1
|
Herreros B, Ramnath VR, Santiago-Saez A, Velasco Sanz TR, Pinto Pastor P. Guidelines for conscientious objection in Spain: a proposal involving prerequisites and protocolized procedure. Philos Ethics Humanit Med 2024; 19:4. [PMID: 38654305 DOI: 10.1186/s13010-024-00155-x] [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: 12/01/2021] [Accepted: 02/28/2024] [Indexed: 04/25/2024] Open
Abstract
Healthcare professionals often face ethical conflicts and challenges related to decision-making that have necessitated consideration of the use of conscientious objection (CO). No current guidelines exist within Spain's healthcare system regarding acceptable rationales for CO, the appropriate application of CO, or practical means to support healthcare professionals who wish to become conscientious objectors. As such, a procedural framework is needed that not only assures the appropriate use of CO by healthcare professionals but also demonstrates its ethical validity, legislative compliance through protection of moral freedoms and patients' rights to receive health care. Our proposal consists of prerequisites of eligibility for CO (individual reference, specific clinical context, ethical justification, assurance of non-discrimination, professional consistency, attitude of mutual respect, assurance of patient rights and safety) and a procedural process (notification and preparation, documentation and confidentiality, evaluation of prerequisites, non-abandonment, transparency, allowance for unforeseen objection, compensatory responsibilities, access to guidance and/or consultative advice, and organizational guarantee of professional substitution). We illustrate the real-world utility of the proposed framework through a case discussion in which our guidelines are applied.
Collapse
Affiliation(s)
- Benjamín Herreros
- Universidad Europea, Madrid, Spain
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain
| | - Venktesh R Ramnath
- Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Health, La Jolla, CA, USA
| | - Andrés Santiago-Saez
- Servicio Medicina Legal Intrahospitalaria, Clínico San Carlos Hospital, Madrid, Spain
- Departamento de Medicina Legal, Psiquiatría y Patología, Facultad de Medicina, Universidad Complutense de Madrid, Pza. Ramón y Cajal S/N, Madrid, 28040, Spain
| | - Tamara Raquel Velasco Sanz
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain
- Departamento Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar Pinto Pastor
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain.
- Departamento de Medicina Legal, Psiquiatría y Patología, Facultad de Medicina, Universidad Complutense de Madrid, Pza. Ramón y Cajal S/N, Madrid, 28040, Spain.
| |
Collapse
|
2
|
Blanco Portillo A, García-Caballero R, Real de Asúa D, Olaciregui Dague K, Herreros B. What Ethics Support for Resolving Ethical Conflicts Do Internists Use in Spanish Hospitals? JOURNAL OF BIOETHICAL INQUIRY 2023:10.1007/s11673-023-10276-1. [PMID: 37882950 DOI: 10.1007/s11673-023-10276-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/31/2023] [Indexed: 10/27/2023]
Abstract
Background Ethical conflicts generate difficulties in daily clinical activity. Which methods of ethical advice are most frequently used to resolve them among Spanish doctors has not been studied. The objective of this study is to describe what methods hospital internal medicine physicians in Spain use to resolve their ethical doubts and which they consider most useful. Design A cross-sectional observational study was conducted through a voluntary and anonymous survey and distributed through an ad hoc platform of the Spanish Society of Internal Medicine. Measures We measured methods by which to resolve doubts, types of tools sought, frequency of consulting the Clinical Ethics Committees, and satisfaction with resolution of ethical issues. Results Of 261 internists surveyed, 86 per cent resolve their ethical doubts with assistance, the most frequently used method being consultation with colleagues (58.6 per cent), followed by using specific protocols or guides (11.8 per cent) and consultation with experts in bioethics (9.6 per cent). The most preferred tools are the creation of protocols (30.3 per cent) and the establishment of a consultant/expert in bioethics (27.8 per cent). Conclusions Internists in Spain usually seek assistance to resolve their ethical doubts. Consulting colleagues is the most frequently adopted method. The majority regard tools to resolve ethical conflicts as necessary, seeking above all protocols and consultants/experts in bioethics.
Collapse
Affiliation(s)
- Antonio Blanco Portillo
- Emergency Department, 12 de octubre University Hospital, Avenida Córdoba s/n, Madrid, Madrid, Spain.
- , Ronda de Segovia, 3, 28005, Madrid, Spain.
| | - Rebeca García-Caballero
- Internal Medicine Service, Infanta Sofía University Hospital, Paseo de Europa 34, San Sebastián de los Reyes, Madrid, Spain
- Bioethics and Professionalism Working Group, Spanish Society of Internal Medicine, Madrid, Spain
| | - Diego Real de Asúa
- Bioethics and Professionalism Working Group, Spanish Society of Internal Medicine, Madrid, Spain
- Internal Medicine Service, La Princesa University Hospital, Calle Diego de León 62, Madrid, Spain
- Francisco Vallés Institute of Clinical Ethics - European University, Madrid, Spain
| | | | - Benjamín Herreros
- Bioethics and Professionalism Working Group, Spanish Society of Internal Medicine, Madrid, Spain
- Francisco Vallés Institute of Clinical Ethics - European University, Madrid, Spain
- Internal Medicine Service, Fundación Alcorcón University Hospital, Calle Budapest s/n, Alcorcón, Madrid, Spain
| |
Collapse
|
3
|
Psychiatric Hospital Ethics Committee Discussions Over a Span of Nearly Three Decades. HEC Forum 2023; 35:55-71. [PMID: 34050841 DOI: 10.1007/s10730-021-09454-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Various types of health settings use clinical ethics committees (CEC) to deal with the ethical issues that confront both healthcare providers and their patients. Although these committees are now more common than ever, changes in the content of ethical dilemmas through the years is still a relatively unexplored area of research. The current study examines the major topics brought to the CEC of a psychiatric hospital in Israel and explores whether there were changes in their frequency across nearly three decades. The present paper reports on a thematic analysis of the written verbatim transcripts from 466 ethical topics brought to the CEC between the years 1991 and 2016. The following major topics related to ethical dilemmas were identified: confidentiality (30%), patient autonomy (23%), health records (14%), dual relationship (12%), allocation of resources (11%), inappropriate professional and personal conduct (9%), and multicultural sensitivity (1%). Topics related to confidentiality increased significantly over the years, as did inappropriate professional and personal conduct. In addition, the analysis showed that the content of the ethical cases and the resolutions suggested by the CEC also varied over the years. In conclusion, although most ethical topics have remained relatively stable over time, the discourse around them has evolved, requiring a dynamic assessment and reflection by the mental health practitioners serving as members of a CEC.
Collapse
|
4
|
García Caballero R, Herreros B. Areas for improvement in end-of-life care. Rev Clin Esp 2021; 221:341-342. [PMID: 32703527 DOI: 10.1016/j.rce.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022]
Affiliation(s)
- R García Caballero
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid. Grupo de Trabajo de Bioética y Profesionalismo de Sociedad Española de Medicina Interna.
| | - B Herreros
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid. Instituto de Ética Clínica Francisco Vallés-Universidad Europea, Madrid, España
| |
Collapse
|
5
|
Areas for improvement in end-of-life care. Rev Clin Esp 2021; 221:341-342. [PMID: 34059231 DOI: 10.1016/j.rceng.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 11/22/2022]
|
6
|
de-Miguel-Díez J, Jiménez-García R, Hernández-Barrera V, Zamorano-Leon JJ, Villanueva-Orbaiz R, Albaladejo-Vicente R, López-de-Andrés A. Trends in mechanical ventilation use and mortality over time in patients receiving mechanical ventilation in Spain from 2001 to 2015. Eur J Intern Med 2020; 74:67-72. [PMID: 31822367 DOI: 10.1016/j.ejim.2019.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/11/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND We examined trends in the incidence of ventilator support with noninvasive ventilation (NIV) or invasive mechanical ventilation (IMV) among patients hospitalized in Spain from 2001 to 2015. We also assessed in-hospital mortality (IHM) after receiving these types of ventilator support. METHODS This study was an observational retrospective epidemiological study. Our data source was the Spanish National Hospital Discharge Database. RESULTS In total, 1,031,497 patients received ventilator support in Spain over the study period. NIV use increased from 18.8 patients per 100.000 inhabitants in 2001 to 108.7 in 2015. IMV utilization increased significantly from 2001 to 2003 and then decreased from 2003 until 2015. Patients who required NIV had the highest mean Charlson Comorbidity Index (CCI) score. Patients who received IMV had the highest in-hospital mortality. Factors associated with an increased risk for IHM were sex, age, conditions included in the CCI (except for COPD and diabetes), haemodialysis, presence of a peripheral arterial catheter, presence of a central venous catheter, readmission and emergency room admission. Undergoing a surgical procedure was a risk factor only for IMV. IHM decreased significantly from 2001 to 2015 in patients who underwent NIV or IMV. CONCLUSIONS We identified an increase in the utilization of NIV over time, whereas use of IMV decreased from 2003 until 2015 after an initial increase from 2001 to 2003. We also found a significant decrease in IHM over time.
Collapse
Affiliation(s)
- Javier de-Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Rodrigo Jiménez-García
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty. Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Jose J Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa Villanueva-Orbaiz
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Romana Albaladejo-Vicente
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty. Rey Juan Carlos University, Alcorcón, Madrid, Spain
| |
Collapse
|