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1.
Artículo en Ruso | MEDLINE | ID: mdl-36385081

RESUMEN

The article gives an idea of health and diseases in various historical epochs. Depending on the historical period, there is a different amount of information about medicine, including diseases and the concept of «Health¼. This is due to the amount of archaeological and documentary evidence. For a long time, ideas about health have been closely linked with religion. Hippocrates and other scientists of the ancient world at the heart of health determined the state of equilibrium of the four main fluids. With the development of anatomy, physiology and medicine, the development of diseases was considered as damage to anatomical structures and disruption of their functions. In the XIV-XV centuries, a direction appeared that considers the influence of social and social factors on human health. In the XIX century, the ideas of health and disease are further developed based on physiological and anatomical studies. The German Anatomical School compared the concepts of human health and pathology, linked the development of diseases with changes in cells. During the 20th century, on the one hand, medicine became more and more molecular and submicroscopic; on the other hand, global attention to people, both healthy and sick, resumed, which gave rise to synergetic, multifaceted definitions of health. The World Health Organization in 1946 formulated the definition of health as «a state of complete physical, mental and social well-being, and not just the absence of diseases or physical defects.¼ In the future, this concept was repeatedly criticized, as it considered health as an ideal and brought it closer to the concept of happiness. Today it is obvious that the concept of health is a multifactorial concept and, in addition to the medical component, is closely related to other areas of human life: sociology, ecology, cultural studies, economics, etc.


Asunto(s)
Ecología , Medicina , Humanos , Estado de Salud
2.
J Med Ethics ; 2021 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-34330798

RESUMEN

The exponential rise in transgender self-identification invites consideration of what constitutes an ethical response to transgender individuals' claims about how best to promote their well-being. In this paper, we argue that 'accepting' a claim to medical transitioning in order to promote well-being would be in the person's best interests iff at the point of request the individual is correct in their self-diagnosis as transgender (i.e., the distress felt to reside in the body does not result from another psychological and/or societal problem) such that the medical interventions they are seeking will help them to realise their preferences. If we cannot assume this-and we suggest that we have reasonable grounds to question an unqualified acceptance in some cases-then 'acceptance' potentially works against best interests. We propose a distinction between 'acceptance' and respectful, in-depth exploration of an individual's claims about what promotes their well-being. We discuss the ethical relevance of the unconscious mind to considerations of autonomy and consent in working with transgender individuals. An inquisitive stance, we suggest, supports autonomous choice about how to realise an embodied form that sustains well-being by allowing the individual to consider both conscious and unconscious factors shaping wishes and values, hence choices.

4.
J Med Ethics ; 2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-33462078

RESUMEN

The WHO, American Academy of Pediatrics and other Western medical bodies currently maintain that all medically unnecessary female genital cutting of minors is categorically a human rights violation, while either tolerating or actively endorsing medically unnecessary male genital cutting of minors, especially in the form of penile circumcision. Given that some forms of female genital cutting, such as ritual pricking or nicking of the clitoral hood, are less severe than penile circumcision, yet are often performed within the same families for similar (eg, religious) reasons, it may seem that there is an unjust double standard. Against this view, it is sometimes claimed that while female genital cutting has 'no health benefits', male genital cutting has at least some. Is that really the case? And if it is the case, can it justify the disparate treatment of children with different sex characteristics when it comes to protecting their genital integrity? I argue that, even if one accepts the health claims that are sometimes raised in this context, they cannot justify such disparate treatment. Rather, children of all sexes and genders have an equal right to (future) bodily autonomy. This includes the right to decide whether their own 'private' anatomy should be exposed to surgical risk, much less permanently altered, for reasons they themselves endorse when they are sufficiently mature.

5.
Health Promot Perspect ; 11(4): 371-381, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-35079581

RESUMEN

Background: The rapid circulation of arboviruses in the human population has been linked with changes in climatic, environmental, and socio-economic conditions. These changes are known to alter the transmission cycles of arboviruses involving the anthropophilic vectors and thus facilitate an extensive geographical distribution of medically important arboviral diseases, thereby posing a significant health threat. Using our current understanding and assessment of relevant literature, this review aimed to understand the underlying factors promoting the spread of arboviruses and how the three most renowned interdisciplinary and holistic approaches to health such as One Health, Eco-Health, and Planetary Health can be a panacea for control of arboviruses. Methods: A comprehensive structured search of relevant databases such as Medline, PubMed, WHO, Scopus, Science Direct, DOAJ, AJOL, and Google Scholar was conducted to identify recent articles on arboviruses and holistic approaches to health using the keywords including "arboviral diseases", "arbovirus vectors", "arboviral infections", "epidemiology of arboviruses", "holistic approaches", "One Health", "Eco-Health", and "Planetary Health". Results: Changes in climatic factors like temperature, humidity, and precipitation support the growth, breeding, and fecundity of arthropod vectors transmitting the arboviral diseases. Increased human migration and urbanization due to socio-economic factors play an important role in population increase leading to the rapid geographical distribution of arthropod vectors and transmission of arboviral diseases. Medical factors like misdiagnosis and misclassification also contribute to the spread of arboviruses. Conclusion: This review highlights two important findings: First, climatic, environmental, socio-economic, and medical factors influence the constant distributions of arthropod vectors. Second, either of the three holistic approaches or a combination of any two can be adopted on arboviral disease control. Our findings underline the need for holistic approaches as the best strategy to mitigating and controlling the emerging and reemerging arboviruses.

7.
J Med Ethics ; 46(11): 743-752, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32709753

RESUMEN

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that (1) the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; (2) there are additional equity-based reasons to offer OPS to non-binary adults as a group; and (3) the ethical defensibility of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient's request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual's context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results.


Asunto(s)
Identidad de Género , Pubertad , Adulto , Femenino , Humanos , Masculino , Principios Morales
8.
J Epidemiol Glob Health ; 10(1): 6-15, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32175705

RESUMEN

This review aims to locate existing studies on health-seeking behavior of people in Indonesia, identify gaps, and highlight important findings. Articles were retrieved from Medline, Scopus, Web of Science, Academic Search Complete (via Ebsco), and ProQuest with a number of key words and various combinations. Articles from Indonesian journals were also searched for with Google Scholar. A total of 56 articles from peer-reviewed journal databases and 19 articles from Indonesian journals were reviewed. Quantitative designs were applied more frequently than qualitative, and mixed methods designs were used in some studies. The majority gathered retrospective information about people's behaviors. Communicable diseases and maternity care were the most frequently studied conditions, in contrast to noncommunicable diseases. In terms of geographical distribution, most research was conducted on Java island, with very few in outside Java. Important findings are a model of Indonesian care-seeking pathways, an understanding of determinants of people's care choices, and the role of sociocultural beliefs. The findings from this narrative review provide insight to what and how Indonesians make decisions to manage their illness and why. This makes an important contribution to understanding the problem of underutilization of medical services despite the government's extensive efforts to improve accessibility.


Asunto(s)
Conductas Relacionadas con la Salud , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Determinantes Sociales de la Salud/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Indonesia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
10.
J Med Ethics ; 45(8): 508-513, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31326898

RESUMEN

Current advances in assisted reproductive technologies aim to promote the health and well-being of future children. They offer the possibility to select embryos with the greatest potential of being born healthy (eg, preimplantation genetic testing) and may someday correct faulty genes responsible for heritable diseases in the embryo (eg, human germline genome modification (HGGM)). Most laws and policy statements surrounding HGGM refer to the notion of 'serious' as a core criterion in determining what genetic diseases should be targeted by these technologies. Yet, this notion remains vague and poorly defined, rendering its application challenging and decision making subjective and arbitrary. By way of background, we begin by briefly presenting two conceptual approaches to 'health' and 'disease': objectivism (ie, based on biological facts) and constructivism (ie, based on human values). The basic challenge under both is sorting out whether and to what extent social and environmental factors have a role in helping to define what qualifies as a 'serious' disease beyond the medical criteria. We then focus on how a human rights framework (eg, right to science and right to the highest attainable health) could integrate the concepts of objectivism and constructivism so as to provide guidance for a more actionable consideration of 'serious'. Ultimately, it could be argued that a human rights framework, by way of its legally binding nature and its globally accepted norms and values, provides a more universal foundation for discussions of the ethical, legal and social implications of emerging or disruptive technologies.


Asunto(s)
Toma de Decisiones/ética , Investigaciones con Embriones/ética , Edición Génica/ética , Marcación de Gen/ética , Predisposición Genética a la Enfermedad , Técnicas Reproductivas Asistidas/ética , Femenino , Edición Génica/tendencias , Asesoramiento Genético , Células Germinativas , Política de Salud , Derechos Humanos/ética , Humanos , Embarazo , Técnicas Reproductivas Asistidas/tendencias
11.
J Med Ethics ; 45(9): 592-593, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31311852

RESUMEN

In this short commentary, I reflect on the new definition of disease proposed by Powell and Scarffe. I suggest that the method they appeal to as objective, namely, rational justification, is open to several criticisms, which I outline and discuss.

13.
J Med Ethics ; 44(3): 192-198, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29079556

RESUMEN

In the Global Burden of Disease study, disease burden is measured as disability-adjusted life years (DALYs). The paramount assumption of the DALY is that it makes sense to aggregate years lived with disability (YLDs) and years of life lost (YLLs). However, this is not smooth sailing. Whereas morbidity (YLD) is something that happens to an individual, loss of life itself (YLL) occurs when that individual's life has ended. YLLs quantify something that involves no experience and does not take place among living individuals. This casts doubt on whether the YLL is an individual burden at all. If not, then YLDs and YLLs are incommensurable. There are at least three responses to this problem, only one of which is tenable: a counterfactual account of harm. Taking this strategy necessitates a re-examination of how we count YLLs, particularly at the beginning of life.


Asunto(s)
Enfermedad Crónica/mortalidad , Enfermedades Transmisibles/mortalidad , Personas con Discapacidad/psicología , Carga Global de Enfermedades/ética , Factores de Edad , Enfermedad Crónica/psicología , Enfermedades Transmisibles/psicología , Teoría Ética , Humanos , Esperanza de Vida , Mortalidad Prematura , Años de Vida Ajustados por Calidad de Vida
14.
Front Vet Sci ; 4: 163, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29085825

RESUMEN

Several holistic and interdisciplinary approaches exist to safeguard health. Three of the most influential concepts at the moment, One Health, EcoHealth, and Planetary Health, are analyzed in this paper, revealing similarities and differences at the theoretical conceptual level. These approaches may appear synonymous, as they all promote the underlying assumption of humans and other animals sharing the same planet and the same environmental challenges, infections and infectious agents as well as other aspects of physical-and possibly mental-health. However, we would like to illuminate the differences between these three concepts or approaches, and how the choice of terms may, deliberately or involuntary, signal the focus, and underlying values of the approaches. In this paper, we have chosen some proposed and well-known suggestions of definitions. In our theoretical analysis, we will focus on at least two areas. These are (1) the value of the potential scientific areas which could be included and (2) core values present within the approach. In the first area, our main concern is whether the approaches are interdisciplinary and whether the core scientific areas are assigned equal importance. For the second area, which is rather wide, we analyze core values such as biodiversity, health, and how one values humans, animals, and ecosystems. One Health has been described as either a narrow approach combining public health and veterinary medicine or as a wide approach as in the wide-spread "umbrella" depiction including both scientific fields, core concepts, and interdisciplinary research areas. In both cases, however, safeguarding the health of vertebrates is usually in focus although ecosystems are also included in the model. The EcoHealth approach seems to have more of a biodiversity focus, with an emphasis on all living creatures, implying that parasites, unicellular organisms, and possibly also viruses have a value and should be protected. Planetary Health, on the other hand, has been put forward as a fruitful approach to deal with growing threats in the health area, not least globally. We conclude that there are actually important differences between these three approaches, which should be kept in mind when using any of these terms.

15.
Cureus ; 9(2): e1042, 2017 Feb 21.
Artículo en Inglés | MEDLINE | ID: mdl-28367381

RESUMEN

In an era of value-based care, the practice of medicine and other health professions have been drawn to subjective, comprehensive and multidimensional views of health such as the World Health Organization(WHO) concept that defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. This paper, through a philosophical analysis, demonstrates that health is not multidimensional and is a natural phenomenon. A philosophical discussion contends that health must realistically and logically reside in the person and this requires it to be a physical state. This paper also illustrates that, in the popular language of health, many times, health professionals: (1) inappropriately view health as a subjective human construct as opposed to viewing health as an objective phenomena, (2) confuse what is desired and valued as a good life with what is good health, and (3) fail to recognize the vital distinction between what affects health and what is health. A meaning of health is offered through several examples and arguments that demonstrate why health is a state of physical well-being or physical fitness that is defined by how well the body is functioning in accordance with its natural design and how well this natural design affords individuals the ability to achieve essential functional objectives of humans on the biological and person level.

16.
J Med Ethics ; 43(12): 865-866, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-28341756

RESUMEN

The discovery that certain selective serotonin reuptake inhibitors delay ejaculation and the later development and approval of dapoxetine as an on-demand treatment option has led to a dramatic increase in medical interest in premature ejaculation. This paper analyses the diagnostic criteria and the discussion within the medical community about suitable treatments against the backdrop of theories of science, sex and gender. Our conclusion is that the diagnosis itself and the suggested treatments contribute to normative models of sexual conduct and therefore reinforce the norms that cause patients' distress over ejaculating 'too soon'.


Asunto(s)
Bencilaminas/farmacología , Eyaculación/efectos de los fármacos , Medicalización , Naftalenos/farmacología , Eyaculación Prematura/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/farmacología , Conducta Sexual/psicología , Estrés Psicológico/etiología , Bencilaminas/uso terapéutico , Humanos , Masculino , Medicalización/ética , Naftalenos/uso terapéutico , Eyaculación Prematura/diagnóstico , Eyaculación Prematura/psicología , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico
17.
J Med Ethics ; 42(11): 715-716, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27531925
19.
Int J Technol Assess Health Care ; 32(1-2): 3-9, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26956573

RESUMEN

Current thinking about the methodology of health technology assessment (HTA) seems to be dominated by two fundamental tensions: [1] between maintaining a tight focus on quality-adjusted life-years and broadening its concern out to pay attention to a broader range of factors, and [2] between thinking of the evaluative dimensions that matter as being objectively important factors or as ones that are ultimately of merely subjective importance. In this study, I will argue that health is a tremendously important all-purpose means to enjoying basic human capabilities, but a mere means, and not an end. The ends to which health is a means are manifold, requiring all those engaged in policy making to exercise intelligence in a continuing effort to identify them and to think through how they interrelate. Retreating to the subjective here would be at odds with the basic idea of HTA, which is to focus on certain objectively describable dimensions of what matters about health and to collect empirical evidence rigorously bearing on what produces improvements along those dimensions. To proceed intelligently in doing HTA, it is important to stay open to reframing and refashioning the ends we take to apply to that arena. The only way for that to happen, as an exercise of public, democratic policy making, is for the difficult value questions that arise when ends clash not to be buried in subjective preference information, but to be front-and-center in the analysis.


Asunto(s)
Estado de Salud , Formulación de Políticas , Evaluación de la Tecnología Biomédica/organización & administración , Análisis Costo-Beneficio , Política de Salud , Humanos , Inteligencia , Años de Vida Ajustados por Calidad de Vida , Reproducibilidad de los Resultados , Proyectos de Investigación , Medicina Estatal/normas , Evaluación de la Tecnología Biomédica/ética , Evaluación de la Tecnología Biomédica/normas , Reino Unido
20.
J Med Ethics ; 42(9): 559-65, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-26670671

RESUMEN

Since 2000, 11 human uterine transplantation procedures (UTx) have been performed across Europe and Asia. Five of these have, to date, resulted in pregnancy and four live births have now been recorded. The most significant obstacles to the availability of UTx are presently scientific and technical, relating to the safety and efficacy of the procedure itself. However, if and when such obstacles are overcome, the most likely barriers to its availability will be social and financial in nature, relating in particular to the ability and willingness of patients, insurers or the state to pay. Thus, publicly funded healthcare systems such as the UK's National Health Service (NHS) will eventually have to decide whether UTx should be funded. With this in mind, we seek to provide an answer to the question of whether there exist any compelling reasons for the state not to fund UTx. The paper proceeds as follows. It assumes, at least for the sake of argument, that UTx will become sufficiently safe and cost-effective to be a candidate for funding and then asks, given that, what objections to funding there might be. Three main arguments are considered and ultimately rejected as providing insufficient reason to withhold funding for UTx. The first two are broad in their scope and offer an opportunity to reflect on wider issues about funding for infertility treatment in general. The third is narrower in scope and could, in certain forms, apply to UTx but not other assisted reproductive technologies (ARTs). The first argument suggests that UTx should not be publicly funded because doing so would be inconsistent with governments' obligations to prevent climate change and environmental pollution. The second claims that UTx does not treat a disorder and is not medically necessary. Finally, the third asserts that funding for UTx should be denied because of the availability of alternatives such as adoption and surrogacy.


Asunto(s)
Atención a la Salud/ética , Accesibilidad a los Servicios de Salud/ética , Infertilidad Femenina/cirugía , Clasificación Internacional de Enfermedades/ética , Servicios de Salud Reproductiva , Medicina Estatal/economía , Donantes de Tejidos/ética , Útero/trasplante , Análisis Costo-Beneficio , Atención a la Salud/economía , Femenino , Accesibilidad a los Servicios de Salud/economía , Humanos , Infertilidad Femenina/clasificación , Infertilidad Femenina/economía , Embarazo , Sector Público , Servicios de Salud Reproductiva/economía , Servicios de Salud Reproductiva/ética , Técnicas Reproductivas Asistidas , Reino Unido
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