The United Nations Educational, Scientific and Cultural Organisation’s Declaration on Bioethics and Human Rights refers to the importance of cultural diversity and pluralism in ethical discourse and care of humanity. The aim of this meta-narrative review is to identify indigenous ethical values pertaining to the Ojibway, Xhosa, and Mayan cultures from peer-reviewed sources and cultural review, and to ascertain if there are shared commonalities. Three main themes were identified, namely illness, healing, and health care choices. Illness was described with a (...) more complex and dynamic picture than from the western view, as illness is not considered to be one dimensional. Healing needs to take place on various levels in order to restore a state of equilibrium between the different spheres. Health care choices were also considered from a multi-level perspective. In all three of the indigenous cultures explored, good decision-making is seen to have occurred when choices are informed by commitments to one’s moral and ethical responsibilities towards the community, nature, and the spirit world. (shrink)

Moral distress is defined as the inability to act according to one’s own core values. During the COVID-19 pandemic, moral distress in medical personnel has gained attention, related to the impact of pandemic-associated factors, such as the uncertainty of treatment options for the virus and the accelerated pace of deaths. Measures to provide aid and mitigate the long-term pandemic effect on providers are starting to be designed. Yet, little has been said about the moral distress experienced by patients and the (...) relational and additive effect on provider moral distress. Pandemic-associated factors affecting moral distress in patients include the constraining effects of isolation on spiritual and religious traditions as well as the intentional separation of patients from their families. This paper will explore the idea that patients are suffering their own moral distress and further how this impacts the intensity of moral distress experienced by the providers—nurses and physicians. The paucity of research in this area with the implications on patient’s distress, decision making, and distress experienced by providers compels further investigation and analysis. (shrink)

Global health conditions are marked by inequities due mostly to poverty and lack of access to healthcare services. In a Pandemic setting, Mayan Communities in the Quintana Roo State in Mexico are a good example of how these disparities are exacerbated. First, they may have difficulty in adhering to directives to stay home from work because of the nature of their job, and the necessity to work, their living conditions are marked by crowding and sometimes lack of basic sanitation. Other (...) susceptibilities generally considered are the underlying host factors and medical conditions that may increase the risk of disease or of complications of disease. In general, our native communities experience a high degree of socio-economic marginalization and are at disproportionate risk in public health emergencies, becoming even more vulnerable during this global pandemic, owing to factors such as their lack of access to effective monitoring and early-warning systems, and adequate health and social services. (shrink)

La nueva enfermedad del coronavirus de 2019 (Covid-19), producida por el coronavirus del Síndrome Respiratorio Agudo Severo 2 (SARS-CoV-2), es una pandemia que está creando una creciente crisis sanitaria mundial, dada su novedad, su alcance y sus inicialmente limitadas opciones de tratamiento eficaz. En efecto, se sabe poco acerca de las intervenciones no farmacéuticas óptimas para evitar la morbilidad y mortalidad causadas por él, y también se conoce poco sobre la rentabilidad y aspectos éticos de dichas intervenciones. Por lo tanto, (...) éste es el primer análisis ético y de rentabilidad de las medidas de contención del Covid-19 que se conoce (así como de las medidas de cuarentena de la población para cualquier pandemia en particular), con el fin de ayudar a los sistemas de salud y a los gobiernos a garantizar la atención clínica más rentable que pueda proporcionarse equitativamente al mayor número posible de pacientes, durante esta pandemia y en las futuras crisis mundiales que sean similares. Este análisis utilizó la metodología adoptada por los Centros para el Control y la Prevención de Enfermedades (CDC), cifras comúnmente aceptadas como entradas, y los supuestos mínimos tanto extremos como del mundo real para proporcionar los resultados más sólidos y confiables posibles. El análisis de costos indicó que en los escenarios extremos, o en el mejor de los casos para las medidas de contención del Covid-19 durante la cuarentena de la población, hay una relación de costo-efectividad de $154.86 millones de dólares gastados por cada muerte evitada, y un costo neto de $1.92 billones a nivel mundial. En el mundo real, esta intervención tiene una proporción de 2,520 millones de dólares gastados por cada muerte evitada y un costo neto de 1,99 billones de dólares. La ética del contrato social personalista, tal y como se articula en el popular sistema ético de derechos y deberes de las Naciones Unidas, pone de manifiesto la especial preocupación por el hecho de que estos confinamientos pueden derivar en injusticias poco éticas perpetuadas por los Estados, de manera que socavan las vidas y las libertades individuales, al tiempo que afectan de manera des- proporcionada a las comunidades de menores ingresos, especialmente a las minorías raciales. Este estudio sugiere, por tanto, que la práctica prevalente de la cuarentena entre la población, en comparación con las precauciones de tipo estándar y las intervenciones más específicas, puede proporcionar un beneficio neto inadecuado por su costo financiero y ético. En un momento de escasez mundial, que pone a prueba la capacidad de los sistemas sanitarios para detectar y atender adecuadamente a los pacientes con Covid-19, especialmente en los países en desarrollo y en las comunidades desatendidas, este estudio respalda que se dediquen menos recursos a intervenciones con una relación costo- beneficio poco clara, y más recursos a intervenciones más asequibles, éticas y equitativas, con mayores pruebas de sus beneficios netos para salvar vidas. (shrink)

The biopsychosocial model is characterized by the systematic consideration of biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery. This model opposes the biomedical model, which is the foundation of most current clinical practice. In the biomedical model, quest for evidence based medicine, the patient is reduced to molecules, genes, organelles, systems, diseases, etc. This reduction has brought great advances in medicine, but it lacks a holistic view of the person. To solve (...) the problem, we propose an early team based approach where the primary care physician leads a group of people that can help her/him address the psychosocial issues while she/he attends to the biomedical issues. This article addresses one case where the clinical ethicist facilitating a team based biopsychosocial model for the care of a patient worked as a bridge between the primary team, the critical care team, and the psychosocial team to advance the argument that good communication among the groups can lead to a true biopsychosocial model where the collaboration of the social worker, psychologist, chaplain, ethicist and the different medical teams can improve the overall patient experience. (shrink)