1,190 results on '"Health Services Accessibility ethics"'
Search Results
2. Moving Beyond Statements to Protect Transgender Youth.
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Santos M, Zempsky WT, and Shmerling J
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- Adolescent, Female, Humans, Male, United States, Politics, Health Personnel education, Health Personnel legislation & jurisprudence, Safety legislation & jurisprudence, Safety standards, Transgender Persons, Gender-Affirming Care ethics, Gender-Affirming Care standards, Health Services Accessibility ethics, Health Services Accessibility legislation & jurisprudence, Health Services Accessibility standards, Health Education ethics, Health Education standards, Hospitals, Pediatric ethics, Hospitals, Pediatric legislation & jurisprudence, Hospitals, Pediatric standards
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- 2024
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3. Emphasizing Future Personhood: Implications for Access to Abortion and in Vitro Fertilization.
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Bayefsky MJ
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- Humans, Female, Pregnancy, United States, Abortion, Legal ethics, Abortion, Induced ethics, Beginning of Human Life ethics, Personhood, Fertilization in Vitro ethics, Health Services Accessibility ethics
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- 2024
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4. What Should Clinicians in Organizations Without Established MLP Programs Do When Their Patients Need Lawyers to Meet Their Health Needs?
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Mohottige D, Adler KA, Charney A, and Cervantes L
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- Humans, United States, Undocumented Immigrants, Insurance Coverage, Health Services Needs and Demand, Physicians ethics, Health Services Accessibility ethics, Lawyers
- Abstract
Undocumented people in the United States face innumerable legal and structural barriers to health and health care services, including for kidney failure. Their experiences vary across states and regions due to wide variation in insurance coverage and unreliable access to health-promoting resources, including medical-legal partnerships. This commentary on a case canvasses key policy about structural and legal determinants of health for undocumented persons., (Copyright 2024 American Medical Association. All Rights Reserved.)
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- 2024
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5. Dermatologic barriers to deployment: Ethical considerations when treating military service members.
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Donohue KN and Grant-Kels JM
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- Humans, Skin Diseases therapy, United States, Military Medicine ethics, Health Services Accessibility ethics, Military Personnel, Dermatology ethics
- Abstract
Competing Interests: Conflicts of interest None disclosed.
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- 2024
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6. The Ethics of Relational AI - Expanding and Implementing the Belmont Principles.
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Sim I and Cassel C
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- Humans, United States, Beneficence, Respect, Social Justice, Physician-Patient Relations ethics, Public-Private Sector Partnerships ethics, Public-Private Sector Partnerships legislation & jurisprudence, Public-Private Sector Partnerships organization & administration, Public-Private Sector Partnerships standards, United States Dept. of Health and Human Services ethics, United States Dept. of Health and Human Services legislation & jurisprudence, United States Dept. of Health and Human Services standards, Health Services Accessibility ethics, Health Services Accessibility standards, Artificial Intelligence ethics, Artificial Intelligence standards, Ethics, Medical, Patient Care ethics, Patient Care standards, Medical Errors ethics, Medical Errors prevention & control, Quality of Health Care ethics, Quality of Health Care standards, Delivery of Health Care ethics, Delivery of Health Care standards
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- 2024
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7. The Integration of Clinical Trials With the Practice of Medicine: Repairing a House Divided.
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Angus DC, Huang AJ, Lewis RJ, Abernethy AP, Califf RM, Landray M, Kass N, and Bibbins-Domingo K
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- Humans, Health Services Accessibility ethics, Health Services Accessibility standards, United States, Communication, Delivery of Health Care ethics, Delivery of Health Care standards, Randomized Controlled Trials as Topic legislation & jurisprudence, Randomized Controlled Trials as Topic standards, Patient Care ethics, Patient Care standards, Diffusion of Innovation
- Abstract
Importance: Optimal health care delivery, both now and in the future, requires a continuous loop of knowledge generation, dissemination, and uptake on how best to provide care, not just determining what interventions work but also how best to ensure they are provided to those who need them. The randomized clinical trial (RCT) is the most rigorous instrument to determine what works in health care. However, major issues with both the clinical trials enterprise and the lack of integration of clinical trials with health care delivery compromise medicine's ability to best serve society., Observations: In most resource-rich countries, the clinical trials and health care delivery enterprises function as separate entities, with siloed goals, infrastructure, and incentives. Consequently, RCTs are often poorly relevant and responsive to the needs of patients and those responsible for care delivery. At the same time, health care delivery systems are often disengaged from clinical trials and fail to rapidly incorporate knowledge generated from RCTs into practice. Though longstanding, these issues are more pressing given the lessons learned from the COVID-19 pandemic, heightened awareness of the disproportionate impact of poor access to optimal care on vulnerable populations, and the unprecedented opportunity for improvement offered by the digital revolution in health care. Four major areas must be improved. First, especially in the US, greater clarity is required to ensure appropriate regulation and oversight of implementation science, quality improvement, embedded clinical trials, and learning health systems. Second, greater adoption is required of study designs that improve statistical and logistical efficiency and lower the burden on participants and clinicians, allowing trials to be smarter, safer, and faster. Third, RCTs could be considerably more responsive and efficient if they were better integrated with electronic health records. However, this advance first requires greater adoption of standards and processes designed to ensure health data are adequately reliable and accurate and capable of being transferred responsibly and efficiently across platforms and organizations. Fourth, tackling the problems described above requires alignment of stakeholders in the clinical trials and health care delivery enterprises through financial and nonfinancial incentives, which could be enabled by new legislation. Solutions exist for each of these problems, and there are examples of success for each, but there is a failure to implement at adequate scale., Conclusions and Relevance: The gulf between current care and that which could be delivered has arguably never been wider. A key contributor is that the 2 limbs of knowledge generation and implementation-the clinical trials and health care delivery enterprises-operate as a house divided. Better integration of these 2 worlds is key to accelerated improvement in health care delivery.
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- 2024
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8. Seeking a voice: the inadequacy of the "four principles" and the need for care ethics in the provision of health care to vulnerable populations.
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Barns KJ and Peachey Girrimay/Djirribal L
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- Humans, Australia, Delivery of Health Care ethics, Health Services Accessibility ethics, Vulnerable Populations
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- 2024
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9. When Equality Is Not Equity: The Ethics of Access to Trauma Care: A Surgical Perspective.
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Strong BL, Cosey-Gay F, Wilson KL, and Rogers SO Jr
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- Humans, Chicago, Wounds and Injuries surgery, Wounds and Injuries therapy, Violence, Healthcare Disparities, Trauma Centers, Health Services Accessibility ethics
- Abstract
Objective: The purpose of this surgical perspective is to describe the trauma care needs of the South Side of Chicago and the creation of an adult trauma center at the University of Chicago Medicine and associated hospital-based violence intervention program., Background: Traumatic injury is a leading cause of death and disability in the United States. Disparities across the continuum of trauma care exist, which are often rooted in the social determinants of health. Trauma center distribution is critical to timely treatment and should be based on the trauma needs of the area. The previous trauma ecosystem of Chicago was incongruent with the concentration of violent injuries on the south and west sides of the city, leading to a fallacy of distributive justice., Methods: A descriptive analysis of community partners, trauma program leadership, trauma surgeons, and the violence intervention program director was performed., Results: The UCM trauma center opened in May 2018 and has since been one of the busiest trauma centers in the country, with a 40% penetrating trauma rate. There have been significant reductions in patient transport time on the South Side up to 8.9 minutes ( P <0.001). The violence intervention program employs credible messengers with lived experience representing the community and has engaged over 8000 patients since 2018, developing both community-based and medical-legal partnerships., Conclusions: The persistent efforts of the community and key stakeholders led to a system change that improved trauma care for the South Side of Chicago., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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10. Emergency Physicians' Ethical Issues with Hospital Business Models.
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Iserson KV, Paxton JH, Martin DR, and Marcolini E
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- Humans, Emergency Medicine ethics, Physicians ethics, Conflict of Interest, Health Services Accessibility ethics, Models, Organizational, Emergency Service, Hospital ethics, Emergency Service, Hospital organization & administration, Emergency Service, Hospital economics
- Abstract
Background: The changing hospital business model has raised ethical issues for emergency physicians (EPs) in a healthcare system that often prioritizes profits over patient welfare. For-profit hospitals, driven by profit motives, may prioritize treating patients with lucrative insurance plans and those who can afford expensive treatments. Private equity investors, who now own many for-profit hospitals, focus on short-term financial gains, leading to cost-cutting measures and pressure on EPs to prioritize financial goals over patient welfare. Nonprofit hospitals, mandated to provide charity care to the underserved, may fail to meet their community service obligations, resulting in disparities in healthcare access., Objective: This review examines the ethical challenges faced by emergency physicians (EPs) in response to the evolving hospital business model, which increasingly prioritizes profits over patient welfare., Discussion: Emergency physicians face ethical dilemmas in this changing environment, including conflicts between patient care and financial interests. Upholding professional ethics and the principle of beneficence is essential. Another challenge is equitable access to healthcare, with some nonprofit hospitals reducing charity care, thus exacerbating disparities. EPs must uphold the ethical principle of justice, ensuring quality care for all patients, regardless of financial means. Conflicts of interest may arise when EPs work in hospitals owned by private equity firms or with affiliations with pharmaceutical companies or medical device manufacturers, potentially compromising patient care., Conclusion: Emergency physicians must navigate these ethical issues while upholding professional ethics and advocating for patients' best interests. Collaboration with hospital administrators, policymakers, and stakeholders is vital to address these concerns and prioritize patient welfare in healthcare delivery., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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11. Transplantation in the Context of Migration and Refugees: A Summary of the DICG and TTS Ethics Committee Workshop, Buenos Aires, Argentina, September 2022.
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Stock PG, Nagral S, Rondeau E, Gawronska S, Groverman J, Barbari A, Coates PT, Domínguez-Gil B, Fadhil R, Malyszko J, and Niño Murcia A
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- Humans, Tissue and Organ Procurement organization & administration, Tissue and Organ Procurement ethics, Tissue and Organ Procurement legislation & jurisprudence, Emigration and Immigration legislation & jurisprudence, Argentina, Transients and Migrants, Vulnerable Populations, Refugees legislation & jurisprudence, Health Services Accessibility ethics, Health Services Accessibility organization & administration, Organ Transplantation legislation & jurisprudence, Organ Transplantation ethics
- Abstract
Global conflicts and humanitarian crises have resulted in an unprecedented number of refugees and migrants. This challenges the limited resources of health care systems and jeopardizes the availability of transplant care for these deserving migrants and refugees. This was the basis for a workshop held during the Congress of the Transplantation Society (Buenos Aires, 2022). We elaborate on the proceedings of the workshop entitled "Transplantation in the Context of Migration and Refugees," organized by the Ethics Committee of The Transplantation Society and Declaration of Istanbul Custodian Group. Transplant providers from around the world shared strategies of how each region has responded to providing access to care for refugees and migrants in need of transplant services. The potential exploitation of this vulnerable group leading to illicit organ removal was addressed for each region. The Transplantation Society, Declaration of Istanbul Custodian Group, and global transplant community should continue to focus on the status of refugees and migrants and collaborate on strategies to provide access to transplant care for this deserving population. Global cooperation will be essential to provide vigilant oversight to prevent exploitation of this vulnerable population., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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12. No (true) right to die: barriers in access to physician-assisted death in case of psychiatric disease, advanced dementia or multiple geriatric syndromes in the Netherlands.
- Author
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van den Ende C and Asscher ECA
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- Humans, Netherlands, Right to Die ethics, Right to Die legislation & jurisprudence, Health Services Accessibility ethics, Suicide, Assisted ethics, Suicide, Assisted legislation & jurisprudence, Dementia, Mental Disorders therapy
- Abstract
Even in the Netherlands, where the practice of physician-assisted death (PAD) has been legalized for over 20 years, there is no such thing as a 'right to die'. Especially patients with extraordinary requests, such as a wish for PAD based on psychiatric suffering, advanced dementia, or (a limited number of) multiple geriatric syndromes, encounter barriers in access to PAD. In this paper, we discuss whether these barriers can be justified in the context of the Dutch situation where PAD is legally permitted for those who suffer unbearably and hopelessly as a result of medical conditions. Furthermore, we explore whether there are options to address some of the barriers or their consequences, both within the Dutch legal framework or by adjusting the legal framework, and whether these options are feasible. We conclude that although there are insufficient arguments to overrule the doctor's freedom of conscience in the Netherlands, there are ways to address some of the barriers, mainly by offering support to doctors that would be willing to support a request. Moreover, we believe it is morally required to reduce or mitigate where possible the negative consequences of the barriers for patients, such as the long waiting time for those who suffer from psychiatric disorders, because it is unlikely the adjustments suggested to the system will ensure reasonable access for these patient groups., (© 2024. The Author(s).)
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- 2024
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13. Respect for bioethical principles and human rights in prisons: a systematic review on the state of the art.
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Esposito M, Szocik K, Capasso E, Chisari M, Sessa F, and Salerno M
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- Humans, Respect, Bioethical Issues, Bioethics, Health Services Accessibility ethics, Human Rights, Prisons, Prisoners
- Abstract
Background: Respect for human rights and bioethical principles in prisons is a crucial aspect of society and is proportional to the well-being of the general population. To date, these ethical principles have been lacking in prisons and prisoners are victims of abuse with strong repercussions on their physical and mental health., Methods: A systematic review was performed, through a MESH of the following words (bioethics) AND (prison), (ethics) AND (prison), (bioethics) AND (jail), (ethics) AND (jail), (bioethics) AND (penitentiary), (ethics) AND (penitentiary), (prison) AND (human rights). Inclusion and exclusion criteria were defined and after PRISMA, 17 articles were included in the systematic review., Results: Of the 17 articles, most were prevalence studies (n.5) or surveys (n.4), followed by cross-sectional studies (n.3), qualitative studies (n.1), retrospective (n.1) and an explanatory sequential mixed-methods study design (n.1). In most cases, the studies associated bioethics with prisoners' access to treatment for various pathologies such as vaccinations, tuberculosis, hepatitis, HIV, it was also found that bioethics in prisons was related to the mental health of prisoners, disability, ageing, the condition of women, the risk of suicide or with the request for end-of-life by prisoners. The results showed shortcomings in the system of maintaining bioethical principles and respect for human rights., Conclusions: Prisoners, in fact, find it difficult to access care, and have an increased risk of suicide and disability. Furthermore, they are often used as improper organ donors and have constrained autonomy that also compromises their willingness to have end-of-life treatments. In conclusion, prison staff (doctors, nurses, warders, managers) must undergo continuous refresher courses to ensure compliance with ethical principles and human rights in prisons., (© 2024. The Author(s).)
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- 2024
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14. When Stigma, Disclosure, and Access to Care Collide: An Ethical Reflection of mpox Vaccination Outreach.
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Birch L, Bindert A, Macias S, Luo E, Nwanah P, Green N, Stamps J, Crooks N, Singer RM, Johnson R, and Singer RB
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- Female, Humans, Male, Chicago, Disclosure ethics, Mpox (monkeypox) prevention & control, Health Services Accessibility ethics, Sexual and Gender Minorities psychology, Social Stigma, Vaccination ethics, Vaccination psychology, Smallpox Vaccine administration & dosage
- Abstract
Experiences of stigma in health care encounters among LGBTQ+ populations (lesbian, gay, bisexual, transgender, and queer and questioning) have long been a barrier to care. Marginalization and historically grounded fears of stigmatization have contributed to a reluctance to disclose sexual behavior and/or gender identity to health care providers. We reflect on how student nurses grappled with the ethics of patient disclosure while providing mobile outreach in Chicago for mpox (formerly monkeypox) from fall 2022 to spring 2023. Student nurses addressed how requiring disclosure of sexual behavior or sexual orientation may serve as a barrier to accessing preventive care, such as mpox vaccination. Accounts of stigma and criminalization experienced by LGBTQ+ people provide insight on challenges historically associated with disclosure in health care., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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15. Cancer prevention in people experiencing homelessness: ethical considerations and experiences from the CANCERLESS project.
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Coronado-Vázquez MDV, Gómez-Trenado R, Benito-Sánchez B, Barrio-Cortes J, Gil-Salmerón A, Amengual-Pliego M, and Grabovac I
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- Humans, Early Detection of Cancer ethics, Europe, Social Justice, Public Health ethics, Health Services Accessibility ethics, Ill-Housed Persons, Neoplasms prevention & control
- Abstract
The incidence of cancer in Europe has been increasing in recent years. Despite this, cancer prevention has remained a low priority in health policies. Cancer is one of the main causes of mortality among people experiencing homelessness, who continue to have difficulties accessing prevention programs. A strategy that has been tested to favor cancer prevention is the health navigator figure. The objective of CANCERLESS project is to implement this model among populations experiencing homelessness in four European countries to foster the prevention and early detection of cancer. In this perspective, a presentation of CANCERLESS project is made, and its ethical aspects are discussed according to the ethics of public health, the ethics of care, solidarity, relational autonomy, and the social recognition of the virtue of just generosity. The ethical foundations of CANCERLESS project are rooted in social justice and in equity in access to health systems in general and cancer screening programs in particular. The ethics of public health guided by utilitarianism are insufficient in serving the interests of the most disadvantaged groups of the population. Hence, it is necessary to resort to relational bioethics that includes the ethics of care and solidarity and that recognizes the moral identity of socially excluded persons, reaffirming their position of equality in society. Relational autonomy therefore provides a broader conception by including the influence of living conditions in decisions. For this reason, the CANCERLESS project opts for a dialogue with those affected to incorporate their preferences and values into decisions about cancer prevention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Coronado-Vázquez, Gómez-Trenado, Benito-Sánchez, Barrio-Cortes, Gil-Salmerón, Amengual-Pliego and Grabovac.)
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- 2024
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16. A Mixed-Methods Study Exploring Colombian Adolescents' Access to Sexual and Reproductive Health Services: The Need for a Relational Autonomy Approach.
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Brisson J, Ravitsky V, and Williams-Jones B
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- Humans, Adolescent, Colombia, Female, Male, Young Adult, Child, Decision Making, Parents psychology, Sexual Health, Sexual Behavior, Privacy, Reproductive Health Services ethics, Health Services Accessibility ethics, Personal Autonomy
- Abstract
This study's objective was to understand Colombian adolescents' experiences and preferences regarding access to sexual and reproductive health services (SRHS), either alone or accompanied. A mixed-method approach was used, involving a survey of 812 participants aged eleven to twenty-four years old and forty-five semi-structured interviews with participants aged fourteen to twenty-three. Previous research shows that adolescents prefer privacy when accessing SRHS and often do not want their parents involved. Such findings align with the longstanding tendency to frame the ethical principle of autonomy as based on independence in decision-making. However, the present study shows that such a conceptualization and application of autonomy does not adequately explain Colombian adolescent participants' preferences regarding access to SRHS. Participants shared a variety of preferences to access SRHS, with the majority of participants attaching great importance to having their parents involved, to varying degrees. What emerges is a more complex and non-homogenous conceptualization of autonomy that is not inherently grounded in independence from parental involvement in access to care. We thus argue that when developing policies involving adolescents, policymakers and health professionals should adopt a nuanced "relational autonomy" approach to better respect the myriad of preferences that Colombian (and other) adolescents may have regarding their access to SRHS., (© 2024. Journal of Bioethical Inquiry Pty Ltd.)
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- 2024
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17. Confronting the Medical Community's Complicity in Marginalizing Abortion Care.
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Borrero S, Talabi MB, and Dehlendorf C
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- Female, Humans, Pregnancy, Ethics, Medical, Abortion, Induced ethics, Complicity, Health Services Accessibility ethics
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- 2022
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18. Legal Risks and Ethical Dilemmas for Clinicians in the Aftermath of Dobbs.
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Reingold RB, Gostin LO, and Goodwin MB
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- Female, Humans, Pregnancy, Abortion, Legal ethics, Abortion, Legal legislation & jurisprudence, Ethics, Medical, Liability, Legal, Morals, United States, Abortion, Induced ethics, Abortion, Induced legislation & jurisprudence, Physicians ethics, Physicians legislation & jurisprudence, Supreme Court Decisions, Health Services Accessibility ethics, Health Services Accessibility legislation & jurisprudence
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- 2022
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19. Revisiting patch test data reporting: Towards equity.
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Murphy V and Cheng H
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- Dermatitis, Contact ethnology, Gender Equity ethics, Gender Equity ethnology, Health Equity ethics, Health Services Accessibility standards, Healthcare Disparities ethnology, Humans, Minority Groups, Sex Factors, Dermatitis, Contact diagnosis, Health Services Accessibility ethics, Healthcare Disparities ethics, Patch Tests, Patient Selection ethics, Research Design standards
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- 2021
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20. Balancing restrictions and access to maternity care for women and birthing partners during the COVID-19 pandemic: the psychosocial impact of suboptimal care.
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Lalor J, Ayers S, Celleja Agius J, Downe S, Gouni O, Hartmann K, Nieuwenhuijze M, Oosterman M, Turner JD, Karlsdottir SI, and Horsch A
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- COVID-19 prevention & control, Europe, Female, Humans, Infection Control, Maternal Health Services organization & administration, Parturition psychology, Pregnancy, Quality of Health Care ethics, SARS-CoV-2, Family psychology, Health Services Accessibility ethics, Maternal Health Services ethics, Patient Acceptance of Health Care psychology, Pregnant Women psychology, Women's Rights ethics
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- 2021
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21. Restricted access to assisted reproductive technology and fertility preservation: legal and ethical issues.
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Oliveira BL, Ataman LM, Rodrigues JK, Birchal TS, and Reis FM
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- Brazil, Family Planning Services economics, Family Planning Services ethics, Family Planning Services legislation & jurisprudence, Female, Healthcare Disparities ethics, Healthcare Disparities legislation & jurisprudence, Humans, Infant, Newborn, Infertility economics, Infertility epidemiology, Infertility therapy, Male, Pregnancy, Reproductive Rights ethics, Reproductive Rights legislation & jurisprudence, Fertility Preservation ethics, Fertility Preservation legislation & jurisprudence, Health Services Accessibility ethics, Health Services Accessibility legislation & jurisprudence, Reproductive Techniques, Assisted economics, Reproductive Techniques, Assisted ethics, Reproductive Techniques, Assisted legislation & jurisprudence
- Abstract
Access to assisted reproductive technology (ART) and fertility preservation remains restricted in middle and low income countries. We sought to review the status of ART and fertility preservation in Brazil, considering social indicators and legislative issues that may hinder the universal access to these services. Although the Brazilian Constitution expressly provides the right to health, and ordinary law ensures the state is obliged to support family planning, access to services related to ART and fertility preservation is neither easy nor egalitarian in Brazil. Only a handful of public hospitals provide free ART, and their capacity far from meets demand. Health insurance does not cover ART, and the cost of private care is unaffordable to most people. Brazilian law supports, but does not command, the state provision of ART and fertility preservation to guarantee the right to family planning; therefore, the availability of state-funded treatments is still scarce, reinforcing social disparities. Economic projections suggest that including ART in the Brazilian health system is affordable and may actually become profitable to the state in the long term, not to mention the ethical imperative of recognizing infertility as a disease, with no reason to be excluded from a health system that claims to be 'universal'., (Copyright © 2021 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)
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- 2021
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22. When Scarcity Meets Disparity: "Resources Allocation and COVID-19 Patients with Diabetes".
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Appel JM
- Subjects
- COVID-19 complications, COVID-19 epidemiology, Diabetes Complications economics, Diabetes Complications epidemiology, Diabetes Mellitus economics, Diabetes Mellitus epidemiology, Health Services Accessibility economics, Health Services Accessibility ethics, Health Services Accessibility standards, Health Services Accessibility statistics & numerical data, Health Status Disparities, Healthcare Disparities economics, Healthcare Disparities ethics, Healthcare Disparities organization & administration, Healthcare Disparities statistics & numerical data, Humans, Pandemics, Racism ethics, Racism statistics & numerical data, Triage economics, Triage ethics, United States epidemiology, Ventilators, Mechanical economics, Ventilators, Mechanical statistics & numerical data, Ventilators, Mechanical supply & distribution, COVID-19 therapy, Diabetes Complications therapy, Diabetes Mellitus therapy, Resource Allocation economics, Resource Allocation ethics, Resource Allocation organization & administration, Resource Allocation statistics & numerical data
- Abstract
The COVID-19 pandemic raised distinct challenges in the field of scarce resource allocation, a long-standing area of inquiry in the field of bioethics. Policymakers and states developed crisis guidelines for ventilator triage that incorporated such factors as immediate prognosis, long-term life expectancy, and current stage of life. Often these depend upon existing risk factors for severe illness, including diabetes. However, these algorithms generally failed to account for the underlying structural biases, including systematic racism and economic disparity, that rendered some patients more vulnerable to these conditions. This paper discusses this unique ethical challenge in resource allocation through the lens of care for patients with severe COVID-19 and diabetes.
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- 2021
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23. Profiteering from vaccine inequity: a crime against humanity?
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Hassan F, Yamey G, and Abbasi K
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- COVID-19 Vaccines supply & distribution, Crime, Drug Industry ethics, Health Services Accessibility economics, Health Services Accessibility ethics, Healthcare Disparities ethics, Humans, SARS-CoV-2, COVID-19 prevention & control, COVID-19 Vaccines economics, Drug Industry economics, Healthcare Disparities economics, Humanities
- Abstract
Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following. FH and GY are signatories to the People’s Vaccine Campaign. FH is founder of the Health Justice Initiative, which is a member of the People’s Vaccine Campaign. She serves on the board of Global Witness and on the strategic advisory board of Resolve to Save Lives and hosts two podcasts, Access and the Witness. She received the first dose of Pfizer vaccine through the South African government in July 2021. GY is a funding member of Amnesty International, which is one of the members of the People’s Vaccine Alliance. He was a member of the covid-19 vaccine development taskforce hosted by the World Bank, and participated as an unpaid academic adviser in the consultation process that led to the launch of Covax. He has received grant funding from WHO; Gavi, the Vaccine Alliance; and the Bill and Melinda Gates Foundation. He received the Pfizer vaccine through his employer (Duke University).
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- 2021
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24. Improving the evidence on health inequities in migrant construction workers preparing for big sporting events.
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Flouris AD, Babar Z, Ioannou LG, Onarheim KH, Phua KH, and Hargreaves S
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- COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 mortality, COVID-19 prevention & control, Data Collection methods, Health Services Accessibility ethics, Healthcare Disparities ethnology, Humans, Occupational Health trends, Occupational Injuries epidemiology, Occupational Injuries mortality, Occupational Injuries prevention & control, Risk Factors, SARS-CoV-2 genetics, SARS-CoV-2 isolation & purification, Social Welfare legislation & jurisprudence, Transients and Migrants psychology, Transients and Migrants statistics & numerical data, Vaccination standards, Vulnerable Populations ethnology, Workplace statistics & numerical data, Construction Industry statistics & numerical data, Healthcare Disparities statistics & numerical data, Occupational Health statistics & numerical data, Sports and Recreational Facilities statistics & numerical data, Transients and Migrants education
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- 2021
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25. The African American experience in reproductive medicine: provider, patient, and pipeline perspectives.
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Legro RS
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- Education, Medical, Graduate ethics, Education, Medical, Graduate history, Education, Medical, Graduate organization & administration, Education, Medical, Graduate trends, Enslavement ethics, Enslavement history, Female, Health Services Accessibility ethics, Health Services Accessibility history, History, 19th Century, History, 20th Century, History, 21st Century, Humans, Infertility ethnology, Infertility history, Infertility therapy, Male, Physician-Patient Relations ethics, Socioeconomic Factors, Black or African American ethnology, Black or African American history, Healthcare Disparities ethics, Healthcare Disparities history, Racism ethics, Racism history, Racism prevention & control, Reproductive Medicine education, Reproductive Medicine ethics, Reproductive Medicine history, Reproductive Medicine trends
- Abstract
The goal of this Views and Reviews is to let colleagues and leaders well versed in the African American experience in reproductive medicine address the problems of racism affecting our trainees and patients and, more significantly, propose solutions. The areas in reproductive medicine that will be explored from the African American perspective include the pipeline of providers, health disparities, and access to infertility treatment., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2021
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26. Should we delay covid-19 vaccination in children?
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Wilkinson D, Finlay I, Pollard AJ, Forsberg L, and Skelton A
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- COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 Vaccines therapeutic use, Child, Decision Making ethics, Health Services Accessibility ethics, Humans, Policy Making, SARS-CoV-2 genetics, United Kingdom epidemiology, COVID-19 prevention & control, COVID-19 Vaccines supply & distribution, Time-to-Treatment ethics, Vaccination legislation & jurisprudence
- Abstract
Competing Interests: Competing interests: IF is chair of the National Mental Capacity Forum, member of the Welsh Medical Ethics Advisory Group, and member of the All Party Parliamentary Group on Coronavirus inquiry. AJP is chair of the UK Department of Health and Social Care’s (DHSC) Joint Committee on Vaccination & Immunisation (JCVI) but does not participate in policy decisions on covid-19 vaccine; he is also a member of the World Health Organization’s Strategic Advisory Group of Experts on Immunisation. The views expressed in this article do not necessarily represent the views of DHSC, JCVI, or WHO. AJP is chief investigator on clinical trials of Oxford University’s covid-19 vaccine funded by the National Institute for Health Research. Oxford University has entered a joint covid-19 vaccine development partnership with AstraZeneca. Competing interests: LF and AS have read and understood BMJ policy on declaration of interests, and AS has no relevant interests to declare. LF is supported by a British Academy Postdoctoral Fellowship (award PF170028).
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- 2021
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27. Emerging topics in dementia care and services.
- Author
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Wolff JL, Benge JF, Cassel CK, Monin JK, and Reuben DB
- Subjects
- Aged, Aged, 80 and over, Female, Health Services Accessibility ethics, Healthcare Disparities ethics, Humans, Male, National Institute on Aging (U.S.), United States, Dementia, Health Services Needs and Demand ethics, Health Services Research trends, Health Services for the Aged ethics
- Abstract
Background: The National Institute on Aging (NIA), in conjunction with the Department of Health and Human Services as part of the National Alzheimer's Project Act (NAPA), convened a 2020 Dementia Care, Caregiving, and Services Research Summit Virtual Meeting Series. This review article summarizes three areas of emerging science that are likely to grow in importance given advances in measurement, technologies, and diagnostic tests that were presented at the Summit., Results: Dr. Cassel discussed novel ethical considerations that have resulted from scientific advances that have enabled early diagnosis of pre-clinical dementia. Dr. Monin then summarized issues regarding emotional experiences in persons with dementia and their caregivers and care partners, including the protective impact of positive emotion and heterogeneity of differences in emotion by dementia type and individual characteristics that affect emotional processes with disease progression. Finally, Dr. Jared Benge provided an overview of the role of technologies in buffering the impact of cognitive change on real-world functioning and their utility in safety and monitoring of function and treatment adherence, facilitating communication and transportation, and increasing access to specialists in underserved or remote areas., Conclusions: National policy initiatives, supported by strong advocacy and increased federal investments, have accelerated the pace of scientific inquiry and innovation related to dementia care and services but have raised some new concerns regarding ethics, disparities, and attending to individual needs, capabilities, and preferences., (© 2021 The American Geriatrics Society.)
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- 2021
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28. COVID-19: children on the front line.
- Author
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Puntis JW
- Subjects
- Child, Health Services Needs and Demand, Humans, SARS-CoV-2, Social Conditions, State Medicine, United Kingdom epidemiology, COVID-19 epidemiology, COVID-19 prevention & control, Child Health standards, Financial Stress, Health Services Accessibility economics, Health Services Accessibility ethics, Health Services Accessibility legislation & jurisprudence, Undocumented Immigrants psychology
- Abstract
Competing Interests: Competing interests: JWP is cochair of ‘Keep Our NHS Public’.
- Published
- 2021
- Full Text
- View/download PDF
29. Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion.
- Subjects
- Ethics Committees, Clinical, Female, Health Services Needs and Demand, Humans, Infertility economics, Infertility ethnology, Insurance Coverage, Insurance, Health, Male, Pregnancy, Race Factors, Risk Assessment, Risk Factors, Treatment Outcome, United States epidemiology, Health Care Costs ethics, Health Services Accessibility economics, Health Services Accessibility ethics, Healthcare Disparities economics, Healthcare Disparities ethics, Healthcare Disparities ethnology, Infertility therapy, Reproductive Techniques, Assisted economics, Reproductive Techniques, Assisted ethics, Social Determinants of Health economics, Social Determinants of Health ethics, Social Determinants of Health ethnology
- Abstract
In the United States, economic, racial, ethnic, geographic, and other disparities prevent access to fertility treatment and affect treatment outcomes. This opinion examines the factors that contribute to these disparities, proposes actions to address them, and replaces the document of the same name, last published in 2015., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
30. Clinical nutrition and human rights. An international position paper.
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Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, and Barazzoni R
- Subjects
- Health Services Accessibility ethics, Humans, Human Rights, Malnutrition, Nutrition Therapy ethics, Patient Rights, Right to Health
- Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition., Competing Interests: Conflicts of interest Diana Cardenas: none; Maria Isabel Toulson Davisson Correia: Lecturer for Abbott, Baxter, Danone, Fresenius, Nestlé, Takeda; Juan B Ochoa: Lecturer for Nestle Health Science, Fresenius Kabi and a past Chief Medical Officer until July 1, 2018 - Nestle Health Science North America; Gil Hardy: none;(;) Dolores Rodriguez-Ventimilla: none; Charles Bermúdez: Abbott, Baxter, Fresenius, Nestlé, Amarey, Bbraun, Fenavi, Eurociencia, Takeda; Karin Papapietro: Lecturer for Fresenius;(;) Régis Hankard: none(;) André Briend: none; Katerina Zakka: none; Teresa Pounds: none; Winai Ungpinitpong: none; Cristina Cuerda: Lecturer for Abbott, Baxter, Fresenius, Nestle, Nutricia, Persan, Takeda;(;) Rocco Barazzoni: none., (Copyright © 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
31. Use of Telemedicine and Smart Technology in Obstetrics: Barriers and Privacy Issues.
- Author
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Eswaran H and Magann EF
- Subjects
- Female, Health Insurance Portability and Accountability Act, Humans, Internet, Licensure, Pregnancy, Technology, United States, Communication Barriers, Health Services Accessibility ethics, Health Services Accessibility legislation & jurisprudence, Health Services Accessibility organization & administration, Obstetrics ethics, Obstetrics legislation & jurisprudence, Obstetrics methods, Obstetrics organization & administration, Privacy legislation & jurisprudence, Telemedicine ethics, Telemedicine legislation & jurisprudence, Telemedicine methods, Telemedicine organization & administration
- Abstract
While telemedicine had been utilized in varying ways over the last several years, it has dramatically accelerated in the era of the COVID-19 pandemic. In this article we describe the privacy issues, in relation to the barriers to care for health care providers and barriers to the obstetric patient, licensing and payments for telehealth services, technological issues and language barriers. While there may be barriers to the use of telehealth services this type of care is feasible and the barriers are surmountable., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
32. Oral Health Matters: The Ethics of Providing Oral Health During COVID-19.
- Author
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Elster N and Parsi K
- Subjects
- Humans, Pandemics, Public Health ethics, SARS-CoV-2, COVID-19 epidemiology, Delivery of Health Care ethics, Ethics, Dental, Health Services Accessibility ethics, Healthcare Disparities ethics, Oral Health ethics
- Abstract
Oral health is a critical part of overall health. The current COVID-19 pandemic has highlighted the importance of oral health. In this article, we describe how dental practice has been impacted by COVID-19, identify the public health response to COVID-19, and explain the gradual resumption of dental care after the initial disruption due to the pandemic. Finally, we discuss how long-standing health disparities in oral health have been exacerbated by the current pandemic.
- Published
- 2021
- Full Text
- View/download PDF
33. HIV in the Amazon's indigenous populations.
- Author
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Daniels JP
- Subjects
- Anti-HIV Agents supply & distribution, Anti-HIV Agents therapeutic use, Antiretroviral Therapy, Highly Active, Brazil epidemiology, COVID-19 epidemiology, HIV Infections drug therapy, HIV Infections psychology, HIV Infections transmission, Health Services Accessibility organization & administration, Health Services, Indigenous organization & administration, Humans, Social Stigma, HIV Infections epidemiology, Health Services Accessibility ethics, Healthcare Disparities ethics, Population Groups psychology, Vulnerable Populations psychology
- Published
- 2021
- Full Text
- View/download PDF
34. INPACVIH: tackling HIV in Peru's indigenous communities.
- Author
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Daniels JP
- Subjects
- Anti-HIV Agents supply & distribution, Anti-HIV Agents therapeutic use, Antiretroviral Therapy, Highly Active, COVID-19 epidemiology, HIV Infections drug therapy, HIV Infections psychology, HIV Infections transmission, Health Services Accessibility economics, Health Services Accessibility organization & administration, Health Services, Indigenous organization & administration, Healthcare Disparities economics, Humans, Peru epidemiology, Social Stigma, HIV Infections epidemiology, Health Services Accessibility ethics, Healthcare Disparities ethics, Population Groups psychology, Vulnerable Populations psychology
- Published
- 2021
- Full Text
- View/download PDF
35. From Vaccine Nationalism to Vaccine Equity - Finding a Path Forward.
- Author
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Katz IT, Weintraub R, Bekker LG, and Brandt AM
- Subjects
- Health Policy, Health Services Accessibility ethics, Humans, United States, COVID-19 Vaccines supply & distribution, Global Health, Health Services Accessibility organization & administration, International Cooperation, Mass Vaccination organization & administration
- Published
- 2021
- Full Text
- View/download PDF
36. Gene therapy companies have an ethical obligation to develop expanded access policies.
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Kearns L, Chapman CR, Moch KI, Caplan AL, Watson T, McFadyen A, Furlong P, and Bateman-House A
- Subjects
- Health Services Accessibility ethics, Humans, Biotechnology ethics, Genetic Therapy ethics, Industry ethics
- Published
- 2021
- Full Text
- View/download PDF
37. Future forward: AGS initiative addressing intersection of structural racism and ageism in health care.
- Author
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Lundebjerg NE and Medina-Walpole AM
- Subjects
- Healthcare Disparities, Humans, Organizational Objectives, Quality Improvement organization & administration, United States, Ageism prevention & control, Culturally Competent Care organization & administration, Health Services Accessibility ethics, Health Services Accessibility standards, Health Services for the Aged ethics, Health Services for the Aged standards, Racism prevention & control
- Abstract
The American Geriatrics Society is committed to taking purposeful steps to address racism in health care, given its impact on older adults, their families, and our communities. In fall 2020, AGS added a statement to our vision for the future, which reflects that our commitment is central to mission: "We all are supported by and able to contribute to communities where ageism, ableism, classism, homophobia, racism, sexism, xenophobia, and other forms of bias and discrimination no longer impact healthcare access, quality, and outcomes for older adults and their caregivers." In 2021, we will be working to flesh out a multi-year, multi-pronged initiative that addresses the intersection of structural racism and ageism in health care. This will include engaging members in identifying strategies and with the goal of increasing member engagement around the idea that it will take all of us working together to achieve our vision for a collective future that is free of discrimination and bias. The Society has set as the first objective that by 2031, 100% of research presented at the AGS Annual Scientific Meeting and published in the Journal of the American Geriatrics Society (JAGS) will reflect the diversity of the population being studied. Other immediate efforts include undertaking a complete update of the Geriatrics Cultural Navigator, development of corresponding public education materials, and a webinar series focused on helping us all understand our own implicit bias, recognize implicit and explicit bias, and consider actions that we each might take to address bias when we observe it., (© 2021 The American Geriatrics Society.)
- Published
- 2021
- Full Text
- View/download PDF
38. Vacuna-gate escalates in Peru.
- Author
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Kenyon G
- Subjects
- COVID-19 epidemiology, Drug Approval, Government Employees, Health Services Accessibility ethics, Humans, Malpractice, Peru, COVID-19 prevention & control, COVID-19 Vaccines administration & dosage, Mass Vaccination ethics, Politics, Public Health ethics
- Published
- 2021
- Full Text
- View/download PDF
39. Ethical limits to placebo use and access to Covid-19 vaccines as a human right.
- Author
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Greco DB
- Subjects
- Ethics, Medical, Human Rights, Humans, Pandemics, SARS-CoV-2, Biomedical Research standards, COVID-19 prevention & control, COVID-19 Vaccines standards, Guidelines as Topic, Health Services Accessibility ethics, Health Services Accessibility standards, Placebos standards
- Abstract
The world is currently facing another severe pandemic, Covid-19, just four decades after the start of AIDS, and the still increasing incidence of HIV infection continues to be one of the greatest global health challenges. The way the latter was confronted is of fundamental importance for a serious discussion on global health, ethics and human rights, and this experience could and can still be applied to Covid-19. The Covid-19 pandemic has specific characteristics and these will be discussed, in relation to vaccine research and especially to the global right to equal access to products proven to be safe and effective. The article focusses primarily on issues related to Covid-19 vaccines, especially the appropriate use and limits on placebo, the right to post-trial access to placebo arm participants, and the use of an active control for subsequent Phase-3 trials after the approval of other safe and efficacious vaccines. Most importantly, it will emphasise that access to Covid-19 vaccines is a human right, which presupposes the establishment of appropriate ethical standards to ensure universal, equal, and affordable access to healthcare and to vaccines for all, and the imperative need for suspension of patents for products developed for Covid-19. It will consider the role of social determinants that contribute to the severity of Covid-19 and that must be addressed to effectively curb the current syndemic.
- Published
- 2021
- Full Text
- View/download PDF
40. Solidarity in the Time of COVID-19?
- Author
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Tomasini F
- Subjects
- Health Services Accessibility ethics, Humans, Social Justice ethics, United Kingdom, COVID-19, Cooperative Behavior, Social Responsibility
- Abstract
This article critically examines how solidarity has been enacted in the first 2 months of the COVID-19 pandemic, mainly, but not exclusively, from a United Kingdom perspective.1 Solidaristic strategies are framed in two ways: aspirations to overcome COVID-19 (utopian anthropocentric solidarity); and those that are illusory, incompatible, contradictory, and disrupting of solidaristic ideals (heterotopian solidarity). Solidarity can also be understood more widely from a biocentric perspective (solidarity with all life). In the context of COVID-19 a lack of biocentric solidarity points to a probable cause of the pandemic; where COVID-19, harmless in bats, jumped species as a consequence of closer contact with humans. Solidarity, therefore, is not only expressed in a fight against a viral "enemy" but is also a reminder of human activity that has upset balances within ecosystems.
- Published
- 2021
- Full Text
- View/download PDF
41. Covid-19 vaccine passports: access, equity, and ethics.
- Author
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Osama T, Razai MS, and Majeed A
- Subjects
- COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 virology, Civil Rights ethics, Documentation ethics, Female, Health Equity ethics, Health Services Accessibility ethics, Humans, Pregnancy, SARS-CoV-2 genetics, SARS-CoV-2 isolation & purification, Vaccination ethics, World Health Organization organization & administration, COVID-19 prevention & control, COVID-19 Vaccines supply & distribution, Public Health ethics
- Abstract
Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: none.
- Published
- 2021
- Full Text
- View/download PDF
42. Hard choices: Ethical challenges in phase 1 of COVID-19 vaccine roll-out in South Africa.
- Author
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Moodley K, Blockman M, Pienaar D, Hawkridge AJ, Meintjes J, Davies MA, and London L
- Subjects
- COVID-19 Vaccines supply & distribution, Developing Countries, Health Personnel statistics & numerical data, Healthcare Disparities, Humans, Private Sector, Public Sector, Social Justice, South Africa, COVID-19 prevention & control, COVID-19 Vaccines administration & dosage, Global Health, Health Services Accessibility ethics
- Abstract
Access to COVID-19 vaccines has raised concerns globally. Despite calls for solidarity and social justice during the pandemic, vaccine nationalism, stockpiling of limited vaccine supplies by high-income countries and profit-driven strategies of global pharmaceutical manufacturers have brought into sharp focus global health inequities and the plight of low- and middle-income countries (LMICs) as they wait in line for restricted tranches of vaccines. Even in high-income countries that received vaccine supplies first, vaccine roll-out globally has been fraught with logistic and ethical challenges. South Africa (SA) is no exception. Flawed global institutional strategies for vaccine distribution and delivery have undermined public procurement platforms, leaving LMICs facing disproportionate shortages necessitating strict criteria for vaccine prioritisation. In anticipation of our first consignment of vaccines, deliberations around phase 1 roll-out were intense and contentious. Although the first phase focuses on healthcare personnel (HCP), the devil is in the detail. Navigating the granularity of prioritising different categories of risk in healthcare sectors in SA is complicated by definitions of risk in personal and occupational contexts. The inequitable public-private divide that characterises the SA health system adds another layer of complexity. Unlike other therapeutic or preventive interventions that are procured independently by the private health sector, COVID-19 vaccine procurement is currently limited to the SA government only, leaving HCP in the private sector dependent on central government allocation. Fair distribution among tertiary, secondary and primary levels of care is another consideration. Taking all these complexities into account, procedural and substantive ethical principles supporting a prioritisation approach are outlined. Within the constraints of suboptimal global health governance, LMICs must optimise progressive distribution of scarce vaccines to HCP at highest risk.
- Published
- 2021
43. Improving the Health of the American Indian and Alaska Native Population.
- Author
-
Sequist TD
- Subjects
- Health Workforce, Humans, Insurance Coverage, Insurance, Health, Quality of Health Care, United States, Alaska Natives, Health Services Accessibility ethics, Social Determinants of Health ethnology, American Indian or Alaska Native
- Published
- 2021
- Full Text
- View/download PDF
44. Vaccinating Health Care Employees - Do They All Deserve Early Access?
- Author
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Ubel PA
- Subjects
- Bioethical Issues, Humans, Time Factors, United States, COVID-19 Vaccines, Health Personnel ethics, Health Services Accessibility ethics, Vaccination ethics
- Published
- 2021
- Full Text
- View/download PDF
45. A Reserve System for the Equitable Allocation of a Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine.
- Author
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Makhoul AT and Drolet BC
- Subjects
- Humans, SARS-CoV-2, COVID-19 epidemiology, COVID-19 prevention & control, COVID-19 Vaccines therapeutic use, Health Care Rationing ethics, Health Care Rationing methods, Health Care Rationing organization & administration, Health Services Accessibility ethics, Health Services Accessibility standards, Immunization Programs ethics, Immunization Programs organization & administration, Resource Allocation organization & administration
- Published
- 2021
- Full Text
- View/download PDF
46. [Ethical issues in primary care during the coronavirus (SARS-CoV-2) pandemic].
- Author
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Beltran-Aroca CM, González-Tirado M, and Girela-López E
- Subjects
- COVID-19 epidemiology, Health Care Rationing methods, Health Care Rationing organization & administration, Health Services Accessibility organization & administration, Health Services for the Aged ethics, Health Services for the Aged organization & administration, Humans, Infection Control instrumentation, Infection Control organization & administration, Pandemics, Personal Protective Equipment supply & distribution, Primary Health Care methods, Primary Health Care organization & administration, Quality of Health Care ethics, Quality of Health Care organization & administration, Spain epidemiology, Telemedicine methods, Telemedicine organization & administration, COVID-19 prevention & control, Health Care Rationing ethics, Health Services Accessibility ethics, Infection Control methods, Primary Health Care ethics, Telemedicine ethics
- Abstract
Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients., (Copyright © 2020 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
47. The COVID-19 era: Ethics in times of crisis.
- Author
-
Gamboa-Antiñolo FM
- Subjects
- Age Factors, COVID-19 epidemiology, Humans, Respiration, Artificial ethics, Spain epidemiology, Triage ethics, COVID-19 therapy, Clinical Decision-Making ethics, Health Care Rationing ethics, Health Services Accessibility ethics
- Published
- 2021
- Full Text
- View/download PDF
48. Collateral damage: Impact of SARS-CoV-2 pandemic in people living with HIV.
- Author
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Cooley SA, Nelson B, Doyle J, Rosenow A, and Ances BM
- Subjects
- Adult, Aged, Anxiety economics, Anxiety psychology, Anxiety virology, COVID-19 economics, COVID-19 psychology, COVID-19 virology, Comorbidity, Depression economics, Depression psychology, Depression virology, Female, HIV Infections economics, HIV Infections psychology, HIV Infections virology, HIV-1 pathogenicity, Health Services Accessibility economics, Health Services Accessibility ethics, Humans, Male, Middle Aged, Missouri epidemiology, Physical Distancing, Quarantine economics, Quarantine psychology, SARS-CoV-2 pathogenicity, Stress, Psychological economics, Stress, Psychological virology, Substance-Related Disorders economics, Substance-Related Disorders psychology, Substance-Related Disorders virology, Surveys and Questionnaires, Anxiety epidemiology, COVID-19 epidemiology, Depression epidemiology, HIV Infections epidemiology, Pandemics, Stress, Psychological epidemiology, Substance-Related Disorders epidemiology
- Abstract
People living with HIV (PLWH) may be at higher risk for adverse outcomes indirectly associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2). When comparing responses to questionnaires administered when social distancing and quarantine guidelines were first implemented, we found that PLWH were more likely to have restricted access to medical care, increased financial stress, increased symptoms of anxiety and depression, and increased substance use compared to demographically-similar people without HIV.
- Published
- 2021
- Full Text
- View/download PDF
49. Withdrawal of intensive care during times of severe scarcity: Triage during a pandemic only upon arrival or with the inclusion of patients who are already under treatment?
- Author
-
Dufner A
- Subjects
- COVID-19 epidemiology, COVID-19 physiopathology, Decision Making ethics, Europe epidemiology, Health Care Rationing ethics, Health Services Accessibility ethics, Humans, SARS-CoV-2 physiology, Triage, Bioethical Issues, COVID-19 therapy, Critical Care ethics, Health Care Rationing standards, Withholding Treatment ethics
- Abstract
Many countries have adopted new triage recommendations for use in the event that intensive care beds become scarce during the COVID-19 pandemic. In addition to establishing the exact criteria regarding whether treatment for a newly arriving patient shows a sufficient likelihood of success, it is also necessary to ask whether patients already undergoing treatment whose prospects are low should be moved into palliative care if new patients with better prospects arrive. This question has led to divergent ethical guidelines. This paper explores the distinction between withholding and withdrawing medical treatment during times of scarcity. As a first central point, the paper argues that a revival of the ethical distinction between doing and allowing would have a revisionary impact on cases of voluntary treatment withdrawal. A second systematic focus lies in the concern that withdrawal due to scarcity might be considered a physical transgression and therefore more problematic than not treating someone in the first place. In light of the persistent disagreement, especially concerning the second issue, the paper concludes with two pragmatic proposals for how to handle the ethical uncertainty: (1) triage protocols should explicitly require that intensive care attempts are designed as time-limited trials based on specified treatment goals, and this intent should be documented very clearly at the beginning of each treatment; and (2) lower survival prospects can be accepted for treatments that have already begun, compared with the respective triage rules for the initial access of patients to intensive care., (© 2020 The Authors. Bioethics published by John Wiley & Sons Ltd.)
- Published
- 2021
- Full Text
- View/download PDF
50. Missed opportunities in tb clinical practice: How to bend the curve? A medical, social, economic and ethical point of view.
- Author
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Riccardi N, Villa S, Canetti D, Giacomelli A, Taramasso L, Martini M, Di Biagio A, Bragazzi NL, Brigo F, Sotgiu G, Besozzi G, and Codecasa L
- Subjects
- Coinfection economics, Coinfection epidemiology, Coinfection therapy, Health Care Costs, Humans, Incidence, Latent Infection economics, Latent Infection epidemiology, Latent Infection therapy, Predictive Value of Tests, Prognosis, Socioeconomic Factors, Tuberculosis economics, Tuberculosis epidemiology, Tuberculosis therapy, Coinfection diagnosis, Health Services Accessibility economics, Health Services Accessibility ethics, Latent Infection diagnosis, Mass Screening economics, Mass Screening ethics, Tuberculosis diagnosis
- Published
- 2021
- Full Text
- View/download PDF
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