Bioethics

生物伦理学
  • 文章类型: Journal Article
    肥胖的患病率,代谢综合征,以及相关的长期慢性疾病(心血管疾病,II型糖尿病,癌症,老年痴呆症,抑郁症)在美国和西方国家已经达到流行水平。为了应对这场公共卫生灾难,本文的作者提出并捍卫了一种新颖的生物伦理学论点:禁止儿童食用SSB(含糖饮料)的一致性论点(“一致性论点”)。这一论点的激进结论指出,政府有理由禁止儿童消费的SSB消费。理由如下:如果人们接受长期饮酒造成的身体伤害证明政府禁止儿童饮用酒精饮料是合理的,有强有力的证据表明,长期食用SSB会导致类似的身体伤害,然后,比照,政府也有理由禁止儿童消费SSB。为了支持这一论点,作者基于流行病学观察研究提供了广泛的证据,介入研究,对照试验,大型荟萃分析,以及SSB和慢性疾病背后的病理生理学和生物学作用机制。长期食用大剂量的SSB和酒精饮料都会导致相同的疾病:肥胖和胰岛素抵抗,心血管疾病,高血压,和癌症。长期食用SSB会增加患阿尔茨海默病的风险,痴呆症,和抑郁症。作者在总结本文时考虑了对一致性论点的突出反对意见,然后证明每个反对意见都是不合理的。
    The prevalence of obesity, metabolic syndrome, and the associated long-term chronic diseases (cardiovascular disease, type II diabetes, cancer, Alzheimer\'s disease, depression) have reached epidemic levels in the United States and Western nations. In response to this public health calamity, the author of this paper presents and defends a novel bioethical argument: the consistency argument for outlawing SSBs (sugar-sweetened beverages) for child consumption (the \"consistency argument\"). This argument\'s radical conclusion states that the government is justified in outlawing SSBs consumption for child consumption. The reasoning is as follows: if one accepts that the physical harm caused by chronic alcohol consumption justifies the government outlawing alcoholic beverages for child consumption, and there is strong evidence that comparable physical harms result from chronic SSBs consumption, then, mutatis mutandis, the government is also justified in outlawing child consumption of SSBs. To support this argument, the author provides extensive evidence based on epidemiological observational studies, interventional studies, controlled trials, large meta-analyses, and the pathophysiology and biological mechanisms of action behind SSBs and chronic disease. Chronic consumption of large doses of SSBs and alcoholic beverages both drive the same diseases: obesity and insulin resistance, cardiovascular disease, hypertension, and cancer. Chronic SSB consumption carries the additional risk of Alzheimer\'s disease, dementia, and depression. The author concludes this paper by considering prominent objections to the consistency argument, and then demonstrating that each objection is unsound.
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  • 文章类型: Journal Article
    在过去的十年中,有关“少即是多”方法的文献主要由描述侵略性过度的临床病例代表,冗余,非个性化,和不尊重的药物。这些文章中的大多数都集中在“越多越差”的方法上,并围绕医疗过度使用的下游负面影响。在文献中发现了较少的经验和实践的差距,而不是过度的危害,我们对“少即是多”的方法在实践中如何发挥作用进行了探索性的定性研究。采用了解释学现象学方法,使我们能够将生活经验的领域作为有效的数据源,并作为从床边理解“少即多”方法的途径。“实践现象学被选为这项研究的更具体的框架,因为它更加关注专业环境中的行动和实际应用。医生写的70个故事,病人,护士,看护者,和其他卫生专业人员已经收到和分析。这些故事是作为一个名为“慢故事”的项目的一部分收集的,该项目旨在收集通过采用“少即是多”的方法对患者进行护理而得到积极解决的临床病例。在进行了深入分析之后,单独和作为一个群体,研究人员确定了五个关键的现象学主题;关联的时间是治愈的时间;做更多的事情并不意味着做更好;慢药的设置;生命终结时的缓慢护理;以及个性化与标准化治疗。这些主题中的每一个都提供了如何在实践中使用“少即是多”方法的见解,并说明了“少即是多”策略如何在积极解决某些临床病例中发挥重要作用。
    In the last decade literature focused on a \"less is more\" approach has been primarily represented by clinical cases describing the excesses of an aggressive, redundant, non-personalized, and non-respectful medicine. Most of these articles focus on a \"more is worse\" approach and centre around the downstream negative consequences of medical overuse. Having identified a gap in the literature on the experience and practice of less, rather than the harms of excess, we carried out an exploratory qualitative study into how a \"less is more\" approach works in practice. A hermeneutic phenomenological approach was adopted to allow us to examine the realm of lived experience as a valid data source and as a path from which to understand a \"less is more\" approach \"from the bedside.\" A Phenomenology of Practice was chosen as a more specific frame for this research because of its added focus on action and practical application in professional settings. Seventy stories written by physicians, patients, nurses, caregivers, and other health professionals have been received and analysed. These stories were gathered as part of a project called \"Slow Stories\" which aimed to collect clinical cases that have been positively resolved by adopting a \"less is more\" approach to patient care. After having conducted an in-depth analysis, separately and as a group, the researchers identified five key phenomenological themes; Time to relate is time to heal; Doing more does not mean doing better; Settings for a slow medicine; Slow care at the end of life; and Personalized vs. standardized treatment. Each of these themes offers insights into how a \"less is more\" approach can be used in practice and illustrates how a \"less is more\" strategy can play a significant role in positively resolving certain clinical cases.
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  • 文章类型: Journal Article
    目的:为影响青少年医疗决策能力的因素的生物伦理基础提供理论研究和模型。
    方法:来自不同来源的材料,包括公认数据库和官方政府文件中的索引文章,进行了有目的地选择的样本检查。该研究包括两个阶段:选择文件和反思主题分析,然后编写一份报告。分析采取了符合人权的现象学立场和反思观点。为了减少偏差并确保结果的鲁棒性,采用了数据三角测量等措施。采取了道德措施来确保数据完整性,包括在选定的研究中考虑匿名和利益冲突。
    结果:可以列出影响青少年患者健康决策能力的内在和外在因素。建立了理论模型,以通过信息图讨论这些因素进行评估。
    结论:很明显,对青少年医疗决策能力的评估必须在道德上对尊重有能力主体的自决的道德义务与保护青少年的必要性之间的紧张关系进行定位。在给定的时间绝对无法做出特定的健康决定。
    OBJECTIVE: To provide a theoretical study and model for the bioethical foundations of the factors that influence adolescents\' healthcare decisional capacity.
    METHODS: Materials from diverse sources, including indexed articles in recognized databases and official government documents, were examined for a purposefully selected sample. The research consisted of two stages: selection of documents and reflective thematic analysis, followed by the preparation of a report. The analysis adopted a phenomenological stance and a reflective view compatible with human rights. To reduce bias and ensure the robustness of the results, measures such as data triangulation were employed. Ethical measures were taken to ensure data integrity, including considerations of anonymity and conflicts of interest in the selected studies.
    RESULTS: It was possible to list intrinsic and extrinsic factors of the adolescent patient that influence their decisional capacity regarding health. A theoretical model was developed to discuss these factors for evaluation by means of an infographic.
    CONCLUSIONS: It seems clear that the evaluation of healthcare decisional capacity of adolescents must position itself ethically regarding the tension between the moral duty to respect the self-determination of the able subject and the need to protect adolescents decidedly unable to make a specific health decision at a given time.
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  • 文章类型: English Abstract
    The national transplant law in Colombia, Law 1805 of 2016, modified the Colombian legislation regarding how a person accesses an organ transplant, but above all, it changed the donor figure, establishing the term derived from the presumptive consent right. This term implies a person’s hypothetical willingness to be an organ donor as a manifestation of solidarity and charity towards another person in a situation of need and vulnerability concerning his/her health and the dimensions that define it. In the following text, seven moments are considered fundamental facts when constructing a culture about the value of healthcare in the national transplant policy in Colombia.
    La Ley Nacional de Trasplantes en Colombia, Ley 1805 de 2016, modificó la legislación colombiana en cuanto a cómo se accede a un trasplante de órganos, pero, sobre todo, cambió la figura de donatario y dispuso el término derivado del derecho del consentimiento presuntivo. Este define la hipotética voluntad de una persona de ser donante de órganos como manifestación de solidaridad y beneficencia con otra persona en situación de necesidad y vulnerabilidad relacionada con su salud y las dimensiones que la definen. En el siguiente texto se presentan siete momentos que se consideran hechos fundamentales en la construcción de una cultura del valor de la atención en salud en la política nacional de trasplantes de Colombia.
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  • 文章类型: Editorial
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  • 文章类型: Editorial
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  • 文章类型: Journal Article
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