The dose limits recommended by the International Commission on Radiological Protection have undergone considerable changes in the course of the past 90 years, and different arguments have been put forward for their justification. This has been largely due to new insights of radiation research, but changing perceptions of the related ethical values have also played a role. The current paper reviews important stages in this development and attempts to derive some implications for the Commission's next general recommendations. Above all, it suggests that it is essential to present clear and consistent justification strategies for dose limits (and related values), compatible with the core values of the system of radiological protection, especially prudence and justice.

• Klíčová slova
• ICRP, dose limitation, ethical basis, radiological protection, scientific basis,
• MeSH
• mravy MeSH
• radiační ochrana * MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: Medical ethics has a tried and tested literature and a global active research community. Even among health professionals, literate and fluent in medical ethics, there is low recognition of radiation protection principles such as justification and optimization. On the other hand, many in healthcare environments misunderstand dose limitation obligations and incorrectly believe patients are protected by norms including a dose limit. Implementation problems for radiation protection in medicine possibly flow from apparent inadequacies of the International Commission on Radiological Protection (ICRP) principles taken on their own, coupled with their failure to transfer successfully to the medical world. Medical ethics, on the other hand, is essentially global, is acceptable in most cultures, is intuitively understood in hospitals, and its expectations are monitored, even by managements. This article presents an approach to ethics in diagnostic imaging rooted in the medical tradition, and alert to contemporary social expectations. ICRP and the International Radiation Protection Association (IRPA), both alert to growing ethical concerns, organized a series of consultations on ethics for general radiation protection in the last few years. METHODS: The literature on medical ethics and implicit ICRP ethical values were reviewed qualitatively, with a view to identifying a system that will help guide contemporary behaviour in radiation protection of patients. Application of the system is illustrated in six clinical scenarios. The proposed system is designed, as far as is possible, so as not to be in conflict with the conclusions emerging from the ICRP/IRPA consultations. RESULTS AND CONCLUSION: A widely recognized and well-respected system of medical ethics was identified that has global reach and claims acceptance in all cultures. Three values based on this system are grouped with two additional values to provide an ethical framework for application in diagnostic imaging. This system has the potential to be robust and to reach conclusions that are in accord with contemporary medical, social and ethical thinking. The system is not intended to replace the ICRP principles. Rather, it is intended as a well-informed interim approach that will help judge and analyse situations that arouse ethical concerns in radiology. Six scenarios illustrate the practicality of the value system in alerting one to possible deficits in practice. ADVANCES IN KNOWLEDGE: Five widely recognized values and the basis for them are identified to support the contemporary practice of diagnostic radiology. These are essential to complement the widely used ICRP principles pending further development in the area.

• MeSH
• lékařská etika * MeSH
• lidé MeSH
• radiační ochrana * MeSH
• radiační poranění prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Achieving ethically responsible decisions is crucial for the success of biodiversity conservation projects. We adapted the ethical matrix, decision tree, and Bateson's cube to assist in the ethical analysis of complex conservation scenarios by structuring these tools so that they can implement the different value dimensions (environmental, social, and animal welfare) involved in conservation ethics. We then applied them to a case study relative to the decision-making process regarding whether or not to continue collecting biomaterial on the oldest of the two remaining northern white rhinoceroses (Ceratotherium simum cottoni), a functionally extinct subspecies of the white rhinoceros. We used the ethical matrix to gather ethical pros and cons and as a starting point for a participatory approach to ethical decision-making. We used decision trees to compare the different options at stake on the basis of a set of ethical desiderata. We used Bateson's cube to establish a threshold of ethical acceptability and model the results of a simple survey. The application of these tools proved to be pivotal in structuring the decision-making process and in helping reach a shared, reasoned, and transparent decision on the best option from an ethical point of view among those available.

Que se logren decisiones éticamente responsables es crucial para el éxito de los proyectos de conservación de la biodiversidad. Adaptamos la matriz ética, el árbol de decisión y el cubo de Bateson para apoyar con el análisis ético de escenarios de conservación compleja mediante la estructuración de estas herramientas de tal manera que puedan ejecutar las diferentes dimensiones de valor (ambiental, social y bienestar animal) involucradas en la ética de la conservación. Después aplicamos las herramientas a un estudio de caso relacionado con el proceso de toma de decisiones respecto a si se debe seguir o no recolectando material biológico del rinoceronte blanco del norte (Ceratotherium simum cottoni) más viejo (una subespecie funcionalmente extinta) de los dos que existen. Usamos la matriz ética como un punto de partida para una estrategia participativa para la toma ética de decisiones y para recopilar los pros y contras éticos. Usamos el árbol de decisión para comparar las diferentes opciones en juego con base en un conjunto de deseos éticos. Usamos el cubo de Bateson para establecer un umbral de aceptación ética y modelar los resultados de una encuesta simple. La aplicación de estas herramientas demostró ser central en la estructuración del proceso de toma de decisiones y en el apoyo para lograr una decisión compartida, razonada y transparente sobre la mejor opción a partir de un punto de vista ético entre aquellos disponibles.

• Klíčová slova
• Bateson's cube, análisis ético, conservation ethics, cubo de Bateson, decision tree, ethical analysis, ethical matrix, matriz ética, northern white rhino, rinoceronte blanco del norte, árbol de decisión, ética de la conservación, 伦理分析, 伦理矩阵, 保护伦理, 决策树, 北方白犀牛, 贝特森方块模型,
• MeSH
• biodiverzita * MeSH
• etická analýza MeSH
• Perissodactyla MeSH
• zachování přírodních zdrojů * MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• Klíčová slova
• SEX BEHAVIOR *,
• MeSH
• lidé MeSH
• sexuální chování * MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: Theories of ethics and ethical reflection may be applied to both theory and practice in psychotherapy. There is a natural affinity between ethics and psychotherapy. Psychotherapy practice is concerned with human problems, dilemmas and emotions related to both one's own and other people's values. Ethics is also concerned with dilemmas in human thinking and with how these dilemmas reflect other individuals' values. Philosophical reflection itself is not a sufficient basis for the ethics of psychotherapy but it may aid in exploring attitudes related to psychotherapy, psychiatry and health care. METHODS: PubMed, Web of Science and Scopus databases were searched for articles containing the keywords "psychotherapy", "ethics", "therapeutic relationship" and "supervision". The search was conducted by repeating the terms in various combinations without language or time restrictions. Also included were data from monographs cited in reviews. The resulting text is a review with conclusions concerning ethical aspects of psychotherapy. RESULTS: The ability to behave altruistically, sense for justice and reciprocity and mutual help are likely to be genetically determined as dispositions to be later developed by upbringing or to be formed or deformed by upbringing. Early experiences lead to formation of ethical attitudes which are internalized and then applied to both one's own and other people's behavior. Altruistic behavior has a strong impact on an individual's health and its acceptance may positively influence the pathophysiological mechanisms underlying numerous diseases. Ethical theory and reflection, however, may be applied to both theory and practice of psychotherapy in a conscious, targeted and thoughtful manner. In everyday practice, psychotherapists and organizations must necessarily deal with conscious conflicts between therapeutic possibilities, clients' wishes, their own as well as clients' ideas and the real world. Understanding one's own motives in therapy is one of the aims of a psychotherapist's personal therapy and a frequent goal of supervision interventions. It is a psychotherapist's ethical obligation to do no harm, maintain clear therapeutic borders, not abuse patients, undertake supervision and learn good self-reflection. CONCLUSION: Knowledge of ethical questions and related issues as well as continuous ethical self-reflection are essential components of high-quality psychotherapeutic management. This requires both good psychotherapy training and systematic supervision.

• MeSH
• duševní poruchy terapie   MeSH
• lidé MeSH
• psychoterapie etika   MeSH
• sociální hodnoty * MeSH
• vztahy mezi zdravotnickým pracovníkem a pacientem etika   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: During the COVID-19 pandemic, global healthcare systems faced unprecedented challenges, with a lack of resources and suboptimal patient care emerging as primary concerns. METHODS: Our research, using a comprehensive 24-item electronic questionnaire, "Reflections on the Provision of Healthcare during the COVID-19 Pandemic," delved into the experiences of 938 physicians across the Czech Republic. RESULTS: Over fifty per cent observed a "lower standard of care" compared to pre-pandemic levels. A division arose among physicians regarding a decision's medical, ethical, or legal basis, with a notable gender disparity: male doctors leaned towards medical perspectives, whereas females accented the ethical perspective. Decision-making concerning health care limitations required agreement among the physicians on duty, interdisciplinary teams, or shift supervisors. Physicians reported varying degrees of patient or family participation in health care decisions. Variables such as age, pre-existing health conditions, and life expectancy influenced care decisions. Surprisingly, half of the physicians faced refusals of patients' transportation to better-equipped facilities due to resource constraints. One-third of physicians never discuss the decision about care limitation and other options with patients or their families. As a result, almost fifty per cent of the physicians rarely or never imparted information about care limitations to patients. CONCLUSION: The survey shed light on the profound ethical dilemmas hospital physicians face across different types of healthcare facilities during the pandemic. It uncovered the need for open dialogue and scholarly debate on resource allocation and strengthening the role of patients and their families in care decisions in future healthcare crises.

• MeSH
• COVID-19 * epidemiologie   MeSH
• dospělí MeSH
• klinické rozhodování etika   MeSH
• lékaři * etika   MeSH
• lékařská etika MeSH
• lidé středního věku MeSH
• lidé MeSH
• pandemie MeSH
• postoj zdravotnického personálu MeSH
• průzkumy a dotazníky MeSH
• rozhodování etika   MeSH
• SARS-CoV-2 MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

The authors submit a report on the establishment and activities of new advisory organs which developed in hospitals and at medical faculties and bear the name of ethical commissions. Their task is to approve grants, advisory activities as well as organizing public discussions of ethical problems. The basis of the report are data obtained by means of questionnaires completed by 62 respondents. At present there are 20 ethical commissions in the Czech Republic, 19 local ones and one central one.

• MeSH
• etické komise * MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Geografické názvy
• Československo MeSH

Hypoplastic left heart syndrome (HLHS) represents a lethal congenital heart disease, which used to be considered inoperable. The improvement of results of cardiac surgery in neonates improved also the prognosis of patients with this heart lesion. HLHS, however, continues to be an unresolved problem from ethical, psychological, social and economical points of view. Opinions regarding the care for these patients depend on economical, political, cultural and religious factors. Based on recent experience it is evident, that HLHS is an operable disease in a child, who without surgery would otherwise die. Approximately 40% of patients with HLHS can live 15 years after surgery. The long-term prognosis remains, however, unclear. Because of the need of demanding care for a patient with HLHS, it is necessary to see also the quality of life and hear the opinion of parents. Psychomotor development and the quality of life may be altered by complications. An individualized approach in fetuses and neonates with HLHS on the basis of prenatal diagnosis, analysis of risk factors, provision of detailed informations to parents and indications for surgery in neonates having chance for an acceptable result is considered to be the most acceptable solution. In the future it will be necessary to concentrate the research on prenatal diagnostics, treatment and postoperative follow-up including psychomotor development and quality of life. In the preparation of legislative, which would reflect more sensitively the contemporary possibilities of medicine and at the same time regard the problems of health care organization, as well as social and economic aspects, narrow interdisciplinary cooperation will be required.

• MeSH
• etika * MeSH
• kardiochirurgické výkony ekonomika   MeSH
• kontraindikace MeSH
• kvalita života MeSH
• lidé MeSH
• novorozenec MeSH
• osobní újma zaviněná nemocí MeSH
• prognóza MeSH
• syndrom hypoplazie levého srdce ekonomika   chirurgie   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

During the first half of the 20th century, it was commonly assumed that radiation-induced health effects occur only when the dose exceeds a certain threshold. This idea was discarded for stochastic effects when more knowledge was gained about the mechanisms of radiation-induced cancer. Currently, a key tenet of the international system of radiological protection is the linear no-threshold (LNT) model where the risk of radiation-induced cancer is believed to be directly proportional to the dose received, even at dose levels where the effects cannot be proven directly. The validity of the LNT approach has been questioned on the basis of a claim that only conclusions that can be verified experimentally or epidemiologically are scientific and LNT should, thus, be discarded because the system of radiological protection must be based on solid science. The aim of this publication is to demonstrate that the LNT concept can be tested in principle and fulfils the criteria of a scientific hypothesis. The fact that the system of radiological protection is also based on ethics does not render it unscientific either. One of the fundamental ethical concepts underlying the LNT model is the precautionary principle. We explain why it is the best approach, based on science and ethics (as well as practical experience), in situations of prevailing uncertainty.

• Klíčová slova
• Dose limitation, Ethical basis, ICRP, LNT, Low radiation dose, Precautionary principle, Radiological protection, Scientific basis,
• MeSH
• dávka záření MeSH
• hodnocení rizik MeSH
• lidé MeSH
• lineární modely MeSH
• nádory vyvolané zářením prevence a kontrola   MeSH
• radiační ochrana * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• lékařská etika * MeSH
• lidé MeSH
• plod cytologie   MeSH
• tkáňové banky * zákonodárství a právo   MeSH
• výzkum * zákonodárství a právo   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH