scholarly journals ETHICAL CHALLENGES IN CESARIAN SECTION PROCEDURES TO INDICATION OF CONTRACTED PELVIS IN COVID-19 CONFIRMED PATIENTS

2021 ◽  
Vol 2 (2) ◽  
pp. 94-103
Author(s):  
Taufik Suryadi ◽  
Cut Nonda Maracilu ◽  
Kulsum Kulsum
Keyword(s):  
Cesarean Section ◽  
Ethical Issues ◽  
Pregnancy Termination ◽  
Medical Personnel ◽  
Regional Hospital ◽  
Rapid Screening ◽  
Elective Cesarean Section ◽  
Ethical Challenge ◽  
Medical Procedure ◽  
Ethical Challenges

The COVID-19 pandemic has posed several ethical challenges for all medical personnel. Every doctor always provides the best service to patients and follows the COVID-19 health protocol in handling patients. Ethical issues arise when doctors are faced with a dilemma in handling COVID-19 patients related to human resources, limited facilities, and infrastructure in handling patients in the regional hospital, so the patient must be referred. It was reported an obstetrics case: a 24-year-old patient presented with the first pregnancy, gestational age 39-40 weeks with heartburn complaints, and spotting from the birth canal. The patient was a referral from a regional hospital whose elective cesarean section was planned due to the diagnosis of a contracted pelvis. However, it turns out that the rapid screening test results were reactive to COVID-19 and positive in RT-PCR examination. The medical procedure taken was the immediate termination of pregnancy by a cesarean section that required mental preparation of the patient, family, and a team of doctors. The formation of a multidisciplinary team of doctors, the preparation of tools and places for postoperative care for mothers and babies, provide information to patients and families, informed consent, special needs of mothers and babies is an ethical challenge that needs to be addressed carefully. In cases of pregnancy termination in COVID-19 patients, the ethical challenge is its appeal, which should find a solution using clinical ethics theory and the basic principle of medical ethics.

Ethical Challenges in Independent Living Donor Advocacy

2021 ◽  
pp. 152692482110246
Author(s):  
Sarah B. Vittone ◽  
Nancy A. Crowell
Keyword(s):  
Decision Making ◽  
Independent Living ◽  
Living Donor ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Ethical Challenge ◽  
Ethical Challenges ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Research Questions

The Independent Living Donor Advocate, who is required on the transplant team, advocates, promotes, and protects the interests of the donor. Previously described ethical challenges perceived by these advocates and the variability of their responses prompted further inquiry. Research Questions: How are ethical obligations perceived by ILDAs? What ethical principles do ILDAs identify as the basis of their decision making? What are the ethical challenges for ILDAs? Study Design: A descriptive cross-sectional survey was designed and administered via REDCap. Participants were recruited from the National Kidney Foundation Living Donor Advocate email list. Quantitative and qualitative data on their role, ethical decision making, and perceived ethical issues, by seriousness and frequency, were collected. Results: Thirty-four participants responded. Nonmaleficence was ranked as the primary ethical principle used in decision making. Participants rated obligations to protect higher than advocacy. Participants reported experiencing internal ethical conflict to protect over advocate for the donor. The most serious ethical challenge participants perceived for donors was their decisional capacity, followed by their emotional or psychological distress, which was also described as a frequent donor challenge experienced in their role. Discussion: The results of this survey validate previous descriptions that the advocate role is largely perceived as protective. Their independent nature as well as the inherent vulnerabilities of the potential living donor compels the continued mitigation of ethical challenges, to enhance advocacy and protection for the living donor.

scholarly journals Ethics in the trenches: Part 2. Case studies of ethical challenges in emergency medicine

CJEM ◽  
2004 ◽  
Vol 6 (05) ◽  
pp. 363-366
Author(s):  
Merril Pauls ◽  
Andrew McRae ◽  
Sam G. Campbell ◽  
Paul Dungey
Keyword(s):  
Emergency Medicine ◽  
Ethical Issues ◽  
Ethical Challenge ◽  
Emergency Physicians ◽  
Ethical Challenges ◽  
Patient Privacy ◽  
Recommended Care ◽  
First Case ◽  
Illegal Activities ◽  
Privacy And Confidentiality

ABSTRACT Unique ethical issues arise in the practice of emergency medicine, and common ethical problems are often more difficult to address in the emergency department than in other medical settings. This article is Part 2 of the Series “Ethics in the Trenches” and it presents and analyses 2 cases — each dealing with an ethical challenge that emergency physicians are likely to encounter. The first case deals with patient refusal of care. When a patient refuses recommended care, the emergency physician must ensure the patient’s decision is informed and that the patient comprehends the implications of his or her choice. The second case deals with patient involvement in criminal activities. Emergency physicians often encounter patients who have engaged in illegal activities. Although certain activities must be reported, physicians should be mindful of their responsibility to protect patient privacy and confidentiality.

scholarly journals Top five ethical lessons of COVID-19 that the world must learn

2021 ◽  
Vol 6 ◽  
pp. 17
Author(s):  
Maxwell J. Smith ◽  
Aasim Ahmad ◽  
Thalia Arawi ◽  
Angus Dawson ◽  
Ezekiel J. Emanuel ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Contact Tracing ◽  
Ethical Challenge ◽  
First Year ◽  
Fair Allocation ◽  
Ethical Challenges ◽  
International Group ◽  
The World ◽  
Virtual Meetings ◽  
One Year

As the world reflects upon one year since the first cases of coronavirus disease 2019 (COVID-19) and prepare for and experience surges in cases, it is important to identify the most crucial ethical issues that might lie ahead so that countries are able to plan accordingly. Some ethical issues are rather obvious to predict, such as the ethical issues surrounding the use of immunity certificates, contact tracing, and the fair allocation of vaccines globally. Yet, the most significant ethical challenge that the world must address in the next year and beyond is to ensure that we learn the ethical lessons of the first year of this pandemic. Learning from our collective experiences thus far constitutes our greatest moral obligation. Appreciating that decision-making in the context of a pandemic is constrained by unprecedented complexity and uncertainty, beginning in June 2020, an international group of 17 experts in bioethics spanning 15 countries (including low-, middle-, and high-income countries) met virtually to identify what we considered to be the most significant ethical challenges and accompanying lessons faced thus far in the COVID-19 pandemic. Once collected, the group met over the course of several virtual meetings to identify challenges and lessons that are analytically distinct in order to identify common ethical themes under which different challenges and lessons could be grouped. The result, described in this paper, is what this expert group consider to be the top five ethical lessons from the initial experience with COVID-19 that must be learned.

scholarly journals Anesthesia practice in cesarean delivery in tertiary care hospital: a retrospective observational study

2018 ◽  
Vol 1 (1) ◽  
pp. 13-15
Author(s):  
Rohini Sigdel ◽  
Maya Lama ◽  
Sanish Gurung ◽  
Sushil Timilsina
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Tertiary Care ◽  
Regional Hospital ◽  
Elective Cesarean Section ◽  
Delivery Mode ◽  
Emergency Cesarean ◽  
Elective Cesarean

Background: Regional anesthesia is being utilized as the preferred anesthetic technique for cesarean delivery worldwide. This study was performed to review cesarean delivery anesthetic practice in our institute which represents a tertiary care regional hospital. Methods: Data was collected regarding the number of cesarean delivery performed during the period of six months from January 2017 to June 2017 at Western Regional Hospital. Number of elective versus emergency cesarean delivery, mode of anesthesia and the reason for general anesthesia and complications was recorded. Results: The number of cesarean delivery was found to be 1174(26.41%) of total deliveries during the study period. Out of which, 64.82% were for emergency indication and 35.18% were elective cesarean delivery. Spinal anesthesia was utilized in 99.03% of elective cesarean section and 97.63% of emergency cesarean section. The percentage of cases performed under general anesthesia was 1.87%. Reasons for general anesthesia included inadequate subarachnoid block, fetal malpresentation, eclampsia and maternal comorbidities. Complications related to general anesthesia like failed intubation, airway difficulty related to general anesthesia and anesthesia related mortality was not encountered. Conclusion: Spinal anesthesia is utilized widely and safely in obstetric practice at our hospital. Use of labour epidural analgesia should be introduced and encouraged in our setting to minimize the side effects of single shot spinal anesthesia and to avoid general anesthesia when indicated.

Acute Dystonia after a Single Dose of Intravenous Metoclopramide during Elective Cesarean Section: A Case Report.

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Danielle Levin
Keyword(s):  
Single Dose ◽  
Case Report ◽  
Cesarean Section ◽  
Epidural Anesthesia ◽  
Elective Cesarean Section ◽  
Single Administration ◽  
Dystonic Reaction ◽  
Elective Cesarean ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

We would like to present the first report of severe acute dystonic reaction after a single administration of metoclopramide during cesarean section under combined spinal-epidural anesthesia.  During elective cesarean section, a 30-year-old female vomited four times and was treated with 10mg intravenous metoclopramide and 8mg intravenous ondansetron.  Nausea subsided with the antiemetic treatment, but two minutes later, patient had rapid eye blinking, uncontrollable head movement, and became unresponsive.  Bolus of 50mg intravenous diphenhydramine resolved the acute dystonic symptoms within seconds.  Patient was again oriented times three, with no recollection of symptoms, and remained symptom free for the rest of admission. 

Comparison of the effects of Dexamethasone and Ondansetron on the Reduction of Postoperative Nausea and Vomiting following Cesarean Section under Spinal Anesthesia

2020 ◽  
Vol 15 ◽  
Author(s):  
Arash karimi ◽  
Jahanbakhsh Nejadi ◽  
Mahnaz Shamseh ◽  
Nooshin Ronasi ◽  
Mehdi Birjandi
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Postoperative Nausea ◽  
Demographic Data ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Elective Cesarean Section ◽  
Double Blind ◽  
Group A ◽  
Group B

Background: Postoperative nausea and vomiting (PONV) is a common complication associated with the use of anesthesia. Several antiemetics are used to reduce the incidence and severity of PONV. The aim of this study is to investigate the role of dexamethasone and ondansetron to treat PONV in patients undergoing cesarean section (c-section) under spinal anesthesia. Methods: This double-blind clinical trial study was performed on patients who were referred to the operating room of Haji Karim Asali Hospital of Khorramabad for elective cesarean section in 2016-17. Upon meeting the inclusion criteria, patients were allotted into two groups (n=60). Group A received 8mg of dexamethasone and group B received 4mg of ondansetron after spinal anesthesia. The Visual Analog Scale (VAS) questionnaire and Depression-Anxiety-Stress Scale (DASS) questionnaire was used for the analysis. Patients with mild to moderate stress, anxiety, and depression were included in the study. Data were analyzed using SPSS 16 software. Results: There was no difference in the demographic data of the two groups. The mean severity of nausea in group A was significantly higher than in group B. The frequency of vomiting in group A was 20 times higher than group B, which was found to be statistically significant, p = 0.018. Concerning the type of delivery with the frequency of nausea, the results showed that the frequency of nausea in group A was 3.24 times higher than group B, however, this difference was not statistically significant, p = 0.106. Conclusion: Based on the results of this study, ondansetron had a significant effect on the alleviation of postoperative nausea and vomiting, as compared to dexamethasone in c-section surgical candidates.

Ethical Issues in Dissemination and Implementation Research

2017 ◽  
Author(s):  
James M. DuBois ◽  
Beth Prusaczyk
Keyword(s):  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Dissemination And Implementation ◽  
Ethical Challenges ◽  
Specific Complex ◽  
Dissemination And Implementation Research ◽  
Research Regulations ◽  
Human Participants ◽  
Context Specific

This chapter focuses primarily on the protection of human participants in D&I studies. It begins by reviewing the Belmont principles that undergird US research regulations and considering the ethical case for D&I research. It then proceeds to examine some ethical issues that might arise during the course of a public health, D&I research agenda in middle schools. It covers the ethical case for D&I research and common ethical challenges. The chapter also discusses strategies for ethical decision-making. While these strategies may be beneficial to all researchers, the authors believe they are of particular value to dissemination and implementation researchers because the nature of their work—context specific, complex, and unfamiliar to many peers, collaborators, and reviewers—means they will deal with uncertainty and conflict on a regular basis, and solutions to the problems they face will rarely be found through simple reference principles, rules, or regulations.

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