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Enviado por Biblio on 6/7/2015 9:42:46 (15 Lecturas)

In her diary, Godelieva De Troyer classified her moods by color. She felt “dark gray” when she made a mistake while sewing or cooking. When her boyfriend talked too much, she moved between “very black” and “black!” She was afflicted with the worst kind of “black spot” when she visited her parents at their farm in northern Belgium. In their presence, she felt aggressive and dangerous. She worried that she had two selves, one “empathetic, charming, sensible” and the other cruel.

Enviado por Biblio on 3/7/2015 9:07:47 (30 Lecturas)

Gènéthique vous informe
17 juin 2015

Dans le cadre du forum Science, Recherche et Société, organisé par le quotidien le Monde et le magazine la Recherche, Nicolas Demassieux (Directeur Recherche et Stratégie de Orange labs), le Dr François Berger (Neuro-cancérologue à l’Inserm), Laurent Alexandre (chirurgien et urologue, fondateur de DNAVision), et le philosophe Jean Michel Besnier sont venus tenir une conférence interrogeant le rapport fascinant et inquiétant qui existe entre le progrès technologique et nos perspectives d’avenir.

Enviado por Biblio on 2/7/2015 9:30:20 (32 Lecturas)

In light of the recent Medicine and Society series of articles by Lisa Rosenbaum, M.D., and the accompanying editorial by Jeffrey M. Drazen, M.D., we invite you to put yourself in the role of editor and help us decide about the suitability of three hypothetical potential authors of review articles for the Journal. A summary of the community responses to this informal poll will appear during the summer. We thank you for participating in the discussion.
Participate in the poll and share your comments through June 17, 2015.

Case 1.
Jane Doe, M.D., Ph.D., is a world-renowned researcher in the area of disease X, a condition affecting hundreds of thousands people worldwide. There is a good diagnostic test for disease X, but there are no effective treatments. Doe’s lab developed the diagnostic test, and her institution held a patent on key technology related to the test. Doe’s institution, her laboratory, and Doe herself received annual royalty payments of $15,000 to $20,000 until 2 years ago, when the patent expired. Doe has consulted for four different pharmaceutical companies; over the past 3 years, each company has paid her over $10,000 per year to develop new therapeutic agents for the disease. Although there are promising leads, no drug has progressed beyond phase 1 safety testing in humans. The Journal is considering soliciting a review article on disease X. Since there are no available treatments, the review will focus largely on disease biology, with indications of where treatments could be used.

Enviado por Biblio on 1/7/2015 8:42:19 (40 Lecturas)

Dutch paediatricians back euthanasia for under-12s
by Michael Cook | 27 Jun 2015 | (3)

tags: euthanasia, euthanasia for children, Netherlands

Dutch paediatricians are backing euthanasia for children aged from 1 to 12. In a position paper released on June 19, the NVK (the Dutch Paediatricians’ Association) recommended that deliberate termination of life be available when palliative care is ineffective.

“We feel that an arbitrary age limit such as 12 should be changed,” said Professor Eduard Verhagen, of Groningen University, a long-time champion of euthanasia for children. “Each child's ability to ask to die should be evaluated on a case-by-case basis.”

Belgium has already removed the age limit on euthanasia and the Netherlands is lagging behind. Under the current rules, children between 12 and 16 must have parental approval, while euthanasia is banned for those under 12 – except for children under 12 months, who can be euthanased involuntarily.

Enviado por Biblio on 30/6/2015 10:16:48 (42 Lecturas)

Unanimity on Death with Dignity — Legalizing Physician-Assisted Dying in Canada
Amir Attaran, D.Phil., LL.B.
N Engl J Med 2015; 372:2080-2082May 28, 2015DOI: 10.1056/NEJMp1502442

In February 2015, Canada legalized physician-assisted dying — a first among countries with common-law systems, in which law is often developed by judges through case decisions and precedent. The Supreme Court of Canada issued the decision in Carter v. Canada,1 and its reasoning and implications for clinical practice bear examination.
Canada's path to this point has not been short. In 1993, the Court rejected legalization of physician-assisted dying on a 5-to-4 vote, and Parliament has since considered the issue several times but demurred — though the province of Quebec passed a “medical aid in dying” law in 2014. The Carter judgment triggered a year-long grace period during which Canada's federal and provincial governments and the medical profession must arrange for an orderly transition so that by early 2016, Canadian patients can choose to die with a doctor's help

Enviado por Biblio on 29/6/2015 10:32:44 (36 Lecturas)

Behavioral Economics and Physician Compensation — Promise and Challenges
Dhruv Khullar, M.D., M.P.P., Dave A. Chokshi, M.D., Robert Kocher, M.D., Ashok Reddy, M.D., Karna Basu, Ph.D., Patrick H. Conway, M.D., and Rahul Rajkumar, M.D., J.D.
N Engl J Med 2015; 372:2281-2283June 11, 2015DOI: 10.1056/NEJMp1502312

Interview with Dr. Dhruv Khullar on uses of behavioral economics concepts in modifying physicians’ behavior under value-based health care models.
Interview with Dr. Dhruv Khullar on uses of behavioral economics concepts in modifying physicians’ behavior under value-based health care models. (9:26)
Medicare aims to apply alternative payment models to 50% of its fee-for-service payments by the end of 2018 — an important shift toward value-based health care.1 The success of national payment reform, however, will depend on engaging clinicians in making better decisions in managing individual and population health. Many physician behaviors are well explained by “rational” economic models (e.g., fee-for-service reimbursement tends to promote well-compensated procedures), and revising incentives may drive changes in decision making, shifting our focus from volume to value. Provider organizations embracing alternative payment models may find that applying behavioral economics can boost the effect of new incentives.

Enviado por Biblio on 26/6/2015 15:07:16 (64 Lecturas)

Letitia Meynell argues that professional schools must both integrate ethics across their curricula and include ethics education taught by people external to the profession and the school.

The case of the Dalhousie Dentistry School Class of 2015 Gentleman brought to the fore both the importance of ethics and our failures to adequately teach ethics at the university. While ethics is important across the academy, it is distinctively important and particularly challenging in professional training contexts. For better or worse, professionals generally are accorded positions of authority and respect in our society. They are frequently in positions of trust whether with regard to individual patients and clients (as with health care professionals and accountants) or with the public at large (as with engineers and architects). Thus it is reasonable to think that substantial effort should be put into equipping students in professional programs with a wide ranging and nuanced understanding of ethical issues and challenges, ranging from those particular to their line of work to quite general concerns about the public good.

Enviado por Biblio on 25/6/2015 9:12:42 (73 Lecturas)

Right to a good death for all

21 May 2015

Atul Gawande, the doctor and Harvard professor who gave this year’s BBC Reith Lectures, has spoken powerfully of what he calls “the problem of hubris” – the medical profession’s insistence that doctors must always have a treatment to offer their patients even when they are entering their final days. The professional focus on recovery sees death as a failure. Gawande admits that he himself has offered the terminally ill experimental treatments rather than accept what felt like defeat.

The report this week from the parliamentary and health service ombudsman into end-of-life care in the NHS makes for disturbing reading. It found that many patients endure undignified and painful deaths. The refusal to accept that someone is dying can be the root of the problem. Rather than switch to palliative care, doctors preferred to try treatments that often proved useless, merely prolonging a patient’s distress. Sometimes they were not even told they were dying.

Enviado por Biblio on 23/6/2015 9:33:13 (70 Lecturas)

Beyond Moral Outrage — Weighing the Trade-Offs of COI Regulation

Lisa Rosenbaum, M.D.
N Engl J Med 2015; 372:2064-2068May 21, 2015DOI: 10.1056/NEJMms1502498

Although I probably couldn’t have explained its rationale, I never questioned the anti-pharma animus that pervaded my medical education. The message I received from certain outspoken classmates and fellow trainees was that interacting with pharmaceutical reps was simply wrong. Being caught with a pharma-sponsored sandwich was like being seen throwing compostable items into the garbage: people glared. Being a pharmascold conferred the do-gooder sheen many of us coveted.

Enviado por Biblio on 22/6/2015 10:12:47 (68 Lecturas)

synthèse de presse bioéthique
19 juin 2015 Fin de vie

Un rapport académique publié par le Journal of medical ethics a révélé les inquiétantes dérives euthanasiques qui ont lieu en Belgique où « l’euthanasie est complètement hors de contrôle » (cf. Synthèse Gènéthique du 15 janvier 2015).
Ce rapport révèle notamment la fréquence des euthanasies actives pratiquée sans consentement du patient.

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Bioètica i Debat Ediciones SL