Ethical Reflection
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2021 ◽  
Vol 31 (Supplement_2) ◽  
João Gentil

Abstract Background In 2019, WHO classified vaccine hesitancy as one of the top 10 threats to global health. Vaccination is an area of excellence in nursing that has gained a new focus and has become a challenge in the provision of care and in the management field. Vaccine hesitation raises questions about mandatory vaccination, individual versus collective freedom that are highlighted in the current context due to the emergence of new vaccines. In this paper, we want to analyze and update knowledge about vaccines hesitancy from an ethical and bioethical perspective. Methods A combination of literature reviews on vaccine refusal/hesitancy, ethics and COVID-19 vaccine confidence, accessed on SciELO and PubMed databases and analysis of documents from General Directorate of Health and Ordem dos Enfermeiros (National Nurses Association). Results Vaccination programs aim is a collective protection. The desirable effects at individual level do not have the same ethical value at collective level, leading to cost-benefit imbalances. Moral conflicts between the individual and the collective, cost-benefit imbalances and the insufficiency of bioethics principles, lead us to the use of other moral values and principles, such as responsibility, solidarity and social justice, as a tool for ethical reflection problems related to COVID-19 vaccines. Conclusions There are no perfect solutions to ethical dilemmas and some optimal solutions could depend the context. In a pandemic situation, one of the most relevant ethical issues is the herd immunity since it leaves public health at risk. Equity and the principle of justice in vaccination campaign are shown daily in the nursing profession.

2021 ◽  
Vol 11 (1) ◽  
Dominique D. Benoit ◽  
Esther N. van der Zee ◽  
Michael Darmon ◽  
An K. L. Reyners ◽  
Victoria Metaxa ◽  

Abstract Background Whether Intensive Care Unit (ICU) clinicians display unconscious bias towards cancer patients is unknown. The aim of this study was to compare the outcomes of critically ill patients with and without perceptions of excessive care (PECs) by ICU clinicians in patients with and without cancer. Methods This study is a sub-analysis of the large multicentre DISPROPRICUS study. Clinicians of 56 ICUs in Europe and the United States completed a daily questionnaire about the appropriateness of care during a 28-day period. We compared the cumulative incidence of patients with concordant PECs, treatment limitation decisions (TLDs) and death between patients with uncontrolled and controlled cancer, and patients without cancer. Results Of the 1641 patients, 117 (7.1%) had uncontrolled cancer and 270 (16.4%) had controlled cancer. The cumulative incidence of concordant PECs in patients with uncontrolled and controlled cancer versus patients without cancer was 20.5%, 8.1%, and 9.1% (p < 0.001 and p = 0.62, respectively). In patients with concordant PECs, we found no evidence for a difference in time from admission until death (HR 1.02, 95% CI 0.60–1.72 and HR 0.87, 95% CI 0.49–1.54) and TLDs (HR 0.81, 95% CI 0.33–1.99 and HR 0.70, 95% CI 0.27–1.81) across subgroups. In patients without concordant PECs, we found differences between the time from admission until death (HR 2.23, 95% CI 1.58–3.15 and 1.66, 95% CI 1.28–2.15), without a corresponding increase in time until TLDs (NA, p = 0.3 and 0.7) across subgroups. Conclusions The absence of a difference in time from admission until TLDs and death in patients with concordant PECs makes bias by ICU clinicians towards cancer patients unlikely. However, the differences between the time from admission until death, without a corresponding increase in time until TLDs, suggest prognostic unawareness, uncertainty or optimism in ICU clinicians who did not provide PECs, more specifically in patients with uncontrolled cancer. This study highlights the need to improve intra- and interdisciplinary ethical reflection and subsequent decision-making at the ICU.

2021 ◽  
Vol 5 (4) ◽  
pp. 405
Maide Barış

Germline genetic intervention (GGI) has been one of the most discussed topics within the bioethics literature since 2012, when the programming of CRISPR/Cas9 for a specifically targeted gene region has become possible. While some authors are optimistic about what GGI may offer, others strongly disagree and refute the use of this technology for different reasons. This paper will aim to examine one of the most widespread arguments against GGI, namely “heritability” argument, comprehensively. Firstly, it will aim to examine the moral importance of the germline. Secondly, it will try to understand three possible assumptions of the heritability argument. Then it will try to respond to these assumptions and argue that they are neither scientifically supportable nor rationally solid for rejecting GGI altogether.International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 405-411

2021 ◽  
pp. 000332862110238
K.D. Joyce

While exhortations to gratitude are present throughout the Bible, contemporary theological scholarship on gratitude has been limited, largely following the lead of secular research. To engage in deeper theological reflection on gratitude, I begin by proposing a working definition of gratitude in the Christian context. An overview of existing gratitude research undertaken in the fields of philosophy and the social sciences, reflections on three of the seven “heavenly virtues,” and insights from existing theologies of grace and the cross provide examples of how existing scholarship forms a solid basis for the creation of a theology of gratitude. Finally, the role that concerns of justice must play in any theology of gratitude is examined—for what should we give thanks? A Christian theology of gratitude invites us to critical ethical reflection on what is truly good in the eyes of God, and calls us to generous response.

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Yi Chen ◽  
Chuanfu Chen ◽  
Si Li

PurposeThe purpose of this study was to investigate the participants' attitudes toward the ethical issues caused by collecting social media data (SMD) for research, as well as the effects of familiarity, trust and altruism on the participants' attitudes toward the ethics of SMD research. It is hoped that through this study, scholars will be reminded to respect participants and engage in ethical reflection when using SMD in research.Design/methodology/approachThis study adopted social media users as its research subjects and used Sina Microblog, the world's largest Chinese social media platform, as the example. Based on the 320 valid responses collected from a survey, structural equation modeling was employed to examine the research model.FindingsThe results indicated that altruism, familiarity and trust have significant influences on participants' attitudes toward the ethics of SMD research, and familiarity also influences attitudes through the mediating role of trust and altruism.Originality/valueThis study explored the mechanism underlying the relationship between the determining factors and participants' attitudes toward the ethics of SMD research, and the results demonstrated that the informed consent mechanism is an effective way to communicate with participants and that the guiding responsibility of the platform should be improved to standardize SMD research.

2021 ◽  
pp. 174701612110227
Christine Hine

There has been considerable debate around the ethical issues raised by data-driven technologies such as artificial intelligence. Ethical principles for the field have focused on the need to ensure that such technologies are used for good rather than harm, that they enshrine principles of social justice and fairness, that they protect privacy, respect human autonomy and are open to scrutiny. While development of such principles is well advanced, there is as yet little consensus on the mechanisms appropriate for ethical governance in this field. This paper examines the prospects for the university ethics committee to undertake effective review of research conducted on data-driven technologies in the university context. Challenges identified include: the relatively narrow focus of university-based ethical review on the human subjects research process and lack of capacity to anticipate downstream impacts; the difficulties of accommodating the complex interplay of academic and commercial interests in the field; and the need to ensure appropriate expertise from both specialists and lay voices. Overall, the challenges identified sharpen appreciation of the need to encourage a joined-up and effective system of ethical governance that fosters an ethical culture rather than replacing ethical reflection with bureaucracy.

2021 ◽  
Vol 34 (13) ◽  
Margarida Sobral ◽  
Bárbara Santa Rosa ◽  
Margarida Silvestre

The COVID-19 pandemic has brought dramatic worldwide consequences affecting social, economic and healthcare systems. Considering that the number of infected patients requiring admission to intensive care units far exceeded the available resources, healthcare professionals have had to face challenging decisions concerning who should benefit from the limited resources and who should not. In this context, after a careful ethical reflection, we propose some principles to be adopted when dealing with allocation resource decisions, based on core ethical values. Ideally, these strategies should be established and integrated into institutional policies before a crisis scenario, in order to anticipate a potential new public health emergency and prevent possible tragic consequences.

2021 ◽  
pp. 084047042110056
Renate Ilse

Clinical ethics and clinical ethics supports, particularly regarding resource allocation and end of life decisions, are well developed in our healthcare system and in most hospitals; this is not the case for the broader category of leadership ethics. Most health managers and executives regularly need to make leadership decisions/choices that require ethical reflection. Without formal training, regular practice, and broad discussion on this issue of leadership ethics, Canadian hospital leaders are increasingly finding their decisions questioned and often end up in the headlines after being judged as failing to make the ethical grade. This article discusses the importance leadership ethics in today's healthcare environment, examines some of the complex ethical challenges created by the current healthcare context and external environment, and then presents an argument for more formal and mandatory leadership ethics education for executives and other health leaders.

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