scholarly journals Ethical Deliberation in the Allocation of Respirators and Beds during the Covid-19 Pandemic in Brazil

2021 ◽  
Author(s):  
Maristela Rodrigues Marinho ◽  
Sandra Pinto ◽  
Juliana Dias Reis Pessalacia ◽  
Priscila Kelly da Silva Neto ◽  
Marcela Tavares de Souza ◽  
...  
Keyword(s):  
Government Responsibility ◽  
Deliberative Process ◽  
Material Resources ◽  
Accountability For Reasonableness ◽  
Unified Health System ◽  
Deliberation Process ◽  
Health Programming ◽  
Health Justice ◽  
Installed Capacity ◽  
Theoretical Reflection

This chapter proposes a theoretical reflection on the ethical deliberation process in the allocation of beds and respirators, in the light of the Theory of Health Justice, the Accountability for Reasonableness approach and the principle of health equity of the Brazilian Unified Health System (SUS, as per its Portuguese acronym), before the COVID-19 pandemic in Brazil. The pandemic has become a serious threat to health systems, as installed capacity has been exceeded whether in terms of material resources, equipment, technology and human resources. Thus, according to the theory of Accountability for Reasonableness, a fair and deliberative process aims to ensure resource allocation through limits and constraints (reasonableness), but government responsibility derived from human rights must be considered, allowing for health programming (accountability). Faced with this scenario, where the situation will often require us to make choices, this chapter intends to discuss the assumptions for ethical deliberation, taking into account the context of the act and its foreseeable consequences.

scholarly journals Ethical aspects of digital health from a justice point of view

2019 ◽  
Vol 29 (Supplement_3) ◽  
pp. 18-22 ◽  
Author(s):  
Caroline Brall ◽  
Peter Schröder-Bäck ◽  
Els Maeckelberghe
Keyword(s):  
Digital Health ◽  
Relevant Literature ◽  
Point Of View ◽  
Health Providers ◽  
Ethical Aspects ◽  
Ethical Perspective ◽  
Accountability For Reasonableness ◽  
A Value ◽  
Set Up ◽  
Health Justice

Abstract Digital health is transforming healthcare systems worldwide. It promises benefits for population health but might also lead to health inequities. From an ethical perspective, it is hence much needed to adopt a fair approach. This article aims at outlining chances and challenges from an ethical perspective, focusing especially on the dimension of justice—a value, which has been described as the core value for public health. Analysed through the lenses of a standard approach for health justice—Norman Daniels’ account of just health and accountability for reasonableness—most recent and relevant literature was reviewed and challenges from a justice point of view were identified. Among them are challenges with regard to digital illiteracy, resulting inequities in access to healthcare, truthful information sharing to end users demanding fully informed consent, dignity and fairness in storage, access, sharing and ownership of data. All stakeholders involved bear responsibilities to shape digital health in an ethical and fair way. When all stakeholders, especially digital health providers and regulators, ensure that digital health interventions are designed and set up in an ethical and fair way and foster health equity for all population groups, there is a chance for this transformation resulting in a fair approach to digital health.

scholarly journals Priority Setting in Neurosurgery as Exemplified by an Everyday Challenge

2013 ◽  
Vol 40 (3) ◽  
pp. 378-383 ◽  
Author(s):  
George M. Ibrahim ◽  
Michael Tymianski ◽  
Mark Bernstein
Keyword(s):  
Decision Making ◽  
Operating Room ◽  
Priority Setting ◽  
Decision Making Process ◽  
Deliberative Process ◽  
Case Patient ◽  
Related Factors ◽  
Healthcare Resources ◽  
Accountability For Reasonableness ◽  
Appeals Process

Background:The allocation of limited healthcare resources poses a constant challenge for clinicians. One everyday example is the prioritization of elective neurosurgical operating room (OR) time in circumstances where cancellations may be encountered. The bioethical framework, Accountability for Reasonableness (A4R) may inform such decisions by establishing conditions that should be met for ethically-justifiable priority setting.Objective:Here, we describe our experience in implementing A4R to guide decisions regarding elective OR prioritization.Methods:The four primary expectations of the A4R process are: (1) relevance, namely achieved by support for the process and criteria for decisions amongst all stakeholders; (2) publicity, satisfied by the effective communication of the results of the deliberation; (3) challengeability through a fair appeals process; and (4) Oversight of the process to ensure that opportunities for its improvement are available.Results:A4R may be applied to inform OR time prioritization, with benefits to patients, surgeons and the institution itself. We discuss various case-, patient-, and surgeon-related factors that may be incorporated into the decision-making process. Furthermore, we explore challenges encountered in the implementation of this process, including the need for timely neurosurgical decision-making and the presence of hospital-based power imbalances.Conclusion:The authors recommend the implementation of a fair, deliberative process to inform priority setting in neurosurgery, as demonstrated by the application of the A4R framework to allocate limited OR time.

scholarly journals Production cost of autologous platelet rich plasma gel

2019 ◽  
Vol 27 ◽  
Author(s):  
Andrea Pinto Leite Ribeiro ◽  
Beatriz Guitton Renaud Baptista de Oliveira
Keyword(s):  
Health System ◽  
Direct Cost ◽  
Platelet Rich Plasma ◽  
Production Costs ◽  
Prospective Longitudinal Study ◽  
Material Resources ◽  
Unified Health System ◽  
Autologous Platelet Rich Plasma ◽  
Prospective Longitudinal ◽  
Autologous Platelet

Objective: to estimate the direct cost of producing autologous platelet rich plasma gel. Method: an economic, prospective, longitudinal study with direct cost estimation, from the perspective of the Unified Health System, conducted in a university hospital in the state of Rio de Janeiro, over a period of 12 weeks. It was approved by the Ethics Committee of the School of Medicine. Direct observation of 18 participants was conducted. Material and human resources categories were analyzed for production costs. Results: the cost of producing platelet rich plasma gel was US $4.88 per session, for a total of US $5.16, when the material resources per unit were considered in the Unified Health System. The time to complete the procedure was approximately 22 minutes. Conclusion: the production of platelet rich plasma gel involves low cost material resources for both blood collection and preparation, enabling universal access to treatment. The procedure requires trained staff in an appropriate location; it is a safe and inexpensive technology.

scholarly journals How to translate scientific knowledge into practice? Concepts, models and application

2020 ◽  
Vol 73 (5) ◽  
Author(s):  
Ana Cláudia Garcia Vieira ◽  
Denise Gastaldo ◽  
Denise Harrison
Keyword(s):  
Scientific Knowledge ◽  
Management Strategies ◽  
Primary Health Care System ◽  
Policy Makers ◽  
Knowledge To Action ◽  
Unified Health System ◽  
Primary Health ◽  
Knowledge Translation And Exchange ◽  
Theoretical Reflection

ABSTRACT Objectives: to present the concept of Knowledge Translation and Exchange as it has been used in the international literature and in Canada, particularly. Next, to describe a renowned conceptual model to guide its implementation, entitled Knowledge-to-Action Cycle. Results: we described the use of the model in the context of the municipal primary health care system in southern Brazil for the implementation of pain management strategies during vaccination. Conclusions: in this theoretical reflection, we argue that in order to promote health equity and quality of care in the Unified Health System (Brazilian SUS) it is important to translate scientific knowledge to various practice settings and create opportunities for exchange with users of this knowledge, such as health professionals, managers, policy makers, patients, family members and other stakeholders.

Current Practices and Perceived Needs in School-Based Mental Health Programming

2009 ◽  
Author(s):  
Nidhi Goel ◽  
Rohini Puri ◽  
Chu-Chun Fu ◽  
Melissa Stormont ◽  
Wendy M. Reinke
Keyword(s):  
Mental Health ◽  
Perceived Needs ◽  
School Based ◽  
Health Programming ◽  
Current Practices

A Review : Sustainability from Waste

2019 ◽  
pp. 134-155
Author(s):  
Kriti Jain ◽  
Chirag Shah
Keyword(s):  
Waste Management ◽  
Solid Waste ◽  
Rural Areas ◽  
Waste To Energy ◽  
Waste Generation ◽  
Material Resources ◽  
Waste Dumps ◽  
Waste Segregation ◽  
Treatment And Disposal ◽  
Engineered Landfill

The increasing volume and complexity of waste associated with the modern economy as due to the ranging population, is posing a serious risk to ecosystems and human health. Every year, an estimated 11.2 billion tonnes of solid waste is collected worldwide and decay of the organic proportion of solid waste is contributing about 5 per cent of global greenhouse gas emissions (UNEP). Poor waste management - ranging from non-existing collection systems to ineffective disposal causes air pollution, water and soil contamination. Open and unsanitary landfills contribute to contamination of drinking water and can cause infection and transmit diseases. The dispersal of debris pollutes ecosystems and dangerous substances from waste or garbage puts a strain on the health of urban dwellers and the environment. India, being second most populated country of the world that too with the lesser land area comparatively, faces major environmental challenges associated with waste generation and inadequate waste collection, transport, treatment and disposal. Population explosion, coupled with improved life style of people, results in increased generation of solid wastes in urban as well as rural areas of the country. The challenges and barriers are significant, but so are the opportunities. A priority is to move from reliance on waste dumps that offer no environmental protection, to waste management systems that retain useful resources within the economy [2]. Waste segregation at source and use of specialized waste processing facilities to separate recyclable materials has a key role. Disposal of residual waste after extraction of material resources needs engineered landfill sites and/or investment in waste-to-energy facilities. This study focusses on the minimization of the waste and gives the brief about the various initiations for proper waste management system. Hence moving towards the alternatives is the way to deal with these basic problems. This paper outlines various advances in the area of waste management. It focuses on current practices related to waste management initiatives taken by India. The purpose of this article put a light on various initiatives in the country and locates the scope for improvement in the management of waste which will also clean up the unemployment.

The Political and Aesthetic Power of the Everyday in Beckett's Happy Days

2019 ◽  
Vol 28 (1) ◽  
pp. 52-66
Author(s):  
Julie Bates
Keyword(s):  
Second World War ◽  
First Century ◽  
Environmental Crisis ◽  
The Political ◽  
Algerian War ◽  
Material Resources ◽  
The Social ◽  
The Everyday ◽  
The Last Man ◽  
Second World

Happy Days is contemporaneous with a number of seminal contributions to the concept of the everyday in postwar France. This essay suggests that the increasingly constrained verbal and physical routines performed by its protagonist Winnie constitute a portrait of the everyday, and goes on to trace the affinities between Beckett's portrait and several formulations of the concept, with particular emphasis on the pronounced gendering of the everyday in many of these theories. The essay suggests the aerial bombings of the Second World War and methods of torture during the Algerian War as potential influences for Beckett's play, and draws a comparison with Marlen Haushofer's 1963 novel The Wall, which reimagines the Romantic myth of The Last Man as The Last Woman. It is significant, however, that the cataclysmic event that precedes the events of Happy Days remains unnamed. This lack of specificity, I suggest, is constitutive of the menace of the play, and has ensured that the political as well as aesthetic power of Happy Days has not dated. Indeed, the everyday of its sentinel figure posted in a blighted landscape continues to articulate the fears of audiences, for whom the play may resonate today as a staging of twenty-first century anxiety about environmental crisis. The essay concludes that in Happy Days we encounter an isolated female protagonist who contrives from scant material resources and habitual bodily rhythms a shelter within a hostile environment, who generates, in other words, an everyday despite the shattering of the social and temporal framework that conventionally underpin its formation. Beckett's play in this way demonstrates the political as well as aesthetic power of the everyday in a time of crisis.

“We’ll Take the Tough Ones”

2019 ◽  
Vol 22 (4) ◽  
pp. 542-584
Author(s):  
Chrysanthi S. Leon ◽  
Corey S. Shdaimah
Keyword(s):  
Criminal Justice ◽  
Diversion Programs ◽  
Social Emotional ◽  
Theoretical Frameworks ◽  
Material Resources ◽  
Professional Goals ◽  
Criminal Justice Systems ◽  
Working Groups ◽  
Justice Systems

Expertise in multi-door criminal justice enables new forms of intervention within existing criminal justice systems. Expertise provides criminal justice personnel with the rationale and means to use their authority in order to carry out their existing roles for the purpose of doing (what they see as) good. In the first section, we outline theoretical frameworks derived from Gil Eyal’s sociology of expertise and Thomas Haskell’s evolution of moral sensibility. We use professional stakeholder interview data (N = 45) from our studies of three emerging and existing prostitution diversion programs as a case study to illustrate how criminal justice actors use what we define as primary, secondary, and tertiary expertise in multi-agency working groups. Actors make use of the tools at their disposal—in this case, the concept of trauma—to further personal and professional goals. As our case study demonstrates, professionals in specialized diversion programs recognize the inadequacy of criminal justice systems and believe that women who sell sex do so as a response to past harms and a lack of social, emotional, and material resources to cope with their trauma. Trauma shapes the kinds of interventions and expertise that are marshalled in response. Specialized programs create seepage that may reduce solely punitive responses and pave the way for better services. However empathetic, they do nothing to address the societal forces that are the root causes of harm and resultant trauma. This may have more to do with imagined capacities than with the objectively best approaches.

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