Non-maleficence

非恶意
  • 文章类型: Journal Article
    背景:活体肾脏捐赠的频率不断上升,伴随着对捐赠者自主权的伦理关注不断增加,披露的全面性,和捐助者对长期后果的理解。
    目的:探讨捐献者对多专业肾脏病学团队在向活体肾脏捐献者披露捐赠后果方面的伦理能力的满意度。
    方法:对以色列活体肾脏捐献者进行了一项横断面研究,这些捐献者在捐赠一年后在两家卫生部移植中心的医院捐赠了肾脏,从2018年12月到2020年12月。数据收集是在网上进行的,并通过与捐助者的母语(希伯来语或阿拉伯语)面对面采访进行的。
    结果:总体而言,纳入91名年龄在18-49岁的活体肾脏捐献者.其中,65.9%为男性,54.9%是学术捐赠者。在活体肾脏捐献者中,59.3%的人报告说,捐赠背后的动机是一级家庭成员与35.2%利他主义和5.5%商业主义。只有13.2%的人报告所提供的公开内容充分解释了与单个肾脏一起生活的可能后果。大约20%的参与者报告说,披露包括有关他们发展ESRD风险的信息,高血压,和蛋白尿。供体报告的指数得分平均值较低,表明医生在捐赠后随访时间较低(平均值=1.16,SD=0.37)。与捐赠前(84.0mL/min/1.73m2)相比,肾脏捐赠后一年的平均GFR水平显着降低(117.8mL/min/1.73m2),p<0.001。
    结论:我们的研究结果表明,捐献者对多专业肾脏病学团队在向活体肾脏捐献者披露捐赠后果方面的伦理能力满意度较低。这项研究表明,供体肾功能恶化的风险增加(肌酐和GFR),BMI。我们的发现强调了向捐赠者建议他们的病情可能会随着时间的推移而恶化并可能导致并发症的必要性;因此,他们应该在短期和长期随访期间进行监测。这项研究未注册。
    BACKGROUND: The rising frequency of live kidney donations is accompanied by growing ethical concerns as to donor autonomy, the comprehensiveness of disclosure, and donors\' understanding of long-term consequences.
    OBJECTIVE: To explore donors\' satisfaction with the ethical competence of multi-professional nephrology teams regarding disclosure of donation consequences to live kidney donors.
    METHODS: A cross-sectional study was performed among Israeli live kidney donors who had donated a kidney in two hospitals that belonged to the Ministry of Health\'s Transplantation Center one year after the donation, from December 2018 to December 2020. Data collection was conducted online and through face-to-face interviews with the donors in their native language (Hebrew or Arabic).
    RESULTS: Overall, 91 live kidney donors aged 18-49 years were enrolled. Of those, 65.9% were males, and 54.9% were academic donors. Among the live kidney donors, 59.3% reported that the motivation behind the donation was a first-degree family member vs. 35.2% altruistic and 5.5% commercial. Only 13.2% reported that the provided disclosure adequately explained the possible consequences of living with a single kidney. Approximately 20% of the participants reported that the disclosure included information regarding their risk of developing ESRD, hypertension, and proteinuria. The donors reported a low mean of the index score that indicates a low follow-up by the physician after the donation (mean = 1.16, SD = 0.37). The mean GFR level was significantly lower in the post-donation period one year following a kidney donation (117.8 mL/min/1.73 m2) compared with the pre-donation period (84.0 mL/min/1.73 m2), p < 0.001.
    CONCLUSIONS: Our findings display that donors\' satisfaction with the ethical competence of multi-professional nephrology teams regarding the disclosure of donation consequences to live kidney donors is low. This study indicates that donors are at an increased risk of worsening kidney functions (creatinine and GFR), and BMI. Our findings underscore the imperative to advise donors that their condition may worsen over time and can result in complications; thus, they should be monitored during short and long-term follow-up periods. This study was not registered.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
    医学院或其任何学术部门接受大型公司捐赠的道德含义,主要来自制药公司,已经辩论了很长时间。虽然这种贡献在其他研究生机构中很常见,医学院必须确信潜在的利益冲突和公众舆论。我们重新探索这些礼物将为改善教育和研究资源带来的好处,以克服这种捐赠所带来的道德困境以及对公众认知和实际利益冲突的担忧。利用仁慈的原则,非恶意,自主性,和分配正义,我们讨论了医生的义务和可能随之而来的患者强烈反对。最终,我们认识到财政资源支持学术任务的必要性,但认为医疗设施和医学教育必须配备,以确保完全没有偏见的赞助。
    The ethical implications of medical schools or any of their academic departments accepting large corporate donations, mainly from pharmaceutical companies, have been long debated. Although such contributions are common in other graduate institutions, medical schools must be convinced about potential conflicts of interest and public opinion. We re-explore the benefits these kinds of gifts would afford for improved educational and research resources against the ethical dilemmas this kind of donation would present and concerns about public perception and actual conflict of interest. Using the principles of beneficence, nonmaleficence, autonomy, and distributive justice, we discuss the physicians\' obligations and conceivable patient backlash that may ensue. Ultimately, we recognize the necessity for financial resources to support academic missions but contend that health care facilities and medical education must be equipped while ensuring a complete lack of bias in sponsorship.
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  • 文章类型: Journal Article
    肿瘤学的医学分专业呈现出多样化的伦理困境,经常挑战癌症医护人员难以处理的临床情况,从个人和专业的角度来看是艰难的。在各种情况下对患者护理做出决定是肿瘤学家的一项明确义务,而这些基于职责的判断不仅需要选择最佳治疗或解决方案。伦理是临床医学的一个重要和不可分割的方面,肿瘤学家以及专职医护人员在伦理上致力于帮助患者,避免或尽量减少伤害,尊重患者的价值观和选择。这篇综述概述了伦理学和临床伦理学以及自治的四个主要伦理原则,仁慈,非恶意,正义被陈述和解释。有时,在患者护理场景中,道德原则之间经常存在矛盾,尤其是在仁慈和自治之间。此外,说实话,敬业精神,同理心,和文化能力;最近被认为在癌症治疗中很重要,也是从印度的角度来看。
    The medical sub-specialty of Oncology presents diverse ethical dilemmas, often challenging cancer healthcare workers with difficult-to-handle clinical scenarios that are tough from a personal and professional perspective. Making decisions on patient care in various circumstances is a defining obligation of an oncologist and those duty-based judgments entail more than just selecting the best treatment or solution. Ethics is an essential and inseparable aspect of clinical medicine and the oncologists as well as the allied health care workers are ethically committed to helping the patient, avoiding or minimizing harm, and respecting the patient\'s values and choices. This review provides an overview of ethics and clinical ethics and the four main ethical principles of autonomy, beneficence, non-maleficence, and justice are stated and explained. At times there are frequently contradictions between ethical principles in patient care scenarios, especially between beneficence and autonomy. In addition, truth-telling, professionalism, empathy, and cultural competence; which are recently considered important in cancer care, are also addressed from an Indian perspective.
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  • 文章类型: Journal Article
    医学伦理与过敏和免疫学的临床实践相关,无论患者类型如何,疾病状态,或练习设置。当从事临床护理时,进行研究,或制定有关医疗资源可及性和分配的政策,医生经常使用医学伦理的基本原则来做出和证明决定。因此,这些原则的知识是最重要的变态反应学家/免疫学家。迄今为止,过敏和免疫学的医学伦理学研究一直缺乏。这篇评论描述了这种稀缺性,突出了一段时间内的出版趋势,并倡导为医学伦理学的研究和培训提供更多支持,重点关注与过敏和免疫学实践密切相关的主题。
    Medical ethics is relevant to the clinical practice of allergy and immunology regardless of the type of patient, disease state, or practice setting. When engaging in clinical care, performing research, or enacting policies on the accessibility and distribution of healthcare resources, physicians regularly make and justify decisions using the fundamental principles of medical ethics. Thus, knowledge of these principles is paramount for allergists/immunologists. To date, there has been a shortage of medical ethics research in allergy and immunology. This review describes this scarcity, highlights publication trends over time, and advocates for additional support for research and training in medical ethics with a focus on topics germane to the practice of allergy and immunology.
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  • 文章类型: Journal Article
    在透明度不断提高的时代,皮肤科医生可能会遇到患者的要求,要求其更改或保留电子病历中的关键医疗信息。根据健康保险携带和责任法案,患者有权查看他们的医疗记录并要求修改,然而,医师是图表中应包含哪些信息的最终决策者.根据慈善和非恶意的原则,在图表中包含医学上必要的信息是不可或缺的。隐瞒医学相关病史可能会对患者造成潜在伤害。在这种具有挑战性的情况下,同时保持透明度,需要彻底了解患者的困境。本文通过应用多种道德原则提供了一个框架,并将授权皮肤科医生浏览此类请求。
    In the age of increasing transparency, dermatologists may encounter requests from patients to alter or withhold key medical information from their electronic medical records. Per the Health Insurance Portability and Accountability Act, patients have the right to view their medical record and request amendments; however, the physician is the final decision maker on what information should be included in the chart. It is integral that medically necessary information is included in the chart in accordance with the principle of beneficence and nonmaleficence. Withholding medically pertinent history may cause harm to the patient. Navigating such challenging situations while maintaining transparency requires a thorough understanding of the patient\'s dilemma. This contribution provides a framework by applying multiple ethical principles and will empower dermatologists to navigate such requests.
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  • 文章类型: Journal Article
    男性绝育,或者输精管切除术,在预防怀孕方面的有效率为99.9%,并发症的风险低于2%。尽管疗效很高,低风险,低成本,和输精管切除术的性别平等利益,2019年,全球只有2%的女性报告说,她们和她们的伴侣依靠输精管结扎术作为避孕方法.一般情况下,医疗保健提供者既可以促进男性健康,也可以成为男性健康的障碍,也可能在输精管切除术中。这项研究旨在描述经验丰富的输精管切除术提供者在评估复杂病例中的患者候选人资格时的决策依据。
    来自七个国家/地区的全球输精管切除术网络Google小组的15个输精管切除术提供商使用半结构化深度访谈指南参加了在线访谈。供应商被问及他们的输精管切除术培训,他们提供输精管切除术的原因,他们面临的具有挑战性的案例,以及用于管理具有挑战性的案例的方法。小插图被用来进一步引出决策理由。使用MAXQDA20进行主题分析。
    提供者的决策是基于确保患者了解情况,能够同意,并确定他们选择进行输精管结扎术。一旦这些基本条件得到满足,提供者通过他们的培训过滤了患者的特征,法律和政策,社会文化规范,经验,和同行影响,以产生成本效益分解。根据成本效益分析,在确定输精管结扎术患者的候选资格时,提供者决定是否更加权衡自主性或非恶意.
    尽管临床最佳实践促进患者自主性优先于非恶意治疗,在输精管结扎术患者的候选资格评估中,一些提供者继续权衡非恶意而非自主性.在提供者被认为后悔风险较高的情况下,非恶意行为尤其优先。这项研究的结果表明,输精管结扎术提供者的培训应强调在共同决策和以患者为中心的护理中基于证据的最佳实践,以促进输精管结扎术的规定,以尊重患者的自主权和权利。
    UNASSIGNED: Male sterilization, or vasectomy, is 99.9% effective at preventing pregnancy with less than a 2% risk of complications. Despite the high efficacy, low risk, low cost, and gender equity benefits of vasectomy, just 2% of women reported that they and their partners relied on vasectomy as their contraceptive method globally in 2019. Health care providers can be both a facilitator and a barrier in men\'s health generally, and may be in vasectomy provision as well. This study sought to describe the decision-making rationales of experienced vasectomy providers when evaluating patient candidacy in complex cases.
    UNASSIGNED: Fifteen vasectomy providers belonging to the global Vasectomy Network google group from seven countries participated in online interviews using a semi-structured in-depth interview guide. Providers were asked about their vasectomy training, their reasons for vasectomy provision, challenging cases they have faced, and approaches used to manage challenging cases. Vignettes were used to further elicit decision-making rationale. Thematic analysis was conducted using MAXQDA20.
    UNASSIGNED: Provider decision-making was predicated on ensuring patients were well-informed, able to consent, and certain about their choice to have a vasectomy. Once those foundational conditions were met, providers filtered patient characteristics through their training, laws and policies, sociocultural norms, experience, and peer influence to produce a cost-benefit breakdown. Based on the cost-benefit analysis, providers determined whether to weigh autonomy or non-maleficence more heavily when determining vasectomy patient candidacy.
    UNASSIGNED: Despite clinical best practices that promote prioritizing patient autonomy over non-maleficence, some providers continued to weigh non-maleficence over autonomy in vasectomy patient candidacy evaluations. Non-maleficence was particularly prioritized in cases providers deemed to be at higher risk of regret. The findings of this study suggest vasectomy provider training should emphasize evidence-based best practices in shared decision-making and patient-centered care to facilitate vasectomy provision that honors patient autonomy and rights.
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  • 文章类型: Journal Article
    QR码技术的广泛应用,最能代表的是我国疫情防控中使用的健康码。这项技术通过实现更高的效率和准确性,增强了该国管理大流行的能力。不幸的是,部分老年人在适应和维持日常活动方面遇到困难。这表明了QR码技术在实现社会隔离方面的局限性。本文认为,要建立更加全面的疫情防控政策体系,管理这项技术的实施应该以更人性化的方式进行,即在三个道德原则的指导下:仁慈,正义,和非恶意。通过这样做,QR码技术的实施不仅有利于COVID-19的预防和控制,而且可以减轻老年人的边缘化。在后大流行时代,数字技术的社会化将加速。因此,在公共卫生领域,我们不仅应该关注资源的公平分配,而且应该关注由于数字鸿沟而产生的身份问题。
    The widespread application of QR code technology is best represented by the health codes used in China\'s pandemic prevention and control. This technology has enhanced the country\'s ability to manage the pandemic by achieving higher efficiency and accuracy. Unfortunately, a certain segment of the older population has encountered difficulties in adapting and maintaining their daily activities. This indicates the limitations of QR code technology in achieving social isolation. This article argues that for a more comprehensive pandemic prevention and control policy system to be established, managing the implementation of this very technology should be done in a more humane fashion, i.e. under the guidance of three moral principles: benevolence, justice, and non-maleficence. By doing so, implementation of QR code technology is done in a way that is not only conducive to COVID-19 prevention and control but also mitigate marginalization of the older people. In the post-pandemic era, the socialization of digital technology will accelerate. Therefore, in the field of public health, we should direct attention not only to the fair distribution of resources but also to the issue of identity that arises due to digital divide.
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  • 文章类型: Journal Article
    英国医学协会和一些皇家学院最近将他们对医生协助自杀的立场从“反对”改为“中立”。皇家麻醉师学院将很快就是否效仿进行投票。在其他地方,专业机构之间的中立先于医生协助自杀的合法化。我们研究了与麻醉界相关的论点及其在英国的潜在影响。
    The British Medical Association and some Royal Colleges have recently changed their stance on physician-assisted suicide from \'opposed\' to forms of \'neutral\'. The Royal College of Anaesthetists will poll members soon on whether to follow suit. Elsewhere neutrality amongst professional bodies has preceded legalisation of physician-assisted suicide. We examine the arguments relevant to the anaesthesia community and its potential impact in the UK.
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