Zerebrale Probleme in der pädiatrischen Intensivmedizin [Cerebral problems in pediatric intensive care]

This paper presents a review of different methods enabling the monitoring of cerebral function in neonatal and paediatric intensive care. EEG, evoked potentials, conventional radiological studies, computerized tomography, ultrasound, intracranial pressure measurements, nuclear magnetic resonance, Doppler ultrasound, radioisotope studies, angiography, infra-red spectral analysis and last, but not least, clinical examination produce information regarding the neurological state of the patient which must be critically analysed in order to ensure optimal management of the case. Unfortunately, and in spite of impressive progress in non-invasive monitoring of the cerebral function, we are still forced to make important medical and ethical decisions without precise information about the neurological state of our patients.

Best Practice Guidance on Joint Working between the HSC and the Pharmaceutical Industry and other relevant organisations (PDF 260KB)

HSS (GEN) 1) 1/95 update. It is intended to replace the guidance previously provided by former HSSBs and Trusts to assist employers and staff in maintaining strict ethical standards in the conduct of HSC business, in this instance, with the pharmaceutical industry

Änderung des Therapieziels am Lebensende: Effekte einer Klinik-Leitlinie [Changing the treatment goal at the end of life: effects of a guideline at a hospital].

BACKGROUND AND OBJECTIVE: Deciding about treatment goals at the end of life is a frequent and difficult challenge to medical staff. As more health care institutions issue ethico-legal guidelines to their staff the effects of such a guideline should be investigated in a pilot project.¦PARTICIPANTS AND METHODS: Prospective evaluation study using the pre-post method. Physicians and nurses working in ten intensive care units of a university medical center in Germany answered a specially designed questionnaire before and one year after issuance of the guideline.¦RESULTS: 197 analyzable answers were obtained from the first (pre-guideline) and 251 from the second (post-guideline) survey (54 % and 58 % response rate, respectively). Initially the clinicians expressed their need for guidelines, advice on ethical problems, and continuing education. One year after introduction of the guideline one third of the clinicians was familiar with the guideline's content and another third was aware of its existence. 90% of those who knew the document welcomed it. Explanation of the legal aspects was seen as its most useful element. The pre- and post-guideline comparison demonstrated that uncertainty in decision making and fear of legal consequences were reduced, while knowledge of legal aspects and the value given to advance directives increased. The residents had derived the greatest benefit.¦CONCLUSION: By promoting the knowledge of legal aspects and ethical considerations, guidelines given to medical staff can lead to more certainty when making in end of life decision.

Comunidad y ciudadanía activa: fenomenología de una ocupación ética en un contexto de inmigración

La teoria i la praxi de la investigació qualitativa actual és hereva de la tradició fenomenològica. L’objectiu de la investigació està relacionat amb la comprensió profunda de les dimensions de l’educació i el treball, així com la seva significació per a les dones i els homes amb històries de vida marcades per la immigració. També, el treball de la investigació actual analitza la construcció de una identitat individual i col•lectiva de les dones i els homes amb una història d’immigració i reflexiona com desenvolupen el seu compromís a través d’una ocupació ètica. Es fa èmfasi en els elements transversals de la cultura i les construccions de gènere dins del domini de treball i educació. El mètode biogràfic narratiu es va utilitzar per estudiar les qüestions plantejades per la investigació. El procés de triangulació de les veus de les dones, els homes i de l’organització participant es va duu a terme per assegurar la validesa dels resultats i es van interpretar els indicadors de la recerca des del marc teòric proposat. A mode de conclusió, el treball es refereix a la formació permanent i considera que la violació del dret a l’educació és un factor que limita les oportunitats d’experimentar aquest tipus d’ocupació i, té efectes en la integritat personal i col·lectiva. Esperem que aquesta investigació pugui contribuir a la política d’immigració de les diferents organitzacions.

The adolescent with a chronic condition. Part II: healthcare provision.

The treatment and management of chronic conditions during adolescence pose specific issues that need to be appropriately handled by health professionals. In this paper, questions related to disclosure of the diagnosis, the management of adherence to therapy, the need for an interdisciplinary network approach, lifestyles' anticipatory guidance and prevention, and the transition into an adult healthcare setting are reviewed. Special areas such as the issue of life threatening diseases and the ethical aspects of the treatment of chronic conditions are also discussed.

Abortion in public reason

What abortion laws a liberal political community ought to have? Much has been said about the moral problem of abortion, but there has not been yet (to my knowledge) a fully articulate account of the bearing of the competing answers to this ethical problem on liberal public reason. The first part of my project consists in a critical review of the different attempts to solve the various philosophical puzzles, both metaphysical and moral, posed by the abortion problem. Why is it wrong to kill beings like you and me? By answering this question we shall gain a better insight into those properties we have that give us such strong reasons against killing beings like us. Here we face a tremendous philosophical diffuculty, for it is not possible to determine what the robustest account of the wrongness of killing is without dealing with deeper metaethical and metaphysical problems. Indeed, consequentialist and nonconsequentialist moral theories differ in what it is that makes an action morally wrong -is it just the outcome of the action as compared with the outcomes of its alternatives? Or is it something else? Also, what are we essentially? Is the foetus merely our precursor? Then killing a foetus is relevantly similar to contraception. Or is the foetus one of us? If so, when we kill it, are we depriving it of a future as valuable as ours? Perhaps the relation of identity (the fact that it is its future as opposed to someone else's) doesn't matter. That may be because the foetus is an aggregate of biological and psychological facts and perhaps aggregates are not substances. Or maybe it is a substance but only psychological realtions matter, not personal identity. The second part of my project has to do with the different status these metaphisical and ethical positions ought to have in liberal public reason. Though this is the part in which most research is still needed, my own intuition is that, given the depth of the philosphical views in competition, restrictive abortion laws ought to be considered unrespectful to citizens' autonomy.

Aggregating brain cell cultures for neurotoxicological studies.

Because of the limited accessibility of the brain for experimentation, but also for ethical and economical reasons, there is considerable interest in culture models suitable for neurotoxicological research. Although it is generally accepted that in vitro models cannot cover the entire spectrum of brain functions, they have proven to be indispensable for investigations in the life sciences since the early work of Harrison (1). To date, many in vitro models of various complexity are available, ranging from monolayer cultures of immortalized cell lines to organotypic cultures. Each of these culture systems has its particularities, therefore, it is of great importance to select the model that is most appropriate for the question to be solved.

Report of the Working Group on Post Mortem Practice

The Madden Report into Post Mortem Practice and Procedure (2005)1 stated that consideration should be given to the implementation of the recommendations made in the Report to other post mortems2, namely those carried out on babies who died before or during birth, minors and adults. It was acknowledged that while many of the recommendations in the Report may apply generically to all categories of post-mortem examinations, these post mortems also raise distinct legal and ethical issues that were not within the Terms of Reference of the Madden Report. The Report advised that a Working Group be established to ensure that appropriate adaptation in relation to those issues takes place. The terms of reference were: Read the report (PDF, 117kb)

Cultural male circumcision - Report of Committee 2004/2005

Male circumcision is performed for two general reasons namely where there are medical indications or for cultural requirements. The tragic death of a male infant following a circumcision performed outside the health-care setting highlighted the need to provide recommendations for health-care providers to help prevent such circumstances arising again. The Minister for Health and Children established a group to advise on the needs, ethical recommendations and practical guidance on circumcision performed for cultural reasons. At all times, the welfare of the child was considered paramount. Read the report (PDF, 83kb)

La ética del cuidar y la atención de enfermería

El present treball analitza l'ètica de la cura i l'atenció d'infermeria. Es descriuen els seus antecedents i la influència del feminisme en les cures d'infermeria. Així mateix, s'analitza mitjançant unes entrevistes en profunditat, la dimensió ètica de les cures segons els models de Watson i Roach a un centre hospitalari del nostre pais.

Ètica de la benevolència : Reflexions sobre el pensament moral de Robert Spaemann

Qui és Robert Spaemann?, en què consisteix l'ètica de la benevolència?, quina correlació hi ha entre la visió antropològica d'aquest filòsof i les seves propostes ètiques? El treball vol respondre aquestes i altres preguntes sobre aquest filòsof i docent, especialitzat en filosofia pràctica, que ha rebut reconeixements arreu, tot i que encara és poc conegut en el nostre país.

Aspectes bioètics de les malalties genètiques hereditàries : Els casos de la fibrosi quística i la corea de Huntington

Els objectius principals del treball que es volen assolir són analitzar la problemàtica a nivell bioètic plantejada per les malalties hereditàries i l'observació de les conseqüències ètico morals de les innovacions tecnològiques en matèria genètica. Altres objectius són el coneixement del vocabulari bioètic i analitzar la influència del pensament filosòfic en l'activitat científica.

La ciència ficció : un pont entre les ciències i les Humanidades

La hipòtesi vol contestar la pregunta següent: pot la ciència-ficció ajudar a construir un nexe d'unió afavorint una lectura ètica de la ciència i la tecnologia? Esbrinant els motius dels distanciament entre ciències i Humanidades, veient en particular com és tractada l'ètica en la literatura de ciència-ficció i cercant punts de connexió entre ambdós mons.

Observing workplace incivility towards women: The roles of target reactions, actor motives, and actor-target relationships

The current study conceptualized observer reactions to uncivil behavior towards women as an ethical behavior and examined three factors (target reaction, actor motive, and actor-target relationship) that influence these reactions. Two vignette studies with women and men undergraduate and graduate students in western Switzerland were conducted. Study 1 (N=148) was a written vignette study that assessed how the reaction of female targets to incivility and the motives of actors influenced observer reactions. Results showed that a female target's reaction influenced observers' evaluations of the harm caused by an uncivil incident, and that an actor's motive affected observers' assessments of the necessity to intervene. Study 2 (N=81) was a video vignette study that assessed the effects of the reactions by female targets to incivility and the relationship between the target and the actor on observer reactions.We found that female targets' reactions influenced observers' evaluations of harm and the perceived necessity to intervene. Furthermore, the effect of a female target's reaction on observers' evaluations of harm was moderated by the relationship between the actor and the target: a female target who laughed at the uncivil behavior was perceived as less harmed, when she and the actor had a personal relationship than when they had a professional relationship. When the female target reacted hurt or neutrally, actor-target relationship did not affect observers' evaluations of harm. We conclude by discussing the implications of our findings for theory and practice.

Polymédication et personne agée: ni trop ni trop peu [Polypharmacy and the elderly: neither too much nor too little].

Elderly persons are at high risk of polypharmacy. Polypharmacy has been associated with numerous adverse outcomes, such as poorer quality of life, higher morbidity and mortality. However, deciding to stop or to continue a treatment is a difficult task, which confronts the physician to complex clinical and ethical choices. Such a decision requires a geriatric multidimensional assessment of the patient, an estimation of his or her prognosis, the definition of the goals of care and a careful assessment of the time to benefit of each drug. Diverse methods and tools to support the physician in this process are discussed in this article. However these can not replace a reflexive approach of the physician that integrates the values and representations of the patient with regard to his or her health and end of life, as well as his or her needs, fears and choices.