Incident

I n t r o d u c t i o n EMERGENCIES IN MODERN WORLD AND CONTEMPORARY MEDICAL ETHICS (BIOETHICS) Joint participation of medical specialists from different countries in rendering timely medical aid plays essential role in the century of cataclysms and man-made disasters. However nowadays different approaches to rendering the first medical aid to victims exist in various countries of the world. As a result the assistance acceptable in some countries turns out to be unacceptable for the representatives of other countries and religions or certain confessions of faith. And similar problem can arise not only during the deployment of medical specialists in other countries but also during rendering first medical aid within such a multinational country as the Russian Federation. Competence of physician's actions, the type of his communication with local population (including health-care workers from local population), patients and members of their families, all these factors represent a big bioethical problem. The brochure structure represents a stepwise description of general moral principles of rendering medical aid and its peculiarities in emergency medicine. After a concise description of emergency concept we will produce a set of universal ethical rules and principles of physician-patient relations. These principles and rules are included in many international and national ethical codes of medical profession. Universal Declaration on Bioethics and Human Rights (UNESCO,

Canadian Geriatrics Journal

Canadian Journal of Bioethics, 2020

Hospital ethics committees (HECs) help clinicians deal with the ethical challenges which have been raised during clinical practice. A comprehensive literature review was conducted to provide a historical background of the development of HECs internationally and describe their functions and practical challenges of their day to day work. This is the first part of a comprehensive literature review conducted between February 2014 and August 2016 by searching through scientific databases. The keyword ethics committee, combined with hospital, clinic, and institution, was used without a time limitation. All original and discussion articles, as well as other scientific documents were included. Of all the articles and theses found using these keywords, only 56 were consistent with the objectives of the study. Based on the review goals, the findings were divided into three main categories; the inception of HECs in the world, the function of HECs, and the challenges of HECs. According to the results, the Americas Region and European Region countries have been the most prominent considering the establishment of HECs. However, the majority of the Eastern Mediterranean Region and SouthEast Asia Region countries are only beginning to establish these committees in their hospitals. The results highlight the status and functions of HECs in different countries and may be used as a guide by health policymakers and managers who are at the inception of establishing these committees in their hospitals.

Academic Emergency Medicine, 2016

T he Peruvian story of 15 years of sustained economic growth is a commonly touted success story in a region known for economic uncertainty. Social statistics show that fewer people live below the poverty line, more have access to basic education, and fewer children experience the consequences of malnutrition. 1,2 Corporations are thriving across all sectors including the private healthcare industry, which would seem to be in line with the optimistic published social welfare figures. Statistics, however impressive, can mask reality. For us, in the public and private healthcare sector, these statistics ring hollow. Peru has four different healthcare systems. Two are public, MINSA and ESSALUD, while two are private, one for the military and one for citizens. The government-run public healthcare systems are not equivalent (e.g., ESSALUD has PCI available, MINSA does not). While the country has experienced unprecedented economic growth and development, the public healthcare system has floundered. The failure of this success to "trickle down" and improve the infrastructure of the public system, much of which is crumbling and inadequate. Chronic underfunding and lack of the appreciation of the sheer scope of human suffering that continues to be present has contributed to a culture of medicine, which can often fail to appreciate the basic humanity of the individual. No place exemplifies this disparity better than the emergency department (ED) of Hospital Cayetano Heredia, a major academic hospital in the north of Lima, Peru's capital. Lima, has grown tremendously from 6 million in 1993 to almost 10 million people in 2015. 3 Our hospitals, medical investment, and medical personal, however, have stagnated and the system is now overwhelmed. While changes have been made to the infrastructure of the ED, this has not contributed to better care for our patients. The halls of the ED are hot and permeated by a suffocating stench that sanitizers cannot disguise. Patients "lucky" enough to have a bed lie in uncomfortable stretchers, so narrow that turning is impossible, particularly in the advanced states of illness necessary for patients to venture into this hell. Patients tremble in this cold, impersonal inferno. Fragile and in pain, their suffering exacerbated by an inefficient, ineffective, and shortsighted system. Here, these patients' intimacy and dignity are violated, their weaknesses displayed to other patients and health workers passing by. And then they wait. A young woman with cancer cries out in pain waiting for a medicine that is not on stock in the pharmacy, and that is too expensive to get outside the hospital (no explanation from the pharmacist and no alternative medication available). An elderly grandmother, confused and alone, cries silently tied down to a wheelchair, rather than examined and reassured. An assaulted alcoholic man without family or ID is left on the floor, shivering. Admission is not a ticket out, as many must stay here, boarding in limbo, on a stretcher, a wheelchair, and some on the floor. For many, this will be their place of death. Many clinicians are overworked because they practice in both the public and the private systems. This is known as dual practice and occurs due to the increased levels of reimbursement offered by the private sector. These clinicians, often working more than 100 hours a week are more likely to experience burnout, which can manifest as a lack of compassion for the tremendous suffering that occurs daily within the walls of our ED.

Mediterranean Journal of Emergency Medicine, 2015

Introduction: To look after a person in an emergency situation leaves little time for philosophical reflections. A life must be saved. The sensitivity of care receivers and their relatives is however at its highest when faced with the caregiver’s human negligence, which they perceive as abusive. Materials and methods: Create a working group of the different professional caregivers and of care-receivers. Writing down a list of shared values of care, and of what is considered to be unacceptable behavior. Definition of care, both that which is respectful of the individual person and that which is not, and what to do in the case of excesses of abusive situations. Conclusions of the French Ministerial Group “Humane treatment in health care institutions (2010-2011)”. Results: The ordinary, involuntary non-respectful care treatment (the “bad care”) is found in all our activities, mostly through the trivialization of the human being and the caregivers’ indifference, preoccupied more with urgency, action, the medico-economic and administrative contingencies, and technicality. There must be increased awareness, which will allow the questioning of all those who take part in the care chain. Discussions should be led with a selection of caregivers, which would allow them to express their human values and their feelings about the quality of their work environment. A virtuous circle unites humane treatment of care receivers with that of caregivers. Discussion, conclusion: all caregivers’ efforts must tend to an improvement in quality of life of care receivers, to a care system which respects the human being. Nevertheless, recent concepts which tend to make the patient a “health system user”, if not a “client”, carry within them the seeds of a consumerist tendency which, far from building a joint relationship of trust, where one requires the other, impose its views while asking the other to assume all the responsibilities. And, unlike the past paternalistic approach in medicine, it is not the caregiver that put themselves in such position. Good care can only come from shared trust and respect.

Perspectives in Biology and Medicine, 2018

The prevention of abuse is a crucial issue in medical ethics. At the very least, the hospital setting should respect basic human rights, including dignity and life. In this respect, the normative reference to the concept of humanity plays a crucial role. However, the public as well as health-care professionals need to be aware of a more subtle and invisible form of abuse, "ordinary abuse." It can be defined as the undue suspension of the implicit rules of ordinary interactions, whose importance has been stressed by Erving Goffman and Harold Garfinkel. Moreover, the respect of "ordinary humanity" has an important ethical value, both in promoting "considerateness" and in sustaining a world of experience common to all human beings. Excerpts from a few letters of complaint from hospitalized patients will serve as an illustration of this important phenomenon and its ethical relevance. I n 2009, an influential and remarkable report to the French highest health authorities (Haute Autorité de Santé) written by Claire Compagnon, a patients' advocate, and Véronique Ghadi, a legal scholar, has brought to public attention a phenomenon that had gone unnoticed in medical ethics: the report's authors called it "ordinary abuse" (maltraitance ordinaire) (Compagnon and Ghadi

International Review of the Red Cross, 2012

Journal of International Humanitarian Action

Wars, disasters, and epidemics affect millions of individuals every year. International non-governmental organizations respond to many of these crises and provide healthcare in settings ranging from a field hospital deployed after an earthquake, to a health clinic in a longstanding refugee camp, to a treatment center during an infectious disease outbreak. The primary focus of these activities is to save lives. However, inevitably, many patients cannot be saved. We undertook an interpretive description study to investigate humanitarian policy-maker and care providers' experiences and perceptions of palliative care during humanitarian crises. In this paper, we report on interviews with 23 health professionals, 11 of whom also had experience as policy-makers within a humanitarian organization. We use the concept of moral experience as an analytic lens: participants' experiences of values that they held to be important being realized or thwarted as they responded to the needs of patients who were dying or likely to die. We identified five themes related to participants' moral experiences, all of which relate to values of compassion in the provision of care, and justice in accessing it. (1) Participants described intervening to ease the suffering of dying patients as an inherent aspect of humanitarianism and their duty as health professionals. (2) Participants also expressed that upholding dignity was of critical importance, stemming from a recognition of shared humanity and as an act of respect. (3) Since humanitarian action is provided in situations of scarcity, prioritization is inescapable. Acknowledging the primacy of curative care in emergencies, participants also emphasized the importance of ensuring that care for the dying was attended to, including during triage. (4) Participants reported working within and pushing against systemic constraints such as legal or logistical barriers to opioids, lack of guidelines, and conflicting views with colleagues. (5) Given the stakes involved, participants felt a heavy weight of responsibility and described their challenges in carrying it. These findings illuminate experiences responding to patients who are dying or likely to die, and how these connect with the values of humanitarian health professionals, sometimes resulting in dissonance between values and actions. They also point to the need to make more space for palliative, alongside curative, approaches to care in situations of humanitarian crises, ideally by further integrating them.

2005