Percorrer por autor "Silvestre, Margarida"
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- Apoio alimentar e o direito humano à alimentação adequada: questões éticasPublication . Lima, João PM; Rosa, Bárbara Santa; Silvestre, MargaridaA Declaração Universal dos Direitos Humanos defende que “todos os indivíduos têm direito à saúde e bem-estar, com acesso incondicional a alimentos, habitação e cuidados médicos”. Coexistem situações em que os indivíduos não têm acesso físico e económico a alimentos seguros e nutritivos, encontrando-se numa situação de insegurança alimentar. As dificuldades no acesso aos alimentos decorrentes de situações de carência socioeconómica são na verdade um dos problemas onde a intervenção na área da ação social é premente. Apesar de responder à garantia de um direito humano básico, a caridade alimentar motiva um dilema ético, contrapondo os princípios éticos que motivam a sua implementação, tais como o da solidariedade e cooperação, responsabilidade social e saúde, dignidade humana e direitos humanos, beneficência e igualdade, justiça e equidade; e aqueles que poderão estar a ser lesados com a mesma, tais como o da autonomia e responsabilidade individual, respeito pela vulnerabilidade humana e integridade pessoal, dignidade humana e direitos humanos e não discriminação e não estigmatização da Declaração Universal sobre Bioética e Direitos Humanos. Tal situação deverá contribuir para uma reflexão apurada e uma melhoria dos procedimentos a ela associados, como forma de garantir o fim último de salvaguarda do bem-estar dos indivíduos implicados.
- Medico-legal examination of sexual assaulted victims unable to consent in Portugal: ethical decision makingPublication . Santa-Rosa, Bárbara; Silvestre, Margarida; Vieira, Duarte Nuno; Corte Real, FranciscoMedical decision-making is a complex task in any field. In the medico-legal examination of victims that have (allegedly) been sexually assaulted there are many specific variables and features influencing the decision. It is essential to complement the clinical intervention with a forensic approach. Clinical parameters such as the victim's physical and cognitive state along with circumstantial information such as the elapsed time from the event and the type of abuse (described or suspected) grant different levels of priority to the forensic medical assessment. In such cases, forensic medical doctors or other medical doctors responsible for attending to the victim may have to decide whether to perform the examination prior to a judicial analysis of the case if consent cannot be obtained. This implies the need to deliberate about performing the examination and/or reporting the case to legal authorities. This article discusses the forensic medical decision-making process in cases of alleged recent sexual assault of victims who are legally unable to consent or unable to consent for other reasons. We aimed to identify possible ethical problems that can arise in this context and discuss which elements should be considered by medical doctors when making decisions about such cases. The Portuguese legal framework of medico-legal examinations is analyzed. The authors also make considerations about reporting these cases from a legal point of view. The discussion turns to an ethical perspective where possible ethical problems arising from medical deliberation are identified. Issues about legally incompetent victims and incompetent victims due to other reasons are addressed. A decision-making tree, based on the problems identified, is proposed.
- Where the public health principles meet the individual: a framework for the ethics of compulsory outpatient treatment in psychiatryPublication . Martinho, Sérgio M.; Santa-Rosa, Bárbara; Silvestre, MargaridaBackground Compulsory treatments represent a legal means of imposing treatment on an individual, usually with a mental illness, who refuses therapeutic intervention and poses a risk of self-harm or harm to others. Compulsory outpatient treatment (COT) in psychiatry, also known as community treatment order, is a modality of involuntary treatment that broadens the therapeutic imposition beyond hospitalization and into the community. Despite its existence in over 75 jurisdictions worldwide, COT is currently one of the most controversial topics in psychiatry, and it presents significant ethical challenges. Nonetheless, the ethical debate regarding compulsory treatment almost always stops at a preclinical level, with the different ethical positions arguing for or against its use, and there is little guidance to support for the individual clinicians to act ethically when making the decision to implement COT.