Healthcare bioethics: a new proposal of ethics for clinical practice

The expression“patient revolution”is the social,educational,cultural,and political movement initiated at the end of the twentieth century and beginning of the twenty-first century,which sustains the protagonism of the patients in their care as the primary decision maker and holder of human rights.The patient revolution comprises varied approaches and references,such as Patient-Centered Care,Shared Decision-Making,Patient Participation,and Patients’Rights,which combine to uphold that the patient is a moral agent and anchor healthcare in the biopsychosocial model.In this sense,this movement is a new proposal of ethics for clinical practice.This theoretical research primary goal is to develop theoretical contributions that support this new Bioethics dimension,emphasizing the context in healthcare that calls for new ethics in clinical practice,characterized as a patient revolution movement.We concluded that the patient revolution had driven a new paradigm in healthcare based on Patient-Centricity,SDM,and Patients’Rights.Despite this critical change in the health sphere,the patient revolution appears to have reverberated in clinical bioethics.Thus,theoretical contributions must be developed for new ethics in the clinic,a task undertaken in this article through the proposal of Healthcare Bioethics as an adequate frame of reference to be adopted at all levels of clinical care.Thus,it is concluded that having Bioethics Healthcare as a beacon of ethics in clinical encounters can contribute to the quality of care and its ethical provision,confronting practices that violate Patients’Rights.It is imperative to change paternalistic theoretical frameworks that mitigate the Patients’Right to participate in every decision regarding their health.Only with the adoption of new approaches and an insight into the patient’s role in clinical interaction can a new culture in Patient-Centered healthcare take shape.

The Alzheimer’s Dementia Patients’ Observed Illness Course and Experience in Ghana and Care Lessons to Be Learnt: A Mental Health Professional’s Perspective

Alzheimer’s disease (AD) and associated dementia patient numbers continue to increase globally with associated economic costs to healthcare systems. Of note is the increase in numbers in lower and middle-income countries (LMICs) including Sub-Saharan African (SSA) countries, which already face challenges with their health budgets from communicable and non-communicable diseases. Ghana, an SSA country, faces the problem of healthcare budgetary difficulties and the additional impact of AD as a consequence of increasing population strata of old aged persons (OAPs) due to the demographic transition effect. This article uses examples of known patients’ illness courses to give a perspective on the lived experience of patients with dementia (PWD) in Ghana, living amongst a populace with a culture of stigmatization of PWD, and a relatively fragile public mental health system (PMHS) for those with mental illness, including AD. The lived experience of AD patients is characterised by stigmatisation, discrimination, non-inclusiveness, diminished dignity and human rights abuses in the face of their mental disability, and eventually death. This article is an advocacy article giving voice to the voiceless and all persons suffering from AD and other dementias in Ghana, whilst pleading for a call to action from healthcare professionals and responsible state agencies.

Emergency Care for Children and Adolescents after Sexual Violence, in Brazil’s Capital, Brasilia

Objective: Sexual violence affects women of all ages but, more commonly, children and adolescents. This study aimed to identify the extent to which services are being provided at the hospitals responsible for the emergency care of children and adolescents who have suffered sexual violence and to determine whether there is any difference in the provision of such services as a function of the victim’s age. Method: This cross-sectional study investigated differences in the care received by female children and adolescents who are victims of sexual violence in a capital city, comparing the treatment given to girls under 15 with that given to adolescents of 15 to 19 years of age. The data were extracted from the State Department of Health database between 01/01/2012 and 31/12/2016. Results: Children under 15 were much less likely to receive prophylaxis against HIV, sexually transmitted infections and hepatitis B, with the number of adolescent girls treated adequately corresponding to between twice and almost three times the number of children treated prophylactically. Only 10% of girls under 15 received emergency contraception. Conclusion: The lack of standard care established by the Ministry of Health highlights the need for urgent debates both locally and probably throughout the country, as the situation may be similar in other regions of the country.

Romanticism and german medicine:a comment to Medizin In Romantik Und Idealismus(Dietrich von Engelhaardt)

Dietrich von Engelhardt and the history of medicine.Dietrich von Engelhardt(1941-)is a German scholar who has devoted his life to research and teaching in the history of medicine and the sciences,literature and medicine,and ethics in medical and scientific research.He studied philosophy,history,and slavistic at the universities of Tübingen,München and Heidelberg and received his doctorate from the last one with a thesis on Hegel and chemistry.From 1983 to 2007 he was Professor and Director of the Institute of Medical and Science History at the University of Lübeck,Germany.

Cheaper Precision Weapons: An Exploratory Study about the HESA Shahed 136

The ability to hit a target with precision and from a great distance has been reserved for the world’s superpowers. However, this resource is increasingly being threatened as drones with this long-range and precision capability are becoming more accessible to those who don’t have this strategic ability. This article starts with an analysis of the Iranian HESA Shahed 136 drone to discuss the latest innovations in low-cost long-range precision weapons, specifically the use of kamikaze drones and loitering munitions. This is an exploratory study that starts by discussing the notion of a kamikaze drone and then analyses the design options for the Shahed 136, to reflect on the future of this new type of weapon and its implications for the economic and political relationship between weapon and cost. The conclusion is that the HESA Shahed 136 revolutionizes the concept of precise long-range strikes, a function that until now was reserved for expensive and technologically demanding tactical missiles and aircraft, and which can now be carried out with cheap drones. This creates an arms race not only in producing the most technological and precise weaponry but also the least expensive.

Assessing the Burden of Choledochian Lithiasis and Cholangiocarcinoma in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography, Using Disability-Adjusted Life Years

Exact estimates of the current and future burden of gastroenterological pathology can support the national public health policy. In order to have a possible comparison between the impact and burden of some diseases, a series of health measurements were developed, simultaneously including morbidity and mortality. The aim of the study was to evaluate the burden of gastrointestinal pathology that requires therapeutic endoscopy, such as choledochian lithiasis and cholangiocarcinoma in a tertiary centre between 2019 and 2020. The scientific research was carried out as a retrospective study, intending to analyze the macroeconomic indicator-Disability-Adjusted-Life Year (DALY) in patients who underwent endoscopic retrograde cholangiopancreatography (ERCP), for the diagnosis of choledochian lithiasis or cholangiocarcinoma. The study included the cases diagnosed based on clinical, biological and imaging criteria. Our study showed that the values of DALY indicator are higher in men than in women. The DALY approach has a strong methodological framework and a firm theoretical grounding. It has been widely accepted by public health experts and employed to measure the global and regional burdens of the disease.

Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health

The British Medical Association(BMA)guidance on non-therapeutic circumcision(NTMC)of male children is limited to ethical,legal and religious issues.Here we evaluate criticisms of the BMA’s guidance by Lempert et al.While their arguments promoting autonomy and consent might be superficially appealing,their claim of high procedural risks and negligible benefits seem one-sided and contrast with high quality evidence of low risk and lifelong benefits.Extensive literature reviews by the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in developing evidence-based policies,as well as risk-benefit analyses,have found that the medical benefits of infant NTMC greatly exceed the risks,and there is no reduction in sexual function and pleasure.The BMA’s failure to consider the medical benefits of early childhood NTMC may partly explain why this prophylactic intervention is discouraged in the United Kingdom.The consequence is higher prevalence of preventable infections,adverse medical conditions,suffering and net costs to the UK’s National Health Service for treatment of these.Many of the issues and contradictions in the BMA guidance identified by Lempert et al stem from the BMA’s guidance not being sufficiently evidence-based.Indeed,that document called for a review by others of the medical issues surrounding NTMC.While societal factors apply,ultimately,NTMC can only be justified rationally on scientific,evidence-based grounds.Parents are entitled to an accurate presentation of the medical evidence so that they can make an informed decision.Their decision either for or against NTMC should then be respected.

De la Cruz-Badiano Codex: a medical text from XVIth Century New Spain

Introduction In 1990 Pope John Paul II returned to Mexico a text that may be the first one composed on medical matters in New Spain[1].According to reputable scholars,this codex was composed under the inspiration of Don Francisco de Mendoza,son of the then Viceroy Antonio de Mendoza.Fray Jacobo de Grado,of the order of San Francisco,commissioned its writing to the"principal Indian"Martín de la Cruz,who composed it in Nahuatl and Spanish.

The relevance of the deliberative model of the doctor-patient relationship in the Indian context

Introduction India is the third largest country in Asia with a population under 1.4 billion population.There are around 28 states and 8 Union territories in India,marked by diverse cultures,religious beliefs,ethnicity,and languages.Health literacy,healthcare services utilization,and trust in modern medicine significantly vary across India[1].

Zika Virus Controversies: Epidemics as a Legacy of Mega Events?

The current knowledge of the Zika Virus epidemic clearly lacks a comprehensive understanding of its determinants and clinical outcomes. Until recently regarded as a “simple” dengue-like infection, it nowadays turned into a real challenge to Public Health around the world. The Zika Epidemic shows a quick spread, affects unprepared health systems, and presents with severe neurological complications of newborns—a concrete threat to pregnancies. This re-emerging infectious disease is a source of deep doubts and harsh debates regarding Public Health and even bioethical issues. Several doubts still remain on how to deal with the various possible transmission ways of the disease, the surge of a generation of thousands of microcephalic newborns (and questions on how to handle them within limited health systems), and severe malformations concentrated so far in Northeastern Brazil. Finally, a debate is raised about how the “Endemic State” of Brazil, deeply merged in a health care crisis for almost 40 years now, currently confronts 3 current epidemics of the arboviruses Dengue, Chikungunya and now Zika, all associated with a lack of basic sanitation. Brazil must deal with these biological threats in the context of the Rio 2016 Olympic Games, since Chikungunya has probably been brought to Brazil during the FIFA Soccer World Cup (2014) and Zika Virus spread is associated with the Soccer Confederations Cup (2013).

Cultured meat in western media: The disproportionate coverage of vegetarian reactions, demographic realities, and implications for cultured meat marketing

This paper examines the media coverage of the 2013 London cultured meat tasting event, particularly in the United States, Canada, and the United Kingdom. Using major news outlets, prominent magazines covering food and science issues, and advocacy websites concerning meat consumption, the paper characterizes the overall emphases of the coverage, the tenor of the coverage, and compares the media portrayal of the important issues to the demographic and psychological realities of the actual consumer market into which cultured meat will compete. In particular, the paper argues that Western media gives a distorted picture of what obstacles are in the path of cultured meat acceptance, especially by overemphasizing and overrepresenting the importance of the reception of cultured meat among vegetarians. Promoters of cultured meat should recognize the skewed impression that this media coverage provides and pay attention to the demographic data that suggests strict vegetarians are a demographically negligible group. Resources for promoting cultured meat should focus on the empirical demographics of the consumer market and the empirical psychology of mainstream consumers.

Platelet-to-lymphocyte ratio and CA19-9 are simple and informative prognostic factors in patients with resected pancreatic cancer

We read with great interest the paper “Combined preoperative platelet-to-lymphocyte ratio and serum carbohydrate antigen 19-9 level as a prognostic factor in patients with resected pancreatic cancer” published in Hepatobiliary & Pancreatic Diseases International [1].

Road Traffic Accidents in Ghana: A Public Health Concern, and a Call for Action in Ghana, (and the Sub-Region)

This paper highlights the increasing problem of road traffic accident (RTA) related morbidity and mortality in Ghana, and the public health measures needed to control the problem. Descriptive data in the public domain from statutory bodies and media houses reports on country RTA information, as well as academic papers on the problem, were used as source of information about the problem. The observed trend in Ghana indicates that RTA related fatalities and injuries continue to be increasing, as morbidity and mortality factors since the year 2000. Most of the remedial measures suggested in academic papers, and state agencies measures to curb the RTA trend in Ghana to date, have discussed the problem in terms of injury and safety issues/measures. This paper suggests that the increasing RTAs with associated morbidity and mortality in Ghana need to be looked at more as a public health problem and priority that requires prompt tackling using a public health problem orientated approach and measures, than just as a safety problem due to RTAs’, as is currently done.

Prospectively Recording Errors Is Valuable in Reducing Complications

Errors have traditionally been a less commonly discussed topic but are becoming increasingly examined due to a trend towards expanded awareness about the high human and financial cost of errors in medicine. Recording and reporting of errors has been a difficult issue in the health sector due to fear of litigation from patients, complaint to governing bodies, and embarrassment from colleagues. In this article we examine the advantages of prospective error recording. The studies on this subject report that the culture of prospective error recording is of high value in improving most parameters of errors and may indeed reduce complications.

Sex Work, Motivations for Entry, and the Combined Impact of Both on Mental Health: A Case Report of Japanese Female Patients within Therapeutic Relationships

The purpose of this study was to explore the motivations for entry into the sex industry. The narratives of four Japanese female psychiatric patients with a past experience of sex work were used for analysis. I identified not only practical factors such as financial difficulties or lack of job skills, but also various psycho-social factors, namely: weak emotional ties with their mothers since infancy, their mothers’ tendency to prioritize sons over daughters, unremitting needs for maternal care, fear of rejection and object-seeking behavior, desire to control others, envy and aggressive self-destructive behavior, difficulties in establishing female peer relationships during adolescence, proneness to dependency on male objects through sexual relationships, past histories of crime and delinquency, weak internal motivation, frequent acting out, and addictive behaviors. In this article I discussed whether their mental maladjustment was purely the product of their past experiences as sex workers, or whether in fact both the maladjustment and the motivations for entry were derived from personality characteristics developed since infancy. Although not applicable to every Japanese sex worker, this article presents a preliminary hypothesis regarding the contribution of the above multi-dimensional factors to the motivations for entry, and the following mental maladjustment.

The laparoscopic approach in emergency surgery: A review of the literature

The role of laparoscopy in the acute care surgery had significantly increased during the latest years, both as a diagnostic and treatment method of all the upper or lower gastrointestinal pathologies. The objective of the present research is to review the current indications for laparoscopy in abdominal emergencies and to detail the benefits and complications associated with this approach. We have reviewed the relevant literature about this topic published between January 2005 and December 2017, using the PubMed/Medline and Web of Science Core Collection databases. According to the current evidence, we may conclude that the laparoscopic approach is an integral part of the emergency surgery for all the abdominal pathologies. Although laparoscopy requires specialized training and curricula, it brings all the benefits of minimal access in acute care arena.

Analysis of “care” and “justice” involved in moral reasoning of nurse based on the Gilligan theory: A literature review using the Gilligan’s protocol

The majority of research on the moral development of nurses is in line with Kohlberg’s theory. However, Gilligan noted that care and justice perspectives coexist in moral conflict, and during the growth process, each complements each other and promotes moral development and maturation. Chally, referring to Gilligan’s theory, which has the perspective of relationship-focused care, argued that the moral development of nurses should be considered from both care and justice perspectives. In this paper, we analyzed publications that used Gilligan protocol to conduct research on moral conflicts experienced by nurses. Given the importance of care and justice perspectives in moral reasoning, Gilligan’s theory, which incorporates both perspectives, is useful for analyzing moral reasoning in nurses. Our analysis suggests that attachment and connections based on relationships with patients and self-care are essential elements of care, and self-care is important in moral decision making. The inequality between nurse and physician roles was an issue raised with the justice perspective. Since nurses’ roles are strongly influenced by their affection toward and connections with their patients, it is important not to overemphasize either perspective.

Palliative Care, Suffering, Death Trajectory: A View of End-of-Life Care (EOL) Related Issues in Sub-Saharan Africa (SSA)

Palliative care in the sub-Saharan Africa (SSA) region despite some progress made since the first hospice was opened in Zimbabwe in 1979, still lags far behind that of countries with developed economies, and relatively suffers from not being wholly included into mainstream public health service delivery in SSA. The situation is made worse due to relatively poor and pervasive socio-politico-economic factors and the challenge of the changing and increasing non-communicable disease epidemiology in SSA countries. This situation results in a tension between scarce resources and service needs/provision which prevails in a good number of SSA countries. In large part the situation where palliative care, end of life and the death trajectory converge in SSA countries currently portrays one of scarcity of resources and suffering for those ill SSA patients who need the services. This article is an overview of the current situation as pertains to palliative care services in the SSA region and some of the factors that contribute to or perpetuate the current state of palliative care delivery in SSA countries.

Police Emergency Commitment Powers in Cases of Persons Experiencing Mental Health Crisis in “Public Spaces”: Review of the Commitment Process in England and Wales, in Comparison to the Practice in the United States of America (USA)

Police emergency commitment powers for detention of persons in the community perceived to be seriously mentally ill for further specialist examination in a designated facility have always raised interest in medical and legal circles on both sides of the Atlantic. The objective of this article is to detail the police commitment procedure in England and Wales, as dictated by the mental health act of 1983 (MHA 1983) amended in 2007 (MHA 2007);and compare this with similar legal provisions as prevails under current state mental health statutes in the United States of America (USA). The comparative review of the commitment processes in England and Wales to that of the USA reveals that the process in England and Wales seeks to primarily ensure that persons with mental disorder (PWMD) in crisis are directed to a specialist hospital for evaluation and appropriate specialist care. In the USA such persons in a good number of cases may end up in the criminal justice system due to application of the “dangerousness” standard. Additionally whereas in England and Wales the commitment law is uniform in law and application, the federal system in the USA is such that the commitment law may have minor variations depending on the individual states. The minor variation in state commitment laws may engender a situation where the commitment law in England and Wales may seem relatively equitable and just towards PWMD in crisis, compared to the state commitment laws in the USA.