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González-González E, Galván-Román JM, García-Sanz Í, Casals F, Fernández-Bueno J, Real de Asúa D. Healthcare workers' perception of the usefulness of a healthcare ethics consultation service. Rev Clin Esp 2023; 223:10-16. [PMID: 36528057 DOI: 10.1016/j.rceng.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinical ethics consultation services (CEC) have arisen from Healthcare Ethics Committees (HEC) to address ethical conflicts in real-time. Our aim was to determine the perception of usefulness of a CEC service among healthcare workers one year after its creation as well as to assess changes in trends in the use of the CEC and HEC between 2015 and 2021. MATERIALS AND METHODS This observational, cross-sectional study was based on a standardized survey of healthcare workers at an urban tertiary care hospital. The results were also compared to those from an identical survey conducted in the same population in 2015. RESULTS A total of 213 professionals participated (mean age 44 ± 11 years, 69% women). The professionals were more familiar with the HEC than the CEC service (94% vs 61%; p < 0.001). Forty-five individuals (21%) had consulted the CEC since its implementation; 95% of them found the consultation useful. Physicians knew about and used the CEC more than other groups of professionals. The degree of knowledge of the HEC increased significantly by 2021 compared to 2015 (94% v. 76%; p < 0.001). Some areas for improvement identified were the need for greater dissemination of the service, guaranteeing institutional resources to maintain the service, and encouraging greater participation from different professional groups. CONCLUSIONS Knowledge of the institutional HEC and CEC services has increased in recent years among healthcare workers, who considered the CEC service to be useful for addressing ethical conflicts in daily practice.
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Affiliation(s)
- E González-González
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain
| | - J M Galván-Román
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain; Servicio de Consultoría en Ética Clínica, Comité de Ética para la Asistencia Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain; Grupo de Trabajo en Bioética y Profesionalismo, Sociedad Española de Medicina Interna, Madrid, Spain
| | - Í García-Sanz
- Servicio de Consultoría en Ética Clínica, Comité de Ética para la Asistencia Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain; Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Spain
| | - F Casals
- Servicio de Consultoría en Ética Clínica, Comité de Ética para la Asistencia Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain; Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Spain
| | - J Fernández-Bueno
- Servicio de Consultoría en Ética Clínica, Comité de Ética para la Asistencia Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain; Unidad de Cuidados Paliativos Hospitalarios, Hospital Universitario de La Princesa, Madrid, Spain
| | - D Real de Asúa
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain.
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Blanco Portillo A, García-Caballero R, Real de Asúa D, Herreros Ruíz-Valdepeñas B. Which are the most prevalent ethical conflicts for Spanish internists? Rev Clin Esp 2021; 221:393-9. [PMID: 34332701 DOI: 10.1016/j.rceng.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinicians face a multitude of ethical conflicts in their daily practice. There have been no studies on the types of ethical conflicts encountered most frequently and that are of most concern to clinicians in Spain. The aim of this study is to report the most common ethical conflicts faced by Spanish internists, as well as the importance that the practitioners attribute to each conflict. MATERIALS AND METHODS Our observational cross-sectional study employed a voluntary and anonymous survey aimed at Spanish medical internists and distributed through an ad hoc platform of the Spanish Society of Internal Medicine. RESULTS The most common and relevant ethical issues for Spanish internists are related to patients' end of life (decisions limiting therapeutic effort, use of palliative treatments, the establishment of do-not-resuscitate orders), the conflicts arising within the doctor-patient/family relationship, and making decisions with noncompetent patients. These results are similar to those of other English and European series. The ethical problems further complicate the healthcare activity of clinicians who more often notice these problems (50.3%) than those who do not notice them (16%). CONCLUSIONS The most common and relevant ethical conflicts among Spanish internists are related to managing patients' end of life, followed by those related to the doctor-patient relationship and the management of noncompetent patients. It is essential that training programs be designed to better address and recognise these problems.
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Blanco Portillo A, García-Caballero R, Real de Asúa D, Herreros B. Which are the most prevalent ethical conflicts for Spanish internists? Rev Clin Esp 2020; 221:S0014-2565(20)30150-8. [PMID: 32650946 PMCID: PMC7340392 DOI: 10.1016/j.rce.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/03/2020] [Accepted: 05/11/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinicians face a multitude of ethical conflicts in their daily practice. There have been no studies on the types of ethical conflicts encountered most frequently and that are of most concern to clinicians in Spain. The aim of this study is to report the most common ethical conflicts faced by Spanish internists, as well as the importance that the practitioners attribute to each conflict. MATERIALS AND METHODS Our observational cross-sectional study employed a voluntary and anonymous survey aimed at Spanish medical internists and distributed through an ad hoc platform of the Spanish Society of Internal Medicine. RESULTS The most common and relevant ethical issues for Spanish internists are related to patients' end of life (decisions limiting therapeutic effort, use of palliative treatments, the establishment of do-not-resuscitate orders), the conflicts arising within the doctor-patient/family relationship, and making decisions with noncompetent patients. These results are similar to those of other English and European series. The ethical problems further complicate the healthcare activity of clinicians who more often notice these problems (50.3%) than those who do not notice them (16%). CONCLUSIONS The most common and relevant ethical conflicts among Spanish internists are related to managing patients' end of life, followed by those related to the doctor-patient relationship and the management of noncompetent patients. It is essential that training programs be designed to better address and recognise these problems.
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Affiliation(s)
- A Blanco Portillo
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - R García-Caballero
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna , Madrid, España
| | - D Real de Asúa
- Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna , Madrid, España; Servicio de Medicina Interna, Hospital Universitario de La Princesa , Madrid, España; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, España
| | - B Herreros
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna , Madrid, España; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, España
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Guadarrama-Orozco JH, Cantú-Quintanilla GR, Ávila-Montiel D, Altamirano-Bustamante M, Peláez-Ballestas I, Caballero-Velarde C, Juárez-Villegas LE, Vega-Morell NDL, Kelly-García J, Hoyos-Bermea AD, Dorantes-Acosta E, Gamboa-Marrufo JD, Muñoz-Hernández O, Garduño-Espinosa J. [The horizon of medical attention in pediatrics: what to do in the case of children who are in abandonment, conflict, harm or danger situations in combination with a severe disease?]. Bol Med Hosp Infant Mex 2018; 75:166-177. [PMID: 29799532 DOI: 10.24875/bmhim.m18000022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Laws refer that minors do not have the capability to give informed consent for their own medical attention. However, there are special conditions in which they are allowed to decide about their health. The greater the judgement and experience limitations in minors, the less weight is given to the values and objectives they express. Also, the more adverse consequences might be, the higher the level of authority that is demanded to decide on behalf of the minor, thus granting the State the capability to guarantee the well-being of the minor. Case report 12-year-old female patient with a diagnosis of acute lymphoblastic leukemia, with precarious social and family background; evolution of the disease obstructed by the disregard of the treatment due to her unsanitary and extreme poverty conditions. Both of her parents died soon after the start of the treatment and she was kept under the care of her half-sister of legal age. The work and the ethical dilemma of the pediatrician and the staff of Hospital Infantil de México Federico Gómez are exposed within the building of support -networks with the objective of prioritizing the minor's well-being, without allowing family break-up or disintegration, thus succeeding in her recovery. Conclusions The case was submitted to the Hospital Bioethics Committee. Inter-institutional support networks were built in order to improve dynamics of the family, thus solving the needs of the minor. Despite the misfortune of the situation, the disease was successfully overcome.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Javier Kelly-García
- Hospital de Oncología, Centro Médico Nacional Siglo XXI, IMSS. Ciudad de México, México
| | | | | | | | - Onofre Muñoz-Hernández
- Hospital Infantil de México Federico Gómez. Ciudad de México, México.,Universidad Nacional Autónoma de México. Ciudad de México, México
| | - Juan Garduño-Espinosa
- Hospital Infantil de México Federico Gómez. Ciudad de México, México.,Universidad Nacional Autónoma de México. Ciudad de México, México
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Herreros B, Del Olmo Ibáñez M, López Wolf D, González E, Pintor E, Márquez O. [Javier Sádaba: A bioethics against suffering]. J Healthc Qual Res 2018; 33:170-175. [PMID: 30337021 DOI: 10.1016/j.jhqr.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/23/2018] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Abstract
The philosopher Javier Sádaba (Portugalete, 1940) is the author of an extensive work in the field of bioethics. It is a procedural bioethics (based on the agreement between the participants, not on absolute truths), casuistry (is based on the analysis of specific problem cases), social (evaluates the context in decision-making), gradual (considers other species, is not "narcissistically human"), and secular (autonomous with respect to religion). Sádaba has also opted for an affirmative bioethics, which seeks to improve the living conditions of humans (in medicine, the quality of life). This is difficult to construct because, for the philosopher, the duty and to establish limits are infinitely easier to elaborate than the specific good and to pursue happiness. In its application to medicine, Sádaba's bioethics focuses on avoiding unnecessary suffering, because suffering does not contribute anything positive and hinders happiness. Likewise, he strives to extract the best of science and open the doors to everything that can bring improvements for the human being, but without ceasing to mention responsibility, because man is capable of the best and the worst. From this perspective, the author is faced with the bioethical issues, leaving the greatest possible margin to freedom of choice.
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Affiliation(s)
- B Herreros
- Instituto de Ética Clínica Francisco Vallés-Universidad Europea, Madrid, España; Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - M Del Olmo Ibáñez
- Grupo de investigación Humanismo-Europa, Universidad de Alicante, Alicante, España
| | - D López Wolf
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, Universidad Autónoma del Estado de México, México
| | - E González
- Instituto de Ética Clínica Francisco Vallés-Universidad Europea, Madrid, España
| | - E Pintor
- Instituto de Ética Clínica Francisco Vallés-Universidad Europea, Madrid, España
| | - O Márquez
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, Universidad Autónoma del Estado de México, México
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Herreros B, Real de Asua D, Palacios G. [Are we still our patients' keepers?: James Drane's contribution to clinical ethics in the current context]. J Healthc Qual Res 2018; 33:54-59. [PMID: 29291915 DOI: 10.1016/j.cali.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 11/22/2022]
Abstract
The current article analyzes the figure of the American bioethicist James Drane (1930). Drane not only played a crucial role in the birth of Bioethics in the United States, but was also instrumental in the inception and development of the field in Spain and Latin America. His «sliding scale» was the first dynamic tool encouraging a systematic evaluation of a patient's capacity to make healthcare-related decisions. However Drane's major contribution to the field was his application of virtue Ethics to the doctor-patient relationship. His proposal rests on the physician's compromise with the patient in all his/her dimensions. This goal will guide the physician's character and serve as compass, with which to exercise a virtuous practice, since only by exercising these virtues can doctors become truly good.
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Affiliation(s)
- B Herreros
- Instituto de Ética Clínica Francisco Valles, Universidad Europea, Madrid, España; Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, España.
| | - D Real de Asua
- Instituto de Ética Clínica Francisco Valles, Universidad Europea, Madrid, España; Division of Medical Ethics, Department of Medicine, Weill Cornell College of Medicine, Nueva York, Estados Unidos; Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, España
| | - G Palacios
- Instituto de Ética Clínica Francisco Valles, Universidad Europea, Madrid, España; Division of Medical Ethics, Department of Medicine, Weill Cornell College of Medicine, Nueva York, Estados Unidos; Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, España
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Herrera-Tejedor J. [Healthcare preferences of the very elderly: A review]. Rev Esp Geriatr Gerontol 2016; 52:209-215. [PMID: 27751613 DOI: 10.1016/j.regg.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/29/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
Abstract
The preferences of the very elderly are not taken into account in healthcare planning. For this reason, a medical literature review was performed in order to fill the gap in appropriate information on this issue. The majority of them think that they receive good healthcare. They favour building a trusting relationship, with the physician handling their decision-making. They also maximise their quality of life at the expense of quantity, and give great importance to comfort and safety. Most of them express the wish to be cared for and die at home. But when an acute event occurs, they want to be transferred to hospital. More explicit communication must be encouraged between very elderly patients, providers, and families to meet their subjective needs, through on-going discussions, focused on expected outcomes and patient care goals. A healthcare system designed to look after them should be based on individual and flexible care, with coordination between healthcare services. Such a healthcare system could enable a growing number of them to die in their preferred conditions.
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Affiliation(s)
- Juan Herrera-Tejedor
- Unidad de Geriatría, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España.
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