The paper discusses inappropriate (futile) treatment by analyzing the casuistics of palliative patients in the terminal stage of illness who are hospitalized at the Department of Internal Medicine and Geriatrics of the Faculty hospital with policlinic (FNsP). Our research applies the principles of palliative care in the context of bioethics. The existing clinical conditions of healthcare in Slovakia are characteristic of making a taboo of the issues of inappropriate treatment of palliative patients. Inductive-deductive and normative clinical bioethics methods of palliative (...) care and ethical strategy are applied for defining issues found in inappropriate hemodialysis treatment. An algorithm of hemodialysis treatment requires the definition of those lege artis criteria which, in the context of a patient’s autonomy and his/her decision, precondition the avoidance of the situation in which hemodialysis treatment is inappropriate (futile). Futile treatment in a terminal condition is ethically inappropriate medical treatment that extends the suffering of patients and their relatives. Its definition is determined by the relevant legislation and the methods of bioethics. An active palliative strategy is aimed at managing the process of incurable diseases in the patient’s bio-psycho-socio-spiritual continuity in the process of special bioethics. The global bioethical objective of general bioethics for palliative care is based on the paradigm of social harmony and solidarity in the context of an authentic modus of the patient’s existence as a constitutive principle for the phenomenon of the patient’s being to finite being (death). (shrink)

The paper discusses the problem of triaging the elderly in the period of the COVID-19 pandemic crisis by analyzing the triage process, caused by lack of resources, in Germany, Holland, the Czech Republic, and Slovakia. We apply inductive, deductive, and normative bioethical methods, comment on various recommendations for the indication of intensive care during a crisis, and discuss the utilitarianism of benefit maximization. As it follows from the evaluation of the elderly by the frailty parameter, medically inappropriate treatment, as a (...) result of limited resources, is characterized by clinical and bioethical uncertainty. If the main bioethical objective of general bioethics for the COVID-19 pandemic is, in the case of limited resources, based on the non-utilitarian consequentialism paradigm, from the perspective of medical ethics, we face a borderline situation closely related to the topic of dying and death. Such a situation requires social, ethical, and professional reflection. An algorithm for intensive care indication in the situation of crisis and limited resources in the period of the pandemic requires a definition of criteria that identify an acceptable reason for abandoning the treatment in the context of the autonomy of the elderly and by respecting their human dignity and humanity. A global objective of general bioethics in the situation of the pandemic crisis should be based on the paradigm of social justice. (shrink)

Bioethical phenomena of current medicine re-evaluate the universal validity of the bioethical principles of autonomy and justice. Individual areas of medicine feature various degrees of inherent paternalism in clinical situations. External paternalism in itself is not ethical. Abstract principles of medical ethics need to be (re)interpreted. From the bioethical point of view, clinical situations require methodological plurality, i.e., a combination of principilism and inductive models (casuistic ethics, ethics of care). At present, the main ethical clinical approach to patients is ethics (...) of responsibility representing a holistic and continuous paradigm. (shrink)

Case studies are used to reflect on the treatment of patients with dementia hospitalized at the Geriatric Department of the Faculty hospital in Prešov, emphasizing human dignity in clinical practice. The discussion is focused on the palliative care of patients with severe dementia. The biomedical method, which respects human dignity is defined by means of inductive, deductive, and normative bioethical methods. They make it possible to provide guidelines for palliative care and individualized prognosis strategy. An analysis of health status of (...) individuals with severe dementia enables us to offer a clinical definition of purposeful treatment based on normative justice and decision-making that reflects the patient’s best interest, thus respecting their dignity. An evaluation of a patient’s care is based on a biomedical method that considers the dementia stage. Applying a bioethical model in a holistic context preconditions the human rights of patients with dementia. (shrink)