'Ultrasound is an invaluable third eye, but it can't see everything' : a qualitative study with obstetricians in Australia

Background: Obstetric ultrasound has come to play a significant role in obstetrics since its introduction in clinical care. Today, most pregnant women in the developed world are exposed to obstetric ultrasound examinations, and there is no doubt that the advantages of obstetric ultrasound technique have led to improvements in pregnancy outcomes. However, at the same time, the increasing use has also raised many ethical challenges. This study aimed to explore obstetricians' experiences of the significance of obstetric ultrasound for clinical management of complicated pregnancy and their perceptions of expectant parents' experiences. Methods: A qualitative study was undertaken in November 2012 as part of the CROss-Country Ultrasound Study (CROCUS). Semi-structured individual interviews were held with 14 obstetricians working at two large hospitals in Victoria, Australia. Transcribed data underwent qualitative content analysis. Results: An overall theme emerged during the analyses, 'Obstetric ultrasound - a third eye', reflecting the significance and meaning of ultrasound in pregnancy, and the importance of the additional information that ultrasound offers clinicians managing the surveillance of a pregnant woman and her fetus. This theme was built on four categories: I:'Everyday-tool' for pregnancy surveillance, II: Significance for managing complicated pregnancy, III: Differing perspectives on obstetric ultrasound, and IV: Counselling as a balancing act. In summary, the obstetricians viewed obstetric ultrasound as an invaluable tool in their everyday practice. More importantly however, the findings emphasise some of the clinical dilemmas that occur due to its use: the obstetricians' and expectant parents' differing perspectives and expectations of obstetric ultrasound examinations, the challenges of uncertain ultrasound findings, and how this information was conveyed and balanced by obstetricians in counselling expectant parents. Conclusions: This study highlights a range of previously rarely acknowledged clinical dilemmas that obstetricians face in relation to the use of obstetric ultrasound. Despite being a tool of considerable significance in the surveillance of pregnancy, there are limitations and uncertainties that arise with its use that make counselling expectant parents challenging. Research is needed which further investigates the effects and experiences of the continuing worldwide rapid technical advances in surveillance of pregnancies.

Life and Death: The Religious, Philosophical and Moral Dilemmas in Medicine

Religious beliefs often play a major role in the decisions that are made in the home and the hospital concerning issues at the beginning and end of life. Only recently, however, due to rapidly advancing medical technology, have religious, moral, and philosophical beliefs taken such a controversial role. One of the major questions that has arisen from these various controversies is whether or not we have the right to posses control over the biological functions of our bodies. The answer is a difficult one, and it may be one that cannot be answered, but the attempt at an answer is what is at the heart of medical ethics.

Medical treatment and the good death: an ethical analysis of euthanasia, physician assisted suicide, and the right to die

Frequent advances in medical technologies have brought fonh many innovative treatments that allow medical teams to treal many patients with grave illness and serious trauma who would have died only a few years earlier. These changes have given some patients a second chance at life, but for others. these new treatments have merely prolonged their dying. Instead of dying relatively painlessly, these unfortunate patients often suffer from painful tenninal illnesses or exist in a comatose state that robs them of their dignity, since they cannot survive without advanced and often dehumanizing forms of treatment. Due to many of these concerns, euthanasia has become a central issue in medical ethics. Additionally, the debate is impacted by those who believe that patients have the right make choices about the method and timing of their deaths. Euthanasia is defined as a deliberate act by a physician to hasten the death of a patient, whether through active methods such as an injection of morphine, or through the withdrawal of advanced forms of medical care, for reasons of mercy because of a medical condition that they have. This study explores the question of whether euthanasia is an ethical practice and, as determined by ethical theories and professional codes of ethics, whether the physician is allowed to provide the means to give the patient a path to a "good death," rather than one filled with physical and mental suffering. The paper also asks if there is a relevant moral difference between the active and passive forms of euthanasia and seeks to define requirements to ensure fully voluntary decision making through an evaluation of the factors necessary to produce fully informed consent. Additionally, the proper treatments for patients who suffer from painful terminal illnesses, those who exist in persistent vegetative states and infants born with many diverse medical problems are examined. The ultimate conclusions that are reached in the paper are that euthanasia is an ethical practice in certain specific circumstances for patients who have a very low quality of life due to pain, illness or serious mental deficits as a result of irreversible coma, persistent vegetative state or end-stage clinical dementia. This is defended by the fact that the rights of the patient to determine his or her own fate and to autonomously decide the way that he or she dies are paramount to all other factors in decisions of life and death. There are also circumstances where decisions can be made by health care teams in conjunction with the family to hasten the deaths of incompetent patients when continued existence is clearly not in their best interest, as is the case of infants who are born with serious physical anomalies, who are either 'born dying' or have no prospect for a life that is of a reasonable quality. I have rejected the distinction between active and passive methods of euthanasia and have instead chosen to focus on the intentions of the treating physician and the voluntary nature of the patient's request. When applied in equivalent circumstances, active and passive methods of euthanasia produce the same effects, and if the choice to hasten the death of the patient is ethical, then the use of either method can be accepted. The use of active methods of euthanasia and active forms of withdrawal of life support, such as the removal of a respirator are both conscious decisions to end the life of the patient and both bring death within a short period of time. It is false to maintain a distinction that believes that one is active killing. whereas the other form only allows nature to take it's course. Both are conscious choices to hasten the patient's death and should be evaluated as such. Additionally, through an examination of the Hippocratic Oath, and statements made by the American Medical Association and the American College of physicians, it can be shown that the ideals that the medical profession maintains and the respect for the interests of the patient that it holds allows the physician to give aid to patients who wish to choose death as an alternative to continued suffering. The physician is also allowed to and in some circumstances, is morally required, to help dying patients whether through active or passive forms of euthanasia or through assisted suicide. Euthanasia is a difficult topic to think about, but in the end, we should support the choice that respects the patient's autonomous choice or clear best interest and the respect that we have for their dignity and personal worth.

Beyond indifferent players: on the existence of prisoners dilemmas in games with amicable and adversarial preferences

Why don’t agents cooperate when they both stand to gain? This question ranks among the most fundamental in the social sciences. Explanations abound. Among the most compelling are various configurations of the prisoner’s dilemma (PD), or public goods problem. Payoffs in PD’s are specified in one of two ways: as primitive cardinal payoffs or as ordinal final utility. However, as final utility is objectively unobservable, only the primitive payoff games are ever observed. This paper explores mappings from primitive payoff to utility payoff games and demonstrates that though an observable game is a PD there are broad classes of utility functions for which there exists no associated utility PD. In particular we show that even small amounts of either altruism or enmity may disrupt the mapping from primitive payoff to utility PD. We then examine some implications of these results.

Web 2.0, dilemmas 1.0: essay on an evolving market

Today the Internet is entwined into our everyday society. From the beginning days in 1980 to today, the Internet has been evolving. The creator of the World Wide Web, Tim Berners-Lee, envisioned that the Internet would be a system with everything connected to everything. The web today is changing with new applications arriving from outside the previous channels of the megalithic software companies. Thousands of individual developers are creating micro-applications to enhance the earlier framework of the web. This revolution has been coined "Web 2.0". Many observers today are skeptical that Web 2.0 is really a revolution at all, but maybe is just a continuation of Berners-Lee's original concept. This paper examines, based on a critical literature review, the discussions taking place regarding Web 2.0.

On the impossibility of prisoner's dilemmas in adversarial preference games

Why don't agents cooperate when they both stand to gain? This question ranks among the most fundamental in the social sciences. Explanations abound. Among the most compelling are various configurations of the prisonerís dilemma (PD), or public goods problem. Payoffs in PDís are specified in one of two ways: as primitive cardinal payoffs or as ordinal final utility. However, as final utility is objectively unobservable, only the primitive payoff games are ever observed. This paper explores mappings from primitive payoff to utility payoff games and demonstrates that though an observable game is a PD there are broad classes of utility functions for which there exists no associated utility PD. In particular we show that even small amounts of either altruism or jealousy may disrupt the mapping from primitive payoff to utility PD. We then examine some implications of these results ñ including the possibility of conflict inducing growth.

Bioética e biodireito: interfaces e confluências

This thesis addresses the development of technoscience in times of transnational globalization and highlights the vulnerability of the discourse of social progress, which may be replaced by evidence of social risk before the artificiality of nature and humanity. That demands an ethical and legal responses to events that impose the necessity of an ethical control in biotechnology research involving human beings contributing to the rise of Bioethics and Biolaw as fields of knowledge. This theme is studied from a multidisciplinary perspective seeking a dynamic dimension in the interpretation of research data reconnecting Social Sciences to Legal Sciences (Biolaw) and to Philosophy (Bioethics), in order to obtain answers to the problems posed. The objective delimited is to examine the interfaces between Biolaw and Bioethics, in order to observe the confluence of these areas of knowledge. Biolaw is considered as a new legal branch derived from the paradigmatic transition of Law and wonders how it will stand before questions resulting of social transformations caused by biotechnological development that endangers humans and society. It is concluded that the relationship between Bioethics and Biolaw is recursive and inseparable and it contributed to the "unthink" of traditional legal model of linear view/reductionist allowing that the "certainties" will be replaced by "possibilities", which comes to enable Biolaw to confront the issues caused by the development of biotechnology that violates physically and morally the human person. It is perceived, therefore, that Biolaw is driven and aided by bioethical reflections and it positions itself before the dilemmas caused by biotechnology in creating, interpreting and applying coercive rules which aims to protect the human being, his offspring and society

Processo de trabalho na estratégia saúde da família: potencialidades e fragilidades da atuação do enfermeiro

The present study aims to analyze the nurse s work process at Family Health Strategy, considering its basic elements and dynamic, and searching to identify aspects that may constitute strengths and weaknesses in its development. This is an analytical case study, with qualitative approach and theoretical-conceptual mark grounded in Dialectic Hermeneutics. Empirical research fields were the Family Health Units of Natal, RN, Brazil. The subjects are nurses working in this Strategy. Data collection was conducted through semi-structured individual interviews combined with field observation. The research was initiated after approval by the Ethics Committee of Universidade Federal do Rio Grande do Norte, according to the guidelines and rules for research involving humans (Resolution 466/12), ensuring proper ethical precepts. The project was approved by register number 398.929, CAAE 19588813.7.0000.5537. From the 9 interviewed nurses, 8 were female and 1 male, average age of 52 years, average graduation time of 27 years and average time they stayed at the same Family Health territory of 7 years. It was found that it is up to the professional nurse in the Family Health care the important role of taking care of human beings in their life, family and community contexts, producing conditions to meet their needs through therapeutic act in health, using for such purpose both materials and immaterial instruments. It was possible to relate aspects that characterize strengths and weaknesses in the work process of nurses in the ESF, according to the speech of the interviewed workers, including the meanings and contradictions. Among the potentialities observed, it was possible to highlight the wide role of the nurse at Family Health; the perception of nurses about teamwork; the relative autonomy of nurses; the commitment of professionals to work; Humanization as a technology; the presence of other agents at work, such as directors and officers at the primary health units; the professional s experience time and contract type in the case studied. As weaknesses in the work process of nurses at Family Health Strategy, were highlighted the limited skills of the workforce; the difficulty in 10 identifying specific limits of the work of nurses in this scenario; the disturbances that occur in the process, the existing gaps in multiprofessional teams; Structural deficits of the units in the studied case, the low coverage of the Family Health in the county, and the political vulnerability of the work conditions. It is considered necessary to understand the dilemmas experienced in everyday life of nurses at Family Health Strategy as part of multiprofessional teams, facing actual achievement of changes in work processes necessary for the reorientation of health care in Brazil. In accordance, it is necessary to promote proper working conditions and welfare of labor agents which are protagonists the work at the United Health System

A formação graduada em psicologia no Brasil: reflexão sobre os principais dilemas em um contexto pos-DCN

Criticism done to the undergraduate training process of the psychologist in Brazil raised debates known as "dilemmas of training". In recent years the classic training model, based on the Minimum Curriculum has undergone a series of changes after the National Curriculum Guidelines (DCN), modifying the context of courses. Thus, this paper aimed to investigate, in a post- DCN context how undergraduate courses in Psychology in Brazil have been dealing with the dilemmas of training. So, we decided to analyze the Course Pedagogical Projects (CPPs) of Psychology in the country. Forty CPPs, selected by region, academic organization and legal status were collected. The data was grouped into three blocks of discussions: theoretical, philosophical and pedagogical foundations; curriculum emphases and disciplines; and professional practices. The results were grouped into four sets of dilemmas: a) ethical and political; b) theoreticalepistemological; c) professional practice of the psychologist and d) academic-scientific. Courses claim a socially committed, generalist, pluralistic training, focusing on research, non-dissociation of teaching-research-extension, interdisciplinary training and defending a vision of man and of critical and reflective and non-individualistic psychology. The curriculum keeps the almost exclusive teaching of the classical areas of traditional fields of applied Psychology. Training is content based. The clinic is hegemonic, both in theory and in application fields. The historical debate is scarce and themes linked to the Brazilian reality are missing, despite having social policies present in the curricula. Currently, DCNs have a much greater impact on courses due to the influence of the control agencies, fruit of current educational policy, and the result is felt in the homogenization of curriculum discourses

Processo argumentativo na (re)significação de concepções ético/morais

This study analysed the relationship between the production of argumentative discourses and the development and (re)signification of ethical/moral concepts, conceptions and reasoning. It focused on ethical-argumentative reasoning concerning other people and their different points of view. The specific aims of this research were: (1) to investigate the considering alternative positions on adolescents previous views on a specific topic; (2) to verify whether the ability to generate counterarguments was associated with higher levels of moral reasoning, according to Kohlberg theory, and (3) to have a better comprehension of a possible relationship between adolescents abilities to use cognitive and verbal-argumentative strategies and the (re) signification of concepts/beliefs of an ethical/moral nature, and also the solution of conflicts of the same nature. The participants in this study were seventh grade students of private and public schools. Four empirical tasks were used in order to evaluate argumentative and moral reasoning. These tasks focused on: the evaluation of moral dilemmas (DIT); the evaluation of moral dilemmas with the presentation of a written justification for subjects responses; the production of arguments and the reaction to counterarguments. There was also a group-debate situation in which both argumentation and the discussion ethical/moral issues were observed. The moral dilemmas tasks aimed to evaluate the level of moral reasoning of the participants. The argumentation tasks investigated whether the adolescents generated and justified a point of view and how they dealt with counterarguments or alternative information which could lead the participants to modify their initial positions on the topic under discussion in a monological situation as well as in a group-debate setting. The results showed that, in a monological situation, most of the adolescents produced only a partial developed argumentative discourse, whereas in a more social-verbal interaction situation their discourse appeared to be more elaborated. As a general result, it was observed that the confrontation with the other s views, or dealing with counterarguments allow the adolescents to re-evaluate and re-elaborate their own views on a debatable topic. Regarding the relationship between counterargumentation and moral reasoning, it was verified that there was a subtle tendency associating the two processes. However, other factors, such as, social, emotional and cultural aspects might also influence the development of moral reasoning

Male Homosexuality in Brazilian Indexing Languages: Some Ethical Questions

Studies on ethics in information organization have deeply contributed to the recognition of the social dimension of Information Science. The subject approach to information is linked to an ethical dimension because one of its major concerns is related to its reliability and usefulness in a specific discursive community or knowledge domain. In this direction, we propose, through an exploratory research design with qualitative and inductive characteristics, to identify the specific terminology that Brazilian indexing languages allow for terms relating to male homosexuality. We also analyzed the terms assigned to papers published in the Journal of Homosexuality, Sexualities and Journal of Gay & Lesbian Mental Health between the years 2005 to 2009. From this analysis of terms and the Brazilian indexing languages, we see (1) the Brazilian context, (2) imprecision in the terminology, (3) indications of prejudices disseminated by political correctness, (4) biased representation of the subject matter, (5) and the presence of figures of speech.

Analysis of the ethical aspects of professional confidentiality in dental practice

From the point of view of deontological ethics, privacy is a moral right that patients are entitled to and it is bound to professional confidentiality. Otherwise, the information given by patients to health professionals would not be reliable and a trustable relationship could not be established. The aim of the present study was to assess, by means of questionnaires with open and closed questions, the awareness and attitudes of 100 dentists working in the city of Andradina, São Paulo State, Brazil, with respect to professional confidentiality in dental practice. Most dentists (91.43%) reported to have instructed their assistants on professional confidentiality. However, 44.29% of the interviewees showed to act contradictorily as reported talking about the clinical cases of their patients to their friends or spouses. The great majority of professionals (98.57%) believed that it is important to have classes on Ethics and Bioethics during graduation and, when asked about their knowledge of the penalties imposed for breach of professional confidentiality, only 48.57% of them declared to be aware of it. Only 28.57% of the interviewees affirmed to have exclusive access to the files; 67.14% reported that that files were also accessed by their secretary; 1.43% answered that their spouses also had access, and 2.86% did not answer. From the results of the present survey, it could be observed that, although dentists affirmed to be aware of professional confidentiality, their attitudes did not adhere to ethical and legal requirements. This stand of health professionals has contributed to violate professional ethics and the law itself, bringing problems both to the professional and to the patient.