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Pharmacological Prophylaxes against Moral Injury. 预防道德伤害的药物疗法。
IF 1.6 Q1 Arts and Humanities Pub Date : 2023-06-01 DOI: 10.1007/s40592-022-00167-3
Ned Dobos
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引用次数: 1
Human enhancement drugs and Armed Forces: an overview of some key ethical considerations of creating 'Super-Soldiers'. 人类增强药物和武装力量:创造“超级士兵”的一些关键道德考虑的概述。
IF 1.6 Q1 Arts and Humanities Pub Date : 2023-06-01 DOI: 10.1007/s40592-022-00170-8
Adrian Walsh, Katinka Van de Ven

There is a long history and growing evidence base that the use of drugs, such as anabolic-androgenic steroids, to enhance human performance is common amongst armed forces, including in Australia. We should not be surprised that this might have occurred for it has long been predicted by observers. It is a commonplace of many recent discussion of the future of warfare and future military technology to proclaim the imminent arrival of Super Soldiers, whose capacities are modified via drugs, digital technology and genetic engineering, in ways that increase their performance exponentially. This is what some observers have referred to as the "Gladiator Model" wherein the aim is to create soldiers able to perform feats of which ordinary citizens are not capable. One key aspect of this "gladiator project" is the use of illicit drugs to enhance performance. Could we use drugs, such as steroids or amphetamines, to enhance performance? Should we use such drugs? In this paper we explore the ethics of creating Super Soldiers, and raise issues of consent, coercion and the extent to which such use is permitted or condemned by just war theory. We conclude that much will depend on the extent to which such use is harmful to the soldiers themselves and this is still an open question.

有悠久的历史和越来越多的证据表明,在包括澳大利亚在内的武装部队中,使用合成代谢-雄激素类固醇等药物来提高人类表现是很常见的。我们不应该对这种情况的发生感到惊讶,因为观察家们早就预测到了这一点。在最近关于未来战争和未来军事技术的讨论中,宣称超级士兵即将到来是司空见惯的事情,他们的能力通过药物、数字技术和基因工程来改变,以指数方式提高他们的性能。这就是一些观察家所说的“角斗士模型”,其目的是创造能够执行普通公民无法完成的壮举的士兵。这个“角斗士计划”的一个关键方面是使用非法药物来提高成绩。我们是否可以使用类固醇或安非他明等药物来提高表现?我们应该使用这些药物吗?在本文中,我们探讨了创造超级士兵的伦理,并提出了同意、强制以及正义战争理论允许或谴责这种使用的程度等问题。我们的结论是,这在很大程度上取决于这种使用对士兵本身有害的程度,这仍然是一个悬而未决的问题。
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引用次数: 2
When Enhancements need Therapy: disenhancements, Iatrogenesis, and the responsibility of Military Institutions. 当增强需要治疗:去增强,医源性,和军事机构的责任。
IF 1.6 Q1 Arts and Humanities Pub Date : 2023-06-01 DOI: 10.1007/s40592-022-00169-1
Adam Henschke
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引用次数: 1
Transparency or restricting gifts? Polish medical students' opinions about regulating relationships with pharmaceutical sales representatives. 透明还是限制赠与?波兰医学生对规范与药品销售代表关系的看法。
IF 1.6 Q1 Arts and Humanities Pub Date : 2022-12-01 DOI: 10.1007/s40592-021-00128-2
Marta Makowska, Emilia Kaczmarek, Marcin Rodzinka

Relationships between physicians and pharmaceutical sales representatives (PSRs) often create conflicts of interest, not least because of the various benefits received by physicians. Many countries attempt to control pharmaceutical industry marketing strategies through legal regulation, and this is true in Poland where efforts are underway to eliminate any practices that might be considered corrupt in medicine. The present research considered Polish medical students' opinions about domestic laws restricting doctors' acceptance of expensive gifts from the industry, the idea of compulsory transparency, and the possibility of introducing a Polish Sunshine Law. A qualitative, focus group-based, interview method was used. Data were gathered from nine focus groups involving 92 medical students from three universities located in major Polish cities. The article presents a classification of opposing student views with regard to the consequences of introducing different legal solutions; this should be useful for policy makers deliberating on how to optimally regulate pharmaceutical marketing. The study's results are discussed in the context of the public bioethical debate in Poland.

医生和药品销售代表(psr)之间的关系经常产生利益冲突,尤其是因为医生获得了各种各样的利益。许多国家试图通过法律监管来控制制药行业的营销策略,波兰就是这样,该国正在努力消除任何可能被视为医药腐败的做法。本研究考虑了波兰医学生对限制医生接受行业昂贵礼物的国内法、强制性透明度的想法以及引入波兰阳光法的可能性的看法。采用定性的、焦点小组为基础的访谈方法。数据收集自9个焦点小组,涉及来自波兰主要城市三所大学的92名医科学生。文章介绍了关于引入不同法律解决方案的后果的对立学生观点的分类;这对决策者在考虑如何以最佳方式监管药品营销应该是有用的。该研究的结果在波兰公共生物伦理辩论的背景下进行了讨论。
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引用次数: 2
A review of "Caregiving, Carebots, and Contagion". “护理、护理机器人和传染病”综述。
IF 1.6 Q1 Arts and Humanities Pub Date : 2022-12-01 Epub Date: 2022-08-06 DOI: 10.1007/s40592-022-00162-8
Wayne Shelton

How far can smart machines, or carebots, go in performing the profoundly intimate human work of patient caregivers? How will mechanization alter how we understand the essential features of the human task of caregiving and the role of the caregiver? It is these complex questions, with real world implications, that this article discusses in reviewing "Caregiving, Carebots, and Contagion" by philosopher and bioethicist Michael Brannagan.

智能机器或护理机器人能在多大程度上完成病人护理人员的亲密工作?机械化将如何改变我们对人类照料任务的基本特征和照料者角色的理解?这篇文章在回顾哲学家和生物伦理学家Michael Brannagan的《看护、看护机器人和传染病》时,讨论的正是这些具有现实世界含义的复杂问题。
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引用次数: 1
Co-editors of the special issue "East European post-communist legacy in medicine, health care, and bioethics". 《东欧后共产主义医学、医疗保健和生物伦理学遗产》特刊的联合编辑。
IF 1.6 Q1 Arts and Humanities Pub Date : 2022-12-01 DOI: 10.1007/s40592-022-00173-5
Ana S Iltis, Nataliya Shok
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引用次数: 0
Bulgaria at the onset of clinical ethics consultation. 保加利亚开始进行临床伦理咨询。
IF 1.6 Q1 Arts and Humanities Pub Date : 2022-12-01 DOI: 10.1007/s40592-022-00158-4
Silviya Aleksandrova-Yankulovska

Background: Over the years, Bulgarian bioethics has been mainly an academic enterprise and fallen short of providing health professionals with skills for ethical decision-making. Clinical ethics support (CES) was piloted by the author through two bottom-up models - METAP (Modular, Ethical, Treatment, Allocation of resources, Process) and MCD (Moral Case Deliberation).

Aims: This paper aims to present and analyse developments in the area of clinical ethics and the first experiences in CES in Bulgaria.

Methodology: The project reported here included a review of relevant literature on CES methods and evaluation and a documentary review of data from two CES pilot projects: METAP and MCD.

Results: Most of the 69 METAP ethics meetings reviewed were first time meetings (88,4%); the average duration was 36 min and the average number of participants was four (44,9%). The meetings were organized in response to cases of severely or critically ill patients. The ethical dilemmas included choice of treatment (31,9%) and conflicts with the patient or their relatives (23,2%). Consensus was achieved in 34,8% of the cases. The situation was clarified with the patient (27,5%) and within the team (15,9%). The rights and obligations of both sides were discussed in 7,2% of the cases. The experience of the members of the Bulgarian Association of Bioethics and Clinical Ethics (BABCE) with MCD was also presented to justify the inference about the applicability of the two CES models in a Bulgarian context.

Conclusion: Among Eastern European countries Bulgaria has made progress in CES. Both METAP and MCD have been found to be useful methods.

背景:多年来,保加利亚生物伦理学主要是一项学术事业,未能为卫生专业人员提供伦理决策的技能。临床伦理支持(CES)由作者通过METAP(模块化、伦理、治疗、资源分配、过程)和MCD(道德案例审议)两个自下而上的模型进行试点。目的:本文旨在介绍和分析临床伦理学领域的发展和保加利亚CES的第一次经验。方法:这里报告的项目包括对CES方法和评价的相关文献的审查,以及对两个CES试点项目METAP和MCD的数据的文献审查。结果:69次METAP伦理会议中,绝大多数为首次会议(88.4%);平均持续时间为36分钟,平均参与者人数为4人(44.9%)。这些会议是针对重症或危重病人的病例而组织的。伦理困境包括治疗选择(31.9%)和与患者或其亲属的冲突(23.2%)。34.8%的病例达成共识。患者(27.5%)和团队(15.9%)明确了这一情况。在7.2%的案例中讨论了双方的权利和义务。还介绍了保加利亚生物伦理学和临床伦理学协会(BABCE)成员在MCD方面的经验,以证明两种CES模型在保加利亚情况下适用性的推断是合理的。结论:在东欧国家中,保加利亚在消费电子学方面取得了进步。METAP和MCD都是有用的方法。
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引用次数: 0
Assessment of studies based on the use of questionnaires in the time of Covid-19 pandemic. Covid-19大流行期间基于问卷调查的研究评估。
IF 1.6 Q1 Arts and Humanities Pub Date : 2022-12-01 Epub Date: 2021-09-12 DOI: 10.1007/s40592-021-00136-2
Corinna Porteri

During the covid-19 pandemic a huge number of research projects have been promoted internationally, nationally and locally. This also happened in Italy which was the first affected European country. Among these studies, research protocols based on the use of online questionnaires to evaluate the reaction of health workers and researchers to the emergency situation and their state of well-being were promoted. This contribution focuses on research protocols based on the use of online questionnaires and presents as a case study three different research proposals with the purpose of showing their different degree of compliance to scientific and ethical requirements and the need for a clear regulation. A guideline for the assessment of studies based on questionnaires is then suggested, in the absence of a national regulation on the issue. Having established rules, albeit flexible, can help to guarantee transparency in the evaluation process and contribute to the scientific and ethical compliance of the research.

在2019冠状病毒病大流行期间,国际、国家和地方推动了大量研究项目。这也发生在意大利,这是第一个受影响的欧洲国家。在这些研究中,推广了基于使用在线问卷来评估卫生工作者和研究人员对紧急情况的反应及其福祉状况的研究方案。本贡献侧重于基于使用在线问卷的研究方案,并作为案例研究提出了三种不同的研究建议,目的是显示它们对科学和伦理要求的不同程度的遵守以及对明确监管的需求。在没有关于这个问题的国家条例的情况下,然后提出了一项评价基于调查表的研究的准则。建立规则,尽管是灵活的,可以帮助保证评估过程的透明度,并有助于研究的科学和道德合规。
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引用次数: 1
Intervention hesitancy among healthcare personnel: conceptualizing beyond vaccine hesitancy. 卫生保健人员干预犹豫:概念化超出疫苗犹豫
IF 1.6 Q1 Arts and Humanities Pub Date : 2022-12-01 Epub Date: 2022-03-20 DOI: 10.1007/s40592-022-00152-w
Rachel Gur-Arie, Nadav Davidovitch, Anat Rosenthal

We propose an emerging conceptualization of "intervention hesitancy" to address a broad spectrum of hesitancy to disease prevention interventions among healthcare personnel (HCP) beyond vaccine hesitancy. To demonstrate this concept and its analytical benefits, we used a qualitative case-study methodology, identifying a "spectrum" of disease prevention interventions based on (1) the intervention's effectiveness, (2) how the intervention is regulated among HCP in the Israeli healthcare system, and (3) uptake among HCP in the Israeli healthcare system. Our cases ultimately contribute to a more nuanced conceptualization of hesitancy that HCP express towards disease prevention interventions. Our case interventions included the seasonal influenza vaccine, the Mantoux test, and the hepatitis B (HBV) vaccine. Influenza and HBV are vaccine-preventable diseases, though their respective vaccines vary significantly in effectiveness and uptake among HCP. The Mantoux test is a tuberculin skin test which provides a prevention benchmark for tuberculosis (TB), a non-vaccine preventable disease. We conducted semi-structured interviews with relevant stakeholders and analyzed them within Israeli and international policy context between 2016 and 2019, a period just prior to the COVID-19 pandemic. We propose the conceptualization of "intervention hesitancy"-beyond "vaccine hesitancy"-as "hesitancy towards a wide range of public health interventions, including but not limited to vaccines". Results suggested that intervention hesitancy among HCP is rooted in weak trust in their employer, poor employment conditions, as well as mixed institutional guidelines and culture. Conceptualizing intervention hesitancy expands the ability of healthcare systems to understand the root of hesitancy and foster a supportive institutional culture and trust, cognizant of diverse disease prevention interventions beyond vaccination.

我们提出了一个新兴的 "干预犹豫 "概念,以解决医疗保健人员(HCP)在疫苗犹豫之外对疾病预防干预措施的广泛犹豫。为了证明这一概念及其分析优势,我们采用了定性案例研究方法,根据以下几点确定了疾病预防干预措施的 "范围":(1)干预措施的有效性;(2)以色列医疗保健系统中如何规范医护人员的干预措施;以及(3)以色列医疗保健系统中医护人员对干预措施的接受程度。我们的案例最终有助于从更细微的概念上理解卫生保健人员对疾病预防干预措施的犹豫不决。我们的案例干预措施包括季节性流感疫苗、曼图氏试验和乙型肝炎 (HBV) 疫苗。流感和乙型肝炎 (HBV) 是可通过疫苗预防的疾病,但这两种疫苗的效果和在卫生保健人员中的使用率差别很大。Mantoux 试验是一种结核菌素皮肤试验,为结核病(TB)这种非疫苗可预防疾病提供了预防基准。我们对相关利益攸关方进行了半结构化访谈,并在 2016 年至 2019 年期间,即 COVID-19 大流行之前的以色列和国际政策背景下对访谈内容进行了分析。我们提出了 "干预犹豫 "的概念--除 "疫苗犹豫 "外,还包括 "对包括但不限于疫苗在内的各种公共卫生干预措施的犹豫"。研究结果表明,卫生保健人员对干预措施犹豫不决的根源在于对雇主的信任度低、就业条件差以及机构准则和文化参差不齐。将干预犹豫概念化可提高医疗保健系统的能力,使其了解犹豫的根源,培养支持性的机构文化和信任,认识到除疫苗接种以外的各种疾病预防干预措施。
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引用次数: 0
Dignity at the end of life: from philosophy to health care practice - Lithuanian case. 生命终结时的尊严:从哲学到保健实践——立陶宛案例。
IF 1.6 Q1 Arts and Humanities Pub Date : 2022-12-01 DOI: 10.1007/s40592-022-00160-w
Žydrūnė Luneckaitė, Olga Riklikienė

Regulation and clinical practices regarding end of human life care differ among the nations and countries. These differences reflect the history of the development of state health systems, different societal values, and different understandings of dignity and what it means to protect or respect dignity. The result is variation in the ethical, legal, and practical approaches to end-of-life issues. The article analyzes the diversity of strategies to strengthen dignity at the end of life of terminally ill patients and to highlight the legal preconditions and limitations for implementing these strategies in independent Lithuania, as a former state of the Soviet Union. It is based on the critical analysis of philosophical literature, legal national and international documents and scientific evidence related to the issue. The author argues that the legal system in Lithuania is not sufficient to ensure the patient's dignity at the end of life and remains far behind other Western European countries. Legal regulations in Lithuania do not guarantee the right of the patient to express his or her will regarding the future treatment, including the refusal of resuscitation, do not regulate the termination of burdensome, non-viable and meaningless treatment that is undesired by the patient, and limit the accessibility of palliative care with its necessary quality and comfort.

关于人类生命终结护理的法规和临床实践在不同的国家和地区有所不同。这些差异反映了国家卫生系统发展的历史、不同的社会价值观以及对尊严的不同理解以及保护或尊重尊严的含义。其结果是在伦理、法律和实际处理临终问题的方法上发生了变化。本文分析了加强绝症患者生命结束时尊严的战略的多样性,并强调了在独立的立陶宛实施这些战略的法律前提和限制,作为前苏联的一个国家。它基于对哲学文献、国内和国际法律文件以及与该问题相关的科学证据的批判性分析。提交人认为,立陶宛的法律制度不足以确保病人在生命结束时的尊严,远远落后于其他西欧国家。立陶宛的法律法规不保障患者表达其对未来治疗的意愿的权利,包括拒绝复苏,也不规范终止患者不希望的负担,不可行和无意义的治疗,并且限制了姑息治疗的必要质量和舒适性。
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引用次数: 0
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Monash Bioethics Review
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