“A landmark case transforms informed consent in the UK”, BioEdge

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“A ruling by a UK court last year forces doctors to tell their patients the full range of treatment options and allowing them to choose. The Royal College of Surgeons has warned of “a dramatic increase in the number of litigation pay-outs” made if doctors and hospitals do not make changes to the processes they use to gain consent from patients before surgery.

Traditionally it was up to British doctors to decide what risks to communicate to patients. But last year the UK Supreme Court held in a case called Montgomery vs Lanarkshire Health Board, that doctors must ensure patients are aware of any and all risks that an individual patient, not a doctor, might consider significant.

In other words, doctors can no longer be the sole arbiter of determining what risks are material to the patient.

In the past, litigation in malpractice suits was governed by the Bolam principle, which saw the judgement of medical experts as the main criterion for assessing reasonable care in negligence cases and for deciding what risks should be communicated to the patient for a chosen treatment.

Now the pendulum has swung from the “reasonable doctor” to the “reasonable patient”. This could mean a huge increase in the workload of doctors. A spokesman for the College said:

“It’s not hard to see how in many hospitals gaining a patient’s consent has become a paper tick-box exercise, hurriedly done in the minutes before a patient is wheeled into theatre for their procedure. Operating lists and consultation clinics are packed leaving little time for these important consent discussions. Patients must be given enough time to make an informed decision about their treatment and hospitals are going to have to give serious thought to how they plan in time for these discussions.”

Philippa Taylor, a bioethicist with the Christian Medical Fellowship, in London, believes that the Montgomery ruling may have the unexpected consequence of curbing abortion in the UK.

There is no absolute legal requirement for the doctor to have seen a patient requesting an abortion, or to have a one-to-one conversation about personal values and beliefs. However the new ruling has now made it clear that in the consent process doctors should explore options with that specific patient in mind. Those who ignore or withhold information due to bias (or paternalism) are breaking the law.

It is also possible that doctors who withhold information on the risks of abortion, even if small, such as the now well recognised link between abortions and later preterm deliveries, and the link to adverse mental health consequences, and even on the possible link to breast cancer, evidenced in some research, may be at risk of now breaking the law. It seems that the case for independent abortion counselling and accurate information giving has just got stronger.”

(os negritos foram assinalados por mim)

– See more at: http://www.bioedge.org/bioethics/a-landmark-case-transforms-informed-consent-in-the-uk/12082#sthash.2mpKywVJ.dpuf

João Lobo Antunes, 04.06.1944 – 27.10.2016

Site CNECV “É com profunda tristeza que damos conta do falecimento do Presidente do Conselho Nacional de Ética para as Ciências da Vida, Professor Doutor João Lobo Antunes.

A intervenção do Professor João Lobo Antunes no Conselho Nacional de Ética, como seu Presidente desde 2015, mas também como membro do seu terceiro mandato, de 2003 a 2009, deixa, a todos quantos tiveram a ventura de com ele partilhar a reflexão bioética, a força e a inspiração de uma participação intelectualmente elevada, humanista, de grande sensibilidade, movida por um grande sentido de serviço ao país, que estendeu ao Conselho Nacional de Ética, onde promoveu e estimulou uma reflexão da maior pertinência em matérias de particular sensibilidade.

Homem da ciência, médico, ensaísta, pensador, o Professor João Lobo Antunes deixa uma marca indelével na cultura portuguesa e a certeza de que a sua obra permanecerá, perpetuada na nossa memória e no nosso quotidiano. Deixa a todos uma enorme saudade também pelas suas qualidades pessoais, a sua generosidade e o seu afeto, que tocaram todos quantos tiveram a felicidade de o conhecer.

O CNECV presta assim a sua mais sentida homenagem e exprime uma imensa gratidão pelo contributo dado pelo Professor João Lobo Antunes para a construção pioneira deste Conselho e para a Bioética em Portugal.”

http://www.cnecv.pt/

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“Are ethical norms and current policies still relevant in face of the recent mass terror events?”

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Um antigo estudante enviou-me o link e o artigo vale a leitura:

Are ethical norms and current policies still relevant in face of the recent mass terror events?

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2016, 24:118
Abstract

The widespread utilization of social media in recent terror attacks in major European cities should raise a “red flag” for the emergency medical response teams. The question arises as to the impact of social media during terror events on the healthcare system. Information was published well before any emergency authority received a distress call or was requested to respond. Photos published at early stages of the attacks, through social media were uncensored, presenting identifiable pictures of victims. Technological advancements of recent years decrease and remove barriers that enable the public to use them as they see fit. These attacks raise ethical considerations for the patients and their rights as they were outsourced from the medical community, into the hands of the public. The healthcare system should leverage social media and its advantages in designing response to terror, but this requires a re-evaluation and introspection into the current emergency response models.

………………….

excertos:

The widespread utilization of social media in recent terror attacks of major European cities, including Brussels (March 2016), Paris (November 2015 & June 2016), and Istanbul (June 2016) should raise a “red flag” for the emergency response community, most specifically for medical response teams.

Social media has been researched extensively in regards to emergency management for both natural and man made emergencies [1, 2]. Major recent disasters, such as the 2010 Haiti earthquake, the 2012 “Super-storm Sandy” or the 2015 Nepal earthquake have all presented social media as the major communication channel between first responders and the public. The question arises as to the impact of social media during terror events, and whether the bi-directional and extremely rapid communication should serve as a wake-up call for the healthcare system concerning ethical norms that up to now have been accepted as important.

……………

conclusions

The terror attacks that were inflicted on European cities during the last year exemplified that EMS organizations, as well as other health services, should reassess their response policies. This should include better education of the public sharing photos and information that may harm and invade patients’ privacy. There is a growing rift between the ethical norms which emergency medicine and health services’ professionals adhere to, compared to those that the public adopts while engaging in social media during emergencies. Medical guidelines and policies utilized during the response phase should be modified and adjusted to the new reality that had already changed.

The healthcare system should adopt, use and leverage social media and its advantages in designing response to terror events as well as other types of emergencies

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Junto o pdf aqui: are-ethical-norms-and current-policies still relevant

Leituras ou [re]leituras: “Pessoas transparentes”

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Pessoas Transparentes. Questões Actuais de Bioética, de Manuel Curado e Nuno Oliveira

 O que primeiro vi no livro, a par do título, foi a silhueta recortada de uma pessoa na capa (mesmo recortada) e a interrogativa sobre o conceito – «transparentes»?!
Prefácio
“A nossa boca abre-se de espanto quando nos deparamos com notícias relacionadas com a Bioética. A história dos bebés que nascem depois da morte das suas mães, as técnicas de reprodução que usam óvulos de duas mulheres e esperma de um homem para conceber uma criança, as aplicações de engenharia biomédica no corpo humano, os transplantes da cara, a interrupção das medidas de nutrição e hidratação artificiais de pessoas em coma, a clonagem, a investigação e comércio de células estaminais, o transplante de órgãos, a utilização de fármacos para alteração do humor e da personalidade das pessoas, o aborto em diferentes momentos de gestação,  a alteração do sexo, a engenharia genética, o consentimento informado, o direito a saber, o direito a não saber, a definição de morte, o diagnóstico pré-natal, o armazenamento de embr´~oes humanos congelados, o uso de seres humanos, de animais e de tecido fetal na investigação científica, a identificação de portadores do vírus da SIDA e de outras infecções graves, o destino a dar aos resíduos tóxicos e hospitalares, a afetação de recursos escassos na saúde, a fronteira ténue e perigosa entre o estado e o indivíduo no que diz respeito à vida e à intimidade, a eutanásia e o suicídio assistido… A lista de notícias que nos surpreendem, encantam, chocam e nos envchem de perplexidade pode continuar infindavelmente.”

Edições Almedina, 2010

“Study on the gender dimension of trafficking in human beings”

study on the gender

“A Comissão Europeia acaba de publicar o «Estudo Sobre a Dimensão de Género no Tráfico de Seres Humanos», no âmbito da Estratégia da União Europeia para a Erradicação do Tráfico de Seres Humanos 2012-2016. Este estudo enquadra-se na prioridade E da Estratégia, que visa conhecer melhor os novos problemas relacionados com todas as formas de tráfico de seres humanos (TSH) e dar-lhes uma resposta eficaz. Mais concretamente, diz respeito à Ação 2, cujo objetivo é promover o conhecimento sobre a dimensão do género no TSH e sobre os grupos vulneráveis, nomeadamente as especificidades ligadas ao género, que caracterizam a forma como os homens e mulheres são recrutados/as e explorados/as, as consequências em termos de género das diversas formas de tráfico e as potenciais diferenças entre homens e mulheres no que se refere à vulnerabilidade ao tráfico e o seu impacto sobre ambos os géneros.” (site da CIG)

“This report is concerned with practices to reduce and combat trafficking in human beings: service provision, law enforcement, online safeguarding, and prostitution policy change. Statistics can support the evaluation of these practices by evidencing change over time and between different regimes. In order to do so, robust and comparable measures of trafficking in human beings and in prostitution are needed.

Introduction

Methodology

Review of key issues in the literature

Victim assistance: United Kingdom example

Measuring trafficking EU-28

Demand reduction: Germany and the Netherlands

Demand reduction: Sweden

Law enforcement: justice and home affairs EU agencies

Emerging cyber technology

Conclusions from gender analysis

Recommendations

Annex: Relevant law and policy instruments

References

Relatório aqui

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2015 “Trafficking in Human Beings”

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Em 2013 o Eurostat publicou o primeiro relatório sobre Trafficking in Human Beings in Europe. Na edição de 2015, o Relatório apresenta dados dos 28 membros da UE e inclui Montenegro, Noruega, Sérvia, Suiça, Turquia e Islândia, bem como comparativos com outros países, com dados dos anos de 2010, 2011 e 2012.

” The totals and percentages in the working paper are based on data from the EU Member States. Where relevant, the number of Member States providing data, and on which the statistics are based, is also given. Data from the non-EU countries have been highlighted separately in some sections. This is a working paper looking at statistical data at EU level as gathered and submitted by national authorities. In this respect, it is a unique undertaking in this field at EU level. The data have been collected from official sources, and provide information on registered victims, suspects, prosecutions and convictions, as recorded by the authorities. As such, this working paper differs from other reports which have looked at estimates of the prevalence of trafficking in human beings, for example. There may also be studies at national or regional level which provide greater detail about a specific subset of the phenomenon or which look at a narrower geographical area. This report should be considered alongside such studies to gain maximum benefit from the full evidence base available.

Since the first working paper, encouraging progress has been achieved in terms of availability of data. This working paper reaffirms the need for further improvement, as more comprehensive and comparable data will allow for a more accurate assessment of the nature of the problem, as well as more accurate conclusions at EU level.
Not all Member States have provided comprehensive data on all indicators. In view of this, and the differences between national definitions and recording systems, figures should be interpreted with caution, and with careful consideration of the methodological notes provided. A higher number of reported cases does not necessarily mean that a country has more victims than another country. Nor is it necessarily an indication of a better identification or recording system. Sudden increases or decreases may merely reflect legislative modifications, changes in statistical procedures and counting rules, or be the result of specific law enforcement initiatives. Careful analysis of the information provided in the country notes is required to allow for a comprehensive understanding of the values reported, and comparisons between Member States should be avoided.” (Executive Summary)
1. Key findings
Registered victims
• 30 146 victims were registered in the 28 EU Member States over the three years 2010-2012.
• 80 % of registered victims were female.
• Over 1 000 child victims were trafficked for sexual exploitation.
• 69 % of registered victims were trafficked for sexual exploitation.
• 95 % of registered victims of sexual exploitation were female.
• 71 % of registered victims of labour exploitation were male.
• 65 % of registered victims were EU citizens.
• There are no discernible trends in the variation of victim data at EU level over the three reference years.
Traffickers
• 8 805 prosecutions for trafficking in human beings were reported by Member States over the three years 2010-2012.
• Over 70 % of traffickers were male. This is the case for suspects, prosecutions and convicted traffickers.
• 3 855 convictions for trafficking in human beings were reported by Member States over the three years.
• There are no discernible trends in the number of prosecutions or convictions at EU level.
EU Member States where authorities report coming into contact with more victims as a proportion of the total population (more than 5 registered victims per 100 000 inhabitants) in each of the three reference years are Bulgaria, the Netherlands and Romania. Countries where authorities report coming into contact with a lower number of victims as a proportion of the total population (less than 1 victim per 100 000 inhabitants) are Croatia, Germany, Greece, Lithuania, Portugal, Poland and Slovakia.
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