Ethics, Medicine and Public Health最新文献

Background

Aging is a process associated with changes in physical appearance. Rembrandt Harmenszoon van Rijn was the greatest Dutch artist and one of the leading painters of the 17th century. Osman Hamdi Bey was a pioneer of Ottoman art. Both painters were masters of portraiture. From portraits it is possible to analyze the aging process.

Methods

In this study, high-quality photographs of 6 self-portraits of Rembrandt and 8 portraits of Naile Hanim were evaluated for the presence of facial aging. Medical databases were used to identify studies related facial aging. For the analysis of the portraits, a set of grading scales were used for hair graying, forehead lines, glabellar lines, brow positioning, crow’ s feet, Marionette lines, and nasolabial folds.

Results

Both painters skillfully portrayed the real appearance of people. Visual inspection revealed that Rembrandt's hair grayed earlier than Naile Hanim in the same age group. Rembrandt had more wrinkles than Naile Hanim in the same age group. Rembrandt had many more wrinkles on his upper face than her. Naile Hanim had more prominent nasolabial folds and Marionette lines than Rembrandt in his 40s.

Conclusion

The analysis is consistent with the male and female aging process. The aging process of men and women is different, it is possible to analyze facial aging in portraits, the data of this study can be used in medical education and artworks should be more involved in medical education.

Introduction

After the description of a Chimú zoomorphic vase, a south-American wolf affected with seven cutaneous lesions, we discuss deductions that can be made in French language about the mechanism of vocabulary etymology.

Objectives

The common cutaneous animal pathology observed on this pre-Columbian pottery triggered the etymologic observation of French semantic shifts resulting from the French name of this animal, “loup.” In any language, these linguistic phenomena leading to the general concept of “modifying tropes” and “signifying chain,” deserve our attention for they can be compared with analog shifts that happen in an individual human Unconscious. The overall scope of this review is to lay the stress on the key linkage between symbolism and language in every respect (here subsequently, through an artefact: arts and crafts, myths, and rites) and the patterns of the Freudian Unconscious.

Material, methods and resulting data

This Chimú ceramic vase represents a she-wolf with seven cutaneous pseudo tumoral bump-looking lesions, (histologically: trichilemmal cysts). In French, the popular name of these, “loupe,” derived from the name of the classically affected animal, and was kept in French medical terminology. This work is shaped in three different parts. First a so called “realistic” one, where the Chimú pottery is scrutinized as an object (history, technique, species, function, cutaneous lesions). A “linguistic” approach related to the semantic shifts (metonymy, metaphor, signifying chain) in French language, and their heuristic power as examples. The last chapter ventures into the psychoanalytic practice inasmuch as it stems from a theory of language in relation to the Unconscious, first borrowing from Freud, and then from Saussure, Levi-Strauss, Lacan.

Conclusion

A modern approach of brain functioning by the medium of linguistics and structuralism is under strain, as evidence-based medicine and behavioral approaches nowadays claim a greater relevance. Very long-term dynamic human observations cannot be obtained with instant medical imagery. Language is one of the fields, which can supply this dynamic material. Although this purpose seems guilty reductive, we believe that a short review of the scientific sources of Freudian theory is worth being reminded from time to time… Freud, first thrilled by bio-anatomical description, intuitively suggested a parallel with the ability of reconstructing psychological contexts from the use of artistic artefacts, thanks to the words establishing a link between image and meaning. Further studies from numerous followers interested in art confirmed this reality.

Background

Little academic research has been done on palliative care for dogs and cats in France. However, palliative care (PC) is often practiced in veterinary hospitals without naming it precisely, providing great opportunities for the management of pets’ life-threatening diseases.

Method

In order to assess how pet end-of-life support is performed and PC could alleviate associated ethical dilemmas, we performed a qualitative study by interviewing two human PC professionals and nine veterinarians who often deal with pet end-of-life. After these interviews, we also made a comparison with existing literature, which mainly consists on experience sharing.

Results

Globally, the interviewed veterinarians define palliative care for dogs and cats as the support of a dog or a cat with a life-threatening disease intended to treat clinical symptoms, pain and suffering without curing the patient, giving its quality of life a high priority. It can be done at any stage of the disease. Support should also be provided to the pet's owners, always with emphasis on the quality of life of the animal. All veterinary interviewees, as opposed to human medicine professionals, overlooked the support to the veterinary team included in a structured PC approach. Such a platform should include both in clinics and ambulatory care in order for the severely ill pet to stay as much as possible in a familiar environment. This also requires render to owner competent in pet nursing.

Conclusion

This preliminary work tends to show the relevance of the ethics of care approach structured PC would provide to pets. Support from professionals such as veterinary nurses is mandatory.

Many physicians are familiar with patients who leave against medical advice, much less known is the refusal to leave the hospital. Here we report a case, that we encountered during the Covid pandemic, of a patient who was convinced of having Cauda-Equina syndrome and refused to leave the hospital until the MRI was done. Taking inspiration from this case, we decided to offer a practical approach to dealing with situations like these, to avoid discharge to the street and discuss the ethical implications of similar situations, like the one we encountered. Proactive psychiatric consultation services were demonstrated to reduce the length of stay. Based on these considerations we also suggest early psychiatric consultation to assist medical teams in identifying possible barriers to discharge and help with the management of these difficult cases. Hospitals should also develop internal protocols to deal with difficult discharges. Well-defined protocols could help to deal with emotional states such as bursts of outrage and allegations of abandonment by the patients, like the ones we recently encountered. Nonetheless, we believe a shared discharge decision between patients and physicians should be the common goal. This problem is often encountered in clinical practice but literature on the matter is scarce, since staying against medical advice (SAMA) is far less common than its sibling: leaving against medical advice (LAMA).

Background

This study aims to investigate the knowledge and attitudes of the general population toward medico-legal autopsy.

Methodology

It was a questionnaire based cross-sectional study performed among 422 heads of families in the city of Bouake, Cote d’Ivoire. A standard pretested questionnaire was used to collect the responses on knowledge and perception of the people about medico legal autopsy, over a period of 45 days (running from April 1st 2021 to May 15th 2021). Data analysis was performed with the IBM Statistical Package for Social Sciences (SPSS, version 24). We used counts, percentages, means, and comparative analyses.

Results

The respondents’ average age was 37 years old. The majority of the respondents (74%) were male with a higher level of education (58.53%), and they worked in the informal sector (52.13%). A ratio was calculated for the assessment of autopsy knowledge data. The average ratio was 1.90 of a total of 6, representing 75.05% of the participants. The opponents to the autopsy advocated based on some religious considerations (52%) and (46%) personal reasons. A significant portion of the participants (50 of 126) approved the performance of a medico-legal investigation on a relative but not on themselves. For these participants, consenting to an autopsy on oneself for life insurance was easier than for the needs of a judicial investigation (OR: 0.41; 95% CI: 0.29–0.58). However, 66.49% of our respondents approved the performance of an autopsy on themselves and 78.45% on a relative.

Conclusions

The Bouake populations approve the performance of an autopsy, although they lack knowledge on the basic elements of a medico-legal autopsy. These populations raised some issues that infringe on the judicial investigation process and may lead to misunderstandings.

Background

Ecobiology is an ecosystemic approach to skincare created by Jean-Noël Thorel, the founder of an international skin care company. While it was groundbreaking at the time of its creation, both the company and the society in which it operates have changed. Thus, we questioned whether the term is still comprehensible and if its meaning pertains to contemporary society.

Methodology

Two semi-structured surveys targeting worldwide general public and the employees of an international company specialized in ecobiological skin care; a 2 two-hour advisory board with dermatologists from 11 countries; and 7 phone interviews with French dermatologists were conducted in order to determine the perception of the term “ecobiology,” its meaning, and its significance.

Results

The results show that there is confusion over the term, which has various meanings depending on cultural context. Nevertheless, our results indicate that it is a profound concept that is felt, rather than understood as the connection between human and the natural world that surrounds us.

Conclusion

The term remains a forward-looking concept that is more important than ever due to the current concern about the effects of nearly half a century of expanding consumerism. Our research indicates that underneath our cultural model of production based on the exploitation of nature, the human connection with the natural world remains deeply entrenched in our collective unconscious.

Introduction

Compassionate use of drugs is becoming increasingly popular among terminally ill patients who require palliative care and have exhausted all treatment options, with no satisfactory authorized therapies.

Objectives

This scoping review aimed to systematically map the literature on the compassionate use of drugs: (1) for symptom control in palliative care and (2) the ethical justification for its use.

Methods

PubMed, EMBASE and Cochrane databases were searched. Eligibility criteria: any participant with palliative needs, any control, and any study design was accepted. Interventions: any drug used for compassionate reasons. Outcomes: symptom control and ethical-related issues. Filters: articles written in English and published between 2012–2022. Critical appraisal of sources of evidence was made.

Results

Five moderate/high-quality studies were included: one clinical trial, one case series, two case reports/studies, and one expert opinion. Patients were 28, mostly with cancer. Three studies showed symptom control, namely pain. Ethical justifications for compassionate use of drugs were sustained by autonomy, beneficence, and justice. Barriers to compassionate use of drugs were inequitable access, inattentive risk/benefit assessment, and doubtful validity of informed consent.

Conclusions

Although there is some evidence that compassionate use of drugs may help symptom management in palliative care, additional research is necessary to verify its effectiveness.