30 research outputs found
Ethics Consultation Services: The Scenario
No full textThis chapter aims to provide a review of the state of the art of the ethical consultation services. In particular, we present a map of the most important traditions, discussing the different conceptions and the different roles they give to the counsellors. Then, we show the place of our ethical counselling methodology within this scenario
CANCER DURING PREGNANCY: A FRAMEWORK FOR ETHICAL CARE
No full textCancer affects about 1 in 1000 pregnancies, which is estimated to account for approximately 5000 pregnancies in Europe each year. Despite affluent availability of clinical practice guidelines for cancer management in the course of pregnancy, there is very little ethical guidance consolidated for everyday use. Therefore, the aim of this work is to construct a framework, which would serve healthcare professionals as a reference tool when addressing ethical issues in cancer care during pregnancy.
The framework is constructed around relational approach to respect for patient’s autonomy and ethics of care. It combines classical biomedical ethics principles and relational approaches to patient care. It emphasizes the importance of recognising the patient as another human being with her views on life, relationships and wishes, as well as forming a relationship between the patient and healthcare team, which is known as relational ethics.
However, respect for individual autonomy is not discarded entirely. First and foremost, evidence-based information disclosure is essential to personalised patient care. The latter invites to integrate technical aspects of personalised medicine with relational approach to patient care. Furthermore, protection of the vulnerable also serves as a safeguard ensuring that patient is not compelled to choices that are not her own.
Overall, this framework is expected to serve as a tool supporting ethical decision-making in cancer care during pregnancy. It can also be utilised by a variety of patient counselling services
Setting up an ethical oncofertility practice in developing countries
No full textFertility preservation for cancer patients is a relatively new field in medicine which requires
interdisciplinary approach. Improving therapies and rising survival rates require to consider patient’s
quality of life after cancer is cured which is relevant personal issue regardless of the individual income and the level of development of the country of origin. Fertility preservation offers possible solution but also raises ethical questions. We provide a summary of ethical principles embodied in professional guidelines together with options and restrictions to access fertility preservation in developing countries. We also make a suggestion that oncofertility counselling could be a pillar to address fertility preservation issues in cancer patients. Our proposed decisional support model is patient centred and focuses on patient values, personal philosophy and view of life emphasizing sensitivity to individual patient’s needs and wishes. Some fertility preservation concerns in oncology might be addressed mirroring already available expertise while some others will call for innovative and region specific solutions. Therefore, in addition to our proposal we also provide a list of organisations working in oncofertility field
Oocyte cryopreservation beyond cancer : tools for ethical reflection
No full textPurpose: This article offers physicians a tool for structured ethical reflection on challenging situations surrounding oocyte cryopreservation in young healthy women. Methods: A systematic literature review offers a comprehensive overview of the ethical debate surrounding the practice. Ethical Counseling Methodology (ECM) offers a practical approach for addressing ethical uncertainties. ECM consists of seven steps: (i) case presentation; (ii) analysis of possible implications; (iii) presentation of ethical question(s); (iv) explanation of ethical terms; (v) presentation of the ethical arguments in favor of and against the procedure; (vi) examination of the individual patient’s beliefs and wishes; and (vii) conclusive summary. Results: The most problematic aspects in the ethical debate include the distinction between medical and non-medical use of oocyte cryopreservation, safety and efficiency of the procedure, and marketing practices aimed at healthy women. Female empowerment and enhanced reproductive choices (granted oocyte cryopreservation is a safe and efficient technique) are presented as ethical arguments supporting the practice, while ethical reservations towards oocyte cryopreservation are based on concerns about maternal and fetal safety and wider societal implications. Conclusions: Oocyte cryopreservation is gaining popularity among healthy reproductive age women. However, despite promised benefits it also involves risks that are not always properly communicated in commercialized settings. ECM offers clinicians a tool for structured ethical analysis taking into consideration a wide range of implications, various ethical standpoints, and patients’ perceptions and beliefs
Fertility preservation in cancer patients : The global framework
No full textCancer treatment is the most frequent cause of reduced fertility in cancer patients, with up to 80% of survivors affected. None of the established or experimental fertility preservation methods can assure parenthood, rather they may provide a future opportunity to overcome treatment induced sterility. Around 70-75% of young cancer survivors are interested in parenthood but the numbers of patients who access fertility preservation techniques prior treatment are significantly lower. Moreover, despite existing guidelines, healthcare professionals do not address fertility preservation issues adequately. Lack of time and knowledge about existing options, delay in potentially useful treatment, patient's age, partnership status, existing children, sexual orientation and socioeconomic situation are the main barriers to effective fertility preservation. Patient's fears, expectations and priorities shaped by personal values have to be addressed in the framework of medical necessities, realistic survival probabilities, socio-cultural environment and resources availability. We call for a need of patient centred fertility counselling within a framework that should include patients understanding of medical aspects of their cancer, realistic fertility preservation options, preferences based on personal values and goals. Optional support services could also include legal guidance, psychological and spiritual support and financial counselling
Potential Pitfalls in the Evaluation of Ethics Consultation: The Case of Ethical Counseling
No full textWe discuss our account of ethical counseling in comparison with the American ethical consultation
Comprehending and communicating statistics in breast cancer screening. Ethical implications and potential solutions
No full textCancer screening and cancer prevention currently constitute the most promising way of tackling cancer in clinical practice and the public health domain. Cancer screening aims to find early signs of the disease in asymptomatic individuals so that it can be treated early. Although early detection has been shown to be beneficial for several conditions, it is also associated with the possibility of false-positive test results, and an increased number of insignificant abnormal findings (that is, overdiagnosis), which usually leads to unnecessary and harmful treatment with no benefits for the patient. Moreover, it has been shown that patients find it challenging to understand risk in terms of probabilities and percentages, which constitutes a serious obstacle to making a well-informed choice. We suggest that dedicated counselling could help patients better to understand the benefits and risks related to cancer screening and, therefore, enhance the decision-making process, and trust in healthcare professionals
Function-selective domain architecture plasticity potentials in eukaryotic genome evolution
No full textAbstractTo help evaluate how protein function impacts on genome evolution, we introduce a new concept of ‘architecture plasticity potential’ – the capacity to form distinct domain architectures – both for an individual domain, or more generally for a set of domains grouped by shared function. We devise a scoring metric to measure the plasticity potential for these domain sets, and evaluate how function has changed over time for different species. Applying this metric to a phylogenetic tree of eukaryotic genomes, we find that the involvement of each function is not random but highly selective. For certain lineages there is strong bias for evolution to involve domains related to certain functions. In general eukaryotic genomes, particularly animals, expand complex functional activities such as signalling and regulation, but at the cost of reducing metabolic processes. We also observe differential evolution of transcriptional regulation and a unique evolutionary role of channel regulators; crucially this is only observable in terms of the architecture plasticity potential. Our findings provide a new layer of information to understand the significance of function in eukaryotic genome evolution. A web search tool, available at http://supfam.org/Pevo, offers a wide spectrum of options for exploring functional importance in eukaryotic genome evolution
Routine psychosocial care in infertility and medically assisted reproduction - a guide for fertility staff: External Review Report
No full text
