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Quintal A, Carreau I, Grenier AD, Hébert C, Yergeau C, Berthiaume Y, Racine E. An Ethics Action Plan for Rare Disease Care: Participatory Action Research Approach. J Particip Med 2023; 15:e46607. [PMID: 37995128 DOI: 10.2196/46607] [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: 02/21/2023] [Revised: 08/03/2023] [Accepted: 09/01/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Owing to their low prevalence, rare diseases are poorly addressed in the scientific literature and clinical practice guidelines. Thus, health care workers are inadequately equipped to provide timely diagnoses, appropriate treatment, and support for these poorly understood conditions. These clinical tribulations are experienced as moral challenges by patients, jeopardizing their life trajectories, dreams, and aspirations. OBJECTIVE This paper presents an ethical action plan for rare disease care and the process underlying its development. METHODS This action plan was designed through an ethical inquiry conducted by the Ethics and Rare Diseases Working Group, which included 3 patient partners, 2 clinician researchers, and 1 representative from Québec's rare disease association. RESULTS The plan is structured into 4 components. Component A presents the key moral challenges encountered by patients, which are the lack of knowledge on rare diseases among health care workers, the problematic attitudes that it sometimes elicits, and the distress and powerlessness experienced by patients. Component B emphasizes a vision for patient partnership in rare disease care characterized by open-mindedness, empathy, respect, and support of patient autonomy from health care workers. Component C outlines 2 courses of action prompted by this vision: raising awareness among health care workers and empowering patients to better navigate their care. Component D compares several interventions that could help integrate these 2 courses of action in rare disease care. CONCLUSIONS Overall, this action plan represents a toolbox that provides a review of multiple possible interventions for policy makers, hospital managers, practitioners, researchers, and patient associations to critically reflect on key moral challenges experienced by patients with rare diseases and ways to mitigate them. This paper also prompts reflection on the values underlying rare disease care, patient experiences, and health care workers' beliefs and behaviors. Health care workers and patients were the primary beneficiaries of this action plan.
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Affiliation(s)
- Ariane Quintal
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Département de médecine sociale et préventive, Université de Montréal, Montréal, QC, Canada
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Isabelle Carreau
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Annie-Danielle Grenier
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Caroline Hébert
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Christine Yergeau
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Regroupement québécois des maladies orphelines, Sherbrooke, QC, Canada
| | - Yves Berthiaume
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Département de médecine, Université de Montréal, Montréal, QC, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Département de médecine sociale et préventive, Université de Montréal, Montréal, QC, Canada
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Département de médecine, Université de Montréal, Montréal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
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Lopes WSL, Moreira MCN, Gomes R. The sickle cell illness experience under the qualitative lens. CIENCIA & SAUDE COLETIVA 2023; 28:2489-2500. [PMID: 37672440 DOI: 10.1590/1413-81232023289.03812023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/24/2023] [Indexed: 09/08/2023] Open
Abstract
This article aims to analyze the content of the qualitative production (2000-2023) on sickle cell disease to support the analytical category - the sickle cell disease experience. Methodologically, we conducted a qualitative, bibliographical study with a thematic content analysis anchored in the dialogue between the revised collection and the adopted theoretical-conceptual references. The thematic content analysis triggered eight interpretative dimensions: daily life and itineraries, care, reproductive decisions, stigma and its expressions, gender, participation, ethnicity, and religiosity. The sickle cell experience emerges and is related to exclusion, devaluation, ignorance, and invisibility, strongly allied to race components in nuances that distance it from the generic illness experience.
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Affiliation(s)
- Winnie Samanú Lima Lopes
- Departamento de Ensino, Instituto Fernandes Figueira (IFF/Fiocruz). Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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Quintal A, Hotte É, Hébert C, Carreau I, Grenier AD, Berthiaume Y, Racine E. Understanding Rare Disease Experiences Through the Concept of Morally Problematic Situations. HEC Forum 2023:10.1007/s10730-023-09511-4. [PMID: 37515692 DOI: 10.1007/s10730-023-09511-4] [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: 06/30/2023] [Indexed: 07/31/2023]
Abstract
Rare diseases, defined as having a prevalence inferior to 1/2000, are poorly understood scientifically and medically. Appropriate diagnoses and treatments are scarce, adding to the burden of living with chronic medical conditions. The moral significance of rare disease experiences is often overlooked in qualitative studies conducted with adults living with rare diseases. The concept of morally problematic situations arising from pragmatist ethics shows promise in understanding these experiences. The objectives of this study were to (1) acquire an in-depth understanding of morally problematic situations experienced by adults living with rare diseases in the province of Québec and (2) to develop an integrative model of the concept of morally problematic situations. To this end, an online survey targeting this population was developed through a participatory action research project. Respondents provided 90 long testimonies on the most important morally problematic situations they faced, often in healthcare settings. An integrative model was developed based on various qualitative analyses of these testimonies and relevant literature. The integrative model showcases that morally problematic situations have causes (i.e., contextual and relational factors, personal factors, jeopardized valuations), have affective repercussions (i.e., emotions and feelings, internal tensions), prompt action (i.e., through empowerment strategies leading to the evolution of situations), and elicit outcomes (i.e., factual consequences, residual emotions and feelings, positive or negative resolutions). In sum, this study advances understanding of the moral experiences of adults living with rare diseases while proposing a comprehensive conceptual tool to guide future empirical bioethics research on moral experiences.
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Affiliation(s)
- Ariane Quintal
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, 110 Pine Avenue West, Montréal, QC, H2W 1R7, Canada
- Département de médecine sociale et préventive, Université de Montréal, Montréal, QC, Canada
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Élissa Hotte
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, 110 Pine Avenue West, Montréal, QC, H2W 1R7, Canada
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Caroline Hébert
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Isabelle Carreau
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Annie-Danielle Grenier
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Yves Berthiaume
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Département de médecine, Université de Montréal, Montréal, QC, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, 110 Pine Avenue West, Montréal, QC, H2W 1R7, Canada.
- Département de médecine sociale et préventive, Université de Montréal, Montréal, QC, Canada.
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, QC, Canada.
- Division of Experimental Medicine, and Department of Neurology and Neurosurgery, Department of Medicine, McGill University, Montréal, QC, Canada.
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Moreira MCN. Configurations of atypical parenting activism in disability and chronicity. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-812320222710.07572022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract This article aims to reflect on the configurations of atypical parenting in the field of disability and chronicity. The atypical emic category composes with these fields. Associative symbolicities are explored with an ethnography in social media and interviews with activists. We indicate ongoing processes in the anticapacitist struggle that dialogue with agendas of Politics as Care. We conclude that “atypical activist parenting” operates with meanings and learnings of living and being familiar with disability/chronicity/rarity in proximity to a son/daughter, not being restricted to biographical ruptures.
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Moreira MCN. Configurations of atypical parenting activism in disability and chronicity. CIENCIA & SAUDE COLETIVA 2022; 27:3939-3948. [PMID: 36134799 DOI: 10.1590/1413-812320222710.07572022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/22/2022] Open
Abstract
This article aims to reflect on the configurations of atypical parenting in the field of disability and chronicity. The atypical emic category composes with these fields. Associative symbolicities are explored with an ethnography in social media and interviews with activists. We indicate ongoing processes in the anticapacitist struggle that dialogue with agendas of Politics as Care. We conclude that "atypical activist parenting" operates with meanings and learnings of living and being familiar with disability/chronicity/rarity in proximity to a son/daughter, not being restricted to biographical ruptures.
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Affiliation(s)
- Martha Cristina Nunes Moreira
- Instituto Nacional de Saúde da Mulher, Criança e Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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Tanabe RF, Moreira MCN. [Narratives in the body: scars and tattoos from chronic, rare, and complex illnesses]. CAD SAUDE PUBLICA 2022; 38:e00197521. [PMID: 35293538 DOI: 10.1590/0102-311x00197521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022] Open
Abstract
This essay explores the tattoos and scars that convey narratives on experiencing and living with chronic, rare, and complex illnesses. We view such marks as public expressions, when individuals bear witness to lives traversed by disability and frailty, whether as their own personal experience or in the role of caregivers. The body as witness and performative support is explored here in its aesthetic and political dimensions, in the expression of symbolic contents that gain visibility in the affirmation of neglected identities and agendas by persons who claim the recognition and valorization of their lives.
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Affiliation(s)
- Roberta Falcão Tanabe
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Martha Cristina Nunes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Moreira MCN, Mendes CHF, Nascimento MAFD, Melo APLD, Albuquerque MDSVD, Kuper H, Pinto M, Penn-Kenkana L, Moreira MEL. Stigmas of congenital Zika syndrome: family perspectives. CAD SAUDE PUBLICA 2022; 38:e00104221. [DOI: 10.1590/0102-311x00104221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022] Open
Abstract
This article uses a socio-anthropological framework to explore the stigmas around interactions with children born with congenital Zika syndrome caused by the Zika virus epidemic in two Brazilian municipalities. Semi-structured interviews were conducted with parents and other relatives. We reflected on the search for meaning when having a baby with unexpected body marks, the moral suffering, the societal ableism, the burden of care, and the need for support networks. We concluded that public policies, especially social policies (health, education, and social assistance), are essential for compensatory mechanisms, recognition, and social inclusion of these children and their families.
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Affiliation(s)
| | | | | | | | | | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, U.K
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Amaral MB, Rego S. [Rare diseases on the agenda for innovation in health: progress and challenges with cystic fibrosis]. CAD SAUDE PUBLICA 2020; 36:e00115720. [PMID: 33331552 DOI: 10.1590/0102-311x00115720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/01/2020] [Indexed: 11/22/2022] Open
Abstract
The article proposes to discuss the many complexities involved in the incorporation of new health technologies for rare diseases, with a central focus on the case of cystic fibrosis. Cystic fibrosis was chosen because it is a autosomal recessive genetic disorder, considered the most common of the rare diseases. The disease has also benefited greatly from investments in research in the field of molecular biology, mainly in the United States, but also among European research groups, which resulted in the registration and marketing of four new drugs. These new drugs act for the first time on the basic defect in cystic fibrosis. From a perspective that views rare diseases as a field of research woven among many others, the article aims to problematize cystic fibrosis from a more person-centered approach, the duality of witnessing from afar the molecularization of life, the emergence of last-generation drugs that interrupt, at the molecular level, the cascade of errors and thus the symptoms and evolution of the disease. The article aims to bring various elements to the debate that traverse the complex local reality of Brazilian cystic fibrosis patients in a global context of technological innovation and with a break in the treatment paradigm. Based on the field of rare diseases, including the presentation of cystic fibrosis in the age of precision medicine, alongside discussions on biopolitics in a context of health innovation and high-cost drugs, the article aims to shed light on the current challenges and possibilities.
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Affiliation(s)
- Marise Basso Amaral
- Faculdade de Educação, Universidade Federal Fluminense, Niterói, Brasil.,Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Sergio Rego
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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