scholarly journals Parental obligation and compelled caesarean section: careful analogies and reliable reasoning about individual cases

2020 ◽  
pp. medethics-2020-106072
Author(s):  
Elselijn Kingma ◽  
Lindsey Porter
Keyword(s):  
Caesarean Section ◽  
Invasive Surgery ◽  
Emergency Surgery ◽  
Third Parties ◽  
Moral Duty ◽  
Moral Argument ◽  
Basic Form ◽  
Viable Option ◽  
Moral Permissibility ◽  
Undergo Emergency Surgery

Whether it is morally permissible to compel women to undergo a caesarean section is a topic of longstanding debate. Despite plenty of arguments against the moral permissibility of a forced caesarean section, the question keeps cropping up. This paper seeks to scrutinise a particular moral argument in favour of compulsion: the appeal to parental obligation. We present what we take to be a distillation of the basic form of this argument. We then argue that, in the absence of an exhaustive theory of parental obligation, the question of whether a labouring woman is morally obliged to undergo emergency surgery—and especially the further question of it is morally permissible for third parties to compel this—cannot be answered via ready-made theory. We propose that the most viable option for settling both questions is by analogy. We follow earlier writers in presenting an analogous case—that of fathers being compelled to undergo non-consensual invasive surgery to save their children—but expand the analogy by considering objections that appeal to the ownership of the fetus. We offer two lines of response: (1) the parthood view of pregnancy and (2) chimaera dad. We argue that it is clear in the analogous case that compulsion cannot be justified. We also offer this analogy as a useful tool for assessing whether mothers have a moral duty to undergo caesarean sections, both in general and in particular cases, even if such a duty is insufficient to warrant compulsion.

scholarly journals Management of patients with suspected COVID-19 who underwent emergency surgery

2020 ◽  
Author(s):  
Yanzhe Tan ◽  
Chengwei Yan ◽  
chunbao guo
Keyword(s):  
Pregnant Woman ◽  
Caesarean Section ◽  
Surgical Management ◽  
Femoral Fracture ◽  
Emergency Surgery ◽  
Medical Staff ◽  
Surgical Intervention ◽  
Indirect Hernia ◽  
Negative Results ◽  
Hospital Transmission

Abstract Background: Since the outbreak of COVID-19, no official guidelines for urgent surgical management of patients with the COVID-19 concern have been recommended. The current study provides our experience about the management for the patients with suspected or confirmed COVID-19 who required urgent surgical intervention.Methods: From February 5, 2019, to May 26, 2020, there were 5 cases of patients with suspected or confirmed COVID-19 infection managed with urgent surgical intervention in two hospitals in Chongqing. Results: The five cases with COVID-19 concern were admitted with different diseases, including acute intussusception, strangulated inguinal indirect hernia, acute purulent appendicitis, femoral fracture and onset to delivery. Finally, four patients obtained negative results afterwards. One pregnant woman with confirmed COVID-19 infection underwent caesarean section. All medical staff involved in the patients management were well, and no in-hospital transmission occurredConclusion:Suspected COVID-19 patients must be managed as positive patients until proven or denied in order to minimize the spread and transmission of infection. The current protocol carried out in our practice might be plausible and technically feasible for hospitals when dealing with COVID-19 infection.

scholarly journals Outcome of post caesarian pregnancy in a tertiary care hospital in Udaipur, Rajasthan

2021 ◽  
Vol 10 (4) ◽  
pp. 1614
Author(s):  
Archana Sharma ◽  
Harshdeep Jadeja ◽  
Preeti Malhotra
Keyword(s):  
Caesarean Section ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Patient Choice ◽  
Care Hospital ◽  
Viable Option ◽  
Relative Safety

Background: The prevalence of caesarean section has increased due to a variety of factors such as patient choice and relative safety of the procedure. However in many cases the risk involved in LSCS is still present.Methods: The present study was designed to evaluate the outcome in cases where VBAC or TOLAC were used for the second pregnancy in a previous LSCS case. The study employed a sample of 60 subjects who were equally divided in two groups who were subjected to elective cesarian and TOLAC.Results: The results showed that TOLAC did have a better outcome as compared to repeat cesarian in context of maternal and foetal factors.Conclusions: The practice of TOLAC must be tried as an alternative and can be a viable option for uncomplicated post cesarian deliveries. 

scholarly journals A Comparative Study of Different Techniques of Brachial Plexus Block in Upper Limb Surgery

2020 ◽  
Vol 5 (1) ◽  
pp. 05-12
Author(s):  
Ahsan Mustafa ◽  
Atif Mohammed ◽  
Shaher Banu
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Upper Limb ◽  
Emergency Surgery ◽  
Brachial Plexus Block ◽  
Supraclavicular Approach ◽  
Undergo Emergency Surgery ◽  
Upper Limb Surgery ◽  
One Year ◽  
Plexus Block

Background: Different techniques of Brachial Plexus block in upper limb surgery depending on the site of operation the approach of the brachial plexus was chosen. For the operations around the shoulder joint interscalene approach was chosen; for the operations up to the shoulder either interscalene or supraclavicular or Infraclavicular routes were chosen and for the operations up to and around the elbow joint any one of the four approaches were tried. Objective of this study was to evaluate its clinical applications and practical utility in providing good analgesia for the upper extremity surgery in elective as well as emergency cases.Design: This was a hospital based retrospective study. Duration: One Year i.e. from June 2018 to June 2019. Participants: 80 patients.Subjects and Methods:The present study includes 80 blocks of brachial plexus by four different routes. 1. Supraclavicular approach – 20 cases. 2. Infraclavicular approach – 20 cases. 3. Axillary perivascular approach – 20 cases. 4. Interscalene – 20 cases. The cases were selected at random, who were subjected for various types of surgery of upper extremity both elective and emergency as in-patients.Results:In this series of 80 blocks, when the type of the surgery (emergency or elective) is considered, it has been that about one third of the patients underwent emergency surgery successfully with the brachial plexus block. In the remaining two-third of the patients, the surgery was planned procedure.Conclusion:Thus, our study reveals that the brachial plexus block can be equally safely employed for emergency surgery as for any elective procedure. Some-times the brachial plexus block can be the only choice with no alternatives affording a reasonable chance to a moribund patient to undergo emergency surgery. The dosage of the drug was modified according to the patient’s general condition.

scholarly journals Percutaneous Transvenous Mitral Commissurotomy: SGNHC Experience

2004 ◽  
Vol 3 (3) ◽  
pp. 22
Author(s):  
Rajib Rajbhandari ◽  
Man Bahadur KC ◽  
Y Bhatt ◽  
Shyam Regmi ◽  
Deewakar Sharma ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Tamponade ◽  
Emergency Surgery ◽  
Left Atrial ◽  
Subjective Improvement ◽  
Post Procedure ◽  
Undergo Emergency Surgery ◽  
Mean Pressure ◽  
Percutaneous Transvenous Mitral Commissurotomy ◽  
Mitral Commissurotomy

One hundred patients had PTMC from June 2003 to January 2004, Seventy four percent of them were female. Youngest was 10 years and oldest was 5 8 years, Mean age was 25 years. Under 21 years were 26%, Atrial fibrillation was present in 32%, Mean MVA increased from range 0.91 cm2 to 1.90 cm2 with range of 0.5 cm? preprocedure to 2.3 cm2 post-procedure, Left atrial mean pressure decreased from average 19 mm Hg to 6 mm Hg. Subjective improvement was reported in 99%. There was no mortality. Significant MR (>2 Grade) was noted in 3 patients (3%) post- procedure. None developed severe MR. Procedure failed in two patients. None had cardiac tamponade. None had to undergo emergency surgery. One had systemic embolisation during the procedure which recovered subsequently.

The ethics of belief and Christian faith as commitment to assumptions

2009 ◽  
Vol 46 (1) ◽  
pp. 97-107 ◽  
Author(s):  
RIK PEELS
Keyword(s):  
Religious Faith ◽  
Moral Duty ◽  
Christian Faith ◽  
Recent Attempt ◽  
Ethics Of Belief ◽  
Moral Argument ◽  
The Ethics Of Belief

AbstractIn this paper I evaluate Brian Zamulinski's recent attempt to rebut an argument to the conclusion that having any kind of religious faith violates a moral duty. I agree with Zamulinski that the argument is unsound, but I disagree on where it goes wrong. I criticize Zamulinski's alternative construal of Christian faith as existential commitment to fundamental assumptions. It does not follow that we should accept the moral argument against religious faith, for at least two reasons. First, Zamulinski's Cliffordian ethics of belief is defective in several regards. Second, the truth of doxastic involuntarism and the possibility of doxastic excuse conditions can be used to demonstrate that the argument is unconvincing.

scholarly journals 1118 The Role of Emergency Surgery in Diverticular Strictures of Those Who Were Initially Managed Conservatively

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Jayawardena ◽  
O Jayawardena ◽  
R Peris ◽  
A Rafie
Keyword(s):  
Medical Treatment ◽  
Emergency Surgery ◽  
Medical Records ◽  
Elective Surgery ◽  
Bowel Perforation ◽  
Safety Net ◽  
Undergo Emergency Surgery ◽  
The Uk ◽  
Surgical Admission

Abstract Aim The presence of diverticulosis can lead to several different complications including formation of strictures. However, the literature concerning management of diverticular strictures is poor. The purpose of this study is to evaluate the patients who were initially treated non surgically and had to undergo emergency surgery. Method A retrospective study was performed using a cohort of patients between 2016 and 2020 where 84 patients with diverticular strictures were identified and followed up. Data on the management of diverticular stricture was captured using the hospital’s electronic medical records. Results Out of 84 patients with diverticular strictures, 9 had elective surgery without any medical treatment while 75 had medical treatment first. Out of the 75 patients who were medically treated, 12 underwent emergency surgery while 2/75 underwent elective surgery after receiving medical treatment due to ongoing symptoms. Out of the 12 patients that underwent emergency surgery, 9 patients presented with obstruction while 3 had a bowel perforation. 6 patients had Hartmann’s procedure, 5 had defunctioning colostomy and 1 patient had adhesiolysis. No patient deaths were recorded at 12 months. Conclusions Although medical management remains the preferred method of managing diverticular strictures in the UK, it is not without its complications. 1 in 5 patients had an acute surgical admission requiring emergency surgery. This raises the importance of a good ‘safety net’ in those managed non-surgically, to reduce delays associated with seeking medical advice. We also appreciate the importance of carrying out more extensive studies to establish the best way to manage diverticular strictures.

scholarly journals Angka Mortalitas dan Faktor Risiko pada Pasien Geriatri yang Menjalani Operasi Emergensi Akut Abdomen di RSUP Dr. Hasan Sadikin Bandung Tahun 2014−2015

2017 ◽  
Vol 5 (2) ◽  
pp. 94
Author(s):  
Donny Prasetyo Priyatmoko ◽  
Reza Widianto Sudjud ◽  
Rudi Kurniadi Kadarsah
Keyword(s):  
Risk Factor ◽  
Severe Sepsis ◽  
Mortality Rate ◽  
Acute Abdomen ◽  
Emergency Surgery ◽  
Geriatric Patients ◽  
Elective Surgery ◽  
The Body ◽  
Old Patients ◽  
Undergo Emergency Surgery

Geriatri memiliki kekhususan yang perlu diperhatikan dalam bidang anestesi dan tindakan operasi karena terdapat kemunduran sistem fisiologis dan farmakologis sejalan dengan penambahan usia. Penelitian di Yunani tahun 2007 menjelaskan bahwa angka mortalitas akibat tindakan operasi setelah usia 65 tahun menjadi 3 kali lipat dibanding dengan usia 18−40 tahun. Angka mortalitas geriatri tahun 2007 pada operasi elektif sebesar 5%, sedangkan operasi emergensi sebesar 10%. Tujuan penelitian ini adalah memperoleh angka mortalitas dan faktor risiko pada pasien geriatri yang menjalani operasi emergensi akut abdomen tahun 2014−2015. Tipe penelitian ini merupakan deskriptif dengan pendekatan retrospektif terhadap 180 subjek penelitian yang diambil di bagian rekam medis sejak Juli−Oktober 2016 pada pasien geriatri yang menjalani operasi emergensi akut abdomen di RSUP Dr. Hasan Sadikin Bandung tahun 2014−2015. Hasil penelitian ini memperlihatkan angka mortalitas sebesar 9% dengan faktor penyebab mortalitas paling dominan adalah syok sepsis sebesar 50%. Faktor predisposisi disebabkan oleh indeks massa tubuh <18,5 kg/m2 sebesar 56,3%, diagnosis primer tumor intestinal sebesar 31,3%, penyakit penyerta diabetes melitus sebesar 31,3%, sepsis sebesar 93,8%, hipoalbumin sebesar 56,3% dan status fisik ASA 4E sebesar 62,5%. Simpulan, faktor presipitasi disebabkan oleh waktu respons penanganan >6 jam sebesar 93,8% dan komplikasi pascaoperasi severe sepsis disertai pneumonia sebesar 50%. Kata kunci: Akut abdomen, angka mortalitas, geriatri, operasi emergensi Mortality Rate and Risk Factor in Geriatric Patients Undergo Emergency Surgery for Acute Abdoment in Dr. Hasan Sadikin Hospital Bandung in 2014−2015Geriatric has special anesthetic and surgical consideration because of reducing physiologic function and pharmacodynamic as the age increase. A study in Greece in 2007 shows that surgery in patient more than 65 year old has three times mortality rate than 18–40 years old patients. Geriatric mortality rate in 2007 undergo elective surgery is 5%, while the emergency surgery 10%. Purpose of this study was to obtain mortality rate and risk factor in geriatric patients underwent emergency surgery for acute abdomen in 2014−2015. This was a descriptive retrospective study of 180 subjects taken from the medical records in July to October, 2016 in geriatric patients underwent emergency surgery for acute abdomen at the Dr. Hasan Sadikin hospital in 2014−2015. Results of this study showed a mortality rate of 9%, with most dominant factors that cause mortality was septic shock (50%). Predisposing factors was the body mass index <18.5 kg/m2 (56.3%), the diagnosis of primary tumor intestinal amounted to 31.3%, comorbidities of diabetes mellitus at 31.3%, sepsis (93.8%), hipoalbumin (56.3%) and ASA physical status 4E (62.5%). In conclution, precipitation factors caused by response time >6 hours (93.8%) and postoperative complications of severe sepsis with pneumonia (50%).Key words: Acute abdomen, emergency surgery, geriatrics, mortality rate

Moral Arguments (actually R1 to Rn)

2018 ◽  
Author(s):  
David Baggett
Keyword(s):  
Moral Duty ◽  
Moral Fact ◽  
Moral Obligations ◽  
Moral Argument ◽  
Distinctive Features ◽  
Formidable Challenge ◽  
Moral Arguments

This chapter quickly summarizes the contours of an abductive moral argument for God’s existence. The specific moral phenomenon in question here is moral duty or obligation, Plantinga’s preferred variant for this sort of argument, considering it to be the moral fact most resistant to naturalistic analysis. Noting the distinctive features of moral obligations without domesticating or watering them down enables one to see that the best explanation needs to be more robust than what naturalistic sources alone are likely to generate. The chapter gives two versions of the argument, the deductive version and the abductive version, an inference to the best explanation. It will be asserted that the second formulation, in particular, constitutes a formidable challenge for the skeptic about God’s existence.

scholarly journals Improving Outcomes for Elderly Patients Following Emergency Surgery: a Cutting-edge Review

2021 ◽  
Author(s):  
James M. Halle-Smith ◽  
David N. Naumann ◽  
Susan L. Powell ◽  
Laura K. Naumann ◽  
Ewen A. Griffiths
Keyword(s):  
Elderly Patients ◽  
General Surgery ◽  
Emergency Surgery ◽  
The Elderly ◽  
Postoperative Management ◽  
Direct Care ◽  
Failure To Rescue ◽  
Emergency General Surgery ◽  
Undergo Emergency Surgery ◽  
The Right

Abstract Purpose of Review The aim of this review is to explore the consequence of emergency general surgery in the elderly, and to summarise recent developments in the pre-, peri- and postoperative management of these patients, in order to improve outcomes. Recent Findings Preoperatively, accurate risk assessment is vital to ensure the right patients undergo emergency surgery. Perioperatively, there are multiple interventions specific to elderly patients that have been shown to improve outcomes. Postoperatively, elderly patients must be cared more in an appropriate setting in order to avoid failure to rescue and promote return to function. Summary This review of contemporary evidence identifies multiple pre-, peri- and postoperative interventions that can improve outcomes for elderly patients after emergency general surgery. These evidence-based recommendations should help direct care of elderly patients undergoing emergency surgery and foster further quality improvement measures and research investigations.

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