidelines endorsed by recognized expert groups or individuals, and have increased reliance on interpersonal support. Structured strategies for leadership and communication at team, service group and organizational levels, provision of psychological support, and consideration of the potential negative effects of centralizing control, would assist in ameliorating the extreme pressures of working within a pandemic environment.
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Affiliation(s)
- J Broom
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - L Williams Veazey
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, New South Wales, Australia
| | - A Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, New South Wales, Australia
| | - S Hor
- Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - C Degeling
- Centre for Health Engagement, Evidence and Values, University of Wollongong, New South Wales, Australia
| | - P Burns
- ANU Medical School, Hospital Road, Garran ACT, 2605, Australia; School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - M Wyer
- The Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, New South Wales, Australia; Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - G L Gilbert
- The Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, New South Wales, Australia; Westmead Institute for Medical Research, Westmead, New South Wales, Australia
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