In line with how ethics has developed for the last three centuries, public health ethics has been widely dominated by a deontological as well as a utilitarian approach. The latter is a version of ...consequentialism, which states that maximizing utility is the primary goal of the majority of individuals or group action, while, on the other hand, virtue ethics, or at least the appeal to virtues, has been largely marginalized. The aim of this article is twofold. Firstly, we aim to highlight the political and ethical nature of public health interventions, often interpreted and presented as mere scientific enterprises. Secondly, we try to highlight the need to integrate or at least recognize the value of appeal to virtues in public health measures. The analysis will reference the Italian COVID-19 vaccination program as a case study. Initially, we will explore the political and ethical nature of any public health measure, using the implementation of the COVID-19 vaccination program in Italy as an example. Subsequently, we will illustrate the deontological approach to ethics, the utilitarian one, and the virtues one, focusing on the dynamic of the agent's perspective. Lastly, we will briefly analyze both the Italian COVID-19 vaccination program and the communication campaign that promoted it.
Background and Aim: Digital health technologies (DHTs) are one of the most promising perspectives in healthcare. On the other hand, the investment in of DHTs has an impact on the (ethical, economic, ...organizational, environmental) sustainability of National Healthcare Systems (NHSs). A relevant tool for supporting healthcare decision-makers is Health Technology Assessment (HTA), 'a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner' (EUnetHTA 2007). The aim of our contribution is to deal with HTA around DHTs, particularly ethical, legal and social implications (ELSI). Materials and Methods: The literature/documentation review on HTA and DHTs was carried out on PubMed database through a query, merging the following MESH terms: "digital technolog·"; healthcare; health technology assessment; HTA (last access. August 17, 2021). Results: 90 items were found: 4 were considered relevant for our analysis. The literature on our focus is at the very beginning. Early contributions underline as follows: 1. current HTA frameworks are not well equipped for assessing DHTs. The development of DHT-specific content for HTA frameworks is hampered by DHTs having varied benefit and risk profiles (von Huben et al., 2021); 2. existing HTA process should be adapted for assessing DHTs, including to make provisions for an assessment of app cybersecurity, the impact on DHT clinical utility of software updates, and compatibility issues (Moshi et al., 2020) as well as the need for standardization of reporting characteristics of eHealth services, and specifying assessment outcomes and methods following a stepped-approach tailored to the functional characteristics of eHealth services (Vis et al., 2020); 3. attention should also be paid to ethical issues, such as data privacy, and technology specific characteristics (Moshi et al., 2018).
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IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UL, UM, UPUK
The importance of respecting patients' preferences when making treatment decisions is increasingly recognized. Efficiently retrieving papers from the scientific literature reporting on the presence ...and nature of such preferences can help to achieve this goal. The objective of this study was to create a search filter for PubMed to help retrieve evidence on patient preferences for treatment outcomes.
A total of 27 journals were hand-searched for articles on patient preferences for treatment outcomes published in 2011. Selected articles served as a reference set. To develop optimal search strategies to retrieve this set, all articles in the reference set were randomly split into a development and a validation set. MeSH-terms and keywords retrieved using PubReMiner were tested individually and as combinations in PubMed and evaluated for retrieval performance (e.g. sensitivity (Se) and specificity (Sp)).
Of 8238 articles, 22 were considered to report empirical evidence on patient preferences for specific treatment outcomes. The best search filters reached Se of 100 % 95 % CI 100-100 with Sp of 95 % 94-95 % and Sp of 97 % 97-98 % with 75 % Se 74-76 %. In the validation set these queries reached values of Se of 90 % 89-91 % with Sp 94 % 93-95 % and Se of 80 % 79-81 % with Sp of 97 % 96-96 %, respectively.
Narrow and broad search queries were developed which can help in retrieving literature on patient preferences for treatment outcomes. Identifying such evidence may in turn enhance the incorporation of patient preferences in clinical decision making and health technology assessment.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose: This study aims to estimate the cost-minimization strategy of a preventive testing strategy destined to relatives of patients with BRCA mutated cancer versus a no test strategy in Italia.
...Methods: A BRCA testing pathway was designed by a panel of experts based on the MSTM Excel (2010) tool; the analysis was carried out considering the perspective of the Italian National Health Service. Two alternatives were considered: 1) preventive BRCA testing for relatives of patients affected by ovarian cancer carrying a BRCA1/BRCA2 mutation; 2) no test. Cost and effectiveness data, derived from literature and published sources validated by a Board of experts, were discounted using a discount factor equal to 3%. Probabilistic sensitivity analysis was performed.
Results: Considering an average cost of therapy for breast and ovarian cancer major of €90,000.00 per case, the economic impact related to the preventive testing strategy are equal to –€17,814,767.25. The sensitivity analysis confirms these results in the totality of the simulations performed.
Conclusions: Preventive genetic testing in relatives of patients affected by ovarian cancer is cost-effective and represents a sustainable cost for the National Healthcare System in Italia, also in the light of its reference values.
Abstract Lack of available organs poses a significant challenge in meeting the needs of patients with life‐threatening liver disease who could benefit from liver transplantation (LT). Psychosocial ...vulnerability markers have been linked to post‐transplant outcomes, raising questions about their use in patient selection. However, their incorporation into selection criteria raises concerns about health equity and potential discrimination. As a result, there is a pressing need to refine fair allocation systems that consider both clinical and psychosocial factors to ensure equitable access and optimize post‐transplant outcomes. The Equitable Benefit Approach (EBA) proposed in this paper by the multidisciplinary group of clinical experts in LT from the Italian Society for the Study of the Liver seeks to address these concerns. It presents four procedural principles, the two allocative principles usually applied in transplantation (urgency and utility) and introduces a new one, the principle of health equity. The EBA aims to prioritize patients with the highest transplant benefit while addressing health inequalities. It emphasizes evidence‐based decision‐making and standardized assessment tools to reliably evaluate psychosocial risk factors. Implementing the EBA involves a multi‐step process, including stakeholder engagement, prospective studies to validate its efficacy, development of institutional policies and algorithms, and ongoing monitoring and revision. By following these steps, health care providers can ensure that LT allocation decisions are transparent and responsive to evolving clinical and social contexts. Ultimately, the EBA should offer a comprehensive framework for fair patient selection in LT, considering both biomedical and psychosocial aspects.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Shared core planning represents the decision-making path that best embodies the trust and alliance that should characterize the relationship between the physician/medical team and the patients/their ...families, as it respects autonomy and values of both sides. The Clinical Ethics Consultation Service at Pondazione Policlinico Universitario "A. Gemelli" IRCCS, in Rome, uses a decision-making support tool within the consultations, and calls it "Shared Document for Healthcare Ethics Planning" (SD). This document recalls the inspiring concepts of advance care planning and shared decision-making, and it is an effective tool because of some characteristics, such as: the relational methodology, the personalization case-by-case the interdisciplinary assessment, the impact on patients and their families, the processing time, and the benefits connected to it.
Clinical ethics consultation (CEC) is an expertise aimed at helping patients, their family, health professionals and managers, and other stakeholders involved, in order to solve moral ...doubts/conflicts that rise in the current clinical practice marked by an unprecedented complexity, and for which the experience and sensitivity of the individual medical doctor may not be enough to address the ethical concerns encountered in the exercise of the profession. Among the technical aspects that need to be addressed, an issue is represented by the process through which CEC is carried out, i.e. Standard Operating Procedures (SOPs). In fact, the ordered sequence of the phases through which a CEC takes place is a necessary requirement for achieving an adequate CEC. This paper deals with to contribute to the debate on this topic by illustrating the SOPs utilized by Clinical Ethics Consultation Service earned out by the Research Center for Clinical Bioethics and Medical Humanities of the Università Cattolica del Sacro Cuore for the "A. Gemelli" Teaching Hospital Foundation IRCCS (FPUG) in Rome (Italy).
In the last few decades, Clinical Ethics Consultation (CEC) has been introduced in the clinical practice of some Italian hospital facilities. It has proved itself to be a precious and efficient tool: ...it helps healthcare professionals, as well as patients and guardians/trustees, to identify the ethical and value dimensions within those complex and problematic clinical coses where ethics dilemmas or conflicts arise with regards to decisions to be taken. The overall objective of CEC is to serve the good of the whole person, through the optimization of the quality of care and by fostering a better climate within the hospital selling.
To compare and contrast different methods of qualitative evidence synthesis (QES) against criteria identified from the literature and to map their attributes to inform selection of the most ...appropriate QES method to answer research questions addressed by qualitative research.
Electronic databases, citation searching, and a study register were used to identify studies reporting QES methods. Attributes compiled from 26 methodological papers (2001–2014) were used as a framework for data extraction. Data were extracted into summary tables by one reviewer and then considered within the author team.
We identified seven considerations determining choice of methods from the methodological literature, encapsulated within the mnemonic Review question–Epistemology–Time/Timescale–Resources–Expertise–Audience and purpose–Type of data. We mapped 15 different published QES methods against these seven criteria. The final framework focuses on stand-alone QES methods but may also hold potential when integrating quantitative and qualitative data.
These findings offer a contemporary perspective as a conceptual basis for future empirical investigation of the advantages and disadvantages of different methods of QES. It is hoped that this will inform appropriate selection of QES approaches.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
OBJECTIVE. To analyse some ethical issues involved in umbilical cord blood (UCB) collection, storage and use.
MATERIALS AND METHODS. Ethical issues were addressed in the light of the wellknown ...fundamental ethical principles for biomedicine: beneficence/non maleficence, respect for autonomy and justice. Specific issues that have been debated concerning the clinical utility
of autologous use compared with allogeneic use for transplantation, the validity of informed consent, especially in private UCB banking, and finally the controversial question of private UCB banking for-profit compared to public UCB banking non-profit.
RESULTS. Our ethical analysis has highlighted that the allogeneic UCB use for transplantation, compared to autologous UCB use, seems to fulfil the principle of beneficence/non maleficence as it provides “logistic” and clinical benefits and it decreases risks; the acquisition of informed consent requires some counselling, particularly for autologous collection; finally, public UCB banking seems to fulfil the criteria for justice more than private ones.
CONCLUSION. Present and future therapeutic UCB possibilities for treating a wide variety of diseases need to increase the number of UCB units available. For this purpose, a “gift” culture and a “solidarity chain” between donors and recipients are requested. Moreover, in
recent years, a further and emerging model of bank seems usable, i.e. “hybrid” banking.
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