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1

WORLD MEDICAL ASSOCIATION DECLARATION OF HELSINKI Ethical Principles for Medical Research Involving Human Subjects  

E-print Network

1 WORLD MEDICAL ASSOCIATION DECLARATION OF HELSINKI Ethical Principles for Medical Research of Helsinki as a statement of ethical principles for medical research involving human subjects, including participants in medical research involving human subjects to adopt these principles. 3. It is the duty

Pfeifer, Holger

2

Shannon and Jake An Application of Medical Ethics Principles  

NSDL National Science Digital Library

This case was developed to teach first-year medical students the basics of medical ethics. It describes a situation in which a family physician is treating a teenage patient for a sexually transmitted disease. Based on information she gives him, he is concerned not only for her health and welfare, but also for the health and welfare of others. Students read the case and discuss the choices the doctor might make using the ethical principles of autonomy, beneficence, non-maleficence, and justice. Students then develop a rationale for the physician acting according to one of the ethical principles identified, and prepare a debate for the class supporting the rationale.

Knutson, Doug; Post, Doug M.

2006-01-01

3

Bioethical principles and care-based ethics in medical futility.  

PubMed

The process for solving ethical, legal, and moral dilemmas in the field of medicine is complex and time consuming. Frequently, the constraint of time forces the healthcare professional to make decisions quickly. When working with the cancer population, one faces, additionally, the dilemma of medical futility. Guidelines from the bioethical principles of autonomy, beneficence, nonmalificence, and justice help to address this dilemma. The use of care-based ethics allows healthcare professionals to establish trust, thus enabling patients and their families to be open to change and make realistic decisions. This article contrasts care-based ethical theory with justice-based ethical theory, using a case presentation to illustrate the importance of care-based ethics in making a moral decision to forgo medically futile treatment. PMID:8788770

Laffey, J

1996-01-01

4

Ancient Chinese medical ethics and the four principles of biomedical ethics.  

PubMed Central

The four principles approach to biomedical ethics (4PBE) has, since the 1970s, been increasingly developed as a universal bioethics method. Despite its wide acceptance and popularity, the 4PBE has received many challenges to its cross-cultural plausibility. This paper first specifies the principles and characteristics of ancient Chinese medical ethics (ACME), then makes a comparison between ACME and the 4PBE with a view to testing out the 4PBE's cross-cultural plausibility when applied to one particular but very extensive and prominent cultural context. The result shows that the concepts of respect for autonomy, non-maleficence, beneficence and justice are clearly identifiable in ACME. Yet, being influenced by certain socio-cultural factors, those applying the 4PBE in Chinese society may tend to adopt a "beneficence-oriented", rather than an "autonomy-oriented" approach, which, in general, is dissimilar to the practice of contemporary Western bioethics, where "autonomy often triumphs". PMID:10461594

Tsai, D F

1999-01-01

5

The patient-centered medical home: an ethical analysis of principles and practice.  

PubMed

The patient-centered medical home (PCMH), with its focus on patient-centered care, holds promise as a way to reinvigorate the primary care of patients and as a necessary component of health care reform. While its tenets have been the subject of review, the ethical dimensions of the PCMH have not been fully explored. Consideration of the ethical foundations for the core principles of the PCMH can and should be part of the debate concerning its merits. The PCMH can align with the principles of medical ethics and potentially strengthen the patient-physician relationship and aspects of health care that patients value. Patient choice and these ethical considerations are central and at least as important as the economic and practical arguments in support of the PCMH, if not more so. Further, the ethical principles that support key concepts of the PCMH have implications for the design and implementation of the PCMH. This paper explores the PCMH in light of core principles of ethics and professionalism, with an emphasis both on how the concept of the PCMH may reinforce core ethical principles of medical practice and on further implications of these principles. PMID:22829295

Braddock, Clarence H; Snyder, Lois; Neubauer, Richard L; Fischer, Gary S

2013-01-01

6

Ethics in medical research: General principles with special reference to psychiatry research  

PubMed Central

Ethics is an understanding of the nature of conflicts arising from moral imperatives and how best we may deal with them. Ethics in medical research deals with the conflicts of interest across various levels. Guidelines have been proposed for standardized ethical practice throughout the globe. The four fundamental principles of ethics which are being underscored are autonomy, non-maleficence, beneficence, and justice. Some special ethical issues have particular relevance to psychiatric research arising primarily from the specific vulnerabilities of those with mental illness and the risks posed by some research methodologies. Accordingly, sensitivity is required in the design of psychiatric research. It is suggested that though the value of published guidelines and the help that may be available from research ethics committees is quite great, the primary responsibility for maintaining high standards of practice in research rests with research workers themselves. PMID:23440168

Avasthi, Ajit; Ghosh, Abhishek; Sarkar, Sidharth; Grover, Sandeep

2013-01-01

7

Is Rorty's Neopragmatism the "Real" Foundation of Medical Ethics: a Search for Foundational Principles  

PubMed Central

Principlism, the predominate approach to bioethics, has no foundational principles. This absence of foundations reflects the general intellectual climate of postmodern relativism. Even America’s foremost public philosopher, Richard Rorty, whose pragmatism might suggest a philosophy of commonsense, seems to be swimming in the postmodern swamp. Alternatively, principlism’s architects, Beauchamp and Childress, suggest a constantly evolving reflective equilibrium with some basis in common morality as a workable framework for twenty-first century bioethics. The flaw in their approach is failure to conform to real doctors’ and patients’ experiences. Real doctors adopt a scientific paradigm that assumes an objective reality. Patients experience real suffering and seek effective cures, treatments, palliation and solace. The foundation of medical ethics should be that doctors altruistically respond to their patients’ suffering using scientifically acceptable modalities. Compassion, caring, and respect for human dignity are needed as guides in addition to justice, beneficence, nonmaleficence and respect for autonomy. PMID:18528478

Branch, William T

2006-01-01

8

Medical Ethics  

MedlinePLUS

... donate an organ to a sick relative? Your personal health information: who has access to your records? Patient rights: Do you have the right to refuse treatment? When you talk with your doctor, is it ethical for her to withhold information from you or your family?

9

Ethical issues in medical malpractice.  

PubMed

The interrelationships between biomedical ethics and the law are perhaps nowhere as starkly apparent as in the realm of medical malpractice. Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of futile care at the insistence of patients or families; and the various protections of Good Samaritan laws are just a few of these. In addition, the ethical principles governing the conduct of physicians serving as expert witnesses in medical malpractice cases have become a subject of intense interest in recent years. PMID:16877140

Solomon, Robert C

2006-08-01

10

Code of Ethics: Principles for Ethical Leadership  

PubMed Central

The code of ethics for a professional association incorporates values, principles, and professional standards. A review and comparative analysis of a 1934 pledge and codes of ethics from 1957, 1977, 1988, 1998, 2004, and 2011 for a health information management association was conducted. Highlights of some changes in the healthcare delivery system are identified as a general context for the codes of ethics. The codes of ethics are examined in terms of professional values and changes in the language used to express the principles of the various codes. PMID:23346028

Flite, Cathy A.; Harman, Laurinda B.

2013-01-01

11

The dangers of medical ethics.  

PubMed

The dominant conception of medical ethics being taught in British and American medical schools is at best pointless and at worst dangerous, or so it will be argued. Although it is laudable that medical schools have now given medical ethics a secure place in the curriculum, they go wrong in treating it like a scientific body of knowledge. Ethics is a unique subject matter precisely because of its widespread familiarity in all areas of life, and any teaching has to start from this shared ethical understanding and from the familiar ethical concepts of ordinary language. Otherwise there is a real risk that spurious technocratic jargon will be deployed by teacher and student alike in the futile search for intellectual respectability, culminating in a misplaced sense of having "done" the ethics module. There are no better examples of such jargon than "consequentialism", "deontology", and the "Four Principles". At best, they cannot do the work they were designed to do and, at worst, they can lead student and practitioner into ignoring their own healthy ethical intuitions and vocabulary. PMID:16319242

Cowley, C

2005-12-01

12

Ethical Principles: Guiding the Use of Animals in Research.  

ERIC Educational Resources Information Center

Presents arguments on the use of animals in biological and medical research. Discusses ethical considerations, principles, and animal rights in scientific research. (Contains 21 references.) (Author/YDS)

Morrison, Adrian R.

2003-01-01

13

Ethical principles and recommendations for the medical management of differences of sex development (DSD)\\/intersex in children and adolescents  

Microsoft Academic Search

\\u000a Abstract  The medical management of differences of sex development (DSD)\\/intersex in early childhood has been criticized by patients’\\u000a advocates as well as bioethicists from an ethical point of view. Some call for a moratorium of any feminizing or masculinizing\\u000a operations before the age of consent except for medical emergencies. No exhaustive ethical guidelines have been published\\u000a until now. In particular, the

Claudia Wiesemann; Susanne Ude-Koeller; Gernot H. G. Sinnecker; Ute Thyen

2010-01-01

14

A comparative analysis of moral principles and behavioral norms in eight ethical codes relevant to health sciences librarianship, medical informatics, and the health professions  

PubMed Central

Objective: Based on the authors' shared interest in the interprofessional challenges surrounding health information management, this study explores the degree to which librarians, informatics professionals, and core health professionals in medicine, nursing, and public health share common ethical behavior norms grounded in moral principles. Methods: Using the “Principlism” framework from a widely cited textbook of biomedical ethics, the authors analyze the statements in the ethical codes for associations of librarians (Medical Library Association [MLA], American Library Association, and Special Libraries Association), informatics professionals (American Medical Informatics Association [AMIA] and American Health Information Management Association), and core health professionals (American Medical Association, American Nurses Association, and American Public Health Association). This analysis focuses on whether and how the statements in these eight codes specify core moral norms (Autonomy, Beneficence, Non-Maleficence, and Justice), core behavioral norms (Veracity, Privacy, Confidentiality, and Fidelity), and other norms that are empirically derived from the code statements. Results: These eight ethical codes share a large number of common behavioral norms based most frequently on the principle of Beneficence, then on Autonomy and Justice, but rarely on Non-Maleficence. The MLA and AMIA codes share the largest number of common behavioral norms, and these two associations also share many norms with the other six associations. Implications: The shared core of behavioral norms among these professions, all grounded in core moral principles, point to many opportunities for building effective interprofessional communication and collaboration regarding the development, management, and use of health information resources and technologies. PMID:25349543

Byrd, Gary D.; Winkelstein, Peter

2014-01-01

15

Metaphysics and medical ethics.  

PubMed

I take issue with Frank Leavitt's sketch of a pragmatic criterion for the relevance of metaphysics to medical ethics. I argue that appeal to the potential for confusion generated by metaphysical subtlety establishes a need for better communication rather than shows philosophical insight beside the point. I demonstrate that the proposed Criterion of Relevance has absurd consequences, and I claim that the relevance of philosophical doctrines, whether ethical or metaphysical, is best accounted for in terms of improved understanding. PMID:7608933

Parkin, C

1995-04-01

16

Handicapped infants: medical ethics and the law.  

PubMed Central

The main purpose of this paper (1) is to draw attention to a gap between the principles of Common Law and the principles accepted by many leading medical practitioners on the ethics of allowing severely handicapped infants to die. The Common Law principles are shown in Court of Appeal judgements on two cases. The contrasting principles of many paediatricians were illustrated at the trial of Dr Leonard Arthur. The paper suggests that the gap could be closed by statutory guidance on general principles. It also argues that utilitarian concepts misrepresent the ethical issues of medical dilemmas like this one. PMID:2965246

Raphael, D D

1988-01-01

17

Ethics in medical research and publication.  

PubMed

To present the basic principles and standards of Ethics in medical research and publishing, as well as the need for continuing education in the principles and ethics in science and publication in biomedicine. An analysis of relevant materials and documents, sources from the published literature. Investing in education of researches and potential researches, already in the level of medical schools. Educating them on research ethics, what constitutes research misconduct and the seriousness of it repercussion is essential for finding a solution to this problem and ensuring careers are constructed on honesty and integrity. PMID:25317288

Masic, Izet; Hodzic, Ajla; Mulic, Smaila

2014-09-01

18

Ethics in Medical Research and Publication  

PubMed Central

To present the basic principles and standards of Ethics in medical research and publishing, as well as the need for continuing education in the principles and ethics in science and publication in biomedicine. An analysis of relevant materials and documents, sources from the published literature. Investing in education of researches and potential researches, already in the level of medical schools. Educating them on research ethics, what constitutes research misconduct and the seriousness of it repercussion is essential for finding a solution to this problem and ensuring careers are constructed on honesty and integrity. PMID:25317288

Masic, Izet; Hodzic, Ajla; Mulic, Smaila

2014-01-01

19

Ethics and reproductive health: a principled approach.  

PubMed

Universal ethical principles can be used to analyse problems in reproductive health. The principle of beneficence obligates people to strive to bring about more beneficial consequences than harmful ones. The principle known as respect for persons presumes that all human beings have dignity and are worthy of respect. Showing equal respect for women as persons means recognizing their autonomy and treating them as capable decision-makers and full participants in medical decisions. A third leading concern of bioethics is justice, which requires a fair distribution of family planning methods, including access to safe abortion in cases of contraceptive failure. PMID:9050194

Macklin, R

1996-01-01

20

Ethics committees, principles and consequences.  

PubMed

When ethics committees evaluate the research proposals submitted to them by biomedical scientists, they can seek guidance from laws and regulations, their own beliefs, values and experiences, and from the theories of philosophers. The starting point of this paper is that philosophers can only be helpful to the members of ethics committees if they take into account in their models both the basic moral intuitions that most of us share and the consequences of people's choices. A moral view which can be labelled as a consequentialist interpretation of mid-level principlism is developed, defended and applied to some real-life and hypothetical research proposals. PMID:9602993

Häyry, M

1998-04-01

21

Islamic medical ethics: a primer.  

PubMed

Modern medical practice is becoming increasingly pluralistic and diverse. Hence, cultural competency and awareness are given more focus in physician training seminars and within medical school curricula. A renewed interest in describing the varied ethical constructs of specific populations has taken place within medical literature. This paper aims to provide an overview of Islamic Medical Ethics. Beginning with a definition of Islamic Medical Ethics, the reader will be introduced to the scope of Islamic Medical Ethics literature, from that aimed at developing moral character to writings grounded in Islamic law. In the latter form, there is an attempt to derive an Islamic perspective on bioethical issues such as abortion, gender relations within the patient-doctor relationship, end-of-life care and euthanasia. It is hoped that the insights gained will aid both clinicians and ethicists to better understand the Islamic paradigm of medical ethics and thereby positively affect patient care. PMID:17845488

Padela, Aasim I

2007-03-01

22

Power and the teaching of medical ethics.  

PubMed Central

This paper argues that ethics education needs to become more reflective about its social and political ethic as it participates in the construction and transmission of medical ethics. It argues for a critical approach to medical ethics and explores the political context in medical schools and some of the peculiar problems in medical ethics education. PMID:10635507

Nicholas, B

1999-01-01

23

How Many Principles for Public Health Ethics?  

PubMed Central

General moral (ethical) principles play a prominent role in certain methods of moral reasoning and ethical decision-making in bioethics and public health. Examples include the principles of respect for autonomy, beneficence, nonmaleficence, and justice. Some accounts of ethics in public health have pointed to additional principles related to social and environmental concerns, such as the precautionary principle and principles of solidarity or social cohesion. This article provides an overview of principle-based methods of moral reasoning as they apply to public health ethics including a summary of advantages and disadvantages of methods of moral reasoning that rely upon general principles of moral reasoning. Drawing upon the literature on public health ethics, examples are provided of additional principles, obligations, and rules that may be useful for analyzing complex ethical issues in public health. A framework is outlined that takes into consideration the interplay of ethical principles and rules at individual, community, national, and global levels. Concepts such as the precautionary principle and solidarity are shown to be useful to public health ethics to the extent that they can be shown to provide worthwhile guidance and information above and beyond principles of beneficence, nonmaleficence, and justice, and the clusters of rules and maxims that are linked to these moral principles. Future directions likely to be productive include further work on areas of public health ethics such as public trust, community empowerment, the rights of individuals who are targeted (or not targeted) by public health interventions, individual and community resilience and wellbeing, and further clarification of principles, obligations, and rules in public health disciplines such as environmental science, prevention and control of chronic and infectious diseases, genomics, and global health. PMID:20072707

Coughlin, Steven S.

2009-01-01

24

Ethics for Medical Educators: An Overview and Fallacies  

PubMed Central

Ethics is the rule of right conduct or practice in a profession. The basic principles of ethics are beneficence, justice and autonomy or individual freedom. There is very minor demarcation between ethics and the law. The ethics is promulgated by the professional bodies. All are expected to guide the medical professional in their practice. Medical educators have dual ethical obligations: firstly, to the society at large which expects us to produce competent health professionals, and secondly, to the students under our care. The students observe and copy what their teacher does and his/her role modelling can be a gateway to a student's character building. Due to rapid increase in the number of medical colleges, privatization, and capitalism, ethical issue has become much more relevant and needs to discuss in detail. The present paper discusses the ethics for medical educators in detail with, basic principles, common breaches of ethics and fallacies due to wrong application of ethical principles, and the approach to ethics and methods by which we can prevent and avoid breach of ethics. PMID:21716861

Singh, Arjun

2010-01-01

25

Ethics for medical educators: an overview and fallacies.  

PubMed

Ethics is the rule of right conduct or practice in a profession. The basic principles of ethics are beneficence, justice and autonomy or individual freedom. There is very minor demarcation between ethics and the law. The ethics is promulgated by the professional bodies. All are expected to guide the medical professional in their practice. Medical educators have dual ethical obligations: firstly, to the society at large which expects us to produce competent health professionals, and secondly, to the students under our care. The students observe and copy what their teacher does and his/her role modelling can be a gateway to a student's character building. Due to rapid increase in the number of medical colleges, privatization, and capitalism, ethical issue has become much more relevant and needs to discuss in detail. The present paper discusses the ethics for medical educators in detail with, basic principles, common breaches of ethics and fallacies due to wrong application of ethical principles, and the approach to ethics and methods by which we can prevent and avoid breach of ethics. PMID:21716861

Singh, Arjun

2010-07-01

26

Medical ethics in the media.  

PubMed

The mass media function both as reflector and a shaper of a society's attitudes and values and as such represent a forum within which one may understand and influence public opinion. While questions of medical ethics may be largely confined to academic and scientific spaces, their importance to society at large cannot be denied, and how issues of medical ethics play out--if at all--in the media could tell us how society understands and processes these questions. This paper uses the techniques of framing analysis and textual analysis to examine how the print media, represented by two major Indian newspapers, cover medical ethics. The study looked at all articles related to medical research over a three-month period (January-March 2007) and considered how the story was framed, what were the key threads followed, and the dominant themes focused on. The ethical frame is notable by its absence, even in articles related to controversial themes such as drug research and genetics. Discussion of ethics appears to be problematic given the adherence to traditional "news values" when covering science and medicine. The research community and the media need to pay more attention to explicitly focusing on ethics in their interactions. PMID:19241950

Raman, Usha

2009-01-01

27

Medical Efficacy and Medical Ethics  

Microsoft Academic Search

The pro-life movement has a problem, an undiagnosed illness, as it were, which may cause the movement to self-destruct. It is a problem commonly found among those ardently involved in saving the lives of the unborn, the crippled, the senile and others unable to fend for themselves. The problem is an overvaluation of medical care often taking the form of

Hilton P. Terrell

28

Evaluating ethics competence in medical education.  

PubMed Central

We critically evaluate the ways in which competence in medical ethics has been evaluated. We report the initial stage in the development of a relevant, reliable and valid instrument to evaluate core critical thinking skills in medical ethics. This instrument can be used to evaluate the impact of medical ethics education programmes and to assess whether medical students have achieved a satisfactory level of performance of core skills and knowledge in medical ethics, within and across institutions. PMID:10536759

Savulescu, J; Crisp, R; Fulford, K W; Hope, T

1999-01-01

29

A Medical Ethics Assessment of the Case of Terri Schiavo  

ERIC Educational Resources Information Center

The social, legal, and political discussion about the decision to stop feeding and hydration for Terri Schiavo lacked a medical ethics assessment. The authors used the principles of medical indications, quality of life, patient preference, and contextual features as a guide to medical decision-making in this case. Their conclusions include the…

Preston, Tom; Kelly, Michael

2006-01-01

30

Risk and medical ethics.  

PubMed Central

Quantitative estimates of risk, and their comparison with quantitative estimates of benefit, contribute usefully to decision-making in many fields. In medicine, our assessments of the probability of harm, and of the likelihood of benefit, resulting from many procedures are at present very limited. Moreover, the comparison of risk and of benefit is difficult to make in any quantitative way, whether for a procedure in general or, even more so, for its application in any particular patient. Yet it must be ethically insecure to propose or to use a procedure without some assessment, however approximate, of the hazards involved, and without some indication of whether those hazards will be clearly offset by the likelihood of benefit that should result from use of the procedure. PMID:7154031

Pochin, E

1982-01-01

31

Faculty ethics: ideal principles with practical applications.  

PubMed

Ethics in higher education is the subject of intense public attention, with considerable focus on faculty roles and responsibilities. Media reports and scholarly research have documented egregious misconduct that includes plagiarism, falsification of data, illicit teacher-student relationships, and grading bias. These accounts of wrongdoing often portray faculty ethicality as only a legal issue of obeying rules and regulations, especially in the teaching and research roles. My discussion challenges this narrow perspective and argues that characterizations of faculty ethicality should take into account broader expectations for professionalism such as collegiality, respect, and freedom of inquiry. First, I review the general principles of faculty ethics developed by the American Association of University Professors, as well as professional codes of ethics in specific professional fields. Second, I juxtapose the experiences of women and minority faculty members in relation to these general codes of ethics. This section examines three issues that particularly affect women and minority faculty experiences of ethicality: "chilly and alienating" academic climates, "cultural taxation" of minority identity, and the snare of conventional reward systems. Third, I suggest practical strategies to reconcile faculty practice with codes of ethics. My challenge is to the faculty as a community of practice to engage professional ethics as social and political events, not just legal and moral failures. PMID:20054074

Reybold, L Earle

2009-01-01

32

The Ethics of Prescribing Medications to Older People  

Microsoft Academic Search

\\u000a The four principles of medical ethics – beneficence, nonmaleficence, autonomy, and justice – provide a pragmatic foundation\\u000a and steadying influence to guide prescribing in older people where the evidence base for efficacy is uncertain and concerns\\u000a regarding adverse drug reactions are protean. In most cases, the ethical principles are undermined not by intent, but more\\u000a likely by lack of knowledge,

David G. Le Couteur; Hal Kendig; Vasi Naganathan; Andrew J. McLachlan

33

The four principles: Can they be measured and do they predict ethical decision making?  

PubMed Central

Background The four principles of Beauchamp and Childress - autonomy, non-maleficence, beneficence and justice - have been extremely influential in the field of medical ethics, and are fundamental for understanding the current approach to ethical assessment in health care. This study tests whether these principles can be quantitatively measured on an individual level, and then subsequently if they are used in the decision making process when individuals are faced with ethical dilemmas. Methods The Analytic Hierarchy Process was used as a tool for the measurement of the principles. Four scenarios, which involved conflicts between the medical ethical principles, were presented to participants who then made judgments about the ethicality of the action in the scenario, and their intentions to act in the same manner if they were in the situation. Results Individual preferences for these medical ethical principles can be measured using the Analytic Hierarchy Process. This technique provides a useful tool in which to highlight individual medical ethical values. On average, individuals have a significant preference for non-maleficence over the other principles, however, and perhaps counter-intuitively, this preference does not seem to relate to applied ethical judgements in specific ethical dilemmas. Conclusions People state they value these medical ethical principles but they do not actually seem to use them directly in the decision making process. The reasons for this are explained through the lack of a behavioural model to account for the relevant situational factors not captured by the principles. The limitations of the principles in predicting ethical decision making are discussed. PMID:22606995

2012-01-01

34

Methods and principles in biomedical ethics  

PubMed Central

The four principles approach to medical ethics plus specification is used in this paper. Specification is defined as a process of reducing the indeterminateness of general norms to give them increased action guiding capacity, while retaining the moral commitments in the original norm. Since questions of method are central to the symposium, the paper begins with four observations about method in moral reasoning and case analysis. Three of the four scenarios are dealt with. It is concluded in the "standard" Jehovah's Witness case that having autonomously chosen the authority of his religious institution, a Jehovah's Witness has a reasonable basis on which to refuse a recommended blood transfusion. The author's view of the child of a Jehovah's Witness scenario is that it is morally required—not merely permitted—to overrule this parental refusal of treatment. It is argued in the selling kidneys for transplantation scenario that a fair system of regulating and monitoring would be better than the present system which the author believes to be a shameful failure. PMID:14519835

Beauchamp, T

2003-01-01

35

Medical ethics under managed care.  

PubMed

"Managed Care" is having a profound effect on medical ethics and the patient/physician relationship. Historically, the patient (the first party) contracted with a physician (the second party) to provide medical care. The physician had ethical and legal obligations to the patient. In the "new health care," an employer or the government (the fourth party) or infrequently, the patient (the first party) purchases health care from the HMO, PPO, or similar organization (the third party). The third party then contracts with the physician (the second party) to provide that care. The physician has agreed to two, at times competing and possibly immutably conflicting obligations--one to the patient and one to the third party. The ethical and legal problems that arise from conflict between "the bottom line" and "desired" (appropriate) health care will be difficult to solve. The incompatible duality of physician roles both as patient advocate and manager of limited resources will be further explored, with attention to the enormous pressure being applied to this conflict by society, the law, and the third party. Potential resolutions will be offered. Other ethical problems created by the health care system's conversion to managed care include: CONFIDENTIALITY--Information management is a fundamental underpinning of managed care. With patients switching health care programs frequently, and their enormous size and complexity, careful attention to confidentiality is necessary. INFORMED CONSENT--In addition to informed consent relative to the health care being offered, the patient has a right to know what alternatives might be offered independent of her insurance and payment plan. The patient also has a right to know the economic pressures and arrangements between the second and third parties that could influence the quantity and quality of her health care. QUALITY OF CARE--Managed care contends to be religiously attentive to quality of care. If this is so, the very definition of quality of care may be changing. PMID:8829689

Schwartz, P

1996-01-01

36

The healing philosopher: John Locke's medical ethics.  

PubMed

This article examines a heretofore unexplored facet of John Locke's philosophy. Locke was a medical doctor and he also wrote about medical issues that are controversial today. Despite this, Locke's medical ethics has yet to be studied. An analysis of Locke's education and his teachers and colleagues in the medical profession, of the 17th century Hippocratic Oath, and of the reaction to the last recorded outbreak of the bubonic plague in London, shines some light on the subject of Locke's medical ethics. The study of Locke's medical ethics confirms that he was a deontologist who opposed all suicide and abortion through much of pregnancy. PMID:15709441

Short, Bradford William

2004-01-01

37

Ethical Principles in Russias Social and Economic Policy  

Microsoft Academic Search

The role and place of the ethical approach in Russias social and economic policy are shown; ethical aspects of economic policy are considered; basic ethical principles which should be taken into account in the process of development of social and economic policy are offered. Ethical requirements to such basic directions of state economic policy as fiscal and price policy, labor

D. PETROSYAN; N. FATKINA

2008-01-01

38

A moral principles framework for human resource management ethics  

Microsoft Academic Search

This paper argues that the analysis of ethical issues in human resource management is legitimate and important. It argues that the theory of ethical relativism should be rejected and that it is meaningful to search for universal moral principles. It then presents a comprehensive framework for making judgments about human resource management ethics that consists of five complementary moral principles

Paul L. Schumann

2001-01-01

39

Western medical ethics taught to junior medical students can cross cultural and linguistic boundaries  

PubMed Central

Background Little is known about teaching medical ethics across cultural and linguistic boundaries. This study examined two successive cohorts of first year medical students in a six year undergraduate MBBS program. Methods The objective was to investigate whether Arabic speaking students studying medicine in an Arabic country would be able to correctly identify some of the principles of Western medical ethical reasoning. This cohort study was conducted on first year students in a six-year undergraduate program studying medicine in English, their second language at a medical school in the Arabian Gulf. The ethics teaching was based on the four-principle approach (autonomy, beneficence, non-malfeasance and justice) and delivered by a non-Muslim native English speaker with no knowledge of the Arabic language. Although the course was respectful of Arabic culture and tradition, the content excluded an analysis of Islamic medical ethics and focused on Western ethical reasoning. Following two 45-minute interactive seminars, students in groups of 3 or 4 visited a primary health care centre for one morning, sitting in with an attending physician seeing his or her patients in Arabic. Each student submitted a personal report for summative assessment detailing the ethical issues they had observed. Results All 62 students enrolled in these courses participated. Each student acting independently was able to correctly identify a median number of 4 different medical ethical issues (range 2–9) and correctly identify and label accurately a median of 2 different medical ethical issues (range 2–7) There were no significant correlations between their English language skills or general academic ability and the number or accuracy of ethical issues identified. Conclusions This study has demonstrated that these students could identify medical ethical issues based on Western constructs, despite learning in English, their second language, being in the third week of their medical school experience and with minimal instruction. This result was independent of their academic and English language skills suggesting that ethical principles as espoused in the four principal approach may be common to the students' Islamic religious beliefs, allowing them to access complex medical ethical reasoning skills at an early stage in the medical curriculum. PMID:15283868

Ypinazar, Valmae A; Margolis, Stephen A

2004-01-01

40

Medical Devices: Principles of Clinical Evaluation of Effectiveness and Safety  

E-print Network

Medical Devices: Principles of Clinical Evaluation of Effectiveness and Safety P1 D11 v2 050521 in trials including ethical issues. However, it goes on to indicate where trials of medical devices need basic groups of users in mind: The manager or non-specialist, including the new recruit, requiring

Oakley, Jeremy

41

Principles of Medical Management  

Microsoft Academic Search

In the past, patients rarely questioned the therapeutic decisions made by their physicians. Physicians, in turn, were guided\\u000a by the principle of “doing onto others as you would have done onto you” and were largely limited by their clinical experiences.\\u000a Today, evidence-based medicine dictates most treatment decisions, and the role of the physician in educating patients about\\u000a available therapeutic options

Tarek Mekhail; Rony Abou-Jawde; Maurie Markman

42

Casuistry: A Complement to Principle Ethics and a Foundation for Ethical Decisions  

ERIC Educational Resources Information Center

Ethical dilemmas within any system are created when moral/ethical principles, rules, or guidelines can be cited for opposing actions with neither side presenting the obvious, right course to follow. This condition exposes the intricate interrelationship between abstract moral/ethical principles and the description and evaluation of real-life…

Freeman, Stephen J.; Francis, Perry C.

2006-01-01

43

Rethinking medical ethics: a view from below.  

PubMed

In this paper, we argue that lack of access to the fruits of modern medicine and the science that informs it is an important and neglected topic within bioethics and medical ethics. This is especially clear to those working in what are now termed 'resource-poor settings'- to those working, in plain language, among populations living in dire poverty. We draw on our experience with infectious diseases in some of the poorest communities in the world to interrogate the central imperatives of bioethics and medical ethics. AIDS, tuberculosis, and malaria are the three leading infectious killers of adults in the world today. Because each disease is treatable with already available therapies, the lack of access to medical care is widely perceived in heavily disease-burdened areas as constituting an ethical and moral dilemma. In settings in which research on these diseases are conducted but there is little in the way of therapy, there is much talk of first world diagnostics and third world therapeutics. Here we call for the 'resocialising' of ethics. To resocialise medical ethics will involve using the socialising disciplines to contextualise fully ethical dilemmas in settings of poverty and, a related gambit, the systematic participation of the destitute sick. Clinical research across steep gradients also needs to be linked with the interventions that are demanded by the poor and otherwise marginalised. We conclude that medical ethics must grapple more persistently with the growing problem posed by the yawning 'outcome gap' between rich and poor. PMID:15086372

Farmer, Paul; Campos, Nicole Gastineau

2004-05-01

44

Ethical principles for physician rating sites.  

PubMed

During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites' effects on physicians' performance, patient outcomes, or the public's trust in health care, most contributions refer to normative arguments, hypothetical effects, or indirect evidence. This paper aims, first, to structure the ethical debate about the basic concept of physician rating sites: allowing patients to rate, comment, and discuss physicians' performance, online and visible to everyone. Thus, it provides a more thorough and transparent starting point for further discussion and decision making on physician rating sites: what should physicians and health policy decision makers take into account when discussing the basic concept of physician rating sites and its possible implications on the physician-patient relationship? Second, it discusses where and how the preexisting evidence from the partly related field of public reporting of physician performance can serve as an indicator for specific needs of evaluative research in the field of physician rating sites. This paper defines the ethical principles of patient welfare, patient autonomy, physician welfare, and social justice in the context of physician rating sites. It also outlines basic conditions for a fair decision-making process concerning the implementation and regulation of physician rating sites, namely, transparency, justification, participation, minimization of conflicts of interest, and openness for revision. Besides other issues described in this paper, one trade-off presents a special challenge and will play an important role when deciding about more- or less-restrictive physician rating sites regulations: the potential psychological and financial harms for physicians that can result from physician rating sites need to be contained without limiting the potential benefits for patients with respect to health, health literacy, and equity. PMID:22146737

Strech, Daniel

2011-01-01

45

Buddhism and Medical Ethics: A Bibliographic Introduction  

Microsoft Academic Search

ABSTRACT ,This article provides an introduction to some contemporary issues in medical ethics and the literature which addresses them from a Buddhist perspective. The first part of the article discusses Buddhism,and medicine,and outlines some of the main issues in contemporary,medical ethics. In the rest of the paper three subjects are considered: i) moral personhood, ii) abortion, and iii) death, dying

James J. Hughes

1995-01-01

46

A Systematic Review of Ethical Principles in the Plastic Surgery Literature  

PubMed Central

Background: To perform a systematic review to identify articles that discuss ethical issues relating to the field of plastic and reconstructive surgery and to evaluate whether ethical issues are underrepresented in the plastic surgery literature. Methods: Four medical databases were selected to search through the medical literature with specific inclusion criteria to disqualify irrelevant articles from the study. Appropriate articles were extracted, and their quality and validity were assessed by multiple investigators to maximize reproducibility. The data were then synthesized and analyzed for associations amongst the ethical principles. Results: Out of a total library search of >100,000 plastic surgery oriented articles, only 110 clearly focused on ethical principles. Autonomy (53%) was the most common major theme, whereas distributive justice (15%) represented the least frequently emphasized ethical principle. The proportions of each ethical principle were tested against each other for equality using Cochran's Q test; the Q test reached statistical significance (Q = 67.04, df =3, P < 0.0001), indicating that the ethical principles were not discussed equally in plastic surgery literature, which was expected because autonomy represented 53% of the manuscripts whereas distributive justice represented only 15% of manuscripts. When examining both major and minor themes, over half of the articles (61%) addressed 2 or more ethical principles. Beneficence and nonmaleficence were strongly associated (Pearson's x2 = 55.38, df =1, P<0.0001). Conclusions: Despite the extensive amount of ethical issues that plastic surgeons face, a relatively small proportion of plastic surgery literature was dedicated to discussing ethical principles. PMID:20009860

Chung, Kevin C.; Pushman, Allison G.; Bellfi, Lillian T.

2009-01-01

47

Canadian University Ethics Review: Cultural Complications Translating Principles into Practice  

ERIC Educational Resources Information Center

Drawing from educational research conducted in Canada and Mexico, university researchers explore how culture complicates both the ethics review process and the translation of ethical research principles into practice. University researchers in Canadian contexts seek approval from university Research Ethics Boards to conduct research, following…

Tilley, Susan; Gormley, Louise

2007-01-01

48

Nurse prescribing ethics and medical marketing.  

PubMed

This article suggests that nurse prescribers require an awareness of key concepts in ethics, such as deontology and utilitarianism to reflect on current debates and contribute to them. The principles of biomedical ethics have also been influential in the development of professional codes of conduct. Attention is drawn to the importance of the Association of the British Pharmaceutical Industry's code of practice for the pharmaceutical industry in regulating marketing aimed at prescribers. PMID:21500692

Adams, J

49

Intragastric Balloon: Ethics, Medical Need and Cosmetics  

Microsoft Academic Search

The development of the intragastic balloon as a safe, noninvasive, alternative method to weight reduction raises all the ethical questions routinely faced by practitioners of other forms of cosmetic surgery. In the case of the morbidly, severely or merely obese, the surgeon is faced with a medical decision in a situation defined by medical parameters. The case of the overweight

Katerina Kotzampassi; Anne D. Shrewsbury

2008-01-01

50

Ethical challenges in emergency medical services. A special contribution of the Ethics Committee, National Association of Emergency Medical Services Physicians.  

PubMed

Patient autonomy, beneficence, and justice are the fundamental ethical principles of an emergency medical service. Ethical conflicts are present in the daily practice of prehospital care. These conflicts surround issues of resuscitation, futile therapy, consent, and refusal of care, duty, and confidentiality. Emergency medical services must remain fair and equitable, equally available to those it is designed to serve, regardless of the patient's social or economic status. Establishing priorities for patient care is dictated by medical and operational concerns. Education and information regarding ethical issues are important for the providers of prehospital medical care as well as the medical director. Policies and protocols must continue to be developed to address requests to limit resuscitation, such as refusal of care and patient confidentiality. Policies should be developed in conjunction with experienced legal advice. Current training does not equip even the most advanced prehospital care provider to deal easily with every potential situation. Many learn by experience, some are guided by clear policy. Ideally, medical control personnel will be educated, interested, and available to address dilemmas which arise. Where possible, policies and procedures should be developed to address ethical issues which are likely to be faced by EMS personnel. PMID:10155466

1993-01-01

51

Treating Ed A Medical Ethics Case Study  

NSDL National Science Digital Library

Ed is dying. How should his wishes for medical treatment be carried out? As the case unfolds, students explore the rights and responsibilities of doctors, patients, and patient representatives regarding difficult medical decisions. Specifically, students consider the ramifications of Advance Directives and Durable Powers of Attorney. The case was written for an introductory biology course, but could easily be used in or modified for a human anatomy and physiology, introductory nursing, or medical ethics course.

Ribbens, Eric

2008-01-01

52

Medical ethics and education for social responsibility.  

PubMed Central

The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor's responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization. PMID:7405276

Roemer, M. I.

1980-01-01

53

[Medical expert opinion--credibility, ethics, remuneration].  

PubMed

Israeli Law requires a Personal Injury Claim to be supported by an Expert Medical Opinion. Such evidence provides the Court with information essential for the evaluation of scientific material, which is beyond the Court's "judicial knowledge". Incongruent Expert Opinions are not necessarily the result of deceit. Experts are entitled to differences in their respective evaluation and interpretation of data and conflicting medical opinions may be legitimate. The Court's duty and prerogative is to select the "legally correct" opinion. The sole tool at the Court's disposal is precise and logical thinking, aided by principles set by the U.S. Supreme Court for the evaluation of scientific evidence, and adopted by the Israeli Court. The choice of the "correct" opinion centers on it's objectivity. A court-appointed expert is not necessarily an effective solution. Remuneration of the expert by the interested party increases the level of mistrust. The difficult questions concerning the credibility of an opinion arise as the result of insufficient specific expertise of the witness, presentation by a pretender to expertise or plain misrepresentation of data, excerpts of literature etc. Such transgressions are best exposed by the opposing party's expert and attorney. The court has effective means for the control of such behavior. The fraudulent expert witness is neither immune to criminal prosecution, nor to civil suit. IMA's Code of Ethics for Experts is adequate. Expert's fees should be consistent with the effort involved, as well as with the expert's rank and experience. Any linkage of fees to the outcome of the procedure should be prohibited, as well as the intervention of "contractors". Attempts to limit experts' fees, may result in the abstention of the most knowledgeable specialists from such duties. The blame for a false opinion does not lie with the paying party, it is mostly the witness who is responsible. PMID:17803167

Sahar, Avraham

2007-07-01

54

Jewish medical ethics – a brief overview  

PubMed Central

This paper outlines the traditional Jewish approach to medical ethics, as perceived by the Chief Rabbi of the British Commonwealth, himself an academic specialist in this field. It is based on a `St Paul's Lecture' given to the London Diocesan Council for Christian Jewish understanding. PMID:6576175

Jakobovits, Immanuel

1983-01-01

55

Human Rights, Ethical Principles, and Standards in Forensic Psychology  

Microsoft Academic Search

Human rights create a protective zone around persons and allow them the opportunity to further their valued personal projects without interference from others. This article considers the relationship between human rights and the general ethical principles and standards contained in the American Psychological Association's (APA's) code of ethics as applied to the forensic domain. First, it analyzes the concept of

Tony Ward; Theresa Gannon; Jim Vess

2009-01-01

56

Ethical Principles, Practices, and Problems in Higher Education.  

ERIC Educational Resources Information Center

Eighteen professionals analyze the ethical principles, practices, and problems in institutions of higher learning by examining the major issues facing higher education today. Focusing on ethical standards and judgements that affect decision-making and problem-solving, the contributors review the rights and responsibilities of academic freedom,…

Baca, M. Carlota, Ed.; Stein, Ronald H., Ed.

57

Perspective: Medical education in medical ethics and humanities as the foundation for developing medical professionalism.  

PubMed

Medical education accreditation organizations require medical ethics and humanities education to develop professionalism in medical learners, yet there has never been a comprehensive critical appraisal of medical education in ethics and humanities. The Project to Rebalance and Integrate Medical Education (PRIME) I Workshop, convened in May 2010, undertook the first critical appraisal of the definitions, goals, and objectives of medical ethics and humanities teaching. The authors describe assembling a national expert panel of educators representing the disciplines of ethics, history, literature, and the visual arts. This panel was tasked with describing the major pedagogical goals of art, ethics, history, and literature in medical education, how these disciplines should be integrated with one another in medical education, and how they could be best integrated into undergraduate and graduate medical education. The authors present the recommendations resulting from the PRIME I discussion, centered on three main themes. The major goal of medical education in ethics and humanities is to promote humanistic skills and professional conduct in physicians. Patient-centered skills enable learners to become medical professionals, whereas critical thinking skills assist learners to critically appraise the concept and implementation of medical professionalism. Implementation of a comprehensive medical ethics and humanities curriculum in medical school and residency requires clear direction and academic support and should be based on clear goals and objectives that can be reliably assessed. The PRIME expert panel concurred that medical ethics and humanities education is essential for professional development in medicine. PMID:22373629

Doukas, David J; McCullough, Laurence B; Wear, Stephen

2012-03-01

58

Medical Ethics in the Next 25 Years  

PubMed Central

In the next 10-15 years most of the major ethical dilemmas facing family physicians will grow more acute. This is not to imply that things are getting worse. On the contrary, it is the simultaneous growth of miraculous methods and frightening risks that will make the dilemmas more acute. In the next 15-25 years, we will learn how to minimize the risks. Several major ethical dilemmas of medical practice are reviewed from this perspective. Finally, some issues are considered that do not fit this pattern and that have the potential to become a much greater challenge to humanity. PMID:11662581

Tiberius, Richard G.

1979-01-01

59

[Kairos. Decision-making in medical ethics].  

PubMed

This paper assesses the decision making patterns in medical ethics: the formalized pattern of decision science, the meditative pattern of an art of judgement and lastly the still-to-be-elaborated pattern of kairology or sense of the right time. The ethical decision is to be thought out in the conditions of medical action while resorting to the philosophical concepts that shed light on the issue. And it is precisely where medicine and philosophy of human action meet that the Greek notion of kairos, or "propitious moment", evokes the critical point where decision has to do with what is vital. Reflection shows that this kairos can be thought out outside the sacrificial pattern (deciding comes down to killing a possibility) by understanding the opportune moment as a sign of ethical action, as the condition for the formation of the subject (making a decision) and finally as a new relationship to time, including in the context of medical urgency. Thus with an approach to clinical ethics centred on the relation to the individual, the focus is less on the probabilistic knowledge of the decidable than on the meaning of the decision, and the undecidable comes to be accepted as an infinite dimension going beyond the limits of our acts, which makes the contingency and the grandeur of human responsibility. PMID:25272798

Jousset, David

2014-06-01

60

The ethics of reality medical television.  

PubMed

Reality medical television, an increasingly popular genre, depicts private medical moments between patients and healthcare providers. Journalists aim to educate and inform the public, while the participants in their documentaries-providers and patients-seek to heal and be healed. When journalists and healthcare providers work together at the bedside, moral problems precipitate. During the summer of 2010, ABC aired a documentary, Boston Med, featuring several Boston hospitals. We examine the ethical issues that arise when journalism and medicine intersect. We provide a framework for evaluating the potential benefits and harms of reality medical television, highlighting critical issues such as informed consent, confidentiality, and privacy. PMID:23631335

Krakower, Thalia Margalit; Montello, Martha; Mitchell, Christine; Truog, Robert D

2013-01-01

61

Ethical Principles of Psychologists (Amended June 2, 1989).  

ERIC Educational Resources Information Center

Reports the amended ethical principles of psychologists (June 2, 1989). The following principles are covered: (1) responsibility; (2) competence; (3) moral and legal standards; (4) public statements; (5) confidentiality; (6) welfare of the consumer; (7) professional relationships; (8) assessment techniques; (9) research with human participants;…

American Psychologist, 1990

1990-01-01

62

Medical ethics--a Christian view.  

PubMed Central

All ethics has a religious dimension. This paper considers how specific Christian insights concerning death, suffering, human nature and human creatureliness can help to expose more fully the moral issues at stake in some of the dilemmas faced by doctors. It ends by acknowledging the crushing burden of decision-making which rests on many in the medical profession, and indicates the importance of religious resources in dealing with this. PMID:3981562

Habgood, J S

1985-01-01

63

Ethical and medical dilemmas of space tourism  

NASA Astrophysics Data System (ADS)

Space tourism is an important new venture, however it raises several issues that must be addressed; namely, the medical implications associated with space flight and potential for ethical problems surrounding the safety of such travel. It seems highly likely that businesses involved in space tourism could find themselves liable for any passenger deaths or injuries, if they are found to have been negligent. This paper, therefore, discusses such issues as the medical facilities that need to be made available on board a space facility, and the companies' duty to disclose to potential passengers the risks associated with microgravity and the likelihood of space sickness, loss of bone density, disease, and pregnancy.

Marsh, Melinda

64

Ethics in medical information and advertising.  

PubMed

This article presents findings and recommendations of an international conference held in Cairo, Egypt in 2003 concerning issues of ethical practice in how information is provided to and by medical practitioners. Professional advertising to practitioners and the public is necessary, but should exclude misrepresentation of qualifications, resources, and authorship of research papers. Medical institutions are responsible for how staff members present themselves, and their institutions. Medical associations, both governmental licensing authorities and voluntary societies, have powers and responsibilities to monitor professional advertisement to defend the public interest against deception. Medical journals bear duties to ensure authenticity of authorship and integrity in published papers, and the scientific basis of commercial advertisers' claims. A mounting concern is authors' conflict of interest. Mass newsmedia must ensure accuracy and proportionality in reporting scientific developments, and product manufacturers must observe truth in advertising, particularly in Direct-to-Consumer advertising. Consumer protection by government agencies is a continuing responsibility. PMID:15099793

Serour, G I; Dickens, B M

2004-05-01

65

Militarism, human welfare, and the APA Ethical Principles of Psychologists.  

PubMed

A case study is presented of the American Psychological Association (APA), as a health care organization that promotes human welfare. APA includes policies on human welfare in its Ethical Principles of Psychologists and even lists the advancement of psychology "as a means of promoting human welfare" on its letterhead. Nevertheless, APA has other policies and activities based on military and weapons work that appear to conflict with its promotion of human welfare. Although military work in and of itself may not necessarily be problematic, work that contributes to people purposely being harmed or killed should be squared with the association's ethical guidelines. The results presented here show that this may not be the case: There currently appears to be little justification in the Ethical Principles for work intended to harm people. APA's active lobbying, research, and development for the military are documented here, in relation to an analysis of the Ethical Principles. APA's uncritical support for Operation Desert Storm is examined specifically, with regard to weapons technology and therapeutic treatment of U.S. soldiers on the battlefield. This one-sided support for victims of the war is not in keeping with a Hippocratic health care ethic to treat patients needing care, and to do so with neutrality and impartiality. Similarities to a historical example of nationalistic mental health ethics are discussed, with a review of the development of the German Institute for Psychological Research and Psychotherapy and of the German Society for Psychology in the Nazi wartime effort and the Holocaust. The results here show similar deficiencies in APA's ethical standards, not the least of which is that the code applies to individual members but not to APA policies, committees, or activities. This article concludes with suggested criteria for the Ethical Principles that would at least (a) recognize the ambiguities in systematically developing and using weapons to hurt people and (b) provide an initial rationale of potential justifications. PMID:11651615

Summers, Craig

1992-01-01

66

Medical resource allocation: rationing and ethical considerations, Part II.  

PubMed

The proliferation of medical technology during the past decade has doubtless surpassed that of any other recent period. We have witnessed and are continuing to witness rapid advances in human genetic engineering, reproductive technology, and biomedical intervention in the life process. Our population has benefitted from this technology as a result of its ability to extend the life of individuals, particularly the elderly sector of our society. This technological proliferation has caused philosophers, physicians, engineers, and policy strategists to focus upon questions of ethics and mortality relating to their application. In approaching the ethics of rationing, consideration must be given to both the deontological concepts of the individual and the utilitarian principles of societal preservation. This article continues a discussion of the issues of resource allocation that was begun in the February 1994 issue of Physician Executive. PMID:10132544

Elfenbein, P; Miller, J B; Milakovich, M

1994-03-01

67

Imparting medical ethics: the role of mentorship in clinical training  

Microsoft Academic Search

Mentoring and ethics are integral and intersecting components of medical education. Faculty workloads and diffusion of responsibility for teaching impact both ethics and mentoring. In current academic medical center environments, the expectation that traditional one?on?one mentoring relationships will arise spontaneously between medical students and faculty may be unrealistic. Alternative curricula serve as examples for how to address mentoring and bioethics

Gail L. Rose; Margaret R. Rukstalis

2008-01-01

68

Imparting Medical Ethics: The Role of Mentorship in Clinical Training  

ERIC Educational Resources Information Center

Mentoring and ethics are integral and intersecting components of medical education. Faculty workloads and diffusion of responsibility for teaching impact both ethics and mentoring. In current academic medical center environments, the expectation that traditional one-on-one mentoring relationships will arise spontaneously between medical students…

Rose, Gail L.; Rukstalis, Margaret R.

2008-01-01

69

Characteristics of ethics committees of Japanese medical schools.  

PubMed

In Japan, almost all of the 80 medical colleges and medical faculties of universities have founded ethics committees voluntarily. To date, many of them have concentrated their deliberation on the general policy of advanced medical technologies which should be resolved at national level, while they have failed to become involved in ethical decisions in daily clinical cases. PMID:1484458

Bai, K

1992-01-01

70

An Analysis of Student Choices in Medical Ethical Dilemmas.  

ERIC Educational Resources Information Center

This report describes a study undertaken to assess student choices in medical ethical dilemmas. Medical ethical dilemmas are interpreted to include problems such as abortion, euthanasia, sterilization, experimentation on humans, allocation of scarce medical resources, and physician and health personnel training. The major purpose of the study was…

Woloshin, Phyllis Lerman

71

An international survey of medical ethics curricula in Asia.  

PubMed Central

SETTING: Medical ethics education has become common, and the integrated ethics curriculum has been recommended in Western countries. It should be questioned whether there is one, universal method of teaching ethics applicable worldwide to medical schools, especially those in non-Western developing countries. OBJECTIVE: To characterise the medical ethics curricula at Asian medical schools. DESIGN: Mailed survey of 206 medical schools in China, Hong Kong, Taiwan, Korea, Mongolia, Philippines, Thailand, Malaysia, Singapore, Indonesia, Sri Lanka, Australia and New Zealand. PARTICIPANTS: A total of 100 medical schools responded, a response rate of 49%, ranging from 23%-100% by country. MAIN OUTCOME MEASURES: The degree of integration of the ethics programme into the formal medical curriculum was measured by lecture time; whether compulsory or elective; whether separate courses or unit of other courses; number of courses; schedule; total length, and diversity of teachers' specialties. RESULTS: A total of 89 medical schools (89%) reported offering some courses in which ethical topics were taught. Separate medical ethics courses were mostly offered in all countries, and the structure of vertical integration was divided into four patterns. Most deans reported that physicians' obligations and patients' rights were the most important topics for their students. However, the evaluation was diverse for more concrete topics. CONCLUSION: Offering formal medical ethics education is a widespread feature of medical curricula throughout the study area. However, the kinds of programmes, especially with regard to integration into clinical teaching, were greatly diverse. PMID:10635508

Miyasaka, M; Akabayashi, A; Kai, I; Ohi, G

1999-01-01

72

Principles and Ethics in Scientific Communication in Biomedicine  

PubMed Central

Introduction and aim: To present the basic principles and standards of scientific communication and writing a paper, to indicate the importance of honesty and ethical approach to research and publication of results in scientific journals, as well as the need for continuing education in the principles and ethics in science and publication in biomedicine. Methods: An analysis of relevant materials and documents, sources from the internet and published literature and personal experience and observations of the author. Results: In the past more than 20 years there is an increasingly emphasized importance of respecting fundamental principles and standards of scientific communication and ethical approach to research and publication of results in peer review journals. Advances in the scientific community is based on honesty and equity of researchers in conducting and publishing the results of research and to develop guidelines and policies for prevention and punishment of publishing misconduct. Today scientific communication standards and definitions of fraud in science and publishing are generally consistent, but vary considerably policies and approach to ethics education in science, prevention and penal policies for misconduct in research and publication of results in scientific journals. Conclusion: It is necessary to further strengthen the capacity for education and research, and raising awareness about the importance and need for education about the principles of scientific communication, ethics of research and publication of results. The use of various forms of education of the scientific community, in undergraduate teaching and postgraduate master and doctoral studies, in order to create an ethical environment, is one of the most effective ways to prevent the emergence of scientific and publication dishonesty and fraud. PMID:24505166

Donev, Doncho

2013-01-01

73

Judgement and the role of the metaphysics of values in medical ethics  

PubMed Central

Despite its authors' intentions, the four principles approach to medical ethics can become crudely algorithmic in practice. The first section sets out the bare bones of the four principles approach drawing out those aspects of Beauchamp and Childress's Principles of biomedical ethics that encourage this misreading. The second section argues that if the emphasis on the guidance of moral judgement is augmented by a particularist account of what disciplines it, then the danger can be reduced. In the third section, I consider how much the resultant picture diverges from Beauchamp and Childress's actual position. PMID:16731739

Thornton, T

2006-01-01

74

[The Hippocratic Oath: source of medical ethics].  

PubMed

The Hippocratic Oath is twenty-five centuries old. Probably drawn-up by Hippocrates himself, it intervenes in a particular cultural, political and religious context: that of Greece at the time of Pericles. It guaranteed the Asclepiad doctors of the continuity of their knowledge within their community. Medicine was highly esteemed because of it. The Oath, more than any other work of the Hippocratic collection, has outlived the centuries. It still remains one of the symbols of the medical profession. Despite its age, it provides insight into some of the questions of medical ethics even today. Its topicality is, without doubt, due to the transcendent nature of the values it proclaimed. PMID:11850985

Petit, E P

2002-01-19

75

The obesity epidemic: medical and ethical considerations.  

PubMed

Obesity is increasingly becoming a problem for Western societies, to the extent that politicians, scientists, patient organisations and the media now refer to it as 'the obesity epidemic'. Concerns about the damaging effect of increasing body weight on public health has led to a strong growth in the amount of scientific work on the condition, with the medical professions leading the way. This article discusses that, first of all, scientific evidence for obesity-associated mortality is at best ambiguous, and proposes that at least some of contemporary medical preoccupation with obesity has a moral origin in that it seeks to correct unwanted or immoral behaviour. It then continues to reflect on the effect of the conceptual transformation of healthy children into patients, and concludes with some reflections on the ethical implications of the obesity disease for the wellbeing of children. PMID:17703609

de Vries, Jantina

2007-03-01

76

Public Health Leadership Society Principles of the Ethical Practice of Public Health  

E-print Network

Public Health Leadership Society © 2002 Principles of the Ethical Practice of Public Health #12;Public Health Leadership Society #12;Principles of the Ethical Practice of Public Health Version 2 of the Ethical Practice of Public Health 4 Supplemental Materials: Rationale for a Public Health Code of Ethics 5

Biederman, Irving

77

Telemedicine: medical, legal and ethical perspectives.  

PubMed

Technological innovations in medical care have led to the development of telemedicine programs in both rural and urban environments. The necessity for telemedicine has increased immensely as more cost-effective treatment options have become available for both patients and physicians through the addition of telecommunication technologies to medical practice. The development of telemedicine systems began as a means of providing access to health care resources for individuals living in isolated rural areas, grew into advanced medical intervention techniques for soldiers on the battlefield, and have become prevalent in urban medical centers both as a resource to the underserved populations and as a platform for physicians off-site to conduct patient consults remotely. Urban telemedicine systems, as monitored in the Mercy Health System (Philadelphia, Pennsylvania) and AtlantiCare Regional Medical Center (Atlantic City, New Jersey), display the enormous benefits of telemedicine as a form of preliminary analysis of patients for the treatment of various medical conditions including chronic disease, mental health disorders and stroke. However, the initiation of telemedicine programs requires new protocols and safeguards to be initiated to protect patient confidentiality/privacy, ensure the appropriate licensure of physicians practicing across state borders, and educate patients on the use of new technological systems. Telemedicine represents the progression of medicine in the presence of improving communication technologies and should be instituted in all urban medical centers. This conclusion is based upon the ethical responsibility to treat all persons with dignity and respect, which in this case, mandates the provision of the most cost-effective, beneficial medical care for all populations. PMID:21119593

Clark, Peter A; Capuzzi, Kevin; Harrison, Joseph

2010-12-01

78

Medical ethics in the Islamic Republic of Iran.  

PubMed

Recent trends in biomedical technologies have been associated with increasing discussion about ethical aspects of the new knowledge in many societies, including the Islamic Republic of Iran. Medical ethics has a long history in our country, and great Iranian physicians laid special emphasis on teaching and practising traditional ethics. In recent decades, great strides have been made in biomedical ethics, especially in the fields of education, research and legislation. We present a brief history of medical ethics in our country. Current activities and topics of future plans are also discussed. PMID:16761678

Larijani, B; Zahedi, F; Malek-Afzali, H

2005-01-01

79

[Professional and ethical medical expert quality].  

PubMed

The work of court experts, including those of medical profession, is ruled by Regulations on standing court experts. The Regulations determine requirements for performing the job of court expertise, rights and duties of court experts, awards and remuneration for their work. The ethical codex determines relation of experts to performance of expertise, to court and parties, to colleagues court experts and to the community. The expert must obey the rules on performance of the expertise, complete all his duties, protect respectability of all court experts, and justify trust of legal authorities. In relationship with the court, the expert must respond to court summons, give his finding and opinion, and come to hearing summons. PMID:19146190

Ivekovi?, Renata

2008-01-01

80

Medical photography: principles for orthopedics  

PubMed Central

Background Medical photography is used clinically for patient evaluation, treatment decisions, and scientific documentation. Although standards for medical photography exist in many branches of medicine, we have not encountered such criteria in publications in the area of orthopedics. Purpose This study aims to (1) assess the quality of medical images used in an orthopedic publication and (2) to propose standards for medical photography in this area. Methods Clinical photographs were reviewed from all issues of a journal published between the years 2008 and 2012. A quality of clinical images was developed based on the criteria published for the specialties of dermatology and cosmetic surgery. All images were reviewed on the appropriateness of background, patient preparation, and technique. Results In this study, only 44.9% of clinical images in an orthopedic publication adhered to the proposed conventions. Conclusions Standards have not been established for medical photography in orthopedics as in other specialty areas. Our results suggest that photographic clinical information in orthopedic publications may be limited by inadequate presentation. We propose that formal conventions for clinical images should be established. PMID:24708703

2014-01-01

81

Reflecting on the ethical administration of computerized medical records  

NASA Astrophysics Data System (ADS)

This presentation examines the ethical issues raised by computerized image management and communication systems (IMAC), the ethical principals that should guide development of policies, procedures and practices for IMACS systems, and who should be involved in developing a hospital's approach to these issues. The ready access of computerized records creates special hazards of which hospitals must beware. Hospitals must maintain confidentiality of patient's records while making records available to authorized users as efficiently as possible. The general conditions of contemporary health care undermine protecting the confidentiality of patient record. Patients may not provide health care institutions with information about themselves under conditions of informed consent. The field of information science must design sophisticated systems of computer security that stratify access, create audit trails on data changes and system use, safeguard patient data from corruption, and protect the databases from outside invasion. Radiology professionals must both work with information science experts in their own hospitals to create institutional safeguards and include the adequacy of security measures as a criterion for evaluating PACS systems. New policies and procedures on maintaining computerized patient records must be developed that obligate all members of the health care staff, not just care givers. Patients must be informed about the existence of computerized medical records, the rules and practices that govern their dissemination and given the opportunity to give or withhold consent for their use. Departmental and hospital policies on confidentiality should be reviewed to determine if revisions are necessary to manage computer-based records. Well developed discussions of the ethical principles and administrative policies on confidentiality and informed consent and of the risks posed by computer-based patient records systems should be included in initial and continuing staff system training. Administration should develop ways to monitor staff compliance with confidentiality policies and should assess diligence in maintaining patient record confidentiality as part of staff annual performance evaluations. Ethical management of IMAC systems is the business of all members of the health care team. Computerized patient records management (including IMAC) should be scrutinized as any other clinical medial ethical issue. If hospitals include these processes in their planning for RIS, IMACS, and HIS systems, they should have time to develop institutional expertise on these questions before and as systems are installed rather than only as ethical dilemmas develop during their use.

Collmann, Jeff R.

1995-05-01

82

The medical student global health experience: professionalism and ethical implications.  

PubMed

Medical student and resident participation in global health experiences (GHEs) has significantly increased over the last decade. In response to growing student interest and the proven impact of such experiences on the education and career decisions of resident physicians, many medical schools have begun to establish programmes dedicated to global health education. For the innumerable benefits of GHEs, it is important to note that medical students have the potential to do more harm than good in these settings when they exceed their actual capabilities as physicians-in-training. While medical training programmes are beginning to provide students with the knowledge to put their GHEs in context, they must remember that they also bear the responsibility of training their students in a framework to approach these experiences in a principled and professional way. It is necessary that these institutions provide adequate and formalised preparation for both clinical and ethical challenges of working in resource-poor settings. This paper outlines potential benefits and risks of GHEs and delineates recommendations to some of the current issues. PMID:18448720

Shah, S; Wu, T

2008-05-01

83

Combination of Heterogeneous Criteria for the Automatic Detection of Ethical Principles on Health Web sites  

PubMed Central

The detection of ethical issues of web sites aims at selection of information helpful to the reader and is an important concern in medical informatics. Indeed, with the ever-increasing volume of online health information, coupled with its uneven reliability and quality, the public should be aware about the quality of information available online. In order to address this issue, we propose methods for the automatic detection of statements related to ethical principles such as those of the HONcode. For the detection of these statements, we combine two kinds of heterogeneous information: content-based categorizations and URL-based categorizations through application of the machine learning algorithms. Our objective is to observe the quality of categorization through URL’s for web pages where categorization through content has been proven to be not precise enough. The results obtained indicate that only some of the principles were better processed. PMID:18693839

Gaudinat, Arnaud; Grabar, Natalia; Boyer, Celia

2007-01-01

84

Chinese Confucian culture and the medical ethical tradition  

Microsoft Academic Search

The Confucian culture, rich in its contents and great in its significance, exerted on the thinking, culture and political life of ancient China immense influences, unparalleled by any other school of thought or culture. Confucian theories on morality and ethics, with 'goodness' as the core and 'rites' as the norm, served as the 'key notes' of the traditional medical ethics

Z Guo

1995-01-01

85

Ethics by opinion poll? The functions of attitudes research for normative deliberations in medical ethics.  

PubMed

Empirical studies on people's moral attitudes regarding ethically challenging topics contribute greatly to research in medical ethics. However, it is not always clear in which ways this research adds to medical ethics as a normative discipline. In this article, we aim to provide a systematic account of the different ways in which attitudinal research can be used for normative reflection. In the first part, we discuss whether ethical judgements can be based on empirical work alone and we develop a sceptical position regarding this point, taking into account theoretical, methodological and pragmatic considerations. As empirical data should not be taken as a direct source for normative justification, we then delineate different ways in which attitudes research can be combined with theoretical accounts of normative justification in the second part of the article. Firstly, the combination of attitudes research with normative-ethical theories is analysed with respect to three different aspects: (a) The extent of empirical data which is needed, (b) the question of which kind of data is required and (c) the ways in which the empirical data are processed within the framework of an ethical theory. Secondly, two further functions of attitudes research are displayed which lie outside the traditional focus of ethical theories: the exploratory function of detecting and characterising new ethical problems, and the field of 'moral pragmatics'. The article concludes with a methodological outlook and suggestions for the concrete practice of attitudinal research in medical ethics. PMID:23632008

Salloch, Sabine; Vollmann, Jochen; Schildmann, Jan

2014-09-01

86

Ethnographic research with adolescent students: situated fieldwork ethics and ethical principles governing human research.  

PubMed

This paper explores ethical dilemmas in situated fieldwork ethics concerning ethnographic studies of adolescent students. While consequentialist and deontological ethics form the basis of the ethical stances shared by ethnographers and research ethics committees, the interpretation of those principles may diverge in school-based ethnography with adolescent students because of the particular role of the adult ethnographer vis-à-vis developmentally immature adolescents not held legally responsible for many of their actions. School ethnographers attempt to build trust with adolescent participants in order to learn about their hidden cultural worlds, which may involve activities that are very harmful to the youths involved. They face many difficult and sometimes unexpected choices, including whether to intervene and how to represent events and adolescents in published findings. Scenarios with examples drawn from research conducted in public high schools are used to illustrate and explicate dilemmas in formal research and latent insider/outsider roles and relations involving harmful adolescent behaviors, advocacy, and psychological trauma. Also examined are analytical procedures used to construct interpretations leading to representations of research participants in the resulting publication. PMID:19919317

Hemmings, Annette

2009-12-01

87

Ethics and the ethnography of medical research in Africa.  

PubMed

The ethics of medical research have grown as an area of expertise and debate in recent years, with two broad approaches emerging in relation to transnational research: (1) the refinement of guidelines and strengthening of review, processes primarily to protect the right of individual research participants and strengthen interpersonal relations at the micro-level; and (2) considering more centrally, as crucial ethical concerns, the wider interests of whole populations, the functioning of research institutions, the processes of collaboration, and the ethics of inequitable international relations. We see the two areas of debate and action as complementary, and believe that social science conducted in and around transnational medical research environments can bring these two perspectives together in a more 'situated ethics' of research. To explore this idea for medical research in Africa, we organized a conference in December 2005 in Kilifi, Kenya. In this introduction we outline the two emerging approaches to medical ethics, summarise each of seven papers selected from the conference for inclusion in this special issue on ethics and ethnography, and finally highlight two areas of lively debate at the conference itself: the appropriateness and value of ethics guidelines and review boards for medical research; and the ethical review of social science research. Together, the papers and debates point to the importance of focusing on the ethics of relationships and on justice in both biomedicine and social science research, and on giving greater voice and visibility to the field staff who often play a crucial and under-supported role in 'doing ethics' in the field. They also point to the potential value of social science research on the range of relationships operating at different levels and time scales in medical research, including those surrounding community engagement activities, and the role and functioning of ethics review boards. We conclude by highlighting the ethical priority of capacity strengthening in medical research, social science and research ethics in Africa to ensure that local and national priorities and concerns are considered at both the micro and macro levels. PMID:18455856

Molyneux, Sassy; Geissler, P Wenzel

2008-09-01

88

Ethics and the ethnography of medical research in Africa  

PubMed Central

The ethics of medical research have grown as an area of expertise and debate in recent years, with two broad approaches emerging in relation to transnational research: (1) the refinement of guidelines and strengthening of review, processes primarily to protect the right of individual research participants and strengthen interpersonal relations at the micro-level; and (2) considering more centrally, as crucial ethical concerns, the wider interests of whole populations, the functioning of research institutions, the processes of collaboration, and the ethics of inequitable international relations. We see the two areas of debate and action as complementary, and believe that social science conducted in and around transnational medical research environments can bring these two perspectives together in a more ‘situated ethics’ of research. To explore this idea for medical research in Africa, we organized a conference in December 2005 in Kilifi, Kenya. In this introduction we outline the two emerging approaches to medical ethics, summarise each of seven papers selected from the conference for inclusion in this special issue on ethics and ethnography, and finally highlight two areas of lively debate at the conference itself: the appropriateness and value of ethics guidelines and review boards for medical research; and the ethical review of social science research. Together, the papers and debates point to the importance of focusing on the ethics of relationships and on justice in both biomedicine and social science research, and on giving greater voice and visibility to the field staff who often play a crucial and under-supported role in ‘doing ethics’ in the field. They also point to the potential value of social science research on the range of relationships operating at different levels and time scales in medical research, including those surrounding community engagement activities, and the role and functioning of ethics review boards. We conclude by highlighting the ethical priority of capacity strengthening in medical research, social science and research ethics in Africa to ensure that local and national priorities and concerns are considered at both the micro and macro levels. PMID:18455856

Molyneux, Sassy; Geissler, P. Wenzel

2008-01-01

89

The ethics and safety of medical student global health electives  

PubMed Central

Objectives To explore and characterize the ethical and safety challenges of global health experiences as they affect medical students in order to better prepare trainees to face them. Methods Semi-structured interviews were conducted with 23 Canadian medical trainees who had participated in global health experiences during medical school. Convenience and snowball sampling were utilized. Using Moustakas’s transcendental phenomenological approach, participant descriptions of ethical dilemmas and patient/trainee safety problems were analyzed. This generated an aggregate that illustrates the essential meanings of global health experience ethical and safety issues faced. Results We interviewed 23 participants who had completed 38 electives (71%, n=27, during pre-clinical years) spend-ing a mean 6.9 weeks abroad, and having visited 23 countries. Sixty percent (n=23) had pre-departure training while 36% (n=14) had post-experience debriefing. Three macro-level themes were identified: resource disparities and provision of care; navigating clinical ethical dilemmas; and threats to trainee safety. Conclusions Medical schools have a responsibility to ensure ethical and safe global health experiences. However, our findings suggest that medical students are often poorly prepared for the ethical and safety dilemmas they encounter during these electives. Medical students require intensive pre-departure training that will prepare them emotionally to deal with these dilemmas. Such training should include discussions of how to comply with clinical limitations. PMID:25341214

Dell, Evelyn M.; Varpio, Lara; Petrosoniak, Andrew; Gajaria, Amy

2014-01-01

90

Chinese Confucian culture and the medical ethical tradition.  

PubMed Central

The Confucian culture, rich in its contents and great in its significance, exerted on the thinking, culture and political life of ancient China immense influences, unparalleled by any other school of thought or culture. Confucian theories on morality and ethics, with 'goodness' as the core and 'rites' as the norm, served as the 'key notes' of the traditional medical ethics of China. The viewpoints of Confucianism on benevolence and material interests, on good and evil, on kindheartedness, and on character cultivation were all inherited by the medical workers and thus became prominent in Chinese traditional medical ethics. Hence, it is clear that the medical profession and Confucianism have long shared common goals in terms of ethics. Influenced by the excellent Confucian thinking and culture, a rather highly-developed system of Chinese traditional medical ethics emerged with a well-defined basic content, and the system has been followed and amended by medical professionals of all generations throughout Chinese history. This system, just to mention briefly, contains concepts such as the need: to attach great importance to the value of life; to do one's best to rescue the dying and to heal the wounded; to show concern to those who suffer from diseases; to practise medicine with honesty; to study medical skills painstakingly; to oppose a careless style of work; to comfort oneself in a dignified manner; to respect local customs and to be polite; to treat patients, noble or humble, equally, and to respect the academic achievements of others, etc. Of course, at the same time, Confucian culture has its own historical and class limitations, which exerted negative influences on traditional medical ethics. Now, if we are to keep up with the development of modern medicine, a serious topic must be addressed. That is how to retain the essence of our traditional medical ethics so as to maintain historic continuity and yet, at the same time, add on the new contents of medical ethics so as to incorporate modern features into our system. Therefore, when trying to reform medical practice in China, we are faced with the urgent need to inherit and promulgate the essence of Confucian ethics--discarding its obsolete concepts--while at the same time building up the new medical ethics that can meet the requirements of the outside world and the future. PMID:7473645

Guo, Z

1995-01-01

91

Poverty and maternal mortality in Nigeria: towards a more viable ethics of modern medical practice  

PubMed Central

Poverty is often identified as a major barrier to human development. It is also a powerful brake on accelerated progress toward the Millennium Development Goals. Poverty is also a major cause of maternal mortality, as it prevents many women from getting proper and adequate medical attention due to their inability to afford good antenatal care. This Paper thus examines poverty as a threat to human existence, particularly women's health. It highlights the causes of maternal deaths in Nigeria by questioning the practice of medicine in this country, which falls short of the ethical principle of showing care. Since high levels of poverty limit access to quality health care and consequently human development, this paper suggests ways of reducing maternal mortality in Nigeria. It emphasizes the importance of care ethics, an ethical orientation that seeks to rectify the deficiencies of medical practice in Nigeria, notably the problem of poor reproductive health services. Care ethics as an ethical orientation, attends to the important aspects of our shared lives. It portrays the moral agent (in this context the physician) as a self who is embedded in webs of relations with others (pregnant women). Also central to this ethical orientation is responsiveness in an interconnected network of needs, care and prevention of harm. This review concludes by stressing that many human relationships involve persons who are vulnerable, including pregnant women, dependent, ill and or frail, noting that the desirable moral response is that prescribed by care ethics, which thus has implications for the practice of medicine in Nigeria. PMID:18447920

Lanre-Abass, Bolatito A

2008-01-01

92

Great expectations: teaching ethics to medical students in South Africa.  

PubMed

Many academic philosophers and ethicists are appointed to teach ethics to medical students. We explore exactly what this task entails. In South Africa the Health Professions Council's curriculum for training medical practitioners requires not only that students be taught to apply ethical theory to issues and be made aware of the legal and regulatory requirements of their profession, it also expects moral formation and the inculcation of professional virtue in students. We explore whether such expectations are reasonable. We defend the claim that physicians ought to be persons of virtuous character, on the grounds of the social contract between society and the profession. We further argue that since the expectations of virtue of health care professionals are reasonable, it is also sound reasoning to expect ethics teachers to try to inculcate such virtues in their students, so far as this is possible. Furthermore, this requires of such teachers that they be suitable role models of ethical practice and virtue, themselves. We claim that this applies to ethics teachers who are themselves not members of the medical profession, too, even though they are not bound by the same social contract as doctors. We conclude that those who accept employment as teachers of ethics to medical students, where as part of their contractual obligation they are expected to inculcate moral values in their students, ought to be prepared to accept their responsibility to be professionally ethical, themselves. PMID:23409954

Behrens, Kevin Gary; Fellingham, Robyn

2014-12-01

93

Risk Assessment and Management for Medically Complex Potential Living Kidney Donors: A Few Deontological Criteria and Ethical Values  

PubMed Central

A sound evaluation of every bioethical problem should be predicated on a careful analysis of at least two basic elements: (i) reliable scientific information and (ii) the ethical principles and values at stake. A thorough evaluation of both elements also calls for a careful examination of statements by authoritative institutions. Unfortunately, in the case of medically complex living donors neither element gives clear-cut answers to the ethical problems raised. Likewise, institutionary documents frequently offer only general criteria, which are not very helpful when making practical choices. This paper first introduces a brief overview of scientific information, ethical values, and institutionary documents; the notions of “acceptable risk” and “minimal risk” are then briefly examined, with reference to the problem of medically complex living donors. The so-called precautionary principle and the value of solidarity are then discussed as offering a possible approach to the ethical problem of medically complex living donors. PMID:22174982

Petrini, Carlo

2011-01-01

94

[Civil, criminal and ethical liability of medical doctors].  

PubMed

In the last years doctors have been the target of a growing number of civil, criminal law suits, as well as ethical procedures. Medicine is a widely targeted career, not only owing to its inherent risks, but also owing to a mistaken approach of the Judiciary Power about the obligations of medical doctors. Decisions of the Medical Board in ethical procedures have an impact in civil and criminal justice and therefore should be followed closely. The purpose of this review is to provide a wide view from a doctor-lawyer perspective of cases involving civil, criminal liability of anesthesiologists as well as ethical procedures against them, in an effort to make them comprehensible to doctors. After a brief historical introduction civil liability foundations and legal articles are examined. Responsibilities of doctors, hospitals and health insurance providers are discussed separately, as well as reparation mechanisms. Crimes possible to occur during medical practice and respective penalties are described; the direct relationship between crime and civil reparation is demonstrated. The administrative nature of ethical procedure is described, emphasizing that the legal character of its penalties often serve as grounds for civil and criminal justice decisions. Prevention is still the best medicine. Good medical practice and a good medical-patient relationship are still the best ways to minimize lawsuits and their repercussions. Doctors should have some knowledge of juridical mechanisms in lawsuits and ethical procedures, but should not take defense initiatives without prior consultation of an attorney. Civil, criminal and ethical liability of physicians. PMID:12205537

Udelsmann, Artur

2002-01-01

95

The ethical basis of the precautionary principle in health care decision making  

SciTech Connect

This article explores the relation between the precautionary and health care decision making. Decision making in medical practice as well as health policy is characterized by uncertainty. On the level of clinical practice for example, one never knows in advance whether one has made the right diagnosis or has opted for the right treatment. Though medical decisions have a risk on serious harms and burdens, the precautionary principle is not applicable to health care. This principle holds that one should not act when there is no scientific proof that no harms will result from a medical act or a policy decision. However, in clinical practice there is a duty to act. Physicians have an obligation to do good to their patients and have to weigh the benefits against possible harms and burdens. The basis virtue of medical decision making is not avoidance of risks, as stated in the precautionary principle, but the prudent assessment of benefits, burdens, and harms, in relation to other ethical principles like respect for autonomy and justice. The precautionary principle does play a role in health care, but it should never rule medical decision making as an absolute principle. This is not only true for clinical decision making, but also for the area of health policy. Physicians and other health care decision makers need to have knowledge about the possible effects of treatments or the precision of diagnostic procedures in order to reduce harm and promote well-being. Evidence-based medicine may contribute to the wisdom of health care decision makers, but this evidence-based wisdom should always be applied under the guidance of prudence, which is the central virtue of health care decision making.

Meulen, Ruud H.J. ter [Director Institute of Bioethics, Faculty of Health Sciences, University of Maastricht, PO Box 616, NL 6200 MD Maastricht (Netherlands)]. E-mail: r.termeulen@ige.unimaas.nl

2005-09-01

96

The ethical basis of the precautionary principle in health care decision making.  

PubMed

This article explores the relation between the precautionary and health care decision making. Decision making in medical practice as well as health policy is characterized by uncertainty. On the level of clinical practice for example, one never knows in advance whether one has made the right diagnosis or has opted for the right treatment. Though medical decisions have a risk on serious harms and burdens, the precautionary principle is not applicable to health care. This principle holds that one should not act when there is no scientific proof that no harms will result from a medical act or a policy decision. However, in clinical practice there is a duty to act. Physicians have an obligation to do good to their patients and have to weigh the benefits against possible harms and burdens. The basis virtue of medical decision making is not avoidance of risks, as stated in the precautionary principle, but the prudent assessment of benefits, burdens, and harms, in relation to other ethical principles like respect for autonomy and justice. The precautionary principle does play a role in health care, but it should never rule medical decision making as an absolute principle. This is not only true for clinical decision making, but also for the area of health policy. Physicians and other health care decision makers need to have knowledge about the possible effects of treatments or the precision of diagnostic procedures in order to reduce harm and promote well-being. Evidence-based medicine may contribute to the wisdom of health care decision makers, but this evidence-based wisdom should always be applied under the guidance of prudence, which is the central virtue of health care decision making. PMID:15993912

ter Meulen, Ruud H J

2005-09-01

97

Australian medical students' perceptions of professionalism and ethics in medical television programs  

PubMed Central

Background Medical television programs offer students fictional representations of their chosen career. This study aimed to discover undergraduate medical students' viewing of medical television programs and students' perceptions of professionalism, ethics, realism and role models in the programs. The purpose was to consider implications for teaching strategies. Methods A medical television survey was administered to 386 undergraduate medical students across Years 1 to 4 at a university in New South Wales, Australia. The survey collected data on demographics, year of course, viewing of medical television programs, perception of programs' realism, depiction of ethics, professionalism and role models. Results The shows watched by most students were House, Scrubs, and Grey's Anatomy, and students nominated watching 30 different medical programs in total. There was no statistical association between year of enrolment and perceptions of accuracy. The majority of students reported that friends or family members had asked them for their opinion on an ethical or medical issue presented on a program, and that they discussed ethical and medical matters with their friends. Students had high recall of ethical topics portrayed on the shows, and most believed that medical programs generally portrayed ideals of professionalism well. Conclusions Medical programs offer considerable currency and relevance with students and may be useful in teaching strategies that engage students in ethical lessons about practising medicine. PMID:21798068

2011-01-01

98

Should dingoes die? Principles for engaging ecocentric ethics in wildlife tourism management  

Microsoft Academic Search

Ethics underlie all our decisions and actions. The aim of this paper is to, first, highlight the sorts of ethical positions that inform wildlife management and, second, to propose a different set of ecocentric ethical principles that not only provide for a more authentic visitor experience of nature, but also enhance the long-term survival of wildlife. An ecocentric approach involves

Georgette Leah Burns; Jim MacBeth; Susan Moore

2011-01-01

99

Awareness of medical ethics among undergraduates in a West Bengal medical college.  

PubMed

This descriptive, cross-sectional study was conducted to assess the knowledge of and attitudes towards medical ethics among undergraduate medical students. It also looked at whether there was any improvement with additional years of medical education. 340 medical students of a medical college in West Bengal were given a semi-structured questionnaire that included questions regarding their awareness of ethics, their attitudes towards various issues in clinical ethics, and their knowledge of the code of medical ethics of the West Bengal Medical Council. The responses of 322 students were analysed by simple descriptive statistics. The students generally agreed that awareness of ethics was important. Lectures (54.7%) and books (47.8%) were their predominant sources of knowledge. Only 10.9 % were aware of the existence of an institutional ethics committee and 42.8% did not know its exact role. Their answers showed that the majority of students expressed mixed responses--both desirable and undesirable--in relation to questions exploring different aspects of basic ethical reasoning in their professional life. The most desirable response for each statement was decided by experts of forensic medicine and also from a literature study. Only half the respondents (50.9%) had a good score (61-70 out of a total possible 90) and 37.2% had a fair score (51-60). There was no increase in scores corresponding with additional years of medical education. PMID:22591867

Chatterjee, Biswajit; Sarkar, Jhuma

2012-01-01

100

The ethics of medical marijuana: government restrictions vs. medical necessity.  

PubMed

Marijuana is listed by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no currently accepted medical use. However, on March 17, 1999, 11 independent scientists appointed by the Institute of Medicine reported that medical marijuana was effective in controlling some forms of pain, alleviating nausea and vomiting due to chemotherapy, treating wasting due to AIDS, and combating muscle spasms associated with multiple sclerosis. There was also no evidence that using marijuana would increase illicit drug use or that it was a "gateway" drug. Despite this evidence the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe unadulterated and standardized forms of marijuana. After reviewing the pertinent scientific data and applying the principle of double effect, there is a proportionate reason for allowing physicians to prescribe marijuana. Seriously ill patients have the right to effective therapies. To deny patients access to such a therapy is to deny them dignity and respect as persons. PMID:10754797

Clark, P A

2000-01-01

101

Metaphysics and medical ethics: a reply  

Microsoft Academic Search

The total longitudinal form view of human beings is a metaphysical view which aims to locate our moral judgements about human embryos in a broader set of attitudes and characterisations. On this basis it has explanatory power and a real function in that it grounds our ethical discussion of embryos in other discourses. Contra Leavitt, this grounding suggests a broader

G Gillett

1994-01-01

102

The teaching of medical ethics: University College, Cork, Ireland.  

PubMed Central

Dolores Dooley Clarke describes how the course in medical ethics at University College, Cork is structured, how it has changed and how it is likely to change as time goes on. Originally, the students seemed to view it as an intrusion 'to be tolerated' in their programme of 'strictly medical' studies. However, having moved on from that and away from the lecturer always being a Roman Catholic priest as well as a member of the Philosophy Department, the students now appear to view it as producing a stimulus for a new interest in the area of ethics for physicians. This seems to have come about through the more extensive participation of students in researching and presenting issues of medical ethics. PMID:633310

Clarke, D D

1978-01-01

103

Medical ethics in peace and in the armed conflict.  

PubMed

Global medical ethics on the basis of the General Declaration of Human Rights by the United Nations is a key subject for the 21st century. World Health Organization's new definition of health includes "spiritual health," a term that has to be defined in international consensus despite different anthropologies, cultures, and religions. Old issues in medical ethics such as assisted suicide are still waiting for global consensus among the "pro-life" and "pro-choice" parties. So far The Netherlands and Belgium are the only countries where euthanasia has been legalized, whereas the U.S. Supreme Court has denied a right of medically assisted suicide. The respect of nature is also the basis for guidelines in new issues in medical ethics such as gene therapy and human cloning, which are controversially discussed. Military medical ethics should provide regulations for morally correct decisions in armed conflicts including the war against international terrorism and in peacekeeping missions. Triage of the wounded, distribution of medical aid, and critical incident stress debriefing for soldiers and their relatives are key issues. PMID:12186301

Schapowal, Andreas G; Baer, Hans-Ulrich

2002-08-01

104

Annual report of Council, 1983-1984: medical ethics.  

PubMed

The medical ethics section of the 1983-1984 annual report of the British Medical Association Council describes the Council's successes and continuing campaign against certain clauses in the pending Police and Criminal Evidence Bill and in the re-introduced Data Protection Bill that might require physicians to violate professional standards on informed consent and confidentiality. Other issues touched upon in the report include surrogate motherhood, in vitro fertilization, ethics committees, living wills, advertising, torture, consent to treatment, and the prescribing of contraceptives for minors. PMID:11652415

1984-03-31

105

Annual report of Council, 1985-1986: medical ethics.  

PubMed

Recent activities of the Council of the British Medical Association related to ethical and public policy issues are described. The Council has been working to improve the network of local research ethics committees and favors the establishment of a national committee to review research proposals. It has been engaged in efforts to shape the Data Protection Act to safeguard the confidentiality of personal health records and to protect the confidentiality of minors who seek contraceptive advice without their parents' knowledge. Other Council concerns include advertising by the medical profession and the physician's role in law enforcement in Great Britain and in investigations of torture on the international scene. PMID:11652461

1986-03-29

106

Applied Ethics and eHealth: Principles, Identity, and RFID  

NASA Astrophysics Data System (ADS)

The social and ethical implications of contemporary technologies are becoming an issue of steadily growing importance. This paper offers an overview in terms of identity and the field of ethics, and explores how these apply to eHealth in both theory and practice. The paper selects a specific circumstance in which these ethical issues can be explored. It focuses particularly on radio-frequency identifiers (RFID). It ends by discussing ethical issues more generally, and the practice of ethical consideration.

Whitehouse, Diane; Duquenoy, Penny

107

Thai and American doctors on medical ethics: religion, regulation, and moral reasoning across borders.  

PubMed

Recent scholarship argues that successful international medical collaboration depends crucially on improving cross-cultural understanding. To this end, this study analyzes recent writings on medical ethics by physicians in two countries actively participating in global medicine, Thailand and the United States. Articles (133; published 2004-2008) from JAMA, the New England Journal of Medicine, and the Journal of the Medical Association of Thailand are analyzed to inductively build a portrait of two discursive ethical cultures. Frameworks of moral reasoning are identified across and within the two groups, with a focus on what authority (religion, law, etc.) is invoked to define and evaluate ethical problems. How might similarities and differences in ethical paradigms reflect the countries' historical "semicolonial" relationship, shed light on debates about Eastern vs. Western bioethics, and facilitate or hinder contemporary cross-national communication? Findings demonstrate substantial overlap in Thai and American doctors' vocabulary, points of reference, and topics covered, though only Thai doctors emphasize national interests and identity. American authors display a striking homogeneity in styles of moral reasoning, embracing a secular, legalistic, deontological ethics that generally eschews discussion of religion, personal character, or national culture. Among Thai authors, there is a schism in ethical styles: while some hew closely to the secular, deontological model, others embrace a virtue ethics that liberally cites Buddhist principles and emphasizes the role of doctors' good character. These two approaches may represent opposing reactions-assimilation and resistance, respectively-to Western influence. The current findings undermine the stereotype of Western individualism versus Eastern collectivism. Implications for cross-national dialog are discussed. PMID:23177778

Grol-Prokopczyk, Hanna

2013-01-01

108

Compassion as a basis for ethics in medical education  

PubMed Central

The idea that ethics is a matter of personal feeling is a dogma widespread among medical students. Because emotivism is firmly rooted in contemporary culture, the authors think that focusing on personal feeling can be an important point of departure for moral education. In this contribution, they clarify how personal feelings can be a solid basis for moral education by focusing on the analysis of compassion by the French phenomenologist Emmanuel Housset. This leads to three important issues regarding ethics education: (1) the necessity of a continuous attention for and interpretation of the meaning of language, (2) the importance of examining what aspect of “the other” touches one and what it is that evokes the urge to act morally and (3) the need to relate oneself to the community, both to the medical community and to collectively formulated rules and laws. These issues can have a place in medical education by means of an ethical portfolio that supports students in their moral development. First, keeping a portfolio will improve their expression of the moral dimension of medical practice. Second, the effects of self?knowledge and language mastery will limit the pitfalls of emotivism and ethical subjectivism and will stimulate the inclination to really encounter the other. Third, it will show medical students from the start that their moral responsibility is more than following rules and that they are involved personally. PMID:17906063

Leget, Carlo; Olthuis, Gert

2007-01-01

109

Ethics and the comprehensive application of epistemology in medical practice.  

PubMed

Our simple definition of ethics is good thought, speak and action. Epistemology means the hypothesis of facts about thought, speech and action. Medical practice is all means of medicine. Medicine classifies people into normal and abnormal. The abnormal are the sick. They loose some organs or those normal looking organs are dysfunctional. They are social problems, some can be treated, and some do not get the appropriate care. The problems of society of normal people are overeating and obesity, abortion, drug abuse, promiscuity, torture, terrorism, disobeying rules and order, corruption, brain-washing and unethical advertisements, etc. On the other hand, the social problems of the abnormal are down, deafness, blindness, dumb, hypertension, hypercholesterolemia, diabetes mellitus and cancer, etc. An example of the social-doctor problem is the mal distribution of doctors in rural areas. It was reported by the ministry of public health that the ratio of doctor to population to be 1:800 in Bangkok and 1:5, 700 in some rural areas in the north eastern part of Thailand. The doctors, themselves, are at a high grade of worker and intelligent quotient. They know all the problem and, at the same time, create problems, both, faster than the general population can do. It affects good and bad in the society. In the past, present and the foreseeable future the medical students get their studies in the western style. Their medical schools are situated in big cities. These schools are old and famous. They learn their medical procedure in a big hospital of more than 400 beds in the inpatient department wards. Their instructors and professors are highly qualified, are middle class people and well accepted in the society. Their families are lovely and warm. Their children study in the first class schools in town. The medical students feel very happy and appreciate seeing their professors in television routinely at prime time. In conclusion, their professors are an example of role model for them to follow. Everyone looks for security in her/his profession. Facts need no proof and reference. People with justice in mind should believe and understand the above mentioned. This leads to the problem of mal distribution of doctors in rural areas, why do doctors live in big cities or wish to be in the private sector? In fact, not many a number of doctors serve in the rural area. About 4-5 of them, their name will be announced yearly as the best rural doctor award. After the big ceremony, lasted not longer than a month, it is hard to remember their name. They are proud to be praised, it pushes them into stress intentionally with all the best of their intelligence and the total of their body strength to work harder in rural. Unfortunately their earning, the security of their profession, the increased chance of being sued, to get caught in the medical litigation, the expenses of their family social status and the study of their children cannot be compared to of those doctors in big city and/or in the private sector. Mal distribution of doctors in remote rural areas has been a persisting unresolved problem in many parts of the world, why not apply the principles of ethics and epistemology? They have been left, untouched forever. PMID:16519004

Phaosavasdi, Sukhit; Taneepanichskul, Surasak; Tannirandorn, Yuen; Uerpairojkit, Boonchai; Thamkhantho, Manopchai; Pruksapong, Chumsak; Kanjanapitak, Aurchart; Phupong, Vorapong

2005-12-01

110

Drones--ethical considerations and medical implications.  

PubMed

Drones enhance military capability and form a potent element of force protection, allowing humans to be removed from hazardous environments and tedious jobs. However, there are moral, legal, and political dangers associated with their use. Although a time may come when it is possible to develop a drone that is able to autonomously and ethically engage a legitimate target with greater reliability than a human, until then military drones demand a crawl-walk-run development methodology, consent by military personnel for weapon use, and continued debate about the complex issues surrounding their deployment. PMID:22558742

Pepper, Tom

2012-01-01

111

Covert medication in psychiatric emergencies: is it ever ethically permissible?  

PubMed

Covert administration of medications to patients, defined as the administration of medication to patients without their knowledge, is a practice surrounded by clinical, legal, ethics-related, and cultural controversy. Many psychiatrists would be likely to advocate that the practice of covert medication in emergency psychiatry is not clinically, ethically, or legally acceptable. This article explores whether there may be exceptions to this stance that would be ethical. We first review the standard of emergency psychiatric care. Although we could identify no published empirical studies of covert administration of medicine in emergency departments, we review the prevalence of this practice in other clinical settings. While the courts have not ruled with respect to covert medication, we discuss the evolving legal landscape of informed consent, competency, and the right to refuse treatment. We discuss dilemmas regarding the ethics involved in this practice, including the tensions among autonomy, beneficence, and duty to protect. We explore how differences between cultures regarding the value placed on individual versus family autonomy may affect perspectives with regard to this practice. We investigate how consumers view this practice and their treatment preferences during a psychiatric emergency. Finally, we discuss psychiatric advance directives and explore how these contracts may affect the debate over the practice. PMID:22635297

Hung, Erick K; McNiel, Dale E; Binder, Renée L

2012-01-01

112

The Program for Professional Values and Ethics in Medical Education.  

ERIC Educational Resources Information Center

Describes the Program for Professional Values and Ethics in Medical Education (PPVEME) at Tulane University School of Medicine. It brings together students, residents, and faculty into learning teams that teach the other teams about one of five themes: integrity, communication, teamwork, leadership, and service. It emphasizes learner-driven self…

Lazarus, Cathy J.; Chauvin, Sheila W.; Rodenhauser, Paul; Whitlock, Robin

2000-01-01

113

Medical ethics education: a professor of religion investigates  

Microsoft Academic Search

A study was carried out in a large teaching hospital to ascertain the current view of members of ten ward teams in regard to certain problems in the field of medical ethics. The investigator accompanied each team on their morning rounds and sat in on their discussions. At the end of each week he interviewed the faculty member, residents, intern,

D Belgum

1983-01-01

114

Undergraduate International Medical Electives: Some Ethical and Pedagogical Considerations  

ERIC Educational Resources Information Center

The authors argue that attempts to establish more placements to meet the growing demands of undergraduate medical students in North America for international experiences may be outweighing critical reflection on the ethical issues, curricular content, and pedagogical strategies necessary to support equitable engagements with countries of the…

Hanson, Lori; Harms, Sheila; Plamondon, Katrina

2011-01-01

115

Major issues relating to end-of-life care : Ethical, legal and medical from a historical perspective  

Microsoft Academic Search

Purpose – Ethical, legal and medical progress has been made in end-of-life care, addressing crucial issues in the application of principles to clinical cases. However, despite the progress, there are still unresolved issues concerning the scope and effectiveness of personal decision making and the proper use of last resort measures in terminal care. An analysis of the progress discloses both

Robert F. Rizzo

2005-01-01

116

[Can we accept medical progress without progress in ethics?].  

PubMed

Since the mid 20th century progress in biomedical science has been punctuated by the emergence of bioethics which has fashioned the moral framework of its application to both research and clinical practice. Can we, however, consider the advent of bioethics as a form of progress marking the advances made in biomedical science with an adequate ethical stamp? The argument put forward in this chapter is based on the observation that, far from being a mark of progess, the development of bioethics runs the risk of favouring, like modern science, a dissolution of the links that unite ethics and medicine, and so of depriving the latter of the humanist dimensions that underlie the responsibilities that fall to it. Faced with this possible pitfall, this contribution proposes to envisage as a figure of moral progress, consubstantial with the development of biomedical science, an ethical approach conceived as a means of social intervention which takes the first steps towards an ethics of responsibility integrating the bioethical perspective within a hermeneutic and deliberative approach. By the yardstick of a prudential approach, it would pay particular attention to the diverse sources of normativity in medical acts. It is suggested that this ethical approach is a source of progress insofar as it constitutes an indispensable attitude of watchfulness, which biomedical science can lean on as it advances, with a view to ensuring that the fundamental link uniting ethics and medicine is maintained. PMID:23991542

Benaroyo, Lazare

2013-01-01

117

Feminist ethics and menopause: autonomy and decision-making in primary medical care.  

PubMed

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners' accounts of menopause and treatment in Australia, women's 'choice', 'informed decision-making' and 'empowerment' were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of 'informed decision-making' in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an 'ethic of autonomy' and an 'offer of choice' in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part. PMID:12639581

Murtagh, Madeleine J; Hepworth, Julie

2003-04-01

118

[Bioethics in medical institutions--new custom or help? The example of clinical ethics consultation at a University Medical Center].  

PubMed

Although ethics committees are well established in the medical sciences for human clinical trials, animal research and scientific integrity, the development of clinical ethics in German hospitals started much later during the first decade of the twenty-first century. Clinical ethics consultation should be pragmatic and problem-centered and can be defined as an ethically qualified and informed conflict management within a given legal framework to deal with and resolve value-driven, normative problems in the care of patients. Clinical ethics consultations enable shared clinical decision-making of all parties (e.g. clinicians, patients, family and surrogates) involved in a particular patient's care. The clinical ethicist does not act as an ethics expert by making independent recommendations or decisions; therefore, the focus is different from other medical consultants. Ethics consultation was first established by healthcare ethics committees (HEC) or clinical ethics consultation (CEC) groups which were called in to respond to an ethically problematic situation. To avoid ethical dilemmas or crises and to act preventively with regard to ethical issues in individual patients, an ethics liaison service is an additional option to ethics case consultations which take place on a regular basis by scheduled ethics rounds during the normal ward rounds. The presence of the ethicist offers some unique advantages: it allows early recognition of even minor ethical problems and accommodates the dynamics of ethical and clinical goal-setting in the course of patient care. Most importantly, regular and non-authoritative participation of the ethicist in normal ward rounds allows continuous ethical education of the staff within the everyday clinical routine. By facilitating clinical ethical decision-making, the ethicist seeks to empower physicians and medical staff to deal appropriately with ethical problems by themselves. Because of this proactive approach, the ethics liaison service can make a significant contribution to preventative ethics in reducing the number of emerging ethical problems to the satisfaction of all parties involved. PMID:24902533

Richter, G

2014-08-01

119

How "moral" are the principles of biomedical ethics? - a cross-domain evaluation of the common morality hypothesis  

PubMed Central

Background The principles of biomedical ethics – autonomy, non-maleficence, beneficence, and justice – are of paradigmatic importance for framing ethical problems in medicine and for teaching ethics to medical students and professionals. In order to underline this significance, Tom L. Beauchamp and James F. Childress base the principles in the common morality, i.e. they claim that the principles represent basic moral values shared by all persons committed to morality and are thus grounded in human moral psychology. We empirically investigated the relationship of the principles to other moral and non-moral values that provide orientations in medicine. By way of comparison, we performed a similar analysis for the business & finance domain. Methods We evaluated the perceived degree of “morality” of 14 values relevant to medicine (n1?=?317, students and professionals) and 14 values relevant to business & finance (n2?=?247, students and professionals). Ratings were made along four dimensions intended to characterize different aspects of morality. Results We found that compared to other values, the principles-related values received lower ratings across several dimensions that characterize morality. By interpreting our finding using a clustering and a network analysis approach, we suggest that the principles can be understood as “bridge values” that are connected both to moral and non-moral aspects of ethical dilemmas in medicine. We also found that the social domain (medicine vs. business & finance) influences the degree of perceived morality of values. Conclusions Our results are in conflict with the common morality hypothesis of Beauchamp and Childress, which would imply domain-independent high morality ratings of the principles. Our findings support the suggestions by other scholars that the principles of biomedical ethics serve primarily as instruments in deliberated justifications, but lack grounding in a universal “common morality”. We propose that the specific manner in which the principles are taught and discussed in medicine – namely by referring to conflicts requiring a balancing of principles – may partly explain why the degree of perceived “morality” of the principles is lower compared to other moral values. PMID:24938295

2014-01-01

120

Ethics AbAndonEd: Medical Professionalism  

E-print Network

chAPtEr 5: Health professional accountability for acts of 135 torture through state licensing Evaluations of 169 Torture and Cruel, Inhuman or Degrading Treatment, Annex 4 2. World Medical Association on 181 Interrogation and Torture 4. Professional Misconduct Complaints Filed 201 notEs 215 Copyright

Blanchette, Robert A.

121

Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues  

PubMed Central

The American Academy of Family Physicians (AAFP) has recently been criticized for accepting a large corporate donation from Coca-Cola to fund patient education on obesity prevention. Conflicts of interest, whether individual or organizational, occur when one enters into arrangements that reasonably tempt one to put aside one’s primary obligations in favor of secondary interests, such as financial self-interest. Accepting funds from commercial sources that seek to influence physician organizational behavior in a direction that could run counter to the public health represents one of those circumstances and so constitutes a conflict of interest. Most of the defenses offered by AAFP are rationalizations rather than ethical counterarguments. Medical organizations, as the public face of medicine and as formulator of codes of ethics for their physician members, have special obligations to adhere to high ethical standards. PMID:20644191

Brody, Howard

2010-01-01

122

a principle for ethics and economics in the global information society1  

E-print Network

Trust a principle for ethics and economics in the global information society1 Rainer Kuhlen or a system, is considered of growing ethical and economic importance for all processes in electronic markets software agents. Trust, originally a personal and intimate relation to other people and the basis

Kuhlen, Rainer

123

Ethics education for medical house officers: long-term improvements in knowledge and confidence.  

PubMed Central

OBJECTIVE: To examine the long-term effects of an innovative curriculum on medical house officers' (HOs') knowledge, confidence, and attitudes regarding medical ethics. DESIGN: Long term cohort study. The two-year curriculum, implemented by a single physician ethicist with assistance from other faculty, was fully integrated into the programme. It consisted of monthly sessions: ethics morning report alternating with didactic conferences. The content included topics such as ethics vocabulary and principles, withdrawing life support, informed consent, and justice. Identical content was offered simultaneously at the largest affiliated community hospital. SETTING: A multi-hospital university training programme from July, 1992 to June, 1994. PARTICIPANTS: Thirty-nine HOs responded in 92. Thirty HOs from the same cohort responded in 94 (response rates = 83% v 71%; P = 0.19). RESULTS: The curriculum was well received, with 96% of HOs finding the sessions stimulating. Previously validated scales of knowledge and confidence were administered at baseline and at follow-up. The average knowledge score improved 14% (P < 0.001). Confidence also improved, rising from 3.3 to 3.8 on a 5-point Likert scale (P < 0.001). These findings were independent of age, gender, religion, and prior education. The only attitudinal change was an increase in the proportion of residents who thought that ethics should be a required part of residency training (57% v 80%, P = 0.05). CONCLUSION: This curriculum appears practical, popular, and effective. It should be readily transferable to other institutions. PMID:9134488

Sulmasy, D P; Marx, E S

1997-01-01

124

Ethical Principles for the Management of Infants with Disorders of Sex Development  

Microsoft Academic Search

The Fifth World Congress on Family Law and Children’s Rights (Halifax, August 2009) adopted a resolution endorsing a new set of ethical guidelines for the management of infants and children with disorders of sex development (DSD) [www.lawrights.asn.au\\/index.php?option=com_content&view=article&id=76&Itemid=109]. The ethical principles developed by our group were the basis for the Halifax Resolution. In this paper, we outline these principles and explain

Lynn H. Gillam; Jacqueline K. Hewitt; Garry L. Warne

2010-01-01

125

How philosophy of medicine has changed medical ethics.  

PubMed

The celebration of thirty years of publication of The Journal of Medicine and Philosophy provides an opportunity to reflect on how medical ethics has evolved over that period. The reshaping of the field has occurred in no small part because of the impact of branches of philosophy other than ethics. These have included influences from Kantian theory of respect for persons, personal identity theory, philosophy of biology, linguistic analysis of the concepts of health and disease, personhood theory, epistemology, and political philosophy. More critically, medicine itself has begun to be reshaped. The most fundamental restructuring of medicine is currently occurring--stemming, in part, from the application of contemporary philosophy of science to the medical field. There is no journal more central to these critical events of the past three decades than The Journal of Medicine and Philosophy. PMID:17162729

Veatch, Robert M

2006-12-01

126

An ethical framework for pharmacy management: balancing autonomy and other principles.  

PubMed

Decisions to control pharmaceutical costs can cause conflicts as to what medications are covered. Such conflicts have ethical implications, however implicit, and given this fact, an ethical framework can help address them. In the following commentary, we discuss the more traditional, individual-level ethical considerations likely familiar to most clinicians. We, then, discuss population-level ethical constructs that clinicians may not as readily embrace. We also present a hypothetical cancer-care case to illustrate how imbalances in ethical foci between individual- and population-level constructs may lead to conflicts among health care actors and promote shifts in pharmaceutical decision making away from providers and toward payers, paradoxically reducing provider autonomy and hence patient autonomy. Finally, we propose a more comprehensive ethical framework to help converge individual, payer, and societal interests when making pharmaceutical use decisions. Pharmacists play a crucial role as pharmacy benefits managers and should be familiar with individual- and population-based ethical constructs. PMID:24684637

Glassman, Peter A; Schneider, Paul L; Good, Chester B

2014-04-01

127

Medical ethics in Latin America: a new interest and commitment.  

PubMed

Recent visits to five Latin American nations indicate that some medical professionals are eager to increase the role of bioethics in their countries. Conversations with key figures there point up similarities and differences among Latin nations, and between Latin countries and the United States, in their approaches to ethics. Opportunities exist for U.S. bioethicists to help get bioethics teaching and research off the ground in Latin America. PMID:11645713

Drane, James F; Fuenzalida, Hernán L

1991-12-01

128

The Moral Domain of the Medical Record: The Routine Ethics Evaluation  

Microsoft Academic Search

The structure, content, and orientation of the contemporary medical record inadequately reflect the appropriate influence of patients' rights and bioethics on health care. Most tellingly, the medical chart reveals a remarkable absence of attention to medical ethics, except in the case of crisis management. But medical ethics informs both crisis decision-making and virtually all clinical interventions. Indeed, clinical care embodies

Alfred I. Tauber

2006-01-01

129

Pre-employment medical testing in Brazil: ethical challenges.  

PubMed

Pre-employment medical tests, considered to be a practice within the subspecialty of occupational medicine, are ordered by physicians on behalf of employers. Candidates for a job may be rejected if they are found to suffer from a condition that can be worsened by the job, or one that may put other workers at risk. As the physician who orders pre-employment tests is chosen by the employer, pre-employment tests can violate both the autonomy and the privacy of the individual. This paper discusses ethical conflicts inherent in pre-employment medical testing. PMID:23099602

Palhares, Dario; Laurentino dos Santos, Ivone

2012-01-01

130

Ethical and legal aspects on the use of images and photographs in medical teaching and publication.  

PubMed

The aim of the study was to investigate the legal and ethical concerns raised from the use of photographs and images in medical publication. A search in the pertinent literature was performed. It is of paramount importance that the patient's autonomy, privacy and confidentiality is respected. In all cases in which photographs and images contain identifiable information patient's consent for any potential use of this material is mandatory. Patients should be aware that with the evolution of electronic publication, once an image is published, there is no efficient control of its future misuse. Physicians and hospitals have a duty to use with confidentiality any material kept in the patient's medical records. Efforts should be made to anonymised images and photographs used in teaching and publication so that such information does not raise ethical and legal concerns. The procedures for using photographs and images in medical publication and teaching should respect the ethical principles and contain only anonymous information to avoid legal consequences. Continuous scrutiny and reform is required in order to adapt to the changing social and scientific environment. PMID:20671657

Mavroforou, A; Antoniou, G; Giannoukas, A D

2010-08-01

131

La ética en la práctica. Cuando algo se hace mal: del error médico a la mala praxis Ethics in Practice. When something is done wrong: from the medical error to the malapraxis  

Microsoft Academic Search

Objective: To analyse two of the most significant ethical issues related to medical errors: informing patients and relatives; and the moral duty to prevent and try to minimise this situation. Design: The recommended ethical and medical principles are consistent with those of medicine in general and are underpinned by the specific guidelines published by professional organisations, such as the American

León Sanz P

132

Medical navigation in Israel: description, advantages and ethical considerations.  

PubMed

Throughout history religious figures have been intimately involved in caring for the sick. Not only have they prayed for the welfare of the sick and arranged for their care but in many instances provided medical care as well. With the advent of scientific medicine, the responsibility for medical care was transferred to trained physicians. A new phenomenon has recently emerged in Israel that has threatened this 'division of labor' between physicians and rabbis, namely, the establishment of medical navigation organizations. Medical navigation can improve access to highly specialized care and help build trust between doctors and patients. However, this system is accompanied by numerous ethical and professional difficulties. For example, it is not clear how referrals are made and to what extent the system should be regulated. The phenomenon needs to be further studied to determine its prevalence in Israeli society as well as its impact on the practice of medicine from the perspective of both physicians and patients. PMID:23516765

Jotkowitz, Alan

2013-02-01

133

Bariatric Endocrinology: Principles of Medical Practice  

PubMed Central

Obesity, is a chronic, biological, preventable, and treatable disease. The accumulation of fat mass causes physical changes (adiposity), metabolic and hormonal changes due to adipose tissue dysfunction (adiposopathy), and psychological changes. Bariatric endocrinology was conceived from the need to address the neuro-endocrinological derangements that are associated with adiposopathy, and from the need to broaden the scope of the management of its complications. In addition to the well-established metabolic complications of overweight and obesity, adiposopathy leads to hyperinsulinemia, hyperleptinemia, hypoadiponectinemia, dysregulation of gut peptides including GLP-1 and ghrelin, the development of an inflammatory milieu, and the strong risk of vascular disease. Therapy for adiposopathy hinges on effectively lowering the ratio of orexigenic to anorexigenic signals reaching the the hypothalamus and other relevant brain regions, favoring a lower caloric intake. Adiposopathy, overweight and obesity should be treated indefinitely with the specific aims to reduce fat mass for the adiposity complications, and to normalize adipose tissue function for the adiposopathic complications. This paper defines the principles of medical practice in bariatric endocrinology—the treatment of overweight and obesity as means to treat adiposopathy and its accompanying metabolic and hormonal derangements. PMID:24899894

Gonzalez-Campoy, J. Michael; Richardson, Bruce; Gonzalez-Cameron, David; Ebrahim, Ayesha; Strobel, Pamela; Martinez, Tiphani; Blaha, Beth; Ransom, Maria; Quinonez-Weislow, Jessica; Pierson, Andrea; Gonzalez Ahumada, Miguel

2014-01-01

134

A waste of time: the problem of common morality in Principles of Biomedical Ethics.  

PubMed

From the 5th edition of Beauchamp and Childress' Principles of Biomedical Ethics, the problem of common morality has been given a more prominent role and emphasis. With the publication of the 6th and latest edition, the authors not only attempt to ground their theory in common morality, but there is also an increased tendency to identify the former with the latter. While this stratagem may give the impression of a more robust, and hence stable, foundation for their theoretical construct, we fear that it comes with a cost, namely the need to keep any theory in medical ethics open to, and thereby aware of, the challenges arising from biomedical research and clinical practice, as well as healthcare systems. By too readily identifying the moral life of common morality with rule-following behaviour, Beauchamp and Childress may even be wrong about the nature of common morality as such, thereby founding their, by now, classic theory on quicksand instead of solid rock. PMID:21937468

Karlsen, Jan Reinert; Solbakk, Jan Helge

2011-10-01

135

[Ethical principles of management and planning during influenza pandemic].  

PubMed

The article is dedicated to an actual problem of ethical component inclusion into the system of management and planning of epidemic control measures during threat emergence and in the course of influenza pandemic (epidemic) progress. Data regarding development of international ethical guidelines during influenza including WHO recommendations are presented and analysis of normative documents in Russian Federation is given. A necessity of comprehension and accounting of ethical values in pandemic preparedness is shown, main directions of action and responsibility are revealed. Key ethical positions of planning and implementation of measures during influenza pandemic are outlined, compliance with those determines the level of public support and thus provides the effectiveness of the implemented measures. PMID:22442981

Kubar', O I; Asatrian, A Zh

2012-01-01

136

Medical ethics for senior medical doctors (episode I).  

PubMed

A good leader will never ever forget themselves, or abuse the power or authority, and also not trust only the inner circle voice, nevertheless they have to listen and consider the voice of disagreement from others. Otherwise, they will transform themselves to be a "dictator" unconsciously which is very dangerous and harmful to the democratic ruling system as well as themselves and their family members, as you can see from the past history of foreign countries and even Thailand itself. Thai culture is surrounded and consistes of kindness, mercy and good wishes to each other. The patient is so grateful and appreciates the value of the medical doctor for saving their life. Even although the Western culture is penetrating globally as a business-oriented culture in which medico-legal cases such as patient's rights, the value of the patient's benefit protection and certainly it requires the legal act to get involved eventually. The compromised culture which has been embedded in Thai society for a prolonged period can be changed firmly and gradually because of the usual and regular condition and definitely the good and valued medical doctors is still around. The opportunity of medical doctors to act as a pioneer of the trend and conflicted societies, is responsible to them and it's a great opportunity for Thai medical doctors to reach out to these goals and excellence. The above statements can be found in various media. Is it true that the medical doctors will absolutely be hundred percent good guys and have good luck from time to time? But for sure, even our medical colleagues are very much dedicated and concentrated in their job, as the family members of our medical profession, they have been left out, they have no time to share with or even be responsible to them. Many of our friends in the same profession might feel so sorry or appreciate the term "short-belt situation" or "unexpected" event which might attack us from the society violently and unmercifully. PMID:16149695

Phaosavasdi, Sukhit; Taneepanichskul, Surasak; Tannirandorn, Yuen; Thamkhantho, Manopchai; Pruksapong, Chumsak; Kanjanapitak, Aurchart

2005-05-01

137

Nanotechnology: is there a need for ethical principles?  

PubMed

Nanotechnology (NT) is concerned with materials and systems whose structures and components exhibit novel physical, chemical and biological properties due to their nanoscale size. This new scientific discipline is fast becoming a major driver of the future direction of health care and is likely to have a significant impact on society, medicine and nursing. This article demonstrates that ethical reflections lie at the heart of nursing. In contextualizing the ethics of NT, this article questions the conclusion reached by others that ethical reflections on NT lag behind its scientific developments. Instead it proposes that the ethical issues raised by NT are similar to those relating to biotechnology, considered by ethicists since the 1970s. Consequently, this article argues that a foundation of ethical reflections already exists that can be transferred to NT. Finally, this article asserts the need for nurses to be proactively involved in interdisciplinary discussions likely to extend the current ethical reflections of autonomy, non-maleficence, beneficence and justice to NT. PMID:20081665

Meetoo, Danny

138

An ethical framework for the responsible management of pregnant patients in a medical disaster.  

PubMed

The ethics of managing obstetric patients in medical disasters poses ethical challenges that are unique in comparison to other disaster patients, because the medical needs of two patients--the pregnant patient and the fetal patient--must be considered. We provide an ethical framework for doing so. We base the framework on the justice-based prevention of exploitation of populations of patients, both obstetric and non-obstetric, in medical disasters. We use the concept of exploitation to identify a spectrum from ethically acceptable, to ethically challenging, to ethically unacceptable, management of obstetric patients in medical disasters. We also address the ethics of the care of obstetric and neonatal patients when the resources of a hospital are completely overwhelmed in a large-scale medical disaster. PMID:21595351

Chervenak, Frank A; McCullough, Laurence B

2011-01-01

139

Research Experience and Agreement with Selected Ethics Principles from Canada's "Tri-Council Policy Statement--Ethical Conduct for Research Involving Humans"  

ERIC Educational Resources Information Center

An online survey was conducted of students, instructors, and researchers in distance education regarding principles for the ethical treatment of human research subjects. The study used an online questionnaire based on principles drawn from Canada's "Tri-Council Policy Statement, Ethical Conduct for Research Involving Humans" (TCPS, 2003), which…

Fahy, Pat; Spencer, Bob

2004-01-01

140

Ethical and quasi-ethical issues in medical editing and publishing.  

PubMed

The peer review system is a complex, delicately balanced, and dynamic system by which most new medical information is made known. The participants in the process - authors, reviewers, and editors - all have responsibilities to shoulder and rights that need to be protected. An ethical structure has evolved over time to accomplish these two goals. This paper discusses six of these ethical or quasi-ethical issues. Authorship is currently a contentious matter, in part because authors see it as a credit, whereas editors view it as responsibility. Conflict of interest, usually financial, which seems to be increasing with the growing commercialization of medicine, can undermine the credibility and integrity of publication. Confidentiality is an essential component of peer review to protect an author's creative work from exploitation or misappropriation and to protect reviewers from retribution. Redundant publication, publishing or attempting to publish essentially the same work more than once, is regarded seriously because it wastes a journal's resources, confuses later literature reviews, and depreciates the value of authorship. Advertising is a necessary fact of life for most medical journals, but safeguards must be in place to prevent its influencing editorial decisions. When fraud or plagiarism is alleged about something a journal has published, the journal is not equipped to undertake the kind of investigation needed, and should refer the matter to the institution that sponsored the research. PMID:9575262

Pitkin, R M

1998-06-01

141

Accidental fetal decapitation: a case of medical and ethical mishap.  

PubMed

Blunt trauma to the head and neck of a newborn during delivery process is a rare event. We report a peculiar case of decapitation of a live fetus during vacuum-assisted delivery, where excessive traction on the head of the full-term macrosomic fetus with shoulder dystocia resulted in overstretching of the neck up to the point of decapitation. The ethical considerations related to the case are discussed in light of the policy of complete transparency advocated by the medical profession. Despite the existence of regulations regarding full disclosure of errors to the medical institution, the Ministry of Health and to the patient, medical practitioners are reluctant to divulge all the details of adverse events to the patient. PMID:20190630

Hiss, Jehuda; Kahana, Tzipi; Burshtein, Irad

2011-09-01

142

Ethical, Scientific, and Educational Concerns With Unproven Medications  

PubMed Central

Quackery (promotion of products that do not work or have not been proven to work) was once a commonly used term within the pharmacy and medical communities. However, an increasingly anti-scientific national climate culminated in passage of the 1994 Dietary Supplement Health and Education Act, which granted unprecedented legitimacy to “dietary supplements” that had not been scientifically proven to be effective and/or safe. In part, this was facilitated when professional pharmacy magazines and journals published advertisements and articles promoting these unproven medications. Gradually, pharmacy codes of ethics eliminated references to quackery, and some pharmacy organizations seemed to accept the unproven medications they once exhorted the pharmacist not to sell. The profession's shift in attitude toward unproven medications occurred as the medical community at large began to realize the value of evidence-based medicine. Academicians must resist pressure to present unproven therapies as realistic alternatives for medications with scientific proof of safety and efficacy. They must stress the value of evidence-based medicine and urge students and pharmacists to recommend only those medications with evidence-based proof of safety and efficacy. PMID:17332867

Pray, W. Steven

2006-01-01

143

Ethical boundaries in genetic testing.  

PubMed

The scarcity of resources that can be allocated to genetic testing will ultimately limit the number of diseases subjected to molecular analysis. Medical student David Allan, who claimed first prize in CMAJ's 1995 Logie Medical Ethics Essay Contest, looks at the ethical principles that should guide decisions about genetic testing, and the importance of communicating these principles to patients and their families. PMID:8548713

Allan, D

1996-01-15

144

Biotechnology entrepreneurship and ethics: principles, paradigms, and products.  

PubMed

Biotechnology, whether in the context of new drugs derived from DNA and genetic technology, genetically modified food, or biologics making use of living cells, raises ethical concerns at a variety of different levels. At the research level, there is concern that the very nature of research is being subverted, rather than enhanced, by entrepreneurship. This area of ethical concern has intensified in the United States as a result of the conflicts of interests resulting from the growing alliance between University academia and private industry in the research enterprise. As we travel down the research path into development of a drug or technology, ethical questions arise with respect to protecting human subjects and society from danger and exploitation by researchers. As development gives way to marketing and dissemination of a new product, government regulators are pressed to get drugs and biologics through the regulatory pipeline into the market faster, walking an ethical tightrope between speed and safety. As new biotechnology products enter the market place, doctors and patients traverse yet another tightrope, that between unknown risk and the promise of benefit. And finally, patent protection is increasingly viewed as a unethical culprit in keeping prices high and depriving the global poor from lifesaving drugs and biologics. Bioethics has, to date, been largely a creation of Western research and medicine. As such it is wholly inadequate to respond to the cascade of ethical issues that flow from a vibrant biotechnology industry. And if biotechnology is in its infancy, as most believe, it is crucial that scientists, entrepreneurs and governments engage in dialogue about the ethical and societal questions raised on the road of scientific progress. PMID:17078522

Kuszler, Patricia C

2006-09-01

145

Law and medical ethics in organ transplantation surgery  

PubMed Central

This article in the series describes how UK law and medical ethics have evolved to accommodate developments in organ transplantation surgery. August committees have formulated definitions of the point of death of the person which are compatible with the lawful procurement of functioning vital organs from cadavers. Some of the complexities of dead donor rules are examined. Live donors are a major source of kidneys and the laws that protect them are considered. Financial inducements and other incentives to donate erode the noble concept of altruism, but should they be unlawful? PMID:20501013

Woodcock, Tom; Wheeler, Robert

2010-01-01

146

Ethical Principles in Practice: Evidence from Participatory Action Research  

ERIC Educational Resources Information Center

A significant challenge for all participants in the autism spectrum disorder participatory action research (ASD PAR) project, including the Ministry of Education, the local project teams (LPT) and mentors, was the lack of availability of a single ethics approval process for the project in its entirety and, in particular, one that could accommodate…

Smith, Liz

2008-01-01

147

Searching for solutions to alcohol and other drug abuse during pregnancy: ethics, values, and constitutional principles.  

PubMed

Recent efforts to develop legal mechanisms to detect prenatal substance abuse and force pregnant women into drug-free conditions have precipitated ethical struggles for social workers. This article reviews relevant social work values and ethical issues, particularly the need to balance obligations to promote client self-determination, privacy, and access to chosen services with professional values that support coercive intervention to aid vulnerable people and to protect life. The constitutional principles that most affect coercive interventions--due process and equal protection--are reviewed. Recommendations are offered to guide ethical and legal social work for case interventions and policy development. PMID:7863373

Andrews, A B; Patterson, E G

1995-01-01

148

Private-sector research ethics: marketing or good conflicts management? The 2005 John J. Conley Lecture on Medical Ethics.  

PubMed

Pharmaceutical companies are major sponsors of biomedical research. Most scholars and policymakers focus their attention on government and academic oversight activities, however. In this article, I consider the role of pharmaceutical companies' internal ethics statements in guiding decisions about corporate research and development (R&D). I review materials from drug company websites and contributions from the business and medical ethics literature that address ethical responsibilities of businesses in general and pharmaceutical companies in particular. I discuss positive and negative uses of pharmaceutical companies' ethics materials and describe shortcomings in the companies' existing ethics programs. To guide employees and reassure outsiders, companies must add rigor, independence, and transparency to their R&D ethics programs. PMID:16699963

Dresser, Rebecca

2006-01-01

149

Medical Marijuana for HIV-Associated Sensory Neuropathy: Legal and Ethical Issues.  

PubMed

The number of states legalizing medical marijuana is increasing. Medical marijuana is possibly effective therapy for HIV-associated sensory neuropathy. Despite legalization at the state level, however, the current and contradictory federal drug enforcement policy creates the risk that physicians who recommend medical marijuana to their patients will lose their ability to prescribe medications. The federal-state tension has legal and ethical implications for neurologists who receive a request for medical marijuana from their patients since neurologists must strive to both relieve suffering and obey relevant laws. Recommendation of medical marijuana by neurologists to their patients is ethically permissible but is not ethically mandatory. PMID:25299291

Larriviere, Daniel G

2014-10-01

150

Measuring the ethical sensitivity of medical students: a study at the University of Toronto  

Microsoft Academic Search

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical

P C Hébert; E. M. Meslin; E. V. Dunn

1992-01-01

151

How an ethics workshop for preceptors affects medical students.  

PubMed Central

OBJECTIVE: To determine whether a workshop on medical ethics attended by family medicine preceptors would affect their students' learning of ethics, and what educational and experiential factors affected the students' learning about ethics. DESIGN: A 3-hour workshop planned by a group of family physicians and ethicists and taught by a faculty member and an ethicist was offered to family physician preceptors. Students entering the clerkship were invited by letter to complete written answers to two clinical papers. Their answers were compared with "ideal" answers based on a weighted composite of the responses of 12 family physicians with a particular interest in ethics. The scores of students assigned to preceptors who had been offered the workshop were compared with those of students assigned to a control group of preceptors. Clerks were also asked about influences on their answers. PARTICIPANTS: The 86 preceptors participating in the family medicine programs at the University of Western Ontario, divided by random selection within geographic clustering into an experimental group of 50 and a control group of 36. Preceptors offered the workshop were considered to be in the experimental group whether or not they attended. The student questionnaire was sent to all students entering the family medicine clerkship program in the academic year 1989-1990 and some in the following year, until sufficient responses were received. Responses were analyzed from 32 clerks in the experimental group and 36 in the control group. MAIN OUTCOME MEASURE: Performance of students whose preceptors were invited to the workshop against performance of students whose preceptors were not invited to the workshop. RESULTS: No significant differences were noted between the performance of students whose preceptors were offered the workshop and those whose preceptors were not. CONCLUSION: The single outcome measure and the volunteer bias make conclusions difficult to draw. Further studies varying interventions and outcome measures are warranted. PMID:8086844

Hennen, B. K.; Morrissy, J.; Grindrod, A.

1994-01-01

152

Informed Consent: Corner Stone in Ethical Medical and Dental Practice  

PubMed Central

Progress in health care technologies has enabled patients to be better informed about all aspects of health care. Patients' informed consent is a legal regulation and a moral principle which represents patients' rights to take part in the clinical decisions concerning their treatment. With increasing awareness among the patients, the concept of informed consent is also evolving in developing countries like India. It is important for the medical and dental practitioners to have a written and signed informed consent from their patients before performing any invasive or irreversible procedures. Informed consent is also needed when providing medical care to children, foreign patients, and incorporating images of the patients while conducting medical and dental research. The present review addresses some of the vital issues regarding informed consent when providing medical and dental care with current review of the literature. PMID:24791241

Kakar, Heena; Gambhir, Ramandeep Singh; Singh, Simarpreet; Kaur, Amarinder; Nanda, Tarun

2014-01-01

153

Situation analysis of local ethical committees in medical sciences in Iran  

PubMed Central

BACKGROUND: Local ethical committees in medical sciences in Iran were established in 1999 in order to assess and evaluate the observance of ethical standards throughout the universities and research centers. The purpose of this study is to analyze the situation of local ethical committees in order to develop research ethics guideline. METHODS: For this cross-sectional study which has been conducted with the support of WHO, 40 local ethical committees in all universities of medical sciences were evaluated by use of determined questionnaires. RESULTS: In this study, 40 universities of medical sciences participated; all of them have established local ethical committees. Each committee has 5 to 11 members and in more than 80% cases, written guidelines for selecting the committee's members are available. The minimum number of members for official session is at least 3 and replacement of absent members, did not take place in more than 85% of the committees. Informed consent in 95% of these local ethical committees is available. In all committees, researches regarding the use of human subjects are under ethical consideration. In half of the local ethical committees, penalties for non-compliance with the regulations are considered. The average number of research project evaluated in last session of these committees was 15.2 and the committees in 50% of cases have provided ethics training specifically for their members. CONCLUSIONS: Policymakers should develop a standard guideline for local ethical committees in medical science universities in Iran. PMID:22091250

Fakour, Yousef; Eftekhari, Monir Baradaran; Haghighi, Zohre; Mehr, Najmeh Khosravan; Hejazi, Farzaneh

2011-01-01

154

Rationale and Architecture Principles for Medical Application Platforms John Hatcliff  

E-print Network

Rationale and Architecture Principles for Medical Application Platforms John Hatcliff Kansas State University Sandy Weininger US Food and Drug Administration Julian M. Goldman Massachusetts General Hospital to better inform decision- making, and leveraged to automate control of system units. In contrast, medical

Huth, Michael

155

A Reply on Behalf of the Relativist to Mark Mason's Justification of Universal Ethical Principles  

ERIC Educational Resources Information Center

Mark Mason, in his "A Justification, After the Postmodern Turn, of Universal Ethical Principles and Educational Ideals" Educational Philosophy and Theory, 37 (2005), attempts to justify transcultural multiculturalism. In this paper I argue that he fails to refute moral relativism, and that multiculturalism as he interprets it is not morally…

MacKenzie, Jim

2007-01-01

156

The Failure of Clinical Psychology Graduate Students to Apply Understood Ethical Principles  

Microsoft Academic Search

In a survey of 170 graduate students from 25 American Psychological Association- (APA-) approved clinical training programs, we asked them to state what they should do in a hypothetical situation in which a peer\\/friend is violating the Ethical Principles (APA, 1977, 1981) and then what they would do. Approximately half of these students would do less than they believe they

John L. Bernard; Carmen S. Jara

1986-01-01

157

The ethics of forensic psychiatry: moving beyond principles to a relational ethics approach  

Microsoft Academic Search

Forensic psychiatry has been described as a ‘moral minefield’. The competing obligations at the interface of the justice and healthcare systems raise questions about the very viability of an ethical framework for guiding practice. The explicit need for security and detention, and the implicit ‘untrustworthiness’ of forensic patients shape practitioners' everyday reality. Suspicion colors client–practitioner relationship and fundamental care concepts,

Wendy Austin; Erika Goble; Julija Kelecevic

2009-01-01

158

Ethical issues of medical missions: the clinicians' view.  

PubMed

Surgery is an important part of health care worldwide. Without access to surgical treatments, morbidity and mortality increase. Access to surgical treatment is a significant problem in global public health because surgical services are not equally distributed in the world. There is a disproportionate scarcity of surgical access in low-income countries. There are many charitable organizations around the world that sponsor surgical missions to under served nations. One such organization is Operation Smile International, a group with which both authors have volunteered. This paper will describe the purpose and processes involved in Operation Smile and identify some of the key ethical issues that arise in short term medical volunteer work highlighting the importance of sustainability. PMID:21598049

Ott, Barbara B; Olson, Robert M

2011-06-01

159

Genetic screening; Medical promise amid legal and ethical questions  

SciTech Connect

As efforts gear up to map and sequence the human genome, increasing attention is being focused on the ethical, social and legal issues raised by the acquisition and use of genetic information. Several types of genetic screening carried out in a variety of settings hold enormous potential for improving health care. But such screening also poses an array of questions that are only now being addressed. Other applications of humanity's newfound and rapidly growing ability to peer into the genetic makeup of an individual also have serious implications. Use of so-called DNA fingerprinting, for instance, troubles some observers who question the reliability of such analyses carried out on a large scale and who worry about the effects on civil liberties of widespread genetic testing for identification purposes. The author discusses how genetic screening for medical purposes, though, seems to raise a broader array of difficult questions than do other uses of genetic information.

Baum, R.M. (C and EN, San Francisco, CA (US))

1989-08-01

160

Medical ethics on film: towards a reconstruction of the teaching of healthcare professionals  

PubMed Central

The clinical vignette remains the standard means by which medical ethics are taught to students in the healthcare professions. Although written or verbal vignettes are useful as a pedagogic tool for teaching ethics and introducing students to real cases, they are limited, since students must imagine the clinical scenario. Medical ethics are almost universally taught during the early years of training, when students are unfamiliar with the clinical reality in which ethics issues arise. Film vignettes fill in that imaginative leap. By providing vivid details with images, film vignettes offer rich and textured details of cases, including the patient's perspective and the clinical reality. Film vignettes provide a detailed ethnography that allows for a more complete discussion of the ethical issues. Film can serve as an additional tool for teaching medical ethics to members of the healthcare professions. PMID:17971475

Volandes, Angelo

2007-01-01

161

Developing an ethical framework for short-term international dental and medical activities.  

PubMed

The popularity of volunteering to provide charity health care in third-world countries has increased dramatically in recent years. While there are advantages to both those being helped and to volunteers, there are also ethical issues that need to be addressed. A framework for analyzing the ethical impact of such service is presented which continues 27 principles that should be addressed. PMID:25080664

Friedman, Alexandra; Loh, Lawrence; Evert, Jessica

2014-01-01

162

Medical ethics in cross-cultural and multi-cultural perspectives.  

PubMed

Medical ethics have usually been ignored in comparative studies of medical systems; they are almost exclusively Western and based on the technocratic culture of practitioners of cosmopolitan medicine. Important values of heterogeneous and homogeneous cultural systems may appropriately be studied in a medical context. Cross-cultural medical anthropological studies have not dealt extensively with medical ethics, and have not systematically examined the values involved in decision-making by healers, although the choices made by patients have been emphasized. Studies of decision-making in the context of healing can be useful in investigations of the operation of value systems and of conflicts and changes in such systems. Western examples of ethical conflicts and bases of choice in regulation of the profession, individual vs. social obligation, obligation of the practitioner to take action, allocation of scarce resources, and the patient's right to information suggest general problems that exist in most medical systems regardless of the level of technological development or the concepts of disease prevention and cure. Ethical conflicts in medical care allow study of value ranking in decision-making. Questionnaires have been the most common method for studying ethical questions in Western medical settings, and such questionnaires could be adapted for use cross-culturally. Medical ethics in non-Western settings may also be investigated by looking at "trouble cases," by participant observation, and by intensive interviewing. PMID:7209599

Kunstadter, P

1980-11-01

163

Perceptions and practices of medical practitioners towards ethics in medical practice - a study from coastal South India.  

PubMed

Ethics is the application of values and moral rules to human activities. Medical practitioners are expected to not only have the skills and knowledge relevant to their field but also with the ethical and legal expectations that arise out of the standard practices. The present research was conducted with an aim to study the perceptions and practices of medical practitioners towards healthcare ethics in Indian scenario and to strengthen the evidence in the field of ethics training. A cross-sectional study was carried out in three associate hospitals of a Medical College in Southern India. Medical practitioners included in the study were administered a pre-tested, semi-structured questionnaire. Data was collected based on their responses on a 5 point Likert scale and analyzed using SPSS version 11.5. The majority of the participants mentioned that their perceptions of ethics in medical practice were based on information obtained during their undergraduate training, followed by experience at work. The medical practitioners had a positive perception on issues relating to consent in medical practice. However, the same degree of perception was not observed for issues related to confidentiality and their dealing with patients during emergency conditions. The majority of the medical practitioners agreed that ethical conduct is important to avoid legal and disciplinary actions. Among the medical practitioners, the responses of specialists and non-specialists were mostly similar with major differences of opinion for a few issues. A highest level of knowledge, awareness and understanding of ethics are expected in medical practice as it is the foundation of sound healthcare delivery system. PMID:24485422

Unnikrishnan, B; Kanchan, Tanuj; Kulkarni, Vaman; Kumar, Nithin; Papanna, Mohan Kumar; Rekha, T; Mithra, Prasanna

2014-02-01

164

Towards a community effort to identify ethical principles for research in hydrology  

NASA Astrophysics Data System (ADS)

The hydrological community in Europe is growing rapidly in both size and, more importantly, scientific relevance and integrity. The Hydrological Sciences (HS) Division of EGU actively is promoting the above development by identifying research targets, stimulating the involvement of young scientists and managing a scientific open access journal based on a public peer review process. The management of the Division itself and the organisation of the General Assembly are carried out transparently, with the aim to seek an improved involvement of top and young scientists, with a bottom up approach. I believe the HS community is animated by a strong enthusiasm which, however, is not adequately supported by economical funding. In my opinion this is a major problem which HS should consider and discuss. The relevance of the societal and environmental problems dealt with by hydrologists, in a professional way and with exceptional scientific skills, is without doubt and therefore the limited amount of funding is not justified in practice. In my opinion, in order to refine the structure of the HS community, and promote its visibility, we should formally identify HS ethical principles for research in environmental science. The principles should highlight the role of hydrology as well as the ethical and scientific solidity of the HS community. Establishing ethical principles is even more important in view of the transparent approach HS is adopting for reviewing and publishing contributions and in view of the increasing need to transparently prove how public funding for research is administered. Establishing ethical principles for hydrology is not a trivial task. Hydrology is characterised by a relevant uncertainty in data, models and parameters. Hydrology is also relying on a large variety of approaches, ranging from statistical to physically based. The purpose of this poster is to present a collection of ethical principles for scientific research presented by the literature and/or adopted by institutions. The aim is to stimulate a discussion within the HS community in order to finally propose a collection of principles and rules of conduct that can apply to hydrology. I believe that the visibility and the solidity of the HS community will benefit by placing emphasis on the role of ethics.

Montanari, Alberto

2010-05-01

165

Anticholinesterases: Medical applications of neurochemical principles  

SciTech Connect

Cholinesterases form a family of serine esterases that arise in animals from at least two distinct genes. Multiple forms of these enzymes can be precisely localized and regulated by alternative mRNA splicing and by co- or posttranslational modifications. The high catalytic efficiency of the cholinesterases is quelled by certain very selective reversible and irreversible inhibitors. Owing largely to the important role of acetylcholine hydrolysis in neurotransmission, cholinesterase and its inhibitors have been studied extensively in vivo. In parallel, there has emerged an equally impressive enzyme chemistry literature. Cholinesterase inhibitors are used widely as pesticides; in this regard the compounds are beneficial with concomitant health risks. Poisoning by such compounds can result in an acute but usually manageable medical crisis and may damage the ONS and the PNS, as well as cardiac and skeletal muscle tissue. Some inhibitors have been useful for the treatment of glaucoma and myasthenia gravis, and others are in clinical trials as therapy for Alzheimer`s dementia. Concurrently, the most potent inhibitors have been developed as highly toxic chemical warfare agents. We review treatments and sequelae of exposure to selected anticholinesterases, especially organophosphorus compounds and carbamates, as they relate to recent progress in enzyme chemistry.

Millard, C.B.; Broomfield, C.A.

1995-12-31

166

Medical Students? Cases as an Empirical Basis for Teaching Clinical Ethics  

Microsoft Academic Search

To identify ethical issues that interns encounter in their clinical education and thus build a more empirical basis for the required contents of the clinical ethics curriculum.\\u000aThe authors analyzed a total of 522 required case reports on ethical dilemmas experienced by interns from September 1995 to May 1999 at the medical school of Vrije Universiteit in Amsterdam. They identified

Marli Huijer; Leeuwen van Evert; Annette Boenink; Gerrit Kimsma

2000-01-01

167

Comparing Healthcare Systems: Outcomes, Ethical Principles, and Social Values  

PubMed Central

The question of how healthcare should be structured has been at the forefront of public debate for quite some time. In particular, debate has raged over the acceptability of socialized and rights-oriented approaches to healthcare as opposed to privatized and commodity-oriented approaches. The present discussion looks at the underlying logic of the debate and at the use of outcome measures as a primary determinant. It suggests that outcome measures are of limited use in deciding the issue because they ignore important variables and further suggests that outcome measures are inappropriate tools when comparing distinct healthcare systems because they ignore valuational components that are integral to deciding whether a healthcare system is consistent with a society's principles and values. PMID:18311379

Kluge, Eike-Henner W.

2007-01-01

168

2011-2012BROWNBAGCOLLOQUIUMSERIES Ethical Allocation of Scarce Medical Resources During Public Health  

E-print Network

Wayne State University Law School and a Scholar with the Centers for Law and the Public's HealthCenter" on Facebook Scarcity of resources and services is likely during public health emergencies. Numerous ethical2011-2012BROWNBAGCOLLOQUIUMSERIES Ethical Allocation of Scarce Medical Resources During Public

Berdichevsky, Victor

169

The robustness of medical professional ethics when times are changing: a comparative study of general practitioner ethics and surgery ethics in The Netherlands.  

PubMed

Society in the 21st century is in many ways different from society in the 1950s, the 1960s or the 1970s. Two of the most important changes relate to the level of education in the population and the balance between work and private life. These days a large percentage of people are highly educated. Partly as a result of economic progress in the 1950s and the 1960s and partly due to the fact that many women entered the labour force, people started searching for ways to combine their career with family obligations and a private life (including hobbies, outings and holidays). Medical professional ethics, more specifically: professional attitudes towards patients and colleagues, is influenced by developments such as these, but how much and in what way? It was assumed that surgery ethics would be more robust, resistant to change and that general practitioner (GP) ethics would change more readily in response to a changing society, because surgeons perform technical work in operating theatres in hospitals whereas GPs have their offices in the midst of society. The journals of Dutch surgeons and GPs from the 1950s onwards were studied so as to detect traces of change in medical professional ethics in The Netherlands. GP ethics turned out to be malleable compared with surgery ethics. In fact, GP medicine proved to be an agent of change rather than merely responding to it, both with regard to the changing role of patients and with regard to the changing work life balance. PMID:19793943

Dwarswaard, J; Hilhorst, M; Trappenburg, M

2009-10-01

170

The contribution of Kantian moral theory to contemporary medical ethics: a critical analysis.  

PubMed

Kantian deontology is one of three classic moral theories, among virtue ethics and consequentialism. Issues in medical ethics are frequently addressed within a Kantian paradigm, at least --although not exclusively--in European medical ethics. At the same time, critical voices have pointed to deficits of Kantian moral philosophy which must be examined and discussed. It is argued that taking concrete situations and complex relationships into account is of paramount importance in medical ethics. Encounters between medical or nursing staff and patients are rarely symmetrical relationships between autonomous and rational agents. Kantian ethics, the criticism reads, builds on the lofty ideal of such a relationship. In addition to the charge of an individualist and rationalist focus on autonomy, Kantian ethics has been accused of excluding those not actually in possession of these properties or of its rigorism. It is said to be focussed on laws and imperatives to an extent that it cannot appreciate the complex nuances of real conflicts. As a more detailed analysis will show, these charges are inadequate in at least some regards. This will be demonstrated by drawing on the Kantian notion of autonomy, the role of maxims and judgment and the conception of duties, as well as the role of emotions. Nevertheless the objections brought forward against Kantian moral theory can help determine, with greater precision, its strengths and shortcomings as an approach to current problems in medical ethics. PMID:15906935

Heubel, Friedrich; Biller-Andorno, Nikola

2005-01-01

171

The Good, the Bad, and the Ugly: Ethical Principles for (Re)Presenting Students and Student Writing in Teachers' Publications.  

ERIC Educational Resources Information Center

Addresses interrelated sets of ethical considerations: the ethical principles for representing students and student writing in the teacher's own publications of two types--in textbooks designed for student use, and in research publications and conference presentations designed for the author's peers. Lists 10 points to make clear to students whose…

Bloom, Lynn Z.

2003-01-01

172

Ethics Matter: The Morality and Justice Principles of Elected City Officials and their Impact of Urban Issues  

E-print Network

This article pursues the thesis that ethics matter in urban policymaking. Interviews with 95 elected officials in 12 cities revealed the officials' support for—and opposition to—many principles of political morality and ...

Schumaker, Paul; Kelly, Marisa J.

2012-08-01

173

Ethics and professionalism in medical physics: A survey of AAPM members  

PubMed Central

Purpose: To assess current education, practices, attitudes, and perceptions pertaining to ethics and professionalism in medical physics. Methods: A link to a web-based survey was distributed to the American Association of Physicists in Medicine (AAPM) e-mail membership list, with a follow-up e-mail sent two weeks later. The survey included questions about ethics/professionalism education, direct personal knowledge of ethically questionable practices in clinical care, research, education (teaching and mentoring), and professionalism, respondents’ assessment of their ability to address ethical/professional dilemmas, and demographics. For analysis, reports of unethical or ethically questionable practices or behaviors by approximately 40% or more of respondents were classified as “frequent.” Results: Partial or complete responses were received from 18% (1394/7708) of AAPM members. Overall, 60% (827/1377) of the respondents stated that they had not received ethics/professionalism education during their medical physics training. Respondents currently in training were more likely to state that they received instruction in ethics/professionalism (80%, 127/159) versus respondents who were post-training (35%, 401/1159). Respondents’ preferred method of instruction in ethics/professionalism was structured periodic discussions involving both faculty and students/trainees. More than 90% (1271/1384) supported continuing education in ethics/professionalism and 75% (1043/1386) stated they would attend ethics/professionalism sessions at professional/scientific meetings. In the research setting, reports about ethically questionable authorship assignment were frequent (approximately 40%) whereas incidents of ethically questionable practices about human subjects protections were quite infrequent (5%). In the clinical setting, there was frequent recollection of incidents regarding lack of training, resources and skills, and error/incident reporting. In the educational setting, incidents of unethical or ethically questionable practices were only frequently recollected with respect to mentorship/guidance. With respect to professional conduct, favoritism, hostile work/learning environment, and maltreatment of subordinates and colleagues were frequently reported. A significantly larger proportion of women reported experiences with hostile work/learning environments, favoritism, poor mentorship, unfairness in educational settings, and concerns about student privacy and confidentiality. Conclusions: The survey found broad interest in ethics/professionalism topics and revealed that these topics were being integrated into the curriculum at many institutions. The incorporation of ethics and professionalism instruction into both graduate education and postgraduate training of medical physicists, and into their subsequent lifelong continuing education is important given the nontrivial number of medical physicists who had direct personal knowledge of unethical or ethically questionable incidents in clinical practice, research, education, and professionalism. PMID:23556930

Ozturk, Naim; Armato, Samuel G.; Giger, Maryellen L.; Serago, Christopher F.; Ross, Lainie F.

2013-01-01

174

Development of a medical humanities and ethics certificate program in Texas.  

PubMed

Education in the medical humanities and ethics is an integral part of the formation of future physicians. This article reports on an innovative approach to incorporating the medical humanities and ethics into the four-year curriculum in a Certificate Program spanning all four years of the medical school experience. The faculty of the McGovern Center for Humanities and Ethics at the University of Texas Medical School at Houston conceived and implemented this program to teach medical students a range of scholarly topics in the medical humanities and to engage the full human experience into the process of becoming a physician. This study follows six years of experience, and we report student experiences and learning in their own words. PMID:25283183

Erwin, Cheryl J

2014-12-01

175

Investigation of the Awareness of the Students of Shiraz Dental School Concerning the Patients' Rights and the Principles of Ethics in Dentistry  

PubMed Central

Statement of Problem: Deliberating the patients’ rights is one of the major human ethical and legal principles which can be investigated through the agenda of professional and medical ethics.accordingly , the students of dentistry have to be educated about this issue and achieve the necessary skills in deliberating and concerning the patients’ rights. Purpose: The present study aimed to investigate Shiraz dental students’ awareness and attitude regarding the patients’ rights as well as the principles of dental ethics in order to design methods for organizing and improving the ethics in dentistry. Materials and Method: The present descriptive-analytical study was conducted on 111 students of different departments of Shiraz Dental School. The study data were collected through a questionnaire designed based on the patients’ rights charter in Iran, ADA ethical codes which are internationally acceptable in the field of dentistry, and the guidelines of the ministry of health, treatment, and medical education (No. 140588). Then, the data were entered into the SPSS statistical software and analyzed. Results: Of all participants, 21.6% were men and 78.4% were women. According to the results, 71% of the students were acquainted with the patients’ rights. In addition, the patients’ characteristics, including gender and nationality, were not important for 58.6% of the students. Conclusion: The study findings showed that 71% of the participants were acquainted with the patients’ rights Establishment of a comprehensive, integrated charter in Iran is needed. With rapid development of medical sciences, new issues appear which necessitate taking into account the mutual rights of the physicians, people, and patients. PMID:24724112

Tabei, SZ; Azar, MR; Mahmoodian, F; Mohammadi, N; Farhadpour, H; Ghahramani, Y; Al-e-Yasin, Z

2013-01-01

176

Promoting social responsibility amongst health care users: medical tourists' perspectives on an information sheet regarding ethical concerns in medical tourism  

PubMed Central

Background Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. Results According to feedback provided in interviews with former Canadian medical tourists, the majority of participants responded positively to the information sheet and indicated that this document prompted them to engage in further consideration of these issues. Participants indicated some frustration after reading the information sheet regarding a lack of know-how in terms of learning more about the concerns discussed in the document and changing their decision-making. This frustration was due to participants’ desperation for medical care, a topic which participants frequently discussed regarding ethical concerns related to health care provision. Conclusions The overall perceptions of former medical tourists indicate that an information sheet may promote further consideration of ethical concerns of medical tourism. However, given that these interviews were performed with former medical tourists, it remains unknown whether such a document might impact upon the decision-making of prospective medical tourists. Furthermore, participants indicated a need for an additional tool such as a website for continued discussion about these concerns. As such, along with dissemination of the information sheet, future research implications should include the development of a website for ongoing discussion that could contribute to a raised awareness of these concerns and potentially increase social responsibility in the medical tourism industry. PMID:24314027

2013-01-01

177

Teaching and evaluation methods of medical ethics in the Saudi public medical colleges: cross-sectional questionnaire study  

PubMed Central

Background Saudi Arabia is considered one of the most influential Muslim countries being as the host of the two most holy places for Muslims, namely Makkah and Madina. This was reflected in the emphasis on teaching medical ethics in a lecture-based format as a part of the subject of Islamic culture taught to medical students. Over the last few years, both teaching and evaluation of medical ethics have been changing as more Saudi academics received specialized training and qualifications in bioethics from western universities. Methods This study aims at studying the current teaching methods and evaluation tools used by the Saudi public medical schools. It is done using a self-administered online questionnaire. Results Out of the 14 medical schools that responded, the majority of the responding schools (6; 42.8%), had no ethics departments; but all schools had a curriculum dedicated to medical ethics. These curricula were mostly developed by the faculty staff (12; 85.7%). The most popular teaching method was lecturing (13; 92.8%). The most popular form of student assessment was a paper-based final examination (6; 42.8%) at the end of the course that was allocated 40% or more of the total grade of the ethics course. Six schools (42.8%) allocated 15-30% of the total grade to research. Conclusion Although there is a growing interest and commitment in teaching ethics to medical students in Saudi schools; there is lack of standardization in teaching and evaluation methods. There is a need for a national body to provide guidance for the medical schools to harmonize the teaching methods, particularly introducing more interactive and students-engaging methods on the account of passive lecturing. PMID:24020917

2013-01-01

178

Ethics teaching on 'Beginning of Life' issues in UK medical schools.  

PubMed

Medical ethics forms an essential component of an undergraduate medical programme. In the UK the Institute of Medical Ethics has released a consensus statement detailing its recommendations for a minimum curriculum for ethics. One important issue it highlights for inclusion is 'Beginning of Life', which includes a wide range of themes. This paper presents an evaluation of the current teaching and assessment of these important issues in UK medical schools, complemented by a specific analysis of students' reaction to the teaching they received at the University of Edinburgh as part of their Obstetrics and Gynaecology rotation. Schools which responded to the survey reported a wide range of teaching and assessment methods. While there was a good overall coverage of topics, only one of them was covered by every institution and the religious/cultural elements of those topics were often neglected. The medical schools viewed better clinical integration of ethics teaching as the best route to improvement, but the students reported a desire for more ethics teaching in the form of specific tutorials, lectures or discussions. It is likely that a combination of these approaches will lead to significant improvements in the delivery of ethics teaching in this area and in others. PMID:24335584

Oldroyd, Christopher; Fialova, Lydie

2014-12-01

179

Regulatory and ethical principles in research involving children and individuals with developmental disabilities.  

PubMed

Children and individuals with developmental disabilities (DD) compared to typical participants are disadvantaged not only by virtue of being vulnerable to risks inherent in research participation but also by the higher likelihood of exclusion from research altogether. Current regulatory and ethical guidelines although necessary for their protection do not sufficiently ensure fair distributive justice. Yet, in view of disproportionately higher burdens of co-occurring physical and mental disorders in individuals with DD, they are better positioned to benefit from research by equitable participation. Greater elucidation of this ethical dilemma is called for by researchers, institutional review boards, and funding agencies to urgently redress the imbalance. This article discusses many of the regulatory principles to ensure better research participation of children and individuals with DD: human rights, validity, distributive justice, beneficence/nonmaleficence, and autonomy. PMID:15580725

Yan, Eric G; Munir, Kerim M

2004-01-01

180

Clarifying appeals to dignity in medical ethics from an historical perspective.  

PubMed

Over the past few decades the concept of (human) dignity has deeply pervaded medical ethics. Appeals to dignity, however, are often unclear. As a result some prefer to eliminate the concept from medical ethics, whereas others try to render it useful in this context. We think that appeals to dignity in medical ethics can be clarified by considering the concept from an historical perspective. Firstly, on the basis of historical texts we propose a framework for defining the concept in medical debates. The framework shows that dignity can occur in a relational, an unconditional, a subjective and a Kantian form. Interestingly, all forms relate to one concept since they have four features in common: dignity refers, in a restricted sense, to the 'special status of human beings'; it is based on essential human characteristics; the subject of dignity should live up to it; and it is a vulnerable concept, it can be lost or violated. We argue that being explicit about the meaning of dignity will prevent dignity from becoming a conversation-stopper in moral debate. Secondly, an historical perspective on dignity shows that it is not yet time to dispose of dignity in medical ethics. At least Kantian and relational dignity can be made useful in medical ethics. PMID:19161568

Van Der Graaf, Rieke; Van Delden, Johannes Jm

2009-03-01

181

Ethics and the GMC core curriculum: a survey of resources in UK medical schools.  

PubMed Central

OBJECTIVES: To study the resources available and resources needed for ethics teaching to medical students in UK medical schools as required by the new GMC core curriculum. DESIGN: A structured questionnaire was piloted and then circulated to deans of medical schools. SETTING: All UK medical schools. RESULTS: Eighteen out of 28 schools completed the questionnaire, the remainder either indicating that their arrangements were "under review" (4) or not responding (6). Among those responding: 1) library resources, including video and information technology were found to be fairly well developed; 2) many schools had a good supply of handouts and sample cases for teaching; 3) most had a written syllabus, and 4) two-thirds examined in the subject. However, many schools indicated that there was an urgent need for: 1) full-time teachers (most ethics teaching is still by part-time and voluntary staff); funding for books and journals, and 3) additional teaching materials (including further case vignettes, handouts and sample exam questions). CONCLUSIONS: There has been a considerable overall improvement in resources for medical ethics teaching since the time of the last national survey (The Pond Report). However, provision varies widely from medical school to medical school. The particular needs identified were for full-time teachers, library resources and teaching materials. Wider use of existing organisations concerned with medical ethics could help to meet these needs. PMID:9134487

Fulford, K W; Yates, A; Hope, T

1997-01-01

182

Dismembering the ethical physician  

PubMed Central

Physicians may experience ethical distress when they are caught in difficult clinical situations that demand ethical decision making, particularly when their preferred action may contravene the expectations of patients and established authorities. When principled and competent doctors succumb to patient wishes or establishment guidelines and participate in actions they perceive to be ethically inappropriate, or agree to refrain from interventions they believe to be in the best interests of patients, individual professional integrity may be diminished, and ethical reliability is potentially compromised. In a climate of ever?proliferating ethical quandaries, it is essential for the medical community, health institutions, and governing bodies to pursue a judicious tension between the indispensable regulation of physicians necessary to maintain professional standards and preserve public safety, and the support for “freedom of conscience” that principled physicians require to practise medicine in keeping with their personal ethical orientation. PMID:16597808

Genuis, S J

2006-01-01

183

Developing ethical awareness in global health: four cases for medical educators.  

PubMed

In recent years, the growth of interest in global health among medical students and residents has led to an abundance of short-term training opportunities in low-resource environments. Given the disparities in resources, needs and expectations between visitors and their hosts, these experiences can raise complex ethical concerns. Recent calls for best practices and ethical guidelines indicate a need for the development of ethical awareness among medical trainees, their sponsoring and host institutions, and supervising faculty. As a teaching tool to promote this awareness, we developed a scenario that captures many common ethical issues from four different perspectives. Each perspective is presented in case format followed by questions. Taken together, the four cases may be used to identify many of the elements of a well-designed global health training experience. PMID:23025791

White, Mary; Evert, Jessica

2014-12-01

184

Biopiracy and the ethics of medical heritage: the case of India's traditional knowledge digital library'.  

PubMed

Medical humanities have a central role to play in combating biopiracy. Medical humanities scholars can articulate and communicate the complex structures of meaning and significance which human beings have invested in their ways of conceiving health and sickness. Such awareness of the moral significance of medical heritage is necessary to ongoing legal, political, and ethical debates regarding the status and protection of medical heritage. I use the Indian Traditional Knowledge Digital Library as a case study of the role of medical humanities in challenging biopiracy by deepening our sense of the moral value of medical heritage. PMID:22610726

Kidd, Ian James

2012-09-01

185

Psychoanalysis and analytic psychotherapy in the NHS--a problem for medical ethics.  

PubMed Central

I question the place of psychoanalysis and psychoanalytically oriented psychotherapy in the National Health Service (NHS), with reference to published material; and, particularly, in relation to primary care, health economics and medical ethics. I argue that there are pressing clinical, research, economic, and ethical reasons in support of the contention that an urgent review of the extent and impact of psychoanalytic practices in the health service is called for. PMID:3735363

Wilkinson, G

1986-01-01

186

University of Pennsylvania: Department of Medical Ethics & Health Policy  

NSDL National Science Digital Library

This website presents the University of Pennsylvania's Center for Bioethics, "a leader in bioethics research and its deployment in the ethical, efficient, and compassionate practice of the life sciences and medicine." The website offers information about the Center's programs as well as information regarding faculty and staff contact information, research interests, and selected publications. The Faculty & Staff section also links to a number of downloadable faculty publications including "Are We Ready for Mass Genetic Testing: Ethical and Social Hurdles" by Arthur Caplan, "Bioethics and History" by Bob Baker, and "Toward a New Vocabulary of Human Genetic Variation" by Mildred Cho and Pamela Sankar. The current Center Programs include The Ethics of Gene Patenting, Toward as Understanding of Benefit Sharing, and the Penn High School Bioethics Project.

187

Ethical Expert Systems  

PubMed Central

The title is a double entendre. The discussion approaches expert systems from two directions: “What ethical hazards are created by expert systems in medicine?” and “Would it be ethical to design an expert system for solving problems in bioethics?” Computers present new ethical problems to society, some of which are unprecedented. These can be categorized under several rubrics. The paper describes a rudimentary scheme for understanding ethical issues raised by computers, in general, and medical expert systems, in particular. It focuses on bioethical implications of AI in medicine; explores norms, assumptions and taboos; and highlights certain ethical pitfalls. Principles are elucidated, for building ethically sound systems. Finally, a proposal is discussed, for the design of an expert system for moral problem solving, and the ethical implications of this notion are analyzed.

Victoroff, Michael S.

1985-01-01

188

Oocyte donation in postmenopausal women: medical and ethical considerations  

Microsoft Academic Search

Although maternal morbidity is increased, reported perinatal outcomes from peri- and postmenopausal pregnancy are generally good. Ethical considerations, in particular those relating to long term wellbeing of the child, constitute the primary reason to restrict the use of donated eggs in postmenopausal women.

M. Kortman; N. S. Macklon

2008-01-01

189

Difficult Decisions: Social and Ethical Implications of Changing Medical Technology  

Microsoft Academic Search

Objectives: A primary objective of this paper is to present data on subjective perceptions of health and quality of life in individuals living with early- or late-onset genetic conditions (cystic fibrosis, CF, and Huntington’s disease, HD, respectively). The paper will also discuss the social and ethical dilemmas raised by advances in reproductive and testing technology, consider the different emphases in

Elizabeth Chapman

2002-01-01

190

Medical Ethics and the Interrogation of Guantanamo 063  

Microsoft Academic Search

The controversy over abusive interrogations of prisoners during the war against terrorism spotlights the need for clear ethics norms requiring physicians and other clinicians to prevent the mistreatment of prisoners. Although policies and general descriptions pertaining to clinical oversight of interrogations in United States' war on terror prisons have come to light, there are few public records detailing the clinical

Steven H. Miles

2007-01-01

191

What future for ethical medical practice in the new National Health Service?  

PubMed Central

The British Government is implementing some major alterations to the way health services in Great Britain are organised. As well as the introduction of competition between health care providers, their financial interests are to be linked to their output, in efforts to use market forces to increase efficiency and cut costs. This paper looks at the possible impact of these changes of health care organisation on ethical medical practice. This is investigated with particular reference to the country whose health service has embraced most closely these elements of the market--the United States of America. The question to be answered is whether high standards of ethical care are ensured by factors somehow intrinsic to the medical profession, and are therefore immune to changes in the economics of health care. This assumption is shown to be questionable in light of what is known about the determinants of ethical medical practice. PMID:2033624

Persaud, R D

1991-01-01

192

Medication practice and feminist thought: a theoretical and ethical response to adherence in HIV/AIDS.  

PubMed

Accurate self-administration of antiretroviral medication therapy for HIV/AIDS is a significant clinical and ethical concern because of its implications for individual morbidity and mortality, the health of the public, and escalating healthcare costs. However, the traditional construction of patient medication adherence is oversimplified, myopic, and ethically problematic. Adherence relies on existing social power structures and western normative assumptions about the proper roles of patients and providers, and principally focuses on patient variables, obscuring the powerful socioeconomic and institutional influences on behaviour. Some professionals advocate for alternate approaches to adherence, but many of the available alternatives remain conceptually underdeveloped. Using HIV/AIDS as an exemplar, this paper presents medication practice as a theoretical reconstruction and explicates its conceptual and ethical evolution. We first propose that one of these alternatives, medication practice, broadens the understanding of individuals' medication-taking behaviour, speaks to the inherent power inequities in the patient-provider interaction, and addresses the ethical shortcomings in the traditional construal. We then integrate medication practice with feminist thought, further validating individuals' situated knowledge, choices, and multiple roles; more fully recognizing the individual as a multidiminsional, autonomous human being; and reducing notions of obedience and deference to authority. Blame is thus extricated from the healthcare relationship, reshaping the traditionally adversarial components of the interaction, and eliminating the view of adherence as a patient problem in need of patient-centred interventions. PMID:16222853

Broyles, Lauren M; Colbert, Alison M; Erlen, Judith A

2005-08-01

193

[New evidence for the author of the medical ethics novel Doctor's Mirror].  

PubMed

Yijiejing (Doctor's Mirror), the first novel focused on medical ethics in the late Qing dynasty, aimed at meliorating medical ethical atmosphere by criticizing disorders among medical practitioners. Some contents of this novel were the same as those in Yijie Xianxingji (Revelation of Medical Community). By comparison between the two books and investigation on Doctor's Mirror's introduction, preface and advertisement in the newspaper at that time, we could find that the author of Doctor's Mirror was not the novelist LU Shi-e, but YU Wen-yao, the author of Yijie Xianxingji. Distribution of Yijie Xianxingji was stopped soon after its publication by the Commercial Press for its allusion to a famous doctor in Shanghai. Two years later, YU made some slight modifications the details of the novel's characters and his book was published with a different title Doctor's Mirror and the pen-name 'medical hermit among scholars'. PMID:23336280

Yang, Fang; Zhu, Hui; Pan, Rong-Hua

2012-07-01

194

Counting on Beauty: The role of aesthetic, ethical, and physical universal principles for interstellar communication  

E-print Network

SETI researchers believe that the basic principles of our science and the science of extraterrestrial beings should be fundamentally the same, and we should be able to communicate with them by referring to those things we share, such as the principles of mathematics, physics, and chemistry (a similar cognitive map of nature). This view assumes that there is only one way to conceptualize the laws of nature. Consequently, mathematics and the language of nature should be universal. In this essay, we discuss the epistemological bases of the last assumptions. We describe all the hypotheses behind the universality of the laws of nature and the restrictions that any technology should have to establish contact with other galactic technological civilization. We introduce some discussions about the limitations of homocentric views. We discuss about the possible use of aesthetic cognitive universals as well as ethical ones in the design of interstellar messages. We discuss the role of symmetry as a universal cognitive map. We give a specific example on how to use the Golden Section principles to design a hypothetical interstellar message based in physical and aesthetical cognitive universals. We build a space of configuration matrix, representing all the variables to be taken into account for designing an electromagnetic interstellar message (e.g. frequency, polarization, bandwidth, transmitting power, modulation, rate of information, galactic coordinates, etc.) against the limitations imposed by physical, technological, aesthetical and ethical constraints. We show how to use it, in order to make hypotheses about the characteristics and properties of hypothetical extraterrestrial artificial signals and their detection by existing SETI projects.

Guillermo A. Lemarchand

2008-07-28

195

Living donation and cosmetic surgery: a double standard in medical ethics?  

PubMed

The commitment of transplant physicians to protect the physical and psychological health of potential donors is fundamental to the process of living donor organ transplantation. It is appropriate that strict regulations to govern an individual's decision to donate have been developed. Some may argue that adherence to such regulations creates a doctor-patient relationship that is rooted in paternalism, which is in drastic contrast with a doctor-patient relationship that is rooted in patients' autonomy, characteristic of most other operative interventions. In this article we analyze the similarities between cosmetic plastic surgery and living donor surgery as examples of surgeries governed by different ethical principles. It is interesting that, while the prevailing ethical approach in living donor surgery is based on paternalism, the ethical principle guiding cosmetic surgery is respect for patients' autonomy. The purpose of this article is not to criticize either practice, but to suggest that, given the similarities between the two procedures, both operative interventions should be guided by the same ethical principle: a respect for patients' autonomy. We further suggest that if living organ donation valued donors' autonomy as much as cosmetic plastic surgery does, we might witness a wider acceptance of and increase in living organ donation. PMID:22822698

Testa, Giuliano; Carlisle, Erica; Simmerling, Mary; Angelos, Peter

2012-01-01

196

Shared Principles of Ethics for Infant and Young Child Nutrition in the Developing World  

PubMed Central

Background The defining event in the area of infant feeding is the aggressive marketing of infant formula in the developing world by transnational companies in the 1970s. This practice shattered the trust of the global health community in the private sector, culminated in a global boycott of Nestle products and has extended to distrust of all commercial efforts to improve infant and young child nutrition. The lack of trust is a key barrier along the critical path to optimal infant and young child nutrition in the developing world. Discussion To begin to bridge this gap in trust, we developed a set of shared principles based on the following ideals: Integrity; Solidarity; Justice; Equality; Partnership, cooperation, coordination, and communication; Responsible Activity; Sustainability; Transparency; Private enterprise and scale-up; and Fair trading and consumer choice. We hope these principles can serve as a platform on which various parties in the in the infant and young child nutrition arena, can begin a process of authentic trust-building that will ultimately result in coordinated efforts amongst parties. Summary A set of shared principles of ethics for infant and young child nutrition in the developing world could catalyze the scale-up of low cost, high quality, complementary foods for infants and young children, and eventually contribute to the eradication of infant and child malnutrition in the developing world. PMID:20529339

2010-01-01

197

Principles for websites of the American Medical Association  

PubMed Central

The Internet has the potential to provide patients and physicians with rapid access to high quality, timely evidence regarding health and medical diagnosis and treatment. However, many barriers must be surmounted before this potential is achieved. Quality of content must be able to be verified, including the accuracy and timeliness of the information, the source of the information, and the objectivity of the source. Advertising and sponsorship must not influence content and should not be juxtaposed with related content. Individuals must be able to access information without loss of personal privacy. To address these issues, the American Medical Association has developed principles to guide development and posting of Web site content, govern acquisition and posting of online advertising and sponsorship, ensure site visitors' and patients' rights to privacy and confidentiality, and provide effective and secure means of e-commerce. While these guidelines were developed specifically for the AMA Web sites and visitors to these sites, they also may be useful to other providers and users of medical information on the Web.

Winker, Margaret

2000-01-01

198

Hunger strikers: ethical and legal dimensions of medical complicity in torture at Guantanamo Bay.  

PubMed

Physicians and other licensed health professionals are involved in force-feeding prisoners on hunger strike at the US Naval Base at Guantanamo Bay (GTMO), Cuba, the detention center established to hold individuals captured and suspected of being terrorists in the wake of September 11, 2001. The force-feeding of competent hunger strikers violates medical ethics and constitutes medical complicity in torture. Given the failure of civilian and military law to end the practice, the medical profession must exert policy and regulatory pressure to bring the policy and operations of the US Department of Defense into compliance with established ethical standards. Physicians, other health professionals, and organized medicine must appeal to civilian state oversight bodies and federal regulators of medical science to revoke the licenses of health professionals who have committed prisoner abuses at GTMO. PMID:24073786

Dougherty, Sarah M; Leaning, Jennifer; Greenough, P Gregg; Burkle, Frederick M

2013-12-01

199

Impact of managed care on the development of new medical technology: ethical concerns  

NASA Astrophysics Data System (ADS)

During the last three decades, development of new medical technology has been largely responsible for the spectacular advances in the diagnosis and treatment of many human diseases. This has contributed to improved medical care of our population. However, concerns have been raised that in today's managed care environment of health care, introduction of new medical technology will be difficult. Cost-sensitive health care providers should consider various ethical issues involved before demanding that only those technologies that save money and show highly positive cost benefit ratio will be reimbursed. The impact of such considerations on the innovations of new medical devices and their developments is discussed.

Saha, Pamela; Saha, Subrata

1995-10-01

200

Artificial Intelligence Journal, Volume 150, November 2003, pp. 145-181 Extensionally Defining Principles and Cases in Ethics: an AI Model  

E-print Network

Artificial Intelligence Journal, Volume 150, November 2003, pp. 145-181 1 Extensionally Defining Principles and Cases in Ethics: an AI Model Bruce M. McLaren e-Supply Chain Management Laboratory Carnegie, and ethics. It is difficult, however, if not impossible to define principles in an intensional manner so

McLaren, Bruce Martin

201

Medical and ethical considerations in twin pregnancies discordant for serious cardiac disease  

Microsoft Academic Search

Objective:Prenatal ultrasound has led to the early diagnosis of major anomalies. However, the ready availability of this technology has led to increasing challenges for physicians counseling affected parents, which is all the more difficult in a twin pregnancy with only one affected fetus. This paper reviews the medical and ethical considerations in twin pregnancies discordant for a serious cardiac condition.Study

A Malhotra; S Menahem; P Shekleton; L Gillam

2009-01-01

202

Subject, project or self? Thoughts on ethical dilemmas for social and medical researchers  

Microsoft Academic Search

In this paper we address an important but sadly neglected area; namely some of the ethical issues which arise for social and medical researchers in the course of their work. Our concern is for a wide spectrum of researchers using the full range of social research methods from small-scale in-depth qualitative work through to large scale quantitative studies. The unifying

Jane A. Batchelor; Catherine M. Briggs

1994-01-01

203

Ethical and Legal Issues in Providing Medical Treatment for Seriously Ill Handicapped Persons.  

ERIC Educational Resources Information Center

Ethical and legal issues involving provision of medical treatment to seriously ill handicapped persons are considered. Legislation and court cases (in the United States, Canada, and New Zealand) on withholding treatment from seriously ill infants are reviewed. It is concluded that the presence of handicap does not justify withholding treatment.…

Mitchell, David R.

1985-01-01

204

Ethical and Legal Implications in Seeking and Providing a Second Medical Opinion  

Microsoft Academic Search

Ethical and legal implications arise both when seeking a second medical opinion and when providing one. There has been debate as to whether a second opinion for a patient is a right or a concession and whilst today most would consider it to be a patient’s right, there are nevertheless some disadvantages associated with seeking a second opinion. This article

Anthony Axon; Majid Hassan; Yaron Niv; Christoph Beglinger; Theodore Rokkas

2008-01-01

205

Medication-Related Practice Roles: An Ethical and Legal Primer for School Psychologists  

ERIC Educational Resources Information Center

Given the prevalence of school-age children and adolescents who are prescribed with and are taking psychotropic medications, a critical issue that school psychologists may likely encounter in contemporary practice is providing both quality and continuity of care to these students in the context of relevant legal and ethical parameters. With a…

Shahidullah, Jeffrey D.

2014-01-01

206

[Medicine, physicians and medical ethics in Jewish tradition through the ages].  

PubMed

Medicine has always had a place of honor in the Jewish heritage. Since Biblical times, the sources of Judaism have valued the physician's activities and seen them as a partnership with God's deeds. Later, in the times of the Mishna and the Talmud, a model of scholars evolved who were not only learned sages but also had extensive medical and scientific knowledge. Their dealings with various issues in medical ethics were the basis for deliberation on questions that appeared throughout history on the advancement of medical science. The various sources from this period show the sages' sensitivity regarding the subject of human life, saving lives and the importance of the availability of medicine for all segments of the population. During the years following the completion of the Talmud, the medical profession was common among the Jews and they excelled in this field. Jewish doctors left behind a Legacy of values in medicine. Hebrew was considered a significant Language in the medical field and was cited in various medical texts such as in the book written by Vesalius, the "father" of modern anatomy. The rapid progress of medicine poses new challenges in bioethics. There is a need for physicians with extensive medical knowledge along with an understanding of ethical issues in order to offer solutions to new situations. Knowledge of the Jewish literature throughout the ages on a variety of subjects and the essential values which are their foundation can contribute to the modern discussion on biomedical questions. This is even more important in Israeli society where many of the laws are formed based on Jewish values. Engagement with Jewish medical ethics can help in educating physicians to have the ability to contribute to public debate and legislation in a way that would balance between the values and needs which an ethical issue raises. PMID:25286644

Gesundheit, Benjamin; Zlotnick, Eitan; Steinberg, Avraham

2014-08-01

207

Empirical research in medical ethics: How conceptual accounts on normative-empirical collaboration may improve research practice  

PubMed Central

Background The methodology of medical ethics during the last few decades has shifted from a predominant use of normative-philosophical analyses to an increasing involvement of empirical methods. The articles which have been published in the course of this so-called 'empirical turn' can be divided into conceptual accounts of empirical-normative collaboration and studies which use socio-empirical methods to investigate ethically relevant issues in concrete social contexts. Discussion A considered reference to normative research questions can be expected from good quality empirical research in medical ethics. However, a significant proportion of empirical studies currently published in medical ethics lacks such linkage between the empirical research and the normative analysis. In the first part of this paper, we will outline two typical shortcomings of empirical studies in medical ethics with regard to a link between normative questions and empirical data: (1) The complete lack of normative analysis, and (2) cryptonormativity and a missing account with regard to the relationship between 'is' and 'ought' statements. Subsequently, two selected concepts of empirical-normative collaboration will be presented and how these concepts may contribute to improve the linkage between normative and empirical aspects of empirical research in medical ethics will be demonstrated. Based on our analysis, as well as our own practical experience with empirical research in medical ethics, we conclude with a sketch of concrete suggestions for the conduct of empirical research in medical ethics. Summary High quality empirical research in medical ethics is in need of a considered reference to normative analysis. In this paper, we demonstrate how conceptual approaches of empirical-normative collaboration can enhance empirical research in medical ethics with regard to the link between empirical research and normative analysis. PMID:22500496

2012-01-01

208

Terrorism and the ethics of emergency medical care  

Microsoft Academic Search

The threat of domestic and international terrorism involving weapons of mass destruction–terrorism (WMD-T) has become an increasing public health concern for US citizens. WMD-T events may have a major effect on many societal sectors but particularly on the health care delivery system. Anticipated medical problems might include the need for large quantities of medical equipment and supplies, as well as

Nicki Pesik; Mark E. Keim; Kenneth V. Iserson

2001-01-01

209

Students' Conceptions of Underlying Principles in Medical Physiology: An Interview Study of Medical Students' Understanding in a PBL Curriculum  

ERIC Educational Resources Information Center

Medical physiology is known to be a complex area where students develop significant errors in conceptual understanding. Students' knowledge is often bound to situational descriptions rather than underlying principles. This study explores how medical students discern and process underlying principles in physiology. Indepth interviews, where…

Fyrenius, Anna; Silen, Charlotte; Wirell, Staffan

2007-01-01

210

Ethical considerations regarding early liver transplantation in patients with severe alcoholic hepatitis not responding to medical therapy.  

PubMed

A recent study proposed that liver transplantation may represent life-saving treatment in patients with severe alcoholic hepatitis not responding to medical therapy. In this pilot experience, stringent patient selection resulted in major improvement of short-term survival with low rates of post-transplant alcohol relapse. In the context of organ shortage, which imposes a need for strict selection of transplant candidates, these results raise major ethical questions. Reluctance to perform liver transplantation in alcoholics is based on the fact that alcoholism is frequently considered to be self-inflicted and on fears of harmful post-transplant alcoholism recurrence. A minimal interval of sobriety lasting at least 6 months is a widely adopted criterion for the selection of patients with alcoholic liver disease for liver transplantation. In severe alcoholic hepatitis, the disastrous short-term prognosis in patients not responding to medical therapy does not allow one to reasonably impose an arbitrary period of 6-months of abstinence. This means that these patients must be either systematically excluded from transplantation or selected according to other criteria. Without significant pre-transplant abstinence, it might be argued that these patients do not merit a graft as they have not demonstrated their ability to gain control over their disease through durable modification of their behaviour. Consequently, this procedure could have a negative impact in the public, affecting organ donation and confidence in the fairness of transplant programs. In contrast, ethical principles recommend active treatment of patients, without discrimination, according to the best scientific knowledge. At this stage, we propose that there are no major ethical barriers for further evaluation of this new therapeutic option. The next steps should include transparent communication with the public and further studies to reproduce these results and identify the selection criteria that provide the best long-term outcomes. PMID:24291238

Donckier, Vincent; Lucidi, Valerio; Gustot, Thierry; Moreno, Christophe

2014-04-01

211

The road being paved to neuroethics: A path leading to bioethics or to neuroscience medical ethics?  

PubMed

In 2013, U.S. President Barack Obama decreed the creation of the Presidential Commission for the Study of Bioethical Issues, as part of his $100 million Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative. In the wake of the work of this Commission, the purpose, goals, possible shortcomings, and even dangers are discussed, and the possible impact it may have upon neuroscience ethics (Neuroethics) both in clinical practice as well as scientific research. Concerns were expressed that government involvement in bioethics may have unforeseen and possibly dangerous repercussions to neuroscience in particular and to medicine in general. The author emphasizes that the lessons of history chronicle that wherever governments have sought to alter medical ethics and control medical care, the results have frequently been perverse and disastrous, as in the examples of the communist Soviet Union and National Socialist (Nazi) Germany. The Soviet psychiatrists' and the Nazi doctors' dark descent into ghastly experimentation and brutality was a product of convoluted ethics and physicians willingly cooperating with authoritarianism citing utilitarianism in the pursuit of the 'collective' or 'greater good.' Thus in the 20(th) century, as governments infringed on the medical profession, even the Liberal Democracies have not been immune to the corruption of ethics in science and medicine. PMID:25324975

Faria, Miguel A

2014-01-01

212

The road being paved to neuroethics: A path leading to bioethics or to neuroscience medical ethics?  

PubMed Central

In 2013, U.S. President Barack Obama decreed the creation of the Presidential Commission for the Study of Bioethical Issues, as part of his $100 million Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative. In the wake of the work of this Commission, the purpose, goals, possible shortcomings, and even dangers are discussed, and the possible impact it may have upon neuroscience ethics (Neuroethics) both in clinical practice as well as scientific research. Concerns were expressed that government involvement in bioethics may have unforeseen and possibly dangerous repercussions to neuroscience in particular and to medicine in general. The author emphasizes that the lessons of history chronicle that wherever governments have sought to alter medical ethics and control medical care, the results have frequently been perverse and disastrous, as in the examples of the communist Soviet Union and National Socialist (Nazi) Germany. The Soviet psychiatrists’ and the Nazi doctors’ dark descent into ghastly experimentation and brutality was a product of convoluted ethics and physicians willingly cooperating with authoritarianism citing utilitarianism in the pursuit of the ‘collective’ or ‘greater good.’ Thus in the 20th century, as governments infringed on the medical profession, even the Liberal Democracies have not been immune to the corruption of ethics in science and medicine.

Faria, Miguel A.

2014-01-01

213

Medical management of patients after bariatric surgery: Principles and guidelines  

PubMed Central

Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ? 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ? 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

Elrazek, Abd Elrazek Mohammad Ali Abd; Elbanna, Abduh Elsayed Mohamed; Bilasy, Shymaa E

2014-01-01

214

The medical emergency team, evidence-based medicine and ethics  

Microsoft Academic Search

The medical emergency team (MET), which may be summoned by anyone in a hospital to treat a patient who appears acutely unwell, has been generally accepted as scientifically rational, with no adverse clinical outcomes and only modest resource requirements. Despite this, many centres appear to be awaiting \\

Ross K Kerridge; W Peter Saul

215

Virtual Mentor American Medical Association Journal of Ethics  

E-print Network

-663. MEDICINE AND SOCIETY Will Personalized Medicine Challenge or Reify Categories of Race and Ethnicity? Ramya by various actors to develop what they call "personalized medicine," the effort to tailor and individualize diagnoses and treatments for use during routine medical care. The promises of personalized medicine

Fujimura, Joan

216

Conflicting notions of research ethics. The mutually challenging traditions of social scientists and medical researchers.  

PubMed

Tensions over ethics in research occasionally arise when anthropologists and other social scientists study health services in medical institutions. In order to resolve this type of conflict, and to facilitate mutual learning rather than mutual recrimination, we describe two general categories of research ethics framing: those of anthropology and those of medicine. The latter, we propose, has tended to focus on protection of the individual through preservation of autonomy-principally expressed through the requirement of informed consent-whereas the former has attended more to political implications. After providing few examples of concrete conflicts, we outline four issues that characterise the occasional clashes between social scientists and medical staff, and which deserve further consideration: (1) a discrepancy in the way anthropologists perceive patients and medical staff; (2) ambiguity concerning the role of medical staff in anthropological research; (3) impediments to informed consent in qualitative research projects; and (4) property rights in data. Our contention is that enhanced dialogue could serve to invigorate the ethical debate in both traditions. PMID:16029775

Hoeyer, Klaus; Dahlager, Lisa; Lynöe, Niels

2005-10-01

217

Pre-modern Islamic medical ethics and Graeco-Islamic-Jewish embryology.  

PubMed

This article examines the, hitherto comparatively unexplored, reception of Greek embryology by medieval Muslim jurists. The article elaborates on the views attributed to Hippocrates (d. ca. 375 BC), which received attention from both Muslim physicians, such as Avicenna (d. 1037), and their Jewish peers living in the Muslim world including Ibn Jumay' (d. ca. 1198) and Moses Maimonides (d. 1204). The religio-ethical implications of these Graeco-Islamic-Jewish embryological views were fathomed out by the two medieval Muslim jurists Shih?b al-D?n al-Qar?f? (d. 1285) and Ibn al-Qayyim (d. 1350). By putting these medieval religio-ethical discussions into the limelight, the article aims to argue for a two-pronged thesis. Firstly, pre-modern medical ethics did exist in the Islamic tradition and available evidence shows that this field had a multidisciplinary character where the Islamic scriptures and the Graeco-Islamic-Jewish medical legacy were highly intertwined. This information problematizes the postulate claiming that medieval Muslim jurists were hostile to the so-called 'ancient sciences'. Secondly, these medieval religio-ethical discussions remain playing a significant role in shaping the nascent field of contemporary Islamic bioethics. However, examining the exact character and scope of this role still requires further academic ventures. PMID:23844565

Ghaly, Mohammed

2014-02-01

218

The ethics of everyday practice in primary medical care: responding to social health inequities  

PubMed Central

Background Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities. Results Some see doctors as bound by a notion of care that is blind to a patient's social position, while others respond to this issue through invoking notions of justice and human rights where access to care is a prime focus. Both care and justice orientations however conceal important tensions linked to the presence of bioethical principles underpinning these. Other normative ethical theories like deontology, virtue ethics and utilitarianism do not provide adequate guidance on the problem of social health inequities either. Conclusion This paper explores if Bauman's notion of "forms of togetherness" provides the basis of a relational ethical theory that can help to develop a response to social health inequities of relevance to individual physicians. This theory goes beyond silence on the influence of social position of health and avoids amoral regulatory approaches to monitoring equity of care provision. PMID:20438627

2010-01-01

219

The ethics of medical involvement in torture: commentary  

PubMed Central

Torture does need to be defined if we are to know exactly what we are seeking to ban; but no single definition will do, because there are many possible ones, and we may want to treat different practices that might be called torture differently. Compare the case of homicide; we do not want to punish manslaughter as severely as murder, and may not want to punish killing in self-defence at all. There are degrees of torture as of murder. Unclarities simply play into the hands of would-be torturers. Downie is unsuccessful in deriving the duty of doctors not to be involved in torture from an analysis of the word `doctor'. It may be contrary to the role-duty of doctors to participate in torture; but there might be other duties which overrode this role-duty. The right approach is to ask what principles for the conduct of doctors have the highest acceptance-utility, or, as Kant might have equivalently put it, what the impartial furtherance of everyone's ends demands. This approach yields the result that torture (suitably defined) should be banned absolutely. It also yields prescriptions for the conduct of doctors where, in spite of them, torture is taking place. PMID:8230144

Hare, R M

1993-01-01

220

Practical Divinity and Medical Ethics: Lawful versus Unlawful Medicine in the Writings of William Perkins (1558-1602)  

PubMed Central

This article examines for the first time the theologically based medical ethics of the late sixteenth-century English Calvinist minister William Perkins. Although Perkins did not write a single focused book on the subject of medical ethics, he addressed a variety of moral issues in medicine in his numerous treatises on how laypeople should conduct themselves in their vocations and in all aspects of their daily lives. Perkins wrote on familiar issues such as the qualities of a good physician, the conduct of sick persons, the role of the minister in healing, and obligations in time of pestilence. His most significant contribution was his distinction between “lawful” and “unlawful” medicine, the latter category including both medical astrology and magic. Perkins's works reached a far greater audience in England and especially New England than did the treatises of contemporary secular medical ethics authors and his writings were influential in guiding the moral thinking of many pious medical practitioners and laypersons. PMID:22235029

Gevitz, Norman

2013-01-01

221

Theodore E. Woodward Award. HIV/AIDS, ethics, and medical professionalism: where went the debate?  

PubMed Central

The recent surge of dialogue about medical professionalism has largely ignored HIV/AIDS, perhaps because the ethical issues that abounded during the 1980s and early 1990s have become largely passé. Prior to the introduction of highly active antiretroviral therapy (HAART) in 1996, the care ethic for patients with HIV/AIDS depended heavily on compassion since effective treatment was unavailable. Moreover, physicians and other health care workers often assumed physical risks on behalf of patients. HAART transformed the care ethic for HIV/AIDS to one dependent mainly on medical competence. Reflecting on the epidemic, I propose a distinction between "basic" and "higher" professionalism. Basic professionalism requires discipline-specific competence, facilitated by adherence to the four cardinal virtues (prudence, temperance, justice, and courage). Higher professionalism brings into play the transcendent virtues: faith, hope, and--especially--love (compassion). Specific examples of "compassion" in the strict sense of "suffering with" include caring without adequate reimbursement, caring when one would rather be doing something else, and assuming emotional or physical risks on behalf of patients. The physicians and other health care workers who displayed such compassion in abundance between 1981 and 1996 deserve our remembrance as exemplars of a higher professionalism. PMID:12813930

Bryan, Charles S.

2003-01-01

222

Emergency department triage: an ethical analysis  

PubMed Central

Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach. PMID:21982119

2011-01-01

223

Ethical arguments for and against sperm sorting for non-medical sex selection: a review.  

PubMed

Much has been written about the ethics of sex selection. This article thoroughly explores the ethical arguments put forth in the literature both for and against non-medical sex selection using sperm sorting. While most of these arguments come from philosophers, feminist scholars, social scientists and members of the healthcare community, they are often echoed in empirical studies that have explored community values. This review is timely because the first efficacious method for sex selection via sperm sorting, MicroSort, is currently in clinical trials and moving closer to FDA approval for marketing in the USA. While the clinical trials are currently focused on the use of MicroSort to avoid X-linked genetic diseases, MicroSort can also be used to satisfy parental preferences. PMID:23337421

Kalfoglou, A L; Kammersell, M; Philpott, S; Dahl, E

2013-03-01

224

Medical and ethical issues in genetic screening--an academic view.  

PubMed Central

This article is intended to acquaint those whose principal concerns are the health and safety of workers with genetic screening and some of the medical and ethical issues it raises. Population-based genetic screening increasingly is being considered for predicting future disease in the person being screened. A major problem in screening for alleles that contribute to the development of common, multifactorial disorders is low sensitivity and positive predictive value. In many instances, no demonstrably effective prophylaxis or treatment is available to help those with positive test results. This creates ethical problems of assuring that testing is in the person's best interest and raises in turn issues of autonomy, discrimination, and privacy. Instead of screening for genetic predispositions to harm from workplace exposures, other means of improving the health of workers may bring greater benefits to a higher proportion of workers. The current state of genetic tests for chronic beryllium disease are considered. None are suitable for screening. PMID:8933046

Holtzman, N A

1996-01-01

225

Problems in deceptive medical procedures: an ethical and legal analysis of the administration of placebos  

PubMed Central

The use of placebos in therapy or research poses ethical questions. What are the benefits and the costs in ethical terms of condoning deception of the patient or subject? What does the deception mean for the patient's or subject's right to give informed consent to his treatment? Doctors are rightly expected to disclose to their patient facts which would in their judgement best enable him to give informed consent to treatment. On occasion, the degree of this disclosure may be limited by the need to avoid hazarding the success of treatment of an unstable patient whose condition threatens his life, but doctors should have no right to withhold information just to prevent a patient refusing consent to therapy. No such limitation should apply in experiments where full disclosure must operate to enable the subject to give his informed consent. The potential medical benefits for the patient of placebo therapy have to be weighed against all the ethical costs of the deception and dishonesty involved, including the longer term repercussions on doctor/patient trust: similar ethical costs may arise in experiments involving the use of placebos without disclosure of this as a possibility to the subject. Deception is ethically degrading to both parties not only being a breach of trust, but denying the moral autonomy of the patient or subject to make his own choice. The writer concludes that placebos should be used only with full disclosure and consent whether in therapy or in research, and that this need not impede the success of either. PMID:739513

Simmons, Beth

1978-01-01

226

The ethical imperative to think about thinking - diagnostics, metacognition, and medical professionalism.  

PubMed

While the medical ethics literature has well explored the harm to patients, families, and the integrity of the profession in failing to disclose medical errors once they occur, less often addressed are the moral and professional obligations to take all available steps to prevent errors and harm in the first instance. As an expanding body of scholarship further elucidates the causes of medical error, including the considerable extent to which medical errors, particularly in diagnostics, may be attributable to cognitive sources, insufficient progress in systematically evaluating and implementing suggested strategies for improving critical thinking skills and medical judgment is of mounting concern. Continued failure to address pervasive thinking errors in medical decisionmaking imperils patient safety and professionalism, as well as beneficence and nonmaleficence, fairness and justice. We maintain that self-reflective and metacognitive refinement of critical thinking should not be construed as optional but rather should be considered an integral part of medical education, a codified tenet of professionalism, and by extension, a moral and professional duty. PMID:25033249

Stark, Meredith; Fins, Joseph J

2014-10-01

227

The Implementation of the Sharia Law in Medical Practice: A Balance between Medical Ethics and Patients Rights.  

PubMed

As medical ethics indisputably needs to consider patients' religious beliefs and spiritual ideas, one can suggest that hospitals are responsible for not only patients' rights and dignity, but also for her/his religious concerns and expectations. The current study is designed shed some light on the patients' view of the implementation of religious law in Iranian hospitals, specifically, the right of patients to be visited and delivered health services by professionals from the same sex. This protocol is proposed by the Ministry of Health and Medical Education of the Islamic Republic of Iran as a response to the increasing demand for implementation of the religious law by Iranian patients. This research is a cross-sectional study which was conducted at four teaching general hospitals in Tehran, Iran. The data was collected by the means of a questionnaire distributed to 120 women who were admitted to different wards of the hospitals. These women were asked to express their opinion of the implementation the Same Sex Health Care Delivery (SSHCD) system in Iranian hospitals. All analyses were performed with the use of SPSS software, version 16.0. The results indicate that half of the hospitalized women believed that being visited by a physician from the same gender is necessary who advocated the implementation of SSHCD in a clinical setting; and most of their husbands preferred their wives to be visited exclusively by female physicians. This study highlights the view of the Iranian patients towards the issue and urges the Ministry of Health and Medical Education of the Islamic Republic of Iran to accelerate the implementation of this law. SSHCD is what the majority of Iranian patients prefer, and, considering patients' rights and the medical ethics, it should be implemented by Iranian policy makers. PMID:23908749

Dargahi, Hossein

2011-01-01

228

The Implementation of the Sharia Law in Medical Practice: A Balance between Medical Ethics and Patients Rights  

PubMed Central

As medical ethics indisputably needs to consider patients’ religious beliefs and spiritual ideas, one can suggest that hospitals are responsible for not only patients’ rights and dignity, but also for her/his religious concerns and expectations. The current study is designed shed some light on the patients’ view of the implementation of religious law in Iranian hospitals, specifically, the right of patients to be visited and delivered health services by professionals from the same sex. This protocol is proposed by the Ministry of Health and Medical Education of the Islamic Republic of Iran as a response to the increasing demand for implementation of the religious law by Iranian patients. This research is a cross-sectional study which was conducted at four teaching general hospitals in Tehran, Iran. The data was collected by the means of a questionnaire distributed to 120 women who were admitted to different wards of the hospitals. These women were asked to express their opinion of the implementation the Same Sex Health Care Delivery (SSHCD) system in Iranian hospitals. All analyses were performed with the use of SPSS software, version 16.0. The results indicate that half of the hospitalized women believed that being visited by a physician from the same gender is necessary who advocated the implementation of SSHCD in a clinical setting; and most of their husbands preferred their wives to be visited exclusively by female physicians. This study highlights the view of the Iranian patients towards the issue and urges the Ministry of Health and Medical Education of the Islamic Republic of Iran to accelerate the implementation of this law. SSHCD is what the majority of Iranian patients prefer, and, considering patients’ rights and the medical ethics, it should be implemented by Iranian policy makers. PMID:23908749

Dargahi, Hossein

2011-01-01

229

Ethical Obligations of Medical Directors Resolution 8 (A-98) asked the Council on Ethical and Judicial Affairs to consider “under what  

E-print Network

circumstances those decisions of medical appropriateness made by a medical director of an insurance company, an HMO, or a related entity are within the ‘practice of medicine, ’ thereby falling within the purview of state medical boards.” There are a variety of different types of medical directors, including directors of hospitals, nursing homes, group practices, insurance companies, and managed care organizations. In this report, the term “medical director ” is used narrowly to refer to physicians who are employed by third-party payers in the health care delivery system (i.e., insurance companies, managed care organizations, self-insured employers) or by entities that perform medical appropriateness determinations on behalf of payers. These types of medical directors have specific functions, such as making coverage determinations, which go beyond mere administrative responsibility. This report focuses on the ethical obligations that arise out of such functions. The definition of the “practice of medicine ” is a matter of state law. This report will provide background information regarding the legal debate surrounding the definition of the “practice of medicine ” and the scope of the state medical boards ’ authority. The primary focus of the report, however, will be the ethical obligations of medical directors when they make the types of decisions that fall within the professional

unknown authors

230

Telemedicine as an ethics teaching tool for medical students within the nephrology curriculum.  

PubMed

A novel patient-centered approach was used to deliver ethics curriculum to medical students. Two medical school clinicians designed a telemedicine session linking their facilities (across 2 continents). The session, Exploring the Patient Experience Through Telemedicine: Dialysis and End-Stage Renal Disease, allowed second-year medical students to explore various parameters of quality of life experienced by dialysis patients. A panel of 4 medical students interviewed a dialysis patient via Skype video connection between the medical school and the hospital's dialysis unit. Interview questions were adapted from the Kidney Disease Quality of Life instrument. During the live video-streamed interview, the remaining 23 second-year medical students observed the session. Afterward, the 23 were offered a voluntary anonymous online feedback survey (15 responded). The 4 panelists submitted narrative responses to 2 open-ended questions about their experience. All 15 responding students "Strongly agreed" or "Agreed" that the session was an aid to their professionalism skills and behaviors; 14 of 15 "Strongly agreed" or "Agreed" that telemedicine technology contributed to their understanding of the topic; 12 of 15 "Strongly agreed" that the session improved their understanding of the psychosocial burdens of dialysis, quality of life, and human suffering, and increased their empathy toward patients; and 12 of 15 "Strongly agreed" or "Agreed" that the session encouraged reflective thinking and was an aid to improving their communication skills. Telemedicine can be an effective and feasible method to deliver an ethics curriculum with a patient-centered approach. Additionally, the cross-cultural experience exposes students to additional contextual features of medicine. PMID:25193732

Bramstedt, Katrina A; Prang, Melissa; Dave, Sameer; Shin, Paul Ng Hung; Savy, Amani; Fatica, Richard A

2014-09-01

231

The principles of writing the medical guide for ships.  

PubMed

The medical training and skills of seafarers are rather limited. In Finland, the master is responsible for medical care of his crew members, having only a 5-day training in medical matters which is refreshed every year. As medical incidents are rather rare events on board ship, he has not many opportunities to increase his knowledge in this field. Highly educated and experienced medical doctors have written medical guides for ships, describing diseases and advising on their treatment. This advice is based on diagnoses made on board ship by masters. They are often incorrect, therefore the advice on treatment may also be not correct. Authors of medical guides for ships should take into consideration the limited skills and medical knowledge of persons responsible for providing health services for crews at sea. This service is usually limited to giving first aid in accidents and sudden diseases, and care of the injured or sick seafarer until he can be transported to a medical facility on shore. Long lists of possible diagnoses in the text of such a guide only cause confusion in situations on board ship. In the new edition of the guide published in Finland in 2002, the advice on treatment is based on symptoms rather than on diagnoses. PMID:14974791

Saarni, Heikki

2003-01-01

232

An Invitation for Medical Educators To Focus on Ethical and Policy Issues in Research and Scholarly Practice.  

ERIC Educational Resources Information Center

Reviewed medical education research reports published in 1988 and 1989 and in 1998 and 1999 in two major medical education journals for documentation of six ethically important safeguards and features (e.g., informed consent). Rates of reporting were low and did not increase substantially after 10 years, raising implications for faculty, training…

Roberts, Laura Weiss; Geppert, Cynthia; Connor, Renee; Nguyen, Khanh; Warner, Teddy D.

2001-01-01

233

Disagreements with implications: diverging discourses on the ethics of non-medical use of methylphenidate for performance enhancement  

Microsoft Academic Search

BACKGROUND: There is substantial evidence that methylphenidate (MPH; Ritalin), is being used by healthy university students for non-medical motives such as the improvement of concentration, alertness, and academic performance. The scope and potential consequences of the non-medical use of MPH upon healthcare and society bring about many points of view. METHODS: To gain insight into key ethical and social issues

Cynthia Forlini; Eric Racine

2009-01-01

234

'God's ethicist': Albert Moll and his medical ethics in theory and practice.  

PubMed

In 1902, Albert Moll, who at that time ran a private practice for nervous diseases in Berlin, published his comprehensive book on medical ethics, Ärztliche Ethik. Based on the concept of a contractual relationship between doctor and client, it gave more room to the self-determination of patients than the contemporary, usually rather paternalistic, works of this genre. In the first part of the present paper this is illustrated by examining Moll's views and advice on matters such as truthfulness towards patients, euthanasia, and abortion. The second part of this article discusses how Moll engaged with the then publicly debated issues of experimentation on hospital patients and the 'trade' of foreign private patients between agents and medical consultants. In both matters Moll collected evidence of unethical practices and tried to use it to bring about change without damaging his or the profession's reputation. However, with his tactical manoeuvres, Moll made no friends for himself among his colleagues or the authorities; his book on ethics also met with a generally cool response from the medical profession and seems to have been more appreciated by lawyers than by other doctors. PMID:23002294

Maehle, Andreas-Holger

2012-04-01

235

'God's Ethicist': Albert Moll and His Medical Ethics in Theory and Practice  

PubMed Central

In 1902, Albert Moll, who at that time ran a private practice for nervous diseases in Berlin, published his comprehensive book on medical ethics, Ärztliche Ethik. Based on the concept of a contractual relationship between doctor and client, it gave more room to the self-determination of patients than the contemporary, usually rather paternalistic, works of this genre. In the first part of the present paper this is illustrated by examining Moll’s views and advice on matters such as truthfulness towards patients, euthanasia, and abortion. The second part of this article discusses how Moll engaged with the then publicly debated issues of experimentation on hospital patients and the ‘trade’ of foreign private patients between agents and medical consultants. In both matters Moll collected evidence of unethical practices and tried to use it to bring about change without damaging his or the profession’s reputation. However, with his tactical manoeuvres, Moll made no friends for himself among his colleagues or the authorities; his book on ethics also met with a generally cool response from the medical profession and seems to have been more appreciated by lawyers than by other doctors. PMID:23002294

Maehle, Andreas-Holger

2012-01-01

236

Privacy and disclosure in medical genetics examined in an ethics of care.  

PubMed

The progress of genetic knowledge magnifies existing ethical problems in medical genetics. Among the most troubling types of problems -- for medicine, patients, and the larger society -- are those of privacy and disclosure. Examples of the range of problems involving privacy and disclosure are: 1) disclosure of false paternity to an unsuspecting husband; 2) disclosure of a patient's genetic make-up to his or her unknowing spouse; 3) disclosure of information, against a patient's wishes, to relatives at genetic risk; 4) disclosure of ambiguous test results; 5) disclosure of adventitious nonmedical information, e.g., fetal sex; and 6) disclosure to institutional third parties, such as employers and insurers.... PMID:11659340

Wertz, Dorothy C; Fletcher, John C

1991-07-01

237

From Goya to Afghanistan--an essay on the ratio and ethics of medical war pictures.  

PubMed

For centuries pictures of the dead and wounded have been part and parcel of war communications. Often the intentions were clear, ranging from medical instructions to anti-war protests. The public's response could coincide with or diverge from the publisher's intention. Following the invention of photography in the nineteenth century, and the subsequent claim of realism, the veracity of medical war images became more complex. Analysing and understanding such photographs have become an ethical obligation with democratic implications. We performed a multidisciplinary analysis of War Surgery (2008), a book containing harsh, full-colour photographs of mutilated soldiers from the Iraq and Afghanistan wars. Our analysis shows that, within the medical context, this book is a major step forward in medical war communication and documentation. In the military context the book can be conceived as an attempt to put matters right given the enormous sacrifice some individuals have suffered. For the public, the relationship between the 'reality' and 'truth' of such photographs is ambiguous, because only looking at the photographs without reading the medical context is limiting. If the observer is not familiar with medical practice, it is difficult for him to fully assess, signify and acknowledge the value and relevance of this book. We therefore assert the importance of the role of professionals and those in the humanities in particular in educating the public and initiating debate. PMID:20718285

van Bergen, Leo; de Mare, Heidi; Meijman, Frans J

2010-01-01

238

Affordable access to essential medication in developing countries: conflicts between ethical and economic imperatives.  

PubMed

Recent economic and political advances in developing countries on the African continent and South East Asia are threatened by the rising death and morbidity rates of HIV/AIDS. In the first part of this paper we explain the reasons for the absence of affordable access to essential AIDS medication. In the second part we take a closer look at some of the pivotal frameworks relevant for this situation and undertake an ethical analysis of these frameworks. In the third part we discuss a few of the proposed solutions to the problem and conclude with an argument in support of our preferred course of action. In this article we argue for compulsory licensing of essential AIDS medications in the current conditions of public health emergency. We argue on broadly consequentialist grounds that compulsory licensing is preferable both morally and pragmatically to the alternatives, notably the currently offered price cuts and drug donation schemes. PMID:11961696

Schüklenk, Udo; Ashcroft, Richard E

2002-04-01

239

Medical oncology: Basic principles and clinical management of cancer  

SciTech Connect

This book consists of three section, each containing several papers. The sections are: Basic Principles, Specific Neoplasmas, and Supportive Care. Some of the paper titles are: Pharmacology of Antineoplastic Agents, Hodgkin's Disease, Myeloma, Melanoma, Neoplasms of the Lung, Sarcomas, Pediatric Neoplasms, Infectious Consideration in Cancer, Nursing Considerations in Cancer, and Rehabilitation of the Patient with Cancer.

Calabresi, P.; Schein, P.S.; Rosenberg, S.A.

1985-01-01

240

[Social consensus on medical technology policy: ethical issues and citizen participation].  

PubMed

Social consensus is considered to be a necessary condition for a policy to be introduced and implemented effectively. This is the case with the approval, regulation and prohibition of certain advanced medical research and technology, especially when they could invoke moral disputes in society. Public policies on organ transplantation, definition of death, euthanasia, genetic screening and diagnosis, and human stem cell research are recent examples. The concept of consensus, however, is elusive, along with the measures to secure it. Technocratic decision making, as a paternalistic activity frequently led by experts, sometimes poses a challenge to democratic decision making, supposedly based on a well-informed and rational public. It also remains to be proved whether public involvement in policymaking can be a solution to ethical value conflicts in society. From the perspective of policy sciences, this paper first introduces the concept of consensus, especially consensus on moral issues in pluralistic societies, and its implications to public policy, including citizen participation in decision making. Then, it briefly explains the historical background with which social consensus and public involvement have increasingly flourished in the field of technology assessments and technology policy making, including biomedical technology. Next, major institutions, governmental and nongovernmental, involved in the ethical aspects of medical research and technology, are presented along with their efforts for citizen participation. Finally, the paper discusses some of the future agendas on this issue. PMID:15007900

Sato, Hajime

2004-01-01

241

The challenges and ethical dilemmas of a military medical officer serving with a peacekeeping operation in regard to the medical care of the local population  

PubMed Central

Medical Officers serving with their national contingents in peacekeeping operations are faced with difficult ethical decisions in regard to their obligations to the local civilian population. Such populations may be under-resourced in regard to medical care, and vulnerable to abuse and exploitation. Though the medical officer may support the local medical services, he/she should never undermine these resources. Adopting a human rights approach and observing the requirements of ethical medicine, aids the doctor in prioritising his/her duties. At times there may be conflict with one's own military superiors. It is wise to discuss potential difficulties prior to setting out on the mission. Human rights abuses cannot be ignored. The medical officer has a duty to do his/her best to report their observations so as to prevent abuse or to bring it to an end. PMID:16199596

Tobin, J

2005-01-01

242

Juridical and ethical peculiarities in doping policy.  

PubMed

Criticisms of the ethical justification of antidoping legislation are not uncommon in the literatures of medical ethics, sports ethics and sports medicine. Critics of antidoping point to inconsistencies of principle in the application of legislation and the unjustifiability of ethical postures enshrined in the World Anti-Doping Code, a new version of which came into effect in January 2009. This article explores the arguments concerning the apparent legal peculiarities of antidoping legislation and their ethically salient features in terms of: notions of culpability, liability and guilt; aspects of potential duplication of punishments and the limitations of athlete privacy in antidoping practice and policy. It is noted that tensions still exist between legal and ethical principles and norms that require further critical attention. PMID:20211997

McNamee, Mike J; Tarasti, Lauri

2010-03-01

243

Ethical Dilemmas in Disaster Medicine  

PubMed Central

Background Disasters may lead to ethical challenges that are different from usual medical practices. In addition, disaster situations are related with public health ethics more than medical ethics, and accordingly may require stronger effort to achieve a balance between individual and collective rights. This paper aims to review some ethical dilemmas that arise in disasters and mainly focuses on health services. Disasters vary considerably with respect to their time, place and extent; therefore, ethical questions may not always have `one-size-fits-all` answers. On the other hand, embedding ethical values and principles in every aspect of health-care is of vital importance. Reviewing legal and organizational regulations, developing health-care related guidelines, and disaster recovery plans, establishing on-call ethics committees as well as adequate in-service training of health-care workers for ethical competence are among the most critical steps. It is only by making efforts before disasters, that ethical challenges can be minimized in disaster responses. PMID:23285411

Ozge Karadag, C; Kerim Hakan, A

2012-01-01

244

Principles and Medical Applications of the Polymerase Chain Reaction  

Microsoft Academic Search

The polymerase chain reaction (PCR) is currently one of the mainstays of medical molecular biology. One of the reasons for the wide adoption of PCR is the elegant simplicity of the way in which the reaction proceeds and the relative ease of the practical manipulation steps. Indeed, combined with the relevant bioinformatics resources for the practical design and for the

Bimal D. M. Theophilus

245

Guidelines for Medical and Health Information Sites on the Internet: Principles Governing AMA Web Sites  

NSDL National Science Digital Library

Although developed for American Medical Association Websites and their users, these recently released guidelines and principles may prove useful to other providers and users of online medical information. Available from the Journal of the American Medical Association in HTML or .pdf format, the guidelines address issues such as the development and posting of Website content, acquisition and posting of online advertising and sponsorship, visitors's and patients's rights to privacy and confidentiality, and effective and secure means of e-commerce.

Andrews, Karen.; Chi-Lum, Bonnie.; Deangelis, Catherine D.; Flanagin, Annette.; Kennett, Robert L.; Musacchio, Robert A.

2000-01-01

246

Tolerance for ambiguity: an ethics-based criterion for medical student selection.  

PubMed

Planned changes to the MCAT exam and the premedical course requirements are intended to enable the assessment of humanistic characteristics and, thus, to select students who are more likely to become physicians who can communicate and relate with patients and engage in ethical decision making. Identifying students who possess humanistic and communication skills is an important goal, but the changes being implemented may not be sufficient to evaluate key personality traits that characterize well-rounded, thoughtful, empathic, and respectful physicians. The author argues that consideration should be given to assessing prospective students' tolerance for ambiguity as part of the admission process. Several strategies are proposed for implementing and evaluating such an assessment. Also included in this paper is an overview of the conceptual and empirical literature on tolerance for ambiguity among physicians and medical students, its impact on patient care, and the attention it is given in medical education. This evidence suggests that if medical schools admitted students who possess a high tolerance for ambiguity, quality of care in ambiguous conditions might improve, imbalances in physician supply and practice patterns might be reduced, the humility necessary for moral character formation might be enhanced, and the increasing ambiguity in medical practice might be better acknowledged and accepted. PMID:23524934

Geller, Gail

2013-05-01

247

Luxury Primary Care, Academic Medical Centers, and the Erosion of Science and Professional Ethics  

PubMed Central

Medical schools and teaching hospitals have been hit particularly hard by the financial crisis affecting health care in the United States. To compete financially, many academic medical centers have recruited wealthy foreign patients and established luxury primary care clinics. At these clinics, patients are offered tests supported by little evidence of their clinical and/or cost effectiveness, which erodes the scientific underpinnings of medical practice. Given widespread disparities in health, wealth, and access to care, as well as growing cynicism and dissatisfaction with medicine among trainees, the promotion by these institutions of an overt, two-tiered system of care, which exacerbates inequities and injustice, erodes professional ethics. Academic medical centers should divert their intellectual and financial resources away from luxury primary care and toward more equitable and just programs designed to promote individual, community, and global health. The public and its legislators should, in turn, provide adequate funds to enable this. Ways for academic medicine to facilitate this largesse are discussed. PMID:14748866

Donohoe, Martin

2004-01-01

248

Partnership as an ethical model for medical research in developing countries: the example of the "implementation trial"  

PubMed Central

The existing model for ethical review of medical research consists primarily of regulations designed to prevent exploitation of participants. This model may fail when reviewing other ethical obligations, particularly the responsibility to provide valuable knowledge to society. Such failure is most apparent in developing countries, in which many stakeholders lack incentives or power to uphold society's interests. An alternative ethical model is that of partnership, which actively involves all partners during ethical review and aims to secure partners' best interests through compromise. Unlike the existing “regulatory” model, the partnership model effectively addresses ethical obligations to provide positive benefits to society. For the partnership model to be effective, power must be shared among partners; thus, the partnership model can be harmonised with the “regulatory” model through explicit consideration of power structures. One opportunity for crafting power balance in developing countries is apparent in “implementation trials”—randomised trials motivated by and integrated into the implementation of long term public health interventions. Given the failings of the existing ethical review model, alternative models—for example, partnership—and means to balance power—for example, implementation trials—must be explored to ensure that medical research provides knowledge of value to societies in the developing world. PMID:16731737

Dowdy, D W

2006-01-01

249

Ethical dilemma of mandated contraception in pharmaceutical research at catholic medical institutions.  

PubMed

The Catholic Church proscribes methods of birth control other than sexual abstinence. Although the U.S. Food and Drug Administration (FDA) recognizes abstinence as an acceptable method of birth control in research studies, some pharmaceutical companies mandate the use of artificial contraceptive techniques to avoid pregnancy as a condition for participation in their studies. These requirements are unacceptable at Catholic health care institutions, leading to conflicts among institutional review boards, clinical investigators, and sponsors. Subjects may feel coerced by such mandates to adopt contraceptive techniques inconsistent with their personal situation and beliefs; women committed to celibacy or who engage exclusively in non-heterosexual activities are negatively impacted. We propose principles to insure informed consent to safeguard the rights of research subjects at Catholic institutions while mitigating this ethical conflict. At the same time, our proposal respects the interests of pharmaceutical research agencies and Catholic moral precepts, and fully abides by regulatory guidance. PMID:22694032

Casey, Murray Joseph; O'Brien, Richard; Rendell, Marc; Salzman, Todd

2012-01-01

250

Ethical justifications for access to unapproved medical interventions: an argument for (limited) patient obligations.  

PubMed

Many health care systems include programs that allow patients in exceptional circumstances to access medical interventions of as yet unproven benefit. In this article we consider the ethical justifications for-and demands on-these special access programs (SAPs). SAPs have a compassionate basis: They give patients with limited options the opportunity to try interventions that are not yet approved by standard regulatory processes. But while they signal that health care systems can and will respond to individual suffering, SAPs have several disadvantages, including the potential to undermine regulatory and knowledge-generation structures that constitute significant public goods. The "balance" between these considerations depends in part on how broadly SAPs are used, but also on whether SAPs can be made to contribute to the generation of knowledge about the effects of health interventions. We argue that patients should usually be required to contribute outcome data while using SAPs. PMID:25325801

Walker, Mary Jean; Rogers, Wendy A; Entwistle, Vikki

2014-11-01

251

3/23/10 11:51 AMEthical Principles of Psychologists and Code of Conduct (2002) Page 1 of 12http://www.apa.org/ethics/code/index.aspx  

E-print Network

3/23/10 11:51 AMEthical Principles of Psychologists and Code of Conduct (2002) Page 1 of 12http://www.apa.org/ethics/code/index.aspx Ethics Committee (/ethics/code/committee.aspx) . APA may impose sanctions on its members for violations

Sanders, Matthew

252

Ethical and Legal Implications of Elective Ventilation and Organ Transplantation: "Medicalization" of Dying versus Medical Mission  

PubMed Central

A critical controversy surrounds the type of allowable interventions to be carried out in patients who are potential organ donors, in an attempt to improve organ perfusion and successful transplantation. The main goal is to transplant an organ in conditions as close as possible to its physiological live state. “Elective ventilation” (EV), that is, the use of ventilation for the sole purpose of retrieving the organs of patients close to death, is an option which offsets the shortage of organ donation. We have analyzed the legal context of the dying process of the organ donor and the feasibility of EV in the Italian context. There is no legal framework regulating the practice of EV, neither is any real information given to the general public. A public debate has yet to be initiated. In the Italian cultural and legislative scenario, we believe that, under some circumstances (i.e., the expressed wishes of the patient, even in the form of advance directives), the use of EV does not violate the principle of beneficence. We believe that the crux of the matter lies in the need to explore the real determination and will of the patient and his/her orientation towards the specific aim of organ donation. PMID:25126582

Frati, Paola; Montanari Vergallo, Gianluca; Di Luca, Natale Mario; Turillazzi, Emanuela

2014-01-01

253

Ethics perspectives on end-of-life care  

Microsoft Academic Search

Aggressive medical management of the terminally ill has given rise to significant issues in the ethics of end-of-life care. The major ethics principles of autonomy, beneficence, and justice help frame existing research finding. A wave of national initiatives to improve end-of-life care is occurring.

Virginia P. Tilden

1999-01-01

254

Bio-ethical dilemmas related to medical treatment in pre-modern Jewish society, as a portal for raising current ethical issues.  

PubMed

Real-life ethical issues that concern those engaged in medical practice existed and were discussed in earlier ages. It seems that many of the same dilemmas that we face today occupied our ancestors as well. An investigation of historical sources may be useful in showing earlier methods of coping with the dilemmas relating to health and illness. In this article we will present several such topics taken from the sources of Jewish society in pre-modern Europe. These sources served as the basis for a course given to medical students as part of the Medical Humanities track. The "raw materials" are historical, written Hebrew and Yiddish sources from Jewish society. Genres include Minute books, the huge corpus of Responsa, historical elegies written about epidemics, memoirs, and instruction books written by Jewish physicians. Profound bio-ethical issues can be found in historical sources. Main issues discussed are: physician's fees, obligations, and rights; personal characteristics expected of physicians; physician's obligations when his/her own life is endangered; medicalization of certain human conditions; and ideological questions regarding the relationship between traditional folk medicine and modern, academic medicine. The historical distance facilitates a freer discussion about distant people, while getting in touch with our own attitudes. PMID:24340482

Mack, Tamar Salmon; Shaham, Dorith; Marcus, Esther-Lee

2013-09-01

255

American College of Physicians Ethics Manual: sixth edition.  

PubMed

Medicine, law, and social values are not static. Reexamining the ethical tenets of medicine and their application in new circumstances is a necessary exercise. The sixth edition of the American College of Physicians (ACP) Ethics Manual covers emerging issues in medical ethics and revisits older ones that are still very pertinent. It reflects on many of the ethical tensions in medicine and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession. PMID:22213573

Snyder, Lois

2012-01-01

256

Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions  

PubMed Central

A public health emergency such as an influenza pandemic will lead to shortages of mechanical ventilators, critical care beds, and other potentially life saving treatments. This will raise difficult decisions about who will and will not receive these scarce resources. Existing recommendations reflect a narrow utilitarian perspective in which allocation decisions are based primarily on patients' chances of survival to hospital discharge. Certain patient groups, such as the elderly and those with functional impairment, are denied access to potentially life saving treatments based on selective application of additional allocation criteria. We analyze the ethical principles that could guide allocation and propose an allocation strategy that incorporates and balances multiple morally relevant considerations, including saving the most lives, maximizing the number of “life-years” saved, and prioritizing those who have had the least chance to live through life's stages. We also argue that these principles are relevant to all patients and that justice requires that these principles be applied evenly, rather than selectively to the aged, functionally impaired, and those with certain chronic conditions. We discuss strategies to genuinely engage the public in setting the priorities that will guide allocation of scarce life sustaining treatments during a public health emergency. PMID:19153413

White, Douglas B.; Katz, Mitchell H.; Luce, John M.; Lo, Bernard

2009-01-01

257

Medical and genetic differences in the adverse impact of sleep loss on performance: ethical considerations for the medical profession.  

PubMed

The Institute of Medicine recently concluded that-on average-medical residents make more serious medical errors and have more motor vehicle crashes when they are deprived of sleep. In the interest of public safety, society has required limitations on work hours in many other safety sensitive occupations, including transportation and nuclear power generation. Those who argue in favor of traditional extended duration resident work hours often suggest that there are inter- individual differences in response to acute sleep loss or chronic sleep deprivation, implying that physicians may be more resistant than the average person to the detrimental effects of sleep deprivation on performance, although there is no evidence that physicians are particularly resistant to such effects. Indeed, recent investigations have identified genetic polymorphisms that may convey a relative resistance to the effects of prolonged wakefulness on a subset of the healthy population, although there is no evidence that physicians are over-represented in this cohort. Conversely, there are also genetic polymorphisms, sleep disorders and other inter-individual differences that appear to convey an increased vulnerability to the performance-impairing effects of 24 hours of wakefulness. Given the magnitude of inter-individual differences in the effect of sleep loss on cognitive performance, and the sizeable proportion of the population affected by sleep disorders, hospitals face a number of ethical dilemmas. How should the work hours of physicians be limited to protect patient safety optimally? For example, some have argued that, in contrast to other professions, work schedules that repeatedly induce acute and chronic sleep loss are uniquely essential to the training of physicians. If evidence were to prove this premise to be correct, how should such training be ethically accomplished in the quartile of physicians and surgeons who are most vulnerable to the effects of sleep loss on performance without unacceptably compromising patient safety? Moreover, once it is possible to identify reliably those most vulnerable to the adverse effects of sleep loss on performance, will academic medical centers have an obligation to evaluate the proficiency of both residents and staff physicians under conditions of acute and chronic sleep deprivation? Should work-hour policy limits be modified to ensure that they are not hazardous for the patients of the most vulnerable quartile of physicians, or should the limits be personalized to enable the most resistant quartile to work longer hours? Given that the prevalence of sleep disorders has increased in our society overall, and increases markedly with age, how should fitness for extended duration work hours be monitored over a physician's career? In the spirit of the dictum to do no harm, advances in understanding the medical and genetic basis of inter-individual differences in the performance vulnerability to sleep loss should be incorporated into the development of work-hour policy limits for both physicians and surgeons. PMID:19768182

Czeisler, Charles A

2009-01-01

258

Basic problems of medical ethics in Russia in a historical context.  

PubMed

The paper provides a short overview of key problems of medical ethics in the Russian and Soviet contexts--confidentiality, informed consent, human experimentation, abortion, euthanasia, organ and tissue transplantation, abuse of psychiatry. In Soviet ideology common interests were declared superior to private ones. Hence, medical confidentiality was viewed as a bourgeois survival. On the other hand, diagnosis was normally not disclosed to a patient in the case of an incurable disease (especially cancer). Due to the strong paternalistic traditions of Russian medicine the idea of informed consent is still disputed by many physicians. Abortions were first legalized in Soviet Russia in 1920. A brief history of this landmark event is provided. However, abortions were forbidden in 1936 and legalized again only in 1955. Active euthanasia was legalized in Soviet Russia in 1922 but for a short period. Federal law regulating human transplantation was adopted only in 1992 and based on the presumed consent model. Until then forensic autopsy and procurement of cadaver organs were viewed as equal procedures. In 1960s-1980s there was a practice of declaring political dissidents insane in their involuntary treatment. PMID:17044159

Lichterman, Boleslav L

2005-01-01

259

Ethics in Case Conceptualization and Diagnosis: Incorporating a Medical Model into the Developmental Counseling Tradition  

ERIC Educational Resources Information Center

In this literature review, the author focuses on several ethical considerations in case conceptualization and diagnosis, including diagnostic training and competence. Meeting the American Counseling Association's (1995) ethical standard for diagnostic training has several ethical implications for counselors, counselor educators, and supervisors.…

Dougherty, Jennifer L.

2005-01-01

260

Ethical and social issues in the care of the newborn  

Microsoft Academic Search

Ethical and social issues are based upon a system of moral values that serve the best interests of the society in a humane\\u000a and compassionate manner. The ethical decisions should be based upon the well-enunciated principles of beneficence, non-maleficence,\\u000a parental autonomy, correct medical facts and justice. In view of our economic constraints, we should follow the philosophy\\u000a of utilatarian ethics

Meharban Singh

2003-01-01

261

Psychiatric Residents' Needs for Education about Informed Consent, Principles of Ethics and Professionalism, and Caring for Vulnerable Populations: Results of a Multisite Survey  

ERIC Educational Resources Information Center

Objective: The authors examined psychiatric residents' perceived needs for education in informed consent, principles of ethics and professionalism, and treating vulnerable populations. Method: A written survey was distributed to psychiatric residents (N = 249) at seven U.S. residency programs in 2005. The survey contained 149 questions in 10…

Jain, Shaili; Lapid, Maria I.; Dunn, Laura B.; Roberts, Laura Weiss

2011-01-01

262

Access to Medical Records.  

ERIC Educational Resources Information Center

Although confidentiality with regard to medical records is supposedly protected by the American Medical Associaton's principles of Ethics and the physician-patient privilege, there are a number of laws that require a physician to release patient information to public authorities without the patient's consent. These exceptions include birth and…

Cooper, Nancy

263

Principlism, medical individualism, and health promotion in resource-poor countries: can autonomy-based bioethics promote social justice and population health?  

PubMed Central

Through its adoption of the biomedical model of disease which promotes medical individualism and its reliance on the individual-based anthropology, mainstream bioethics has predominantly focused on respect for autonomy in the clinical setting and respect for person in the research site, emphasizing self-determination and freedom of choice. However, the emphasis on the individual has often led to moral vacuum, exaggeration of human agency, and a thin (liberal?) conception of justice. Applied to resource-poor countries and communities within developed countries, autonomy-based bioethics fails to address the root causes of diseases and public health crises with which individuals or communities are confronted. A sociological explanation of disease causation is needed to broaden principles of biomedical ethics and provides a renewed understanding of disease, freedom, medical practice, patient-physician relationship, risk and benefit of research and treatment, research priorities, and health policy. PMID:20082703

2010-01-01

264

Teaching clinical ethics as a professional skill: bridging the gap between knowledge about ethics and its use in clinical practice.  

PubMed Central

Ethical reasoning and decision-making may be thought of as 'professional skills', and in this sense are as relevant to efficient clinical practice as the biomedical and clinical sciences are to the diagnosis of a patient's problem. Despite this, however, undergraduate medical programmes in ethics tend to focus on the teaching of bioethical theories, concepts and/or prominent ethical issues such as IVF and euthanasia, rather than the use of such ethics knowledge (theories, principles, concepts, rules) to clinical practice. Not surprisingly, many students and clinicians experience considerable difficulty in using what they know about ethics to help them make competent ethical decisions in their day-to-day clinical practice. This paper describes the development of a seminar programme for teaching senior medical students a more systematic approach to ethical reasoning and analysis and clinical decision-making. PMID:7608948

Myser, C; Kerridge, I H; Mitchell, K R

1995-01-01

265

The ethics of managed care: challenges to the principles of relationship-centered care.  

PubMed

Health care reform involves ethical issues on many levels. First, the impetus to reform the health care system stems in large part from concerns about equity, just distribution of goods and services, and commitments to one another in society. Health care itself is more than a commodity, it is a personal healing activity carried out through institutions that embody values such as respect for persons, the value of human life, and duties to care for individuals who suffer. These issues fall under major overarching concerns on the macro level. Reform, however, often functions as a euphemism for changing the health care system to provide greater profitability, and for controlling costs. Admittedly, such changes can be disguised under reforming the health care system, and indeed, some of them are capable of enhancing and simultaneously making more efficient, our care for one another when sick. Most changes, nonetheless, are clearly driven from less noble ideals. Every schema for providing care also embodies values since these schemas presuppose various competing notions of justice and equity. Further, they may endanger long-held values of health care providers in meeting the needs of patients. As part of state or local-level changes in the health care system, issues in this category can be called micro level concerns. when all the changes impact on individuals, either providers of care, or the patients themselves, then the issues are of concern on the personal level. This essay, therefore, examines ethical issues presented by managed care networks on the macro, micro, and individual level, with special attention paid to the health care relationship. The subtitle of the essay points out the focus of the discussion on the impact of these changes for more traditional models of relationship-centered care.1 In particular, the essay concentrates on health providers, including allied health professionals, that in the past were grouped into the category of primary care givers but ought to be called first-level care givers today. PMID:8884435

Thomasma, D C

1996-01-01

266

Policy makers ignoring science and scientists ignoring policy: the medical ethical challenges of heroin treatment  

PubMed Central

A decade of research in Switzerland, The Netherlands, Germany, and Spain now constitutes a massive body of work supporting the use of heroin treatment for the most difficult patients addicted to opiates. These trials concur on this method's safety and efficacy and are now serving as a prelude to the institution of heroin treatment in clinical practice throughout Europe. While the different sampling and research protocols for heroin treatment in these studies were important to the academic claims about specific results and conclusions that could be drawn from each study, the overall outcomes were quite clear – and uniformly positive. They all find that the use of prescribed pharmaceutical heroin does exactly what it is intended to do: it reaches a treatment refractory group of addicts by engaging them in a positive healthcare relationship with a physician, it reduces their criminal activity, improves their health status, and increases their social tenure through more stable housing, employment, and contact with family. The Canadian trial (NAOMI), now underway for over a year, but not yet completed, now faces a dilemma about what to do with its patients who have successfully completed 12 months of heroin and must be withdrawn from heroin and transferred to other treatments in accordance with the research protocol approved by Government of Canada, federal granting body and host institutions. The problem is that the principal criterion for acceptance to NAOMI was their history of repeated failure in these very same treatment programs to which they will now be referred. The existence of the results from abroad (some of which were not yet available when NAOMI was designed and initiated) now raises a very important question for Canada: is it ethical to continue to prohibit the medical use of heroin treatment that has already been shown to be feasible and effective in numerous medical studies throughout the world? And while this is being worked out, is it acceptable to require patients who have been successfully treated with heroin in Canada, to be forced to move back to less effective treatments (treatments that failed to be efficacious in the past)? This essay discusses this dilemma and places it in the broader context of ethics, science, and health policy. It makes the case for continuation of the current successful patients in heroin treatment and the institution of heroin treatment to all Canadian patients living with active addictions who qualify. PMID:16670010

Small, Dan; Drucker, Ernest

2006-01-01

267

Physician-assisted suicide of patients with dementia. A medical ethical analysis with a special focus on patient autonomy.  

PubMed

For many years there has been a controversial international debate on physician-assisted suicide (PAS). While proponents of PAS regularly refer to the unbearable suffering and the right of self-determination of incurably ill patients, critics often warn about the diverse risks of abuse. In our article, we aim to present ethical arguments for and against PAS for patients in an early stage of dementia. Our focus shall be on ethical questions of autonomy, conceptual and empirical findings on competence and the assessment of mental capacity to make health care decisions. While the capacity to make health care decisions represents an ethically significant precondition for PAS, it becomes more and more impaired in the course of the dementia process. We present conditions that should be met in order to ethically justify PAS for patients with dementia. From both a psychiatric and an ethical perspective, a thorough differential diagnosis and an adequate medical and psychosocial support for patients with dementia considering PAS and their relatives should be guaranteed. If, after due deliberation, the patient still wishes assistance with suicide, a transparent and documented assessment of competence should be conducted by a professional psychiatrist. PMID:23850340

Gather, Jakov; Vollmann, Jochen

2013-01-01

268

The ethics of limiting informed debate: censorship of select medical publications in the interest of organ transplantation.  

PubMed

Recently, several articles in the scholarly literature on medical ethics proclaim the need for "responsible scholarship" in the debate over the proper criteria for death, in which "responsible scholarship" is defined in terms of support for current neurological criteria for death. In a recent article, James M. DuBois is concerned that academic critiques of current death criteria create unnecessary doubt about the moral acceptability of organ donation, which may affect the public's willingness to donate. Thus he calls for a closing of the debate on current death criteria and for journal editors to publish only critiques that "substantially engage and advance the debate." We argue that such positions as DuBois' are a threat to responsible scholarship in medical ethics, especially scholarship that opposes popular stances, because it erodes academic freedom and the necessity of debate on an issue that is literally a matter of life and death, no matter what side a person defends. PMID:24225389

Potts, Michael; Verheijde, Joseph L; Rady, Mohamed Y; Evans, David W

2013-12-01

269

Medical ethics in the wake of the Holocaust: departing from a postwar paper by Ludwik Fleck.  

PubMed

In 1948 Ludwik Fleck published a paper in Polish discussing the use of humans in medical experiments, thereby addressing his peers. Though the paper has so far not been translated or studied, it has been taken to indicate Fleck's deep commitment to ethical questions, notably the question of informed consent. In being written by a former victim of the Nazi policy and a survivor of the Holocaust also acting as an expert witness in the trial of the IG Farben in Nuremberg, the paper is of interest. A scrutiny of Fleck's text and related sources discloses, however, not only the complexity of the issue at the centre of the Nuremberg trial, but also Fleck's unexpected stance in seemingly adducing his arguments from both the German defendants and the prosecution, heavily informed by US scientists. Further, the contentious discussion of the past in Fleck's paper reveals its links to modern bioethical discussion. Though sometimes oblivious of that past, it still faces the same questions. PMID:17893071

Hedfors, Eva

2007-09-01

270

Confidentiality of the medical records of HIV-positive patients in the United Kingdom - a medicolegal and ethical perspective  

PubMed Central

This article examines the legal and ethical issues that surround the confidentiality of medical records, particularly in relation to patients who are HIV positive. It records some historical background of the HIV epidemic, and considers the relative risks of transmission of HIV from individual to individual. It explains the law as it pertains to confidentiality, and reports the professional guidance in these matters. It then considers how these relate to HIV-positive individuals in particular. PMID:22312224

Williams, Mike

2011-01-01

271

“Thinking about it for somebody else”: Alzheimer's disease research and proxy decisionmakers' translation of ethical principles into practice  

PubMed Central

Objectives Ethical guidelines suggest that, when enrolling dementia patients in research, alterative decisionmakers (proxies) should base their decision on a “substituted judgment” of how the patient would have decided. If unable to make a substituted judgment, proxies are asked to decide based on the patient’s best interests. This mixed-methods study is the first to examine explicitly whether and to what degree proxies differentiate between these two approaches, and what considerations influence their mode of decisionmaking. Design Interview study regarding enrollment of relative in hypothetical clinical trial of an investigational drug for Alzheimer’s disease (AD). Participants were randomized to respond to questions about one of four hypothetical clinical trials that differed by levels of described risk and potential benefit. Participants Proxy decisionmakers (n=40). Measurements Open-ended and rating-scaled items. Results Half of the proxies agreed with both of two rating-scaled items asking about different approaches to decisionmaking—i.e., agreeing that they would decide based on how their relative would have decided, and agreeing that they would decide based on what they believed was in their relative’s best interests. Narrative responses elaborated on themes within the following three major domains: Substituted Judgment, Best Interests, and Weighing Substituted Judgment and Best Interests. Substituted Judgment was framed as honoring the patient’s wishes and values. Best Interests was described as a perceived duty to maintain quality of life and avoid burdens or risks. Weighing the two standards emerged as a challenging, yet important, way of honoring wishes while maintaining quality of life. An unexpected theme was the attempt by alternative decisionmakers to discern their loved one’s current, vs. premorbid, research preferences. Conclusions Tensions exist between abstract ethical principles regarding decisionmaking “standards” and their translation into research decisions. PMID:23498380

Dunn, Laura B.; Fisher, Stephanie Reyes; Hantke, Melinda; Appelbaum, Paul S.; Dohan, Daniel; Young, Jenifer P.; Roberts, Laura Weiss

2012-01-01

272

Integrating emergency medicine principles and experience throughout the medical school curriculum: why and how.  

PubMed

The management of acutely ill and injured patients is an essential component of medical student education, yet the formal integration of emergency medicine (EM) into the medical school curriculum has progressed slowly since the inception of the specialty. Medical student interest and the number of resident positions in the National Resident Matching Program are higher than any time in the past, yet students often find access to EM faculty and clinical experience limited to a fourth-year rotation. Incorporating EM into all years of the undergraduate medical student curriculum can offer unique educational experiences and enhance exposure to the necessary and recommended knowledge and skills students must attain prior to graduation. Academic emergency physicians (EPs) should advocate our specialty's importance in their medical school curricula using a proactive approach and actively involve themselves in medical student education at all stages of training. The goals of this article are to describe several approaches for EM faculty to expand medical student exposure to the specialty and enhance student experiences in the core principles of EM throughout the undergraduate medical curriculum. PMID:21996073

Tews, Matthew C; Hamilton, Glenn C

2011-10-01

273

Does a Sentiment-Based Ethics of Caring Improve upon a Principles-Based One? The Problem of Impartial Morality  

ERIC Educational Resources Information Center

My task in this paper is to demonstrate, contra Nel Noddings, that Kantian ethics does not have an expectation of treating those closest to one the same as one would a stranger. In fact, Kantian ethics has what I would consider a robust statement of how it is that those around us come to figure prominently in the development of one's ethics. To…

Johnston, James Scott

2008-01-01

274

Ethics education in undergraduate pre-health programs. The contribution of undergraduate colleges and universities to the ethical and moral development of future doctors in the medical and dental professions.  

PubMed

There are many barriers to ethics education of students attending medical and dental schools. The question is asked, "Should more attention be given to addressing students' ethics education during their undergraduate years of preparation for professional healthcare programs?" This qualitative study utilizes digitally recorded personal interviews with two undergraduate pre-healthcare students, one medical student, one recently matriculated dental student, one undergraduate pre-healthcare faculty member, three dental school faculty members, and three medical school faculty members. Interview participants discuss areas of personal knowledge and experience concerning: the admissions process and screening of potential medical/dental students for ethical traits and behaviors, influences on student ethical development, undergraduate pre-healthcare ethics training, and preferred college major for pre-healthcare students. The study concludes that undergraduate pre-healthcare programs should take the initiative to be proactive and deliberate in strengthening the positive influences on students. Strategies include: 1) humanities curricula to broaden perspectives and increase non-prejudice; 2) mentoring and modeling by older students, faculty, and community and professional volunteers; 3) ethical case study discussions in class or extracurricular activities; and 4) volunteer/service learning activities. Additionally, curriculum learning is enhanced by the use of reflection and writing, discussions, and media. PMID:21957781

Erratt, Tamie D

2011-08-01

275

Ethics in cardiovascular medicine. Task Force IV: Scientific responsibility and integrity in medical research.  

PubMed

Ethical standards are a set of affirmative responsibilities to which the investigator must subscribe; behavior that is incompatible with these responsibilities should be presumed unethical, whether or not it is explicitly proscribed. This Task Force sought to present these standards as principles or guidelines. In undertaking research an investigator must accept that publicly funded or supported research is intended to yield public benefit; personal gain should be only incidental to and not at the expense of the public benefit. The responsibilities of the investigator are summarized as follows: Design of Research To develop a research design that effectively and efficiently addresses the scientific question while minimizing the likelihood of incorrect or misleading results. To protect the rights and welfare of human subjects, assure the humane use of laboratory animals and protect the safety of laboratory workers and the environment. Conduct of Research To ensure that accepted laboratory and research practices are followed and that all data are accurately collected and properly recorded; the investigator must participate in the review of original data. To carry out research in accordance with that approved by the institutional review board and ensure that fully informed consent is obtained, that the welfare of human subjects is protected and that animal welfare and laboratory safety procedures are carried out. To provide effective ongoing supervision of research trainees and technicians. In multidisciplinary collaborative research, to have at least an overview familiarity with the work outside his or her areas of expertise. In fixed protocol, multicenter collaborative research the investigator must be satisfied with the adequacy of the collaborative activities.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2358596

Frommer, P L; Ross, J; Benson, J A; Friedman, W F; Friesinger, G C; Goldstein, S; Huth, E J; Levine, R J; Malone, T E; Quash, J A

1990-07-01

276

Ethical Considerations in the Termination of Patient Care The ACOFP Ethics Committee is offering this column to provide a forum for discussion of medical ethical questions.  

E-print Network

, hypertension, hyperlipidemia and alcohol abuse. Over the course of multiple visits he proves to be noncompliant with the medications prescribed by you and is consistently late for his appointments. He becomes verbally abusive) override medical interests? Should the patient have the right to be verbally abusive to the staff

Solka, Jeff

277

TEACHING PHYSICS: An experiment to demonstrate the principles and processes involved in medical Doppler ultrasound  

NASA Astrophysics Data System (ADS)

Doppler ultrasound is widely used in medicine for measuring blood velocity. This paper describes an experiment illustrating the principles of medical Doppler ultrasound. It is designed with A-level/undergraduate physics students in mind. Ultrasound is transmitted in air and reflected from a moving target. The return signal is processed using a series of modules, so that students can discover for themselves how each stage in the instrument works. They can also obtain a quantitative value of the speed of the target.

Andrews, D. G. H.

2000-09-01

278

Ethics in a scientific approach: the importance of the biostatistician in research ethics committees.  

PubMed

In medical practice and research it is necessary to consider the rights of the researcher or physician and of the subject or patient, to conform to scientific standards and to examine the appropriateness with respect to laws and moral values. Research ethics committees have an important role to play in ensuring the ethical standards and scientific merit of research on human subjects. Research of no scientific value is also against ethical principles. To obtain valid and reliable results from biomedical research, it is a scientific and ethical obligation to make use of the science of statistics. Therefore, for research to be evaluated using biostatistics intensively from ethical and scientific points of view, a biostatistics expert is necessary on research ethics committees. Developments in Turkey are used as examples. PMID:18375684

Atici, E; Erdemir, A D

2008-04-01

279

Ethics in surgery: historical perspective.  

PubMed

Ethics codes and guidelines date back to the origins of medicine in virtually all civilizations. Developed by the medical practitioners of each era and culture, oaths, prayers, and codes bound new physicians to the profession through agreement with the principles of conduct toward patients, colleagues, and society. Although less famous than the Hippocratic oath, the medical fraternities of ancient India, seventh-century China, and early Hebrew society each had medical oaths or codes that medical apprentices swore to on professional initiation. The Hippocratic oath, which graduating medical students swear to at more than 60% of US medical schools, is perhaps the most enduring medical oath of Western civilization. Other oaths commonly sworn to by new physicians include the Declaration of Geneva (a secular, updated form of the Hippocratic oath formulated by the World Medical Association, Ferney-Voltaire, France) and the Prayer of Moses Maimondes, developed by the 18th-century Jewish physician Marcus Herz. PMID:10636339

Tung, T; Organ, C H

2000-01-01

280

The major medical ethical challenges facing the public and healthcare providers in Saudi Arabia  

PubMed Central

Background: Despite the relatively high expenditure on healthcare in Saudi Arabia, its health system remains highly centralized in the main cities with its primary focus on secondary and tertiary care rather than primary care. This has led to numerous ethical challenges for the healthcare providers. This article reports the results of a study conducted with a panel of practitioners, and non-clinicians, in Saudi Arabia, in order to identify the top ten ethical challenges for healthcare providers, patients, and their families. Materials and Methods: The study design was a cross-sectional, descriptive, and qualitative one. The participants were asked the question: “What top ten ethical challenges are Saudis likely to face in health care?” The participants were asked to rank the top ten ethical challenges throughout a modified Delphi process, using a ranking Scale. A consensus was reached after three rounds of questions and an experts’ meeting. Results: The major 10 ethical issues, as perceived by the participants in order of their importance, were: (1) Patients’ Rights, (2) Equity of resources, (3) Confidentiality of the patients, (4) Patient Safety, (5) Conflict of Interests, (6) Ethics of privatization, (7) Informed Consent, (8) Dealing with the opposite sex, (9) Beginning and end of life, and (10) Healthcare team ethics. Conclusion: Although many of the challenges listed by the participants have received significant public and specialized attention worldwide, scant attention has been paid to these top challenges in Saudi Arabia. We propose several possible steps to help address these key challenges. PMID:22518351

Alkabba, Abdulaziz F.; Hussein, Ghaiath M. A.; Albar, Adnan A.; Bahnassy, Ahmad A.; Qadi, Mahdi

2012-01-01

281

Physicians’ and nurses’ perceptions of ethics problems on general medical services  

Microsoft Academic Search

Objective:To understand the kinds of clinical situations physicians and nurses regard as “ethics problems.”\\u000a \\u000a \\u000a Design:The authors prospectively studied physicians’ and nurses’ perceptions of ethics problems using paired interviews. Individual\\u000a interviews were conducted with physicians and nurses as they cared for the same patients during a six-week period. Each was\\u000a asked whether any ethics problems had arisen in the care of

Robert M. Walker; Steven H. Miles; Carol B. Stocking; Mark Siegler

1991-01-01

282

Ethical dilemmas in treating clients with eating disorders: A review and application of an integrative ethical decision-making model.  

PubMed

Ethical dilemmas frequently arise in the treatment of clients with eating disorders, and clinicians regularly encounter an array of ethical challenges related to whether or not overt and covert coercive tactics should be implemented. In this paper, the authors provide an overview of perplexing ethical questions relevant to medical, nutritional and psychological treatment of clients with eating disorders including imposed treatment, enforced feeding, the duty to protect minors and adults, the determination of competence and capacity among medically comprised clients, and the effectiveness of coercive treatment for clients with eating disorders. The processes of ethical decision-making in terms of ethical principles, professional codes of conduct, the existing empirical literature and the use of a decision-making framework are explored. Taking a collaborative and client-sensitive approach, the authors outline and apply an integrative ethical decision-making model to facilitate clinicians' decision-making process. PMID:20672390

Matusek, Jill Anne; Wright, Margaret O'Dougherty

2010-01-01

283

Compensation for subjects of medical research: the moral rights of patients and the power of research ethics committees.  

PubMed Central

Awareness of the morally significant distinction between research and innovative therapy reveals serious gaps in the legal provision for compensation in the UK for injured subjects of medical research. Major problems are limitations inherent in negligence actions and a culture that emphasises indemnifying researchers before compensating victims. Medical research morally requires compensation on a no-fault basis even where there is proper consent on the part of the research subject. In particular, for drug research, there is insufficient provision in the current patient guidelines of the Association of the British Pharmaceutical Industry, since they make "no legal commitment" to paying compensation for injury to patient subjects. There is a need for the provision of both adequate insurance and contractual arrangements for making payments. The solution is for Local Research Ethics Committees (LRECs) to make use of their power to withhold approval of medical research where compensation is not legally enforceable. PMID:9220333

Guest, S

1997-01-01

284

Advanced patient records: some ethical and legal considerations touching medical information space.  

PubMed

The application of advanced computer-based information technology to patient records presents an opportunity for expanding the informational resource base that is available to health-care providers at all levels. Consequently, it has the potential for fundamentally restructuring the ethics of the physician/patient relationship and the ethos of contemporary health-care delivery. At the same time, the technology raises several important ethical problems. This paper explores some of these implications. It suggests that the fundamental ethical issue at stake in these developments is the status of the electronic record which functions as the analog of the health-care consumer in health-care decision making. Matters such as control and patient dignity are implicated. Other important ethical issues requiring solution include data ownership, data liability, informed consent to use and retrieval, security and access. The paper suggests that the ethical problems that arise cannot be solved in piecemeal fashion and on a purely national basis. They should be addressed in a coordinated international fashion and receive appropriate legal expression in the relevant countries and be incorporated into appropriate codes of ethics. PMID:8321138

Kluge, E H

1993-04-01

285

StudentsÃÂ conceptions of underlying principles in medical physiology: an interview study of medical studentsÃÂ understanding in a PBL curriculum  

NSDL National Science Digital Library

Medical physiology is known to be a complex area where students develop significant errors in conceptual understanding. StudentsÃÂ knowledge is often bound to situational descriptions rather than underlying principles. This study explores how medical students discern and process underlying principles in physiology. Indepth interviews, where students elaborated on principles related to blood pressure and blood pressure regulation, were carried out with 16 medical students in a problem-based learning curriculum. A qualitative, phenomenographic approach was used, and interviews were audiotaped, transcribed, qualitatively analyzed, and categorized. Four categories were outlined. The underlying principles were conceived as follows: 1) general conditions for body function at a specified time point, 2) transferable phenomena between organ systems and time points, 3) conditionally transferable phenomena between organ systems and time points, and 4) cognitive constructions of limited value in medical physiology. The results offers insights into studentsÃÂ thinking about underlying principles in physiology and suggest how understanding can be challenged to stimulate deep-level processing of underlying principles rather than situational descriptions of physiology. A complex conception of underlying principles includes an ability to problemize phenomena beyond long causal reasoning chains, which is often rewarded in traditional examinations and tests. Keywords for problemized processing are as follows: comparisons, differences, similarities, conditions, context, relevance, multiple sampling, connections, and dependencies.

Anna Fyrenius (Linkoping University Center for Educational Development and Research); Charlotte Silen (Linkoping University Medicine and Care); Staffan Wirell (Linkoping University Medicine and Care-Radiology)

2007-12-01

286

Problems for clinical judgement: 5. Principles of influence in medical practice  

PubMed Central

THE BASIC SCIENCE OF PSYCHOLOGY HAS IDENTIFIED specific ingrained responses that are fundamental elements of human nature, underpin common influence strategies and may apply in medical settings. People feel a sense of obligation to repay a perceived debt. A request becomes more attractive when preceded by a marginally worse request. The drive to act consistently will persist even if demands escalate. Peer pressure is intense when people face uncertainty. The image of the requester influences the attractiveness of a request. Authorities have power beyond their expertise. Opportunities appear more valuable when they appear less available. These 7 responses were discovered decades ago in psychology research and seem intuitively understood in the business world, but they are rarely discussed in medical texts. An awareness of these principles can provide a framework for physicians to help patients change their behaviour and to understand how others in society sometime alter patients' choices. PMID:12126325

Redelmeier, Donald A.; Cialdini, Robert B.

2002-01-01

287

Problems for clinical judgement: 5. Principles of influence in medical practice.  

PubMed

The basic science of psychology has identified specific ingrained responses that are fundamental elements of human nature, underpin common influence strategies and may apply in medical settings. People feel a sense of obligation to repay a perceived debt. A request becomes more attractive when preceded by a marginally worse request. The drive to act consistently will persist even if demands escalate. Peer pressure is intense when people face uncertainty. The image of the requester influences the attractiveness of a request. Authorities have power beyond their expertise. Opportunities appear more valuable when they appear less available. These 7 responses were discovered decades ago in psychology research and seem intuitively understood in the business world, but they are rarely discussed in medical texts. An awareness of these principles can provide a framework for physicians to help patients change their behaviour and to understand how others in society sometime alter patients' choices. PMID:12126325

Redelmeier, Donald A; Cialdini, Robert B

2002-06-25

288

Principles for new optical techniques in medical diagnostics for mHealth applications  

NASA Astrophysics Data System (ADS)

Medical diagnostics is a critical element of effective medical treatment. However, many modern and emerging diagnostic technologies are not affordable or compatible with the needs and conditions found in low-income and middle-income countries and regions. Resource-poor areas require low-cost, robust, easy-to-use, and portable diagnostics devices compatible with telemedicine (i.e. mHealth) that can be adapted to meet diverse medical needs. Many suitable devices will need to be based on optical technologies, which are used for many types of biological analyses. This dissertation describes the fabrication and detection principles for several low-cost optical technologies for mHealth applications including: (1) a webcam based multi-wavelength fluorescence plate reader, (2) a lens-free optical detector used for the detection of Botulinum A neurotoxin activity, (3) a low cost micro-array reader that allows the performance of typical fluorescence based assays demonstrated for the detection of the toxin staphylococcal enterotoxin (SEB), and (4) a wide-field flow cytometer for high throughput detection of fluorescently labeled rare cells. This dissertation discusses how these technologies can be harnessed using readily available consumer electronics components such as webcams, cell phones, CCD cameras, LEDs, and laser diodes. There are challenges in developing devices with sufficient sensitivity and specificity, and approaches are presented to overcoming these challenges to create optical detectors that can serve as low cost medical diagnostics in resource-poor settings for mHealth.

Balsam, Joshua Michael

289

Ethical aspects of obstetric care: expectations and experiences of patients in South East Nigeria  

PubMed Central

Background Medical ethics is not given due priority in obstetric care in many developing countries, and the extent to which patients value compliance with ethical precepts is largely unexplored. Objective To describe the expectations and experiences of obstetric patients in South East Nigeria with respect to how medical ethics principles were adhered to during their care. Methods This was a cross-sectional, questionnaire-based study involving parturient women followed in three tertiary hospitals in South East Nigeria. Results A total of 1,112 women were studied. The mean age of respondents was 29.7 ± 4.1 years. Approximately 98% had at least secondary education. Ninety-six percent considered ethical aspects of care as important. On the average, over 75% of patients expected their doctors to comply with the different principles of medical ethics and specifically, more than 76% of respondents expected their doctors to comply with ethical principles related to information and consent during their antenatal and delivery care. There was a statistically significant difference between the proportions of women who expected compliance of doctors with ethical principles and those who did not (P < 0.001). Multivariate analysis showed that increasing levels of skilled occupation (odds ratio [OR] 9.35, P < 0.001), and residence in urban areas (OR 2.41, P < 0.001) increased the likelihood of patients expecting to be informed about their medical conditions and their opinions being sought. Although the self-reported experiences of patients concerning adherence to ethical principles by doctors were encouraging, experiences fell short of expectations, as the level of expectation of patients was significantly higher than the level of observed compliance for all the principles of medical ethics. Conclusion The level of practice of medical ethics principles by doctors during obstetric care in South East Nigeria was encouraging but still fell short of the expectations of patients. It is recommended that curriculum-based training of doctors and medical students should be implemented, and hospital policy makers should do more to promote ethical aspects of care, by providing official written guidelines for adherence to medical ethical principles during obstetric care. PMID:24043956

Iyoke, Chukwuemeka A; Ezugwu, Frank O; Ugwu, George O; Lawani, Osaheni L; Onyebuchi, Azubuike K

2013-01-01

290

Aequilibrium prudentis: on the necessity for ethics and policy studies in the scientific and technological education of medical professionals  

PubMed Central

Background The importance of strong science, technology, engineering, and mathematics education continues to grow as society, medicine, and the economy become increasingly focused and dependent upon bioscientific and technological innovation. New advances in frontier sciences (e.g., genetics, neuroscience, bio-engineering, nanoscience, cyberscience) generate ethical issues and questions regarding the use of novel technologies in medicine and public life. Discussion In light of current emphasis upon science, technology, engineering, and mathematics education (at the pre-collegiate, undergraduate, graduate, and professional levels), the pace and extent of advancements in science and biotechnology, the increasingly technological orientation and capabilities of medicine, and the ways that medicine – as profession and practice – can engage such scientific and technological power upon the multi-cultural world-stage to affect the human predicament, human condition, and perhaps nature of the human being, we argue that it is critical that science, technology, engineering, and mathematics education go beyond technical understanding and directly address ethical, legal, social, and public policy implications of new innovations. Toward this end, we propose a paradigm of integrative science, technology, ethics, and policy studies that meets these needs through early and continued educational exposure that expands extant curricula of science, technology, engineering, and mathematics programs from the high school through collegiate, graduate, medical, and post-graduate medical education. We posit a synthetic approach that elucidates the historical, current, and potential interaction of scientific and biotechnological development in addition to the ethico-legal and social issues that are important to educate and sustain the next generation of medical and biomedical professionals who can appreciate, articulate, and address the realities of scientific and biotechnological progress given the shifting architectonics of the global social milieu. Summary We assert that current trends in science, technology, medicine, and global politics dictate that these skills will be necessary to responsibly guide ethically sound employment of science, technology, and engineering advancements in medicine so as to enable more competent and humanitarian practice within an increasingly pluralistic world culture. PMID:23617840

2013-01-01

291

Solutions to Infertility: Even the Simplest Medical Answer Raises Troubling Ethical Questions for Catholics.  

ERIC Educational Resources Information Center

Considers the ethical issues surrounding the "simplest" case of in vitro fertilization from the author's interpretation of a Catholic perspective. Discusses serious moral objections to in vitro fertilization voiced by the Vatican, and presents theological reasons why Catholics should question in vitro fertilization. (Author/NB)

Boyle, Philip

1989-01-01

292

The philosophical moment of the medical decision: revisiting emotions felt, to improve ethics of future decisions  

Microsoft Academic Search

The present investigation looks for a solution to the problem of the influence of feelings and emotions on our ethical decisions. This problem can be formulated in the following way. On the one hand, emotions (fear, pity and so on) can alter our sense of discrimination and lead us to make our wrong decisions. On the other hand, it is

Pierr Le Coz; Sebastien Tassy

2007-01-01

293

The impact of an interprofessional problem-based learning curriculum of clinical ethics on medical and nursing students' attitudes and ability of interprofessional collaboration: a pilot study.  

PubMed

Clinical ethic situations in modern multiprofessional healthcare systems may involve different healthcare professions who work together for patient care. The undergraduate interprofessional education of clinical ethics would help to incubate healthcare students' ability of interprofessional collaboration in solving ethical problems. However, the impact from an interprofessional educational model on student's attitudes and confidence of interprofessional collaboration should be carefully evaluated during the process of curricular development. This study aimed to conduct a pilot interprofessional PBL curriculum of clinical ethics and evaluate the curricular impact on interprofessional students' attitude and confidence of collaborative teamwork. Thirty-six medical and nursing students volunteered to participate in this study and were divided into three groups (medical group, nursing group, and mixed group). Tutors were recruited from the Medical School and the College of Nursing. The pilot curriculum included one lecture of clinical ethics, one PBL case study with two tutorial sessions, and one session of group discussion and feedback. A narrative story with multiple story lines and a multiperspective problem analysis tool were used in the PBL tutorials. The students' self-evaluation of learning questionnaire was used to evaluate students' learning of clinical ethics and interprofessional collaborative skills and attitude. The internal consistency of the questionnaire was measured by Cronbach ?, and the criterion-related validity of the questionnaire was evaluated through associations between the dimension scores with the student group by one-way analysis of variance test (ANOVA) test and Tukey-Kramer honestly significant difference (HSD) comparison. There was significant difference among different groups in students' ability and attitudes about "interprofessional communication and collaboration" (p = 0.0184). The scores in the mixed group (37.58 ± 3.26) were higher than the medical group (32.10 ± 4.98). In conclusion, our model for the interprofessional PBL curriculum of clinical ethics is practicable and will produce positive impacts on students' attitudes and confidence of interprofessional collaboration. PMID:24018155

Lin, Yu-Chih; Chan, Te-Fu; Lai, Chung-Sheng; Chin, Chi-Chun; Chou, Fan-Hao; Lin, Hui-Ju

2013-09-01

294

[Medical, legal and ethical aspects of fertility preservation in cancer survivor].  

PubMed

In recent years the number of the young women in fertile age which are oncologically treated is increasing. For these women chemotherapy and radiotherapy introduces potential risk of reproductive dysfunctions. Present techniques of assisted reproduction are offering possibilities to save reproductive functions even after the oncological treatment. As a perspective outlook seems to be frozen premature oocytes with IVM and fertilisation. With these fertility savings methods are naturally coming up some of the ethical and legal issues. PMID:22702076

Záhumenský, J; Kucera, E; Kosová, T; Zmrhal, J; Stejskal, M; Stejskal, D

2012-04-01

295

Health sciences librarians' awareness and assessment of the Medical Library Association Code of Ethics for Health Sciences Librarianship: the results of a membership survey  

PubMed Central

Objective: The Medical Library Association (MLA) Board of Directors and president charged an Ethical Awareness Task Force and recommended a survey to determine MLA members' awareness of and opinions about the current Code of Ethics for Health Sciences Librarianship. Methods: The task force and MLA staff crafted a survey to determine: (1) awareness of the MLA code and its provisions, (2) use of the MLA code to resolve professional ethical issues, (3) consultation of other ethical codes or guides, (4) views regarding the relative importance of the eleven MLA code statements, (5) challenges experienced in following any MLA code provisions, and (6) ethical problems not clearly addressed by the code. Results: Over 500 members responded (similar to previous MLA surveys), and while most were aware of the code, over 30% could not remember when they had last read or thought about it, and nearly half had also referred to other codes or guidelines. The large majority thought that: (1) all code statements were equally important, (2) none were particularly difficult or challenging to follow, and (3) the code covered every ethical challenge encountered in their professional work. Implications: Comments provided by respondents who disagreed with the majority views suggest that the MLA code could usefully include a supplementary guide with practical advice on how to reason through a number of ethically challenging situations that are typically encountered by health sciences librarians. PMID:25349544

Byrd, Gary D.; Devine, Patricia J.; Corcoran, Kate E.

2014-01-01

296

Parental role in medical decision-making: fact or fiction? A comparative study of ethical dilemmas in French and American neonatal intensive care units.  

PubMed

Neonatal intensive care has been studied from an epidemiological, ethical, medical and even sociological perspective, but little is known about the impact of parental involvement in decision-making, especially in critical cases. We rely here on a comparative, case-based approach to study the parental role in decision-making within two technologically identical but culturally and institutionally different contexts: France and the United States. These contexts rely on two opposed models of decision-making: parental autonomy in the United States and medical paternalism in France. This paternalism model excludes parents from the decision-making process. We investigate whether parental involvement leads to different outcomes from exclusively medically determined decisions or whether "technological imperatives" outplay all other factors to shape a unique, 'medically optimal' outcome. Using empirical data generated from extensive ethnographic fieldwork, in-depth interviews with 60 clinicians and 71 parents and chart review over a year in two neonatal intensive care units (one in France and one in the US), we analyze the factors that can explain the observed differences in decision-making in medically identical cases. Parental involvement and the legal context play a less role than physicians' differential use of certainty versus uncertainty in prognosis, a conclusion that corroborates the fact that medical control over ethical dilemmas remains even in the context of autonomy. French physicians do not ask parents permission to withdraw care (as expected in a paternalistic context); but symmetrically, American neonatologists (despite the prevailing autonomy model) tend not to ask permission to continue. The study provides an analysis of the making of "ethics", with an emphasis on how decisions are conceptualized as ethical dilemmas. The final conclusion is that the ongoing medical authority on ethics remains the key issue. PMID:15020016

Orfali, Kristina

2004-05-01

297

[Ethics, knowledge and psychiatry: in Aulus Cornelius Celsus' De Medicina].  

PubMed

Modern medicine has many roots on greco-roman practice of the medical art. The authors analyse the work De Medicina by Aulus Cornelius Celsus. They look upon the nature of the medical knowledge, the principles of ethics, causality and describe the mental disorders (phrenitis, depression, third insanity, seizure disorder and womb disease), with special detail to signs and symptoms, treatment and prognosis. An association with current medical knowledge is established. PMID:18282440

Trancas, Bruno; Borja Santos, Nuno

2007-01-01

298

Implementation of the principle of as low as reasonably achievable (ALARA) for medical and dental personnel  

SciTech Connect

This report is part of a series prepared under the auspices of Scientific Committee 46, Operational Radiation Safety. It provides guidance on the process of implementing the as low as reasonably achievable'' (ALARA) principle for the use of radiation by medical and dental personnel. The use of cost-benefit analysis is recommended as a basic method upon which to base ALARA decisions. Examples are provided to illustrate the ALARA principle as a process of optimization and to provide a starting point for the development of individualized ALARA programs. NCRP Report No. 91, Recommendations on Limits for Exposure to Ionizing Radiation, calls for the use of reference ranges for occupational exposures. This report recommends the use of 2 reference ranges, one based on individual dose equivalents, and the other based on collective dose equivalent. In accordance with the recommendations of NCRP Report No. 82, SI Units in Radiation Protection and Measurements, as of January 1990, only SI units are used in the text. Readers needing factors for conversion of SI to conventional units are encouraged to consult Report No. 82. 84 refs., 10 figs., 10 tabs.

Not Available

1990-12-31

299

HIV/AIDS reduces the relevance of the principle of individual medical confidentiality among the Bantu people of Southern Africa.  

PubMed

The principle of individual medical confidentiality is one of the moral principles that Africa inherited unquestioningly from the West as part of Western medicine. The HIV/AIDS pandemic in Southern Africa has reduced the relevance of the principle of individual medical confidentiality. Individual medical confidentiality has especially presented challenges for practitioners among the Bantu communities that are well known for their social inter-connectedness and the way they value their extended family relations. Individual confidentiality has raised several unforeseen problems for persons living with HIV/AIDS, ranging from stigma and isolation to feelings of dejection as it drives them away from their families as a way of trying to keep information about their conditions confidential. The involvement of family members in treatment decisions is in line with the philosophy of Ubuntu and serves to respect patients' and families' autonomy while at the same time benefiting the individual patient. PMID:19048391

Ndebele, Paul; Mfutso-Bengo, Joseph; Masiye, Francis

2008-01-01

300

Ethical Healthcare Agents  

Microsoft Academic Search

We have combined a bottom-up casuistry approach with a top-down implementation of an ethical theory to develop a system that\\u000a uses machine-learning to abstract relationships between prima facie ethical duties from cases of particular types of ethical dilemmas where ethicists are in agreement as to the correct action.\\u000a This system has discovered a novel ethical principle that governs decisions in

Michael Anderson; Susan Leigh Anderson

301

The use of personal data from medical records and biological materials: ethical perspectives and the basis for legal restrictions in health research  

Microsoft Academic Search

This paper discusses the moral justification for using personal data without informed consent, from both medical records and biological materials, in research where subjects are not physically present in the study and will never have any contact with the study investigators. Although the idea of waiving the requirement for informed consent in certain investigations has been mentioned in several ethical

Enrique Regidor

2004-01-01

302

Principles and practice of hyperbaric medicine: a medical practitioner's primer, part II.  

PubMed

Advances in the treatment of chronic wounds* have steadily occurred over the past decade and include the specialized use of dynamic compression therapy, implementation of moist wound care techniques, chronic lymphedema therapy, negative pressure wound therapy, arterial compression therapy and application of off-loading devices. General medical practitioners should recognize when timely patient referral to a comprehensive wound care center is indicated. The clinical practice of HBOT and its scientific basis has also advanced significantly during this same time period. HBOT is a therapeutic tool with many qualities that are unique to medical care and enable difficult and otherwise untreatable conditions to be safely and effectively managed. Level 1 evidence exists for HBOT and the therapeutic indications are growing. It is the responsibility of all practitioners to become informed about the modern principles and practice of HBOT. Clinicians should take the advice of Mark Twain: "Supposing is good but finding out is better." It is the responsibility of educational institutions and medical societies to become informed and actively engaged in hyperbaric medical care, education and research. This will benefit our patients as well as our systems of medical care. There is now ample access to hyperbaric oxygen facilities and expertise with the state. There is a growing need for HBOT services due to the rising incidence of obesity and diabetes combined with an aging demographic. Appropriate networks and patterns of referral have lagged behind this demand due to a generalized lack of understanding of the true risks, benefits and indications for HBOT. This review will hopefully begin to address this problem. Hyperbaric medicine is in an early phase of development. The current and future demand for clinical services will drive development of research and educational programs. Only through continued efforts for perform high quality research and education will the full potential of HBOT be realized. Much remains to be done. As systems for the delivery of healthcare enter an era of population management, the regenerative potential of hyperbaric therapies should improve quality of and reduce costs and enable us to meet the challenge of providing care for the growing population of chronic wound patients. PMID:25195304

Perdrizet, George A

2014-08-01

303

Ethical problems with the use of animals in medical research and education: An introduction  

Microsoft Academic Search

It is well to remember that the issue of the use of animals in medical research and training is fought with highly emotional appeals. One needs to assess clearly the moral status of animals and the benefits that medical science produces. It is not enough and will not resolve the issues, to show pictures of animals going through a research

Ray Moseley

1989-01-01

304

Ethical Principles Associated with the Publication of Research in ASHA's Scholarly Journals: Importance and Adequacy of Coverage  

ERIC Educational Resources Information Center

Purpose: The purpose of this 2-part study was to determine the importance of specific topics relating to publication ethics and adequacy of the American Speech-Language-Hearing Association's (ASHA's) policies regarding these topics. Method: A 56-item Web-based survey was sent to (a) ASHA journal editors, associate editors, and members of the…

Ingham, Janis C.; Minifie, Fred D.; Horner, Jennifer; Robey, Randall R.; Lansing, Charissa; McCartney, James H.; Slater, Sarah C.; Moss, Sharon E.

2011-01-01

305

Framing the forum: medical ethics in large-scale, interventional respiratory clinical trials.  

PubMed

Clinical research can create a conflict between the quest for science and the quest for individualized best patient care. The researcher must balance the degree of uncertainty about a particular treatment with the risk of patient exposure to control therapy. This is known as clinical equipoise. Clinical research and clinical care are intricately linked, yet they differ significantly from each other. This is an important distinction to make for both patients and physicians. This overview of ethics in clinical research will discuss some of the key contentious issues: informed consent (including payment for participation in a clinical trial, use of a placebo, and defining "standard of care"), research in critically ill patients, dissemination of study results, race issues, and financial disclosure. More research is being conducted by more investigators, in more organizations, in more disciplines than ever before. While this environment creates enormous opportunities for advances in healthcare, it also poses numerous challenges to the ethical conduct of clinical trials and raises numerous heretofore unconsidered issues. PMID:17494726

Criner, Gerard J

2007-05-01

306

Ethics & evidence in medical debates: the case of recombinant activated factor VII.  

PubMed

We cannot just point to the facts to solve a medical debate. The use of evidence is itself a matter of values. What the evidence tells us to do tends to depend on what we see as important. PMID:24532448

Ghinea, Narcyz; Lipworth, Wendy; Kerridge, Ian; Little, Miles; Day, Richard O

2014-01-01

307

21A.215 Medical Anthropology: Culture, Society, and Ethics in Disease and Health, Fall 2008  

E-print Network

This course looks at medicine from a cross-cultural perspective, focusing on the human, as opposed to biological, side of things. Students learn how to analyze various kinds of medical practice as cultural systems. Particular ...

Jackson, Jean

308

Medical Students' Views on the White Coat: A South African Perspective on Ethical Issues  

Microsoft Academic Search

There is a debate regarding the use of the white coat, a traditional symbol of the medical profession, by students. In a study evaluating final-year South African medical students' perceptions, the white coat was associated with traditional symbolic values (e.g., trust) and had practical uses (e.g., identification). The coat was generally perceived to evoke positive emotions in patients, but some

Michelle McLean; Soornarain S. Naidoo

2007-01-01

309

An obstructed death and medical ethics -- a case conference revisited: commentary 2  

Microsoft Academic Search

The dilemma of whether or not a doctor should tell a patient dying of cancer the truth remains a difficult one, as the disagreement between the two previous writers shows. One favours giving priority to patient autonomy, the other feels the doctor's duty of beneficence should be the overriding principle governing such decisions. To this contributor it seems both approaches

Roger Higgs

1990-01-01

310

Ethical Questions for Teachers: A Case Study Approach.  

ERIC Educational Resources Information Center

This paper examines the appropriateness of the case study approach, commonly used in medical and law schools, for prospective and inservice teachers in schools of education. Developing courses in which case studies would be used to illustrate moral dilemmas would aid teachers in examining their ethical principles, weighing moral issues, and…

Kasprisin, Lorraine

311

Principles of Pedagogy in Teaching in a Diverse Medical School: The University of Capetown South Africa Medical School.  

ERIC Educational Resources Information Center

This paper describes a 2-month project developed by the Sage Colleges (New York) and the University of Capetown Medical School in South Africa to help the medical faculty at the Capetown Medical School teach its newly diverse student body. The program is intended to improve student retention and it emphasizes the need for faculty to assure…

Rothenberg, Julia Johnson; Holland, Errol

312

End-of-Life Decisions about Withholding or Withdrawing Therapy: Medical, Ethical, and Religio-Cultural Considerations  

PubMed Central

Towards the end of life, physicians face dilemmas of discontinuing life-sustaining treatments or interventions. In some circumstances, these treatments are no longer of benefit, while in others the patient or family no longer want them. The physician plays an essential role in clarifying the goals of medical treatment, defining the care plan, initiating discussions about life-sustaining therapy, educating patients and families, helping them deliberate, making recommendations, and implementing the treatment plan. Communication is key. It should be clarified that when inevitable death is imminent, it is legitimate to refuse or limit forms of treatment that would only secure a precarious and burdensome prolongation of life, for as long as basic humane, compassionate care is not interrupted. Agreement to DNR status does not preclude supportive measures that keep patients free from pain and suffering as possible. Acceptable clinical practice on withdrawing or withholding treatment is based on an understanding of the medical, ethical, cultural, and religious issues. There is a need to individualize care option discussions to illness status, and patient and family preferences, beliefs, values, and cultures. The process of shared decision making between the patient, the family, and the clinicians should continue as goals evolve and change over time. PMID:25278756

Manalo, Maria Fidelis C

2013-01-01

313

Preconception sex selection for non-medical and intermediate reasons: ethical reflections  

PubMed Central

Sex selection for non-medical reasons is forbidden in many countries. Focusing on preconception sex selection, the authors first observe that it is unclear what should count as a ‘medical reason’ in this context and argue for the existence of ‘intermediate reasons’ that do not fit well within the rigid distinction between ‘medical’and ‘non-medical’. The article further provides a critical review of the arguments for the prohibition of sex selection for non-medical reasons and finds that none of these are conclusive. The authors conclude that the ban should be reconsidered, but also that existing­­ societal concerns about possible harmful effects should be taken seriously. Measures to this effect may include limiting the practice to couples who already have at least one child of the sex opposite to that which they now want to select (‘family balancing’). Finally, a difficult set of questions is raised by concerns about the reliability and unproven (long-term) safety of the only technology (flow cytometry) proven to work. PMID:25009714

de Wert, G.; Dondorp, W.

2010-01-01

314

Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense - A legal perspective  

PubMed Central

A patient approaching a doctor expects medical treatment with all the knowledge and skill that the doctor possesses to bring relief to his medical problem. The relationship takes the shape of a contract retaining the essential elements of tort. A doctor owes certain duties to his patient and a breach of any of these duties gives a cause of action for negligence against the doctor. The doctor has a duty to obtain prior informed consent from the patient before carrying out diagnostic tests and therapeutic management. The services of the doctors are covered under the provisions of the Consumer Protection Act, 1986 and a patient can seek redressal of grievances from the Consumer Courts. Case laws are an important source of law in adjudicating various issues of negligence arising out of medical treatment. PMID:19881134

Pandit, M. S.; Pandit, Shobha

2009-01-01

315

Ethics in sports medicine.  

PubMed

All physicians are faced at some time with fundamental challenges while striving to respect the principle canons which define a physician's ethical code. These canons are: 1. Primacy of patient interests, 2. Patient confidentiality, 3, Informed consent, and 4. Maintenance of a high standard of care. Athletes, because of their focus on performance, often present unique situations which lead to ethical challenges not seen in the general patient population. Adherence to the four principle ethical canons guides physicians to make ethical decisions when dealing with these unique patients. PMID:22894696

Murthy, Anjali M; Dwyer, James; Bosco, Joseph A

2012-01-01

316

The Percutaneous Endoscopic Gastrostomy Tube: Medical and Ethical Issues in Placement  

Microsoft Academic Search

OBJECTIVE:Offering and recommending PEG tube placement to patients has been a topic of considerable interest in the medical literature. The role of individual health care professionals in the decision making process is poorly defined. PEG tubes are often placed inappropriately because of unrealistic and inaccurate expectations of what they can accomplish in patients unable to tolerate adequate oral intake. We

Floyd Angus; Robert Burakoff

2003-01-01

317

Disability, Technology, and Place: Social and Ethical Implications of Long-Term Dependency on Medical Devices  

Microsoft Academic Search

Medical technologies and assistive devices such as ventilators and power wheelchairs are designed to sustain life and\\/or improve functionality but they can also contribute to stigmatization and social exclusion. In this paper, drawing from a study of ten men with Duchenne muscular dystrophy, we explore the complex social processes that mediate the lives of persons who are dependent on multiple

B. E. Gibson; R. E. G. Upshur; N. L. Young; P. McKeever

2007-01-01

318

[Ethical aspects in end-of-life care].  

PubMed

Therapy decisions in the care of critically ill and dying patients in intensive care and emergency medicine must reflect probably conflicting issues of medical indications, ethics and law. This is of particular relevance when treatment preferences of patients are not known or are in contrast to those of the carers. Difficulties regarding prognostication or with determining the beginning of an irreversible dying process may also lead to treatment situations that need ethical reflection. It is recommended to tackle medico-ethical issues by discussion of the meaning of relevant terms and medico-ethical principles, analyzing the professional self-image in intensive care and emergency medicine, consideration of options of palliative medicine and by use of an ethics case consultation. PMID:22038639

Nauck, F

2011-10-01

319

The ethics of policy writing: how should hospitals deal with moral disagreement about controversial medical practices?  

PubMed Central

Every healthcare organisation (HCO) enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it. Using, as an example, the controversy about patient's refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency. Policy writing for morally controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO's obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy. PMID:16199594

Winkler, E

2005-01-01

320

Ethical Issues in Outsourcing: The Case of Contract Medical Research and the Global Pharmaceutical Industry  

Microsoft Academic Search

The outsourcing of medical research has become a strategic imperative in the global pharmaceutical industry. Spurred by the\\u000a challenges of competition, the need for speed in drug development, and increasing domestic costs, pharmaceutical companies\\u000a across the globe continue to outsource critical parts of their value chain activities, namely contract clinical research and\\u000a drug testing, to sponsors across the globe, typically

Henry Adobor

2012-01-01

321

Ethical and legal implications of the risks of medical tourism for patients: a qualitative study of Canadian health and safety representatives' perspectives  

PubMed Central

Objectives Medical tourism involves patients’ intentional travel to privately obtain medical care in another country. Empirical evidence regarding health and safety risks facing medical tourists is limited. Consideration of this issue is dominated by speculation and lacks meaningful input from people with specific expertise in patient health and safety. We consulted with patient health and safety experts in the Canadian province of British Columbia to explore their views concerning risks that medical tourists may be exposed to. Herein, we report on the findings, linking them to existing ethical and legal issues associated with medical tourism. Design We held a focus group in September 2011 in Vancouver, British Columbia with professionals representing different domains of patient health and safety expertise. The focus group was transcribed verbatim and analysed thematically. Participants Seven professionals representing the domains of tissue banking, blood safety, health records, organ transplantation, dental care, clinical ethics and infection control participated. Results Five dominant health and safety risks for outbound medical tourists were identified by participants: (1) complications; (2) specific concerns regarding organ transplantation; (3) transmission of antibiotic-resistant organisms; (4) (dis)continuity of medical documentation and (5) (un)informed decision-making. Conclusions Concern was expressed that medical tourism might have unintended and undesired effects upon patients’ home healthcare systems. The individual choices of medical tourists could have significant public consequences if healthcare facilities in their home countries must expend resources treating postoperative complications. Participants also expressed concern that medical tourists returning home with infections, particularly antibiotic-resistant infections, could place others at risk of exposure to infections that are refractory to standard treatment regimens and thereby pose significant public health risks. PMID:23396563

Crooks, Valorie A; Turner, Leigh; Cohen, I Glenn; Bristeir, Janet; Snyder, Jeremy; Casey, Victoria; Whitmore, Rebecca

2013-01-01

322

Ethical challenges of medicine and health on the Internet: a review.  

PubMed

Knowledge and capabilities, particularly of a new technology or in a new area of study, frequently develop faster than the guidelines and principles needed for practitioners to practice ethically in the new arena; this is particularly true in medicine. The blending of medicine and healthcare with e-commerce and the Internet raises many questions involving what sort of ethical conduct should be expected by practitioners and developers of the medical Internet. Some of the early pioneers in medical and healthcare Web sites pushed the ethical boundaries with questionable, even unethical, practices. Many involved with the medical Internet are now working to reestablish patient and consumer trust by establishing guidelines to determine how the fundamentals of the medical code of ethical conduct can best be adapted for the medical/healthcare Internet. Ultimately, all those involved in the creation, maintenance, and marketing of medical and healthcare Web sites should be required to adhere to a strict code of ethical conduct, one that has been fairly determined by an impartial international organization with reasonable power to regulate the code. This code could also serve as a desirable, recognizable label-of-distinction for ethical Web sites within the medical and healthcare Internet community. One challenge for those involved with the medical and healthcare Internet will be to determine what constitutes "Medical Internet Ethics" or "Healthcare Internet Ethics," since the definition of medical ethics can vary from country to country. Therefore, the emerging field of Medical/ Healthcare Internet Ethics will require careful thought and insights from an international collection of ethicists in many contributing areas. This paper is a review of the current status of the evolving field of Medical/Healthcare Internet Ethics, including proposed definitions and identification of many diverse areas that may ultimately contribute to this multidisciplinary field. The current role that medicine and health play in the growing area of Internet communication and commerce and many of the ethical challenges raised by the Internet for the medical community are explored and some possible ways to address these ethical challenges are postulated. PMID:11720965

Dyer, K A

2001-01-01

323

Managing hypertension: drugs, life-style manipulation or benign neglect? Medical, ethical and economic considerations.  

PubMed

Antihypertensive drugs have been of major benefit to people with moderate or severe hypertension and have contributed enormously to fundamental physiological knowledge. Antihypertensive therapy in milder hypertension reduces the incidence of stroke by 40% or more, may reduce myocardial infarction and prevents progression to more severe hypertension or heart failure but is being criticised as not cost-effective. Much of this criticism is based on deductions from inappropriate data. Nevertheless, it is likely that money is in some cases being wasted on the treatment of people who were not truly hypertensive in the first place. It is also likely that drug dosage is often unnecessarily high. Clearly it is vital that treatment is delivered as economically as possible. A reduction in the prevalence of hypertension would be the best way to reduce costs. Obesity and a high alcohol intake are associated with a higher blood pressure at any age. A high salt intake throughout life appears to be associated with a rise in blood pressure in the second half of life and may well be the main factor in hypertension. A radical rethinking of the method of pricing of medical care should be considered, so as to provide incentives to people to adopt life-style measures that lead to avoidance of hypertension (and other cardiovascular risk factors) or, in established hypertension, to a reduction in the need for medication. PMID:2126730

Simpson, F O

1990-10-01

324

Parental role in medical decision-making: fact or fiction? A comparative study of ethical dilemmas in French and American neonatal intensive care units  

Microsoft Academic Search

Neonatal intensive care has been studied from an epidemiological, ethical, medical and even sociological perspective, but little is known about the impact of parental involvement in decision-making, especially in critical cases. We rely here on a comparative, case-based approach to study the parental role in decision-making within two technologically identical but culturally and institutionally different contexts: France and the United

Kristina Orfali

2004-01-01

325

Freedom of access: ethical dilemmas for Internet librarians  

Microsoft Academic Search

Libraries depend on ethical principles more than any other institution because library services are essentially human-oriented. Most national ethical principles for librarians are represented as professional ethic codes. Each of them eventually consolidates the ideology, the paradigm of national library services. Comparative analysis of national library ethic codes indicates the intellectual freedom principle as the key point and the superior

Irina Trushina

2004-01-01

326

[Paracelsianism, astrology and medical ethics in the polemical writings of Tommaso Bovio (1521-1609)].  

PubMed

Tommaso Bovio was a representative of North Italian non-academic medicine in the early modern period. His "dialogues", published in the second half of the 16th century, were written in the Italian vernacular and enjoyed a certain popularity also in Germany. Although Bovio used to exaggerate for rhetorical effect, his portrayal of patients, illness and treatments provides interesting insights into everyday urban life in his time. Sympathising with Paracelsus, Bovio propagated an image of empirics as humanitarians and fought for the recognition of his own practical knowledge and skills. Bovio was a most original figure in the medicine of the period of counter reformation. His writings exemplify the lively debate between the learned medical tradition and unorthodox reform. PMID:15015853

Bondio, Mariacarla Gadebusch

2004-01-01

327

[Ethical medicine in Paracelsus].  

PubMed

The last decades have been an increasing interest in medical ethics. Paracelsus occupies an important place in the development of ethics in medicine in the crucial cultural passage between Middle Ages and Renaissance. Paracelsus' biography is in itself connected with ethical choices and theories. In his medical doctrines ethics is rooted in the belief in a strict correspondence between micro- and macrocosmos. Love is the basis on which a correct doctor-patient relationship can be built. Ilnesses are but episodes in the human life, and care for both spiritual and bodily health should dominate the entire life, and not ony the crucial moments of birth, sickness and death. PMID:11619967

Engelhardt, D V

1997-01-01

328

Medical Scientists  

MedlinePLUS

... Those who go to medical school spend most of the first 2 years in labs and classrooms, taking courses such as anatomy, biochemistry, physiology, pharmacology, psychology, microbiology, pathology, medical ethics, and medical law. They ...

329

A quick guide to ethical theory in healthcare: solving ethical dilemmas in nutrition support situations.  

PubMed

Ethical dilemmas can be challenging for the nutrition support clinician who is accustomed to evidence-based practice. The emotional and personal nature of ethical decision making can present difficulties, and conflict can arise when people have different ethical perspectives. An understanding of ethical terms and ethical theories can be helpful in clarifying the source of this conflict. These may include prominent ethical theories such as moral relativism, utilitarianism, Kantian absolutism, Aristotle's virtue ethics and ethics of care, as well as the key ethical principles in healthcare (autonomy, beneficence, nonmaleficence, and justice). Adopting a step-by-step approach can simplify the process of resolving ethical problems. PMID:16556920

Ferrie, Suzie

2006-04-01

330

Living Organ Donation: An Ethical Evolution or Evolution of Ethics?  

PubMed Central

The disparity between available and needed organs is rapidly increasing, and the number of patients dying while still on the waiting list is growing exponentially. As a partial solution to this disparity, living unrelated transplantation is being performed more frequently, and some have proposed providing financial incentives to donors. The aim of this discussion is to illustrate that with an ever-increasing number of living unrelated transplantations, society and the transplant community should adopt a more active role in developing specific strategies to scrutinize the process. The current paper will also examine the viewpoint that medical ethics is not separable from the prevailing needs of society and involves a constant balancing of often opposing goods. Issues surrounding living unrelated donor transplantation illustrate ethics as a dynamically evolving field, which is often influenced by necessity and which evolves with progression of science and society. As part of this evolution, it is the collective responsibility of society and the transplant community to devise safeguards to guarantee adherence to basic principles of ethics and to avoid “situational ethics.” PMID:25013566

Ghahramani, N.

2010-01-01

331

Observations on ethical problems and terminal care.  

PubMed Central

Progress in medical diagnosis and therapy has raised new problems with far-reaching ethical implications. Medicine must remain a profession and not become a business. Textbooks must address ethical problems in the context of health care decisions and not restrict themselves to pathophysiology and practical therapeutics alone. The relative roles of the principles of autonomy, non-maleficence, beneficence, and justice must be balanced and appropriately applied to individual situations in biomedical ethics. When therapy becomes futile and the suffering of the patient does not justify any anticipated benefit, the patient (and/or patient surrogate) may request withholding or even withdrawing life-prolonging interventions. In the persistent vegetative state, even nutritional support by an unnatural (tube) route may ethically be denied at the patient's (or surrogate's) informed decision. New areas of ethical evaluation have been raised by the desire of some individuals to prolongation of their lives at high expense to the society such that other individuals are denied services because of limitation of available resources. There has been a long-standing conflict of interest between the acceptance by physicians and/or medical institutions of money or gifts from pharmaceutical companies whose drugs they prescribe, stock, or sell. This practice increases the cost of the drugs and is, in effect, a "sick tax," which is morally wrong. PMID:1519374

Fischer, D. S.

1992-01-01

332

Coordinating the norms and values of medical research, medical practice and patient worlds--the ethics of evidence based medicine in orphaned fields of medicine  

PubMed Central

It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients. PMID:15082811

Vos, R; Willems, D; Houtepen, R

2004-01-01

333

Pharmacy measures to improve medication use through health-literacy principles.  

PubMed

More than 90 million Americans have trouble understanding basic health information. Patients with inadequate health literacy encounter problems when trying to understand information related to medication. Consequently, this population has a greater chance of not using pharmaceuticals properly, resulting in poor clinical outcomes. Health care professionals, particularly pharmacists, should improve communication efforts with low-health literacy patients to achieve optimal results. This review examines the relationship between health literacy and medication use with the goals of helping the reader understand how to improve medication adherence and decrease adverse events from improper medication use. PMID:18405206

Safeer, Richard S; Cooke, Catherine E; Robertson, Teisha A

2007-10-01

334

Ethical Considerations of Community-based Participatory Research: Contextual Underpinnings for Developing Countries  

PubMed Central

Background: The nature of community-based participatory research (CBPR) poses distinctive ethical challenges. In the absence of organized guidelines, a remarkable amount of researchers’ time and energy will be spent tackling these ethical challenges. The study aimed to explore ethical issues and principles potentially arising when conducting CBPR. Methods: This qualitative study conducted in CBPR Center of Tehran University of Medical Sciences. Required data were gathered through systematic literature review and semi-structured interviews. Representatives of community, academia, and nongovernmental organizations (NGOs) participated in our study. Ten interviews with representatives of partner organizations, four group interviews with academic staff, and four with representatives of community were conducted. Repeated thematic analysis was used to elicit ethics-related overarching themes from transcribed interviews. As recommendations, these themes were then organized into a set of CBPR-related ethical issues and principles. Results: Four CBPR ethical guidelines (including 173 articles) were selected from a systematic review. Overarching themes relating to ethical principles which emerged from interviews were as follows: Trust, transparency and accountability, equity and inclusion, power imbalance, tolerance and conflict management, and attention to cultural sensitivity. Practical principles that emerged included: Consensus rather than informed consent, ownership of data and research achievements, and sustainability and maintenance of relationships. According to findings and in comparison to international guidelines, the present study put more emphasis on cultural sensitivity and sustainability as CBPR ethical tangles. Conclusions: Community-based participatory research ethical challenges are of the same kind in most parts of the world. However, some discrepancies exist that calls for local scrutiny. Future use and critic of current explored ethical issues and principles are highly encouraged. PMID:25400893

Jamshidi, Ensiyeh; Morasae, Esmaeil Khedmati; Shahandeh, Khandan; Majdzadeh, Reza; Seydali, Elham; Aramesh, Kiarash; Abknar, Nina Loori

2014-01-01

335

Ethics, Ethical Human Research and Human Research Ethics Committees  

ERIC Educational Resources Information Center

Non-medical research involves the same issues of justice, beneficence, and respect for persons that apply to non-medical research. It also may involve risk of harm to participants, and conflicts of interest for researchers. It is therefore not possible to argue that such research should be exempt from ethical review. This paper argues that…

Lindorff, Margaret

2010-01-01

336

Umbilical cord blood banks. Ethical aspects. Public versus private banks.  

PubMed

The creation of umbilical cord blood (UCB) banks raises interesting medical, social, economic and ethical issues. This paper reviews the ethical problems specifically. In this respect, it evaluates: a) whether there are advantages to the use of UCB compared to bone marrow, b) whether or not it is ethical to create UCB banks, c) whether their creation is ethically acceptable in terms of their clinical usefulness or d) the use made of them for therapeutic purposes, and finally e) whether their creation is ethically justified from a cost/profitability point of view. We focus primarily on evaluating the ethical controversy between public and private banks, particularly on whether it is ethical to bank autologous blood in private UCB banks, on the basis of its limited possibilities for use by the cord blood donor. We can conclude that, from an ethical point of view, autologous blood banks have limited acceptance among specialised researchers, scientific societies and other public institutions. Therefore, we believe that it is ethically more acceptable to support the creation of public UCB banks for medical and social reasons and, above all, based on the principle of justice and human solidarity. Nevertheless, there is no definitive ethical argument why a couple, according to their autonomy and freedom, cannot bank their child's UCB in a private bank. An equally acceptable solution could be the creation of mixed banks, such as that proposed by the Virgin Health Bank or like the Spanish system where autologous samples can be stored in public banks but with the proviso that if at any time the stored sample is required by any person other than the donor, it would have to be given to them. PMID:23130743

Aznar Lucea, Justo

2012-01-01

337

Teaching Ethics across the Public Relations Curriculum.  

ERIC Educational Resources Information Center

Suggests ways of incorporating ethics across the undergraduate public relations curriculum. Reviews current coverage of ethics in public relations principles, writing, cases, and textbooks. Suggests other methods that teachers can use to incorporate ethical pedagogical tools in all public relations courses in an effort to develop students' ethical

Hutchison, Liese L.

2002-01-01

338

What ethical and legal principles should guide the genotyping of children as part of a personalised screening programme for common cancer?  

PubMed

Increased knowledge of the gene-disease associations contributing to common cancer development raises the prospect of population stratification by genotype and other risk factors. Individual risk assessments could be used to target interventions such as screening, treatment and health education. Genotyping neonates, infants or young children as part of a systematic programme would improve coverage and uptake, and facilitate a screening package that maximises potential benefits and minimises harms including overdiagnosis. This paper explores the potential justifications and risks of genotyping children for genetic variants associated with common cancer development within a personalised screening programme. It identifies the ethical and legal principles that might guide population genotyping where the predictive value of the testing is modest and associated risks might arise in the future, and considers the standards required by population screening programme validity measures (such as the Wilson and Jungner criteria including cost-effectiveness and equitable access). These are distinguished from the normative principles underpinning predictive genetic testing of children for adult-onset diseases-namely, to make best-interests judgements and to preserve autonomy. While the case for population-based genotyping of neonates or young children has not yet been made, the justifications for this approach are likely to become increasingly compelling. A modified evaluative and normative framework should be developed, capturing elements from individualistic and population-based approaches. This should emphasise proper communication and genuine parental consent or informed choice, while recognising the challenges associated with making unsolicited approaches to an asymptomatic group. Such a framework would be strengthened by complementary empirical research. PMID:23454719

Hall, Alison Elizabeth; Chowdhury, Susmita; Pashayan, Nora; Hallowell, Nina; Pharoah, Paul; Burton, Hilary

2014-03-01

339

Ethical issues in organ transplantation.  

PubMed

Clinical organ transplantation has been recognized as one of the most gripping medical advances of the century as it provides a way of giving the gift of life to patients with terminal failure of vital organs, which requires the participation of other fellow human beings and of society by donating organs from deceased or living individuals. The increasing incidence of vital organ failure and the inadequate supply of organs, especially from cadavers, has created a wide gap between organ supply and organ demand, which has resulted in very long waiting times to receive an organ as well as an increasing number of deaths while waiting. These events have raised many ethical, moral and societal issues regarding supply, the methods of organ allocation, the use of living donors as volunteers including minors. It has also led to the practice of organ sale by entrepreneurs for financial gains in some parts the world through exploitation of the poor, for the benefit of the wealthy. The current advances in immunology and tissue engineering and the use of animal organs, xenotransplantation, while offering very promising solutions to many of these problems, also raise additional ethical and medical issues which must be considered by the medical profession as well as society. This review deals with the ethical and moral issues generated by the current advances in organ transplantation, the problem of organ supply versus organ demand and the appropriate allocation of available organs. It deals with the risks and benefits of organ donation from living donors, the appropriate and acceptable methods to increase organ donation from the deceased through the adoption of the principle of 'presumed consent', the right methods of providing acceptable appreciation and compensation for the family of the deceased as well as volunteer and altruistic donors, and the duties and responsibilities of the medical profession and society to help fellow humans. The review also deals with the appropriate and ethically acceptable ways of utilizing the recent advances of stem cell transplantation from adult versus fetal donors, tissue engineering and the use of organs from animals or xenotransplantation. Data provided in support of the concept that clinical organ and tissue transplantation can be more beneficial and life saving if everyone involved in the process, including physicians and medical institutions, respect and consider the best interests of the patients, as well as honor the ethical, moral and religious values of society and are not tempted to seek personal fame or financial rewards. PMID:12566971

Abouna, George M

2003-01-01

340

Psychological and ethical implications related to infertility.  

PubMed

Being a parent is deeply demanding and one of the most important events in life; parents experience the deepening of human relationships with their partner, within their families, and in society, and moreover the fundamental relationship between parent and child. Every medical, social, and political effort must be made to prevent infertility but also to offer infertile couples the best diagnostic and therapeutic paths. Understanding the suffering of the couple and their families prevents and helps ease the possible psychological and social complications of infertility. Therefore, infertility concerns not only biomedical sciences but also psychological and social ones-ethics and law-in their combined efforts to identify areas of understanding and of research for solutions while respecting the dignity of the couple and unborn child. The Catholic Church offers an ongoing contribution through dialogue in looking for ethical principles guiding scientific and medical research respectful of the true life of human beings. PMID:24156989

Minucci, Daria

2013-12-01

341

Medical Error, Malpractice and Complications: A Moral Geography  

Microsoft Academic Search

This essay reviews and defines avoidable medical error, malpractice and complication. The relevant ethical principles pertaining\\u000a to unanticipated medical outcomes are identified. In light of these principles I critically review the moral culpability of\\u000a the agents in each circumstance and the resulting obligations to patients, their families, and the health care system in general.\\u000a While I touch on some legal

David M. Zientek

2010-01-01

342

Perspectives on key principles of generalist medical practice in public service in sub-saharan africa: a qualitative study  

PubMed Central

Background The principles and practice of Family Medicine that arose in developed Western countries have been imported and adopted in African countries without adequate consideration of their relevance and appropriateness to the African context. In this study we attempted to elicit a priori principles of generalist medical practice from the experience of long-serving medical officers in a variety of African counties, through which we explored emergent principles of Family Medicine in our own context. Methods A descriptive study design was utilized, using qualitative methods. 16 respondents who were clinically active medical practitioners, working as generalists in the public services or non-profit sector for at least 5 years, and who had had no previous formal training or involvement in academic Family Medicine, were purposively selected in 8 different countries in southern, western and east Africa, and interviewed. Results The respondents highlighted a number of key issues with respect to the external environment within which they work, their collective roles, activities and behaviours, as well as the personal values and beliefs that motivate their behaviour. The context is characterized by resource constraints, high workload, traditional health beliefs, and the difficulty of referring patients to the next level of care. Generalist clinicians in sub-Saharan Africa need to be competent across a wide range of clinical disciplines and procedural skills at the level of the district hospital and clinic, in both chronic and emergency care. They need to understand the patient's perspective and context, empowering the patient and building an effective doctor-patient relationship. They are also managers, focused on coordinating and improving the quality of clinical care through teamwork, training and mentoring other health workers in the generalist setting, while being life-long learners themselves. However, their role in the community, was found to be more aspirational than real. Conclusions The study derived a set of principles for the practice of generalist doctors in sub-Saharan Africa based on the reported activities and approaches of the respondents. Patient-centred care using a biopsychosocial approach remains as a common core principle despite wide variations in context. Procedural and hospital care demands a higher level of skills particularly in rural areas, and a community orientation is desirable, but not widely practiced. The results have implications for the postgraduate training of family physicians in sub-Saharan Africa, and highlight questions regarding the realization of community-orientated primary care. PMID:21726454

2011-01-01

343

Principles of medicating children with neurodevelopmental and sleep disorders--a review.  

PubMed

Conflict between the demands of the environment in which a child lives and the child's intrinsic sleep signature, produces stress-behaviour difficulties in the child. Distorted development, especially distorted brain development, often leads to distorted intrinsic sleep signatures. The sleep-behaviour outcome, arising from the conflict between each child's sleep signature and the environmental niche in which they live, can be modified by medications, on the one hand, and taking the role of kin, peer and social networks seriously. Medications alter the intrinsic sleep signature of the child and the stress response. Non-medical interventions address the demands and constraints of the child's environmental niche. When the main medication strategy to address distorted sleep involves brain stimulation, those children that do not respond will often need a reversal of medication priorities; an inhibitory strategy as a short to medium term support, sleep regulation being primary for longer term management, and stimulatory strategies used sparingly, if at all. We are often dealing with vulnerable populations, not all of which are reliable or accurate sources of information. Features of a presentation alerting the clinician to non-medication factors contributing to the failure of treatment are discussed. PMID:24055010

Nunn, Kenneth

2014-03-01

344

Distribution of Problems, Medications and Lab Results in Electronic Health Records: The Pareto Principle at Work  

PubMed Central

Background Many natural phenomena demonstrate power-law distributions, where very common items predominate. Problems, medications and lab results represent some of the most important data elements in medicine, but their overall distribution has not been reported. Objective Our objective is to determine whether problems, medications and lab results demonstrate a power law distribution. Methods Retrospective review of electronic medical record data for 100,000 randomly selected patients seen at least twice in 2006 and 2007 at the Brigham and Women’s Hospital in Boston and its affiliated medical practices. Results All three data types exhibited a power law distribution. The 12.5% most frequently used problems account for 80% of all patient problems, the top 11.8% of medications account for 80% of all medication orders and the top 4.5% of lab result types account for all lab results. Conclusion These three data elements exhibited power law distributions with a small number of common items representing a substantial proportion of all orders and observations, which has implications for electronic health record design. PMID:21991298

Wright, Adam; Bates, David W.

2010-01-01

345

Phase aberration correction using near-field signal redundancy. I. Principles [Ultrasound medical imaging  

Microsoft Academic Search

The signal redundancy principle in the near field is analyzed quantitatively. It is found that common midpoint signals are not identical (or redundant) for echoes coming from arbitrary target distributions in the near field. A dynamic near-field correction is proposed to reduce the difference between common midpoint signals for echoes coming from the region of interest. When phase aberrations are

Yue Li

1997-01-01

346

Biomedical Ethics & Medical Humanities  

E-print Network

students to reflect on, analyze and contribute to the meaning of medicine by focusing on one (or more, philosophy, history, religion, and the arts (visual, theatre, media), as well as humanities-oriented social of medicine; issues of health care access and public health policy; doctor-patient relationship

Ford, James

347

Principles and Paradigms Used in Human Medical Ethics Can Be Used as Models for the Assessment of Animal Research  

Microsoft Academic Search

The preparation of the Obrink Memorial Lecture for presen- tation to the Scandinavian Association of Laboratory Animal Science (1) provided me with an impetus for further reading and thinking about IACUC review of research protocols using animals. One of the primary responsibilities of laboratory ani- mal specialists and comparative medicine scientists is to bridge the worlds of the investigator, the

Gerald L. Van Hoosier

348

American Medical Association  

MedlinePLUS

... Have a hand in shaping updated Code of Medical Ethics A vision for a healthier nation From advocating ... language to describe healthcare services. AMA Code of Medical Ethics Since 1847, the AMA has provided guidance on ...

349

General medicine and surgery for dental practitioners: part 2. Medical emergencies in dental practice: the drug box, equipment and basic principles of management.  

PubMed

Dental practitioners need knowledge of the diagnosis and management of medical emergencies. This paper deals with the general aspects of emergency treatment including basic management principles which are applicable to all emergencies. The next paper in this series, part 3, deals with more specific aspects of medical emergency management. PMID:24923938

Greenwood, M; Meechan, J G

2014-06-13

350

The role of empirical Bayes methodology as a leading principle in modern medical statistics.  

PubMed

This paper reviews and discusses the role of Empirical Bayes methodology in medical statistics in the last 50 years. It gives some background on the origin of the empirical Bayes approach and its link with the famous Stein estimator. The paper describes the application in four important areas in medical statistics: disease mapping, health care monitoring, meta-analysis, and multiple testing. It ends with a warning that the application of the outcome of an empirical Bayes analysis to the individual "subjects" is a delicate matter that should be handled with prudence and care. PMID:25205521

van Houwelingen, Hans C

2014-11-01

351

Public Health Ethics: Establishing “Durable Solutions” Within the Global Polio Eradication Initiative in Nigeria  

Microsoft Academic Search

Discussions on public health ethics often appeal to the same codes of conduct established in the field of bioethics. Principles of bioethics contribute to the morality of the study of public health—proposing an optimal code of conduct in the medical care and human research aspects of the field. For example, public health researchers are aware of their obligations to consider

Tiffany T. Mason

2009-01-01

352

The Ethical Use of Placebo Controls in Clinical Research: The Declaration of Helsinki  

Microsoft Academic Search

Medical ethicists have questioned the use of no-treatment (placebo and sham procedure) controlled studies of new therapies when safe and effective standard therapies are available for use as an active or “equivalence” control. Current ethical principles of conduct for biomedical research specifically prohibit designs that withhold or deny “the best proven diagnostic and therapeutic” treatment to any participant in a

Theodore J. La Vaque; Thomas Rossiter

2001-01-01

353

Problems for clinical judgement: 5. Principles of influence in medical practice  

Microsoft Academic Search

THE BASIC SCIENCE OF PSYCHOLOGY HAS IDENTIFIED specific ingrained responses that are fundamental elements of human nature, underpin common influence strategies and may apply in medical settings. People feel a sense of obligation to repay a per- ceived debt. A request becomes more attractive when preceded by a marginally worse request. The drive to act consistently will persist even if

Donald A. Redelmeier; Robert B. Cialdini

354

An innovative outcomes-based medical education program built on adult learning principles  

Microsoft Academic Search

An innovative medical curriculum at the University of New South Wales (UNSW) has been developed through a highly collaborative process aimed at building faculty ownership and ongoing sustainability. The result is a novel capability-based program that features early clinical experience and small-group teaching, which offers students considerable flexibility and achieves a high degree of alignment between graduate outcomes, learning activities

H. Patrick McNeil; Chris S. Hughes; Susan M. Toohey; S. Bruce Dowton

2006-01-01

355

'I'm more sick than my doctors think': ethical issues in managing somatization in developing countries.  

PubMed

Several ethical issues confront the healthcare professional who is managing somatization in developing countries where cost constraints, low literacy, poverty, poor nutrition and infections and inadequate access to healthcare are common. The paper discusses these in the context of the ethical principles of autonomy, beneficence, non-maleficence and justice. Some of the ethical issues in managing somatization include being influenced by patient distress rather than rational medical decision-making, inadequate attention to the cultural meaning of symptoms, psychologizing versus medicalizing, the ethics of nomenclature and labels, communicating ethically with patients, and managing them adequately given lack of evidence and training. An ethical approach to managing somatization in this context would include using an integrated and simultaneous medical and psychiatric approach. To ensure patient beneficence, the medical, psychological and social assessment should be undertaken side-by-side as much as possible and should be cost effective. Respecting patient autonomy by using adequate communication methods and the patient's cultural model of the illness as part of management is also integral to ethical practice. In the developing world, issues of equity are also an important ethical concern. When more serious illnesses are the health priority, functional syndromes may not get equal importance or resources. PMID:23383669

Chandra, Prabha S; Satyanarayana, Veena A

2013-02-01

356

Contribution Towards a Phenomenological Approach to Business Ethics  

Microsoft Academic Search

There is a crisis in business ethics. In part, this crisis stems from the prevailing method of applying ethical theories to business issues. In most cases, applied business ethics extracts the basic principles from an ethical theory ? usually Aristotle’s virtue ethics, Kant’s metaphysics of morals, or Mill’s utilitarianism ? and uses these concepts as so many tools with which

Stephen Meinster

357

Towards a definition of health informatics ethics  

Microsoft Academic Search

Information technology is a prominent tool in healthcare management. However, healthcare systems often fall short of addressing concerns about privacy, confidentiality and safety of information. Even though there is existing literature on ethical issues in medicine, as well as ethics in computing, information technology in medicine leads to new ethical issues that are not covered by medical or computing ethics.

Hamman W. Samuel; Osmar R. Zaïane; Dick Sobsey

2010-01-01

358

Transcranial magnetic stimulation, deep brain stimulation and personal identity: ethical questions, and neuroethical approaches for medical practice.  

PubMed

Neurotechnology provides means to engage micro- and macrostructural networks of the brain to both mitigate the manifestations of several neurological and psychiatric disorders, and alter cognition and motoric activity. Such capacity also generates questions of how these interventions may affect personal identity. This paper discusses the ethical implications regarding changes to personal identity that arise from the therapeutic use of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) technologies. In addition, we raise the question of whether changes in personal identity, as a side effect of these interventions, are ethically acceptable and whether such alterations of personality foster patients' sense of well-being and autonomy. First, we provide a series of case vignettes that afford an overview of the ways that various neurological interventions can affect personal identity. Second, we offer a brief working definition of personal identity in order to delineate an ethical framework that we deem necessary for the responsible use of neurostimulation technologies. In so doing, we argue that neurostimulation therapy, as a doctoring act, should be directed, and adherent to goals of restoring and/or preserving patients' personal identity. To this end, we offer an ethical framework that we believe enables sound decisions about the right and good use of TMS and DBS. PMID:22200137

Jotterand, Fabrice; Giordano, James

2011-10-01

359

Medical Education and the Pharmaceutical Industry: A Review of Ethical Guidelines and Their Implications for Psychiatric Training  

ERIC Educational Resources Information Center

Objective: This article reviews and summarizes eight ethical guidelines of major professional organizations regarding the pharmaceutical industry's role in the psychiatric education of trainees. Method: The author conducted a literature review of research and guidelines pertaining to the pharmaceutical industry's relationship to trainees, with…

Geppert, Cynthia M. A.

2007-01-01

360

Towards a Sexual Ethics for Adolescence  

ERIC Educational Resources Information Center

Which moral principles should guide us in evaluating sexual contacts of adolescents? This paper tries to answer this question by taking two steps. First, the implications of a liberal sexual ethics for adolescence are spelled out, assessed and refuted. The core principle of the liberal ethical view, the principle of valid consent, takes competence…

Steutel, Jan

2009-01-01

361

Towards a sexual ethics for adolescence  

Microsoft Academic Search

Which moral principles should guide us in evaluating sexual contacts of adolescents? This paper tries to answer this question by taking two steps. First, the implications of a liberal sexual ethics for adolescence are spelled out, assessed and refuted. The core principle of the liberal ethical view, the principle of valid consent, takes competence as a necessary condition of morally

Jan Steutel

2009-01-01

362

Bioethics in practice: Addressing ethically sensitive requests in a Dutch fertility clinic.  

PubMed

This article provides insight into how ethically sensitive requests for the use of assisted reproductive technologies (ARTs) are dealt within the daily practice of a Dutch fertility clinic. The findings presented are part of an ethnographic study conducted in this clinic from September 2003 until April 2005. Information for this article was gathered by attending the multidisciplinary ethics meetings and conversations with clinic staff. By looking at 'bioethics in practice', this article provides insight into the complex and dynamic interplay between particular couples' situations, contextual features, bioethical principles, doctors' subjective feelings and views, and the employment of medical practices. Our study suggests that personal views to a certain extent inform the agenda of the ethics meetings, but in the end neither these views nor bioethical principles fully determine the decisions made. Clinic staff members employ routine medical practices with the intention to carefully resolve ethically sensitive cases. These practices include: collegial consultation, searching for scientific evidence in the literature, obtaining more medical information, offering medical tests, referring couples to other clinics and ensuring informed consent. Rather than examining hypothetical cases, which evoke principles, observations of practices regarding real life cases of which many details are known, allowed us to identify the influence of routine medical practice on ethical decisions. Despite initial concerns from the side of the medical professionals (some of which might be regarded as paternalistic), at the end the reproductive autonomy of most couples seeking ARTs was not jeopardized. The format of the multidisciplinary ethics meetings seems to be promising as it provides a space for clinic staff members to express and reflect on their subjective views and feelings of unease regarding certain requests for ARTs, while at the same time it diminishes the risk that decision making is (too heavily) shaped by these feelings and views. PMID:23422313

Gerrits, Trudie; Reis, Ria; Braat, Didi D M; Kremer, Jan A M; Hardon, Anita P

2013-12-01

363

[Ethical issues of artificial nutritional support].  

PubMed

This review article discusses some ethical issues of clinical nutrition according to the Beauchamp and Childress principles of bioethics: "respect for autonomy, nonmaleficence, beneficence, and justice". PMID:24568858

Weimann, Arved

2014-03-01

364

Is mandatory research ethics reviewing ethical?  

PubMed

Review boards responsible for vetting the ethical conduct of research have been criticised for their costliness, unreliability and inappropriate standards when evaluating some non-medical research, but the basic value of mandatory ethical review has not been questioned. When the standards that review boards use to evaluate research proposals are applied to review board practices, it is clear that review boards do not respect researchers or each other, lack merit and integrity, are not just and are not beneficent. The few benefits of mandatory ethical review come at a much greater, but mainly hidden, social cost. It is time that responsibility for the ethical conduct of research is clearly transferred to researchers, except possibly in that small proportion of cases where prospective research participants may be so intrinsically vulnerable that their well-being may need to be overseen. PMID:22865925

Dyck, Murray; Allen, Gary

2013-08-01

365

Ethical Issues in End-of-Life Care.  

PubMed

BACKGROUND: Physicians who treat patients approaching the end of life often face moral, ethical, and legal issues involving shared decision making, futility, the right to refuse medical treatment, euthanasia, and physician-assisted suicide. METHODS: The author examines cases that involve these issues and also reviews the ethical principles that guide current medical practice. Issues such as end-of-life ethical questions, the right to life-sustaining therapy, medical futility, the distinction between killing and allowing to die, and physician-assisted suicide are discussed. RESULTS: The principal problem involves the appropriate use of technology at the end of life. While developments in technology have enhanced our ability to prolong life, issues have also arisen regarding the resulting quality of life, the sometimes marginal benefits to our patients, and the burdens that this technology imposes on patients, families, and society. CONCLUSIONS: Legal and ethical issues continue to confront patients, courts, and physicians. A better understanding of these issues and an awareness of the availability of effective palliative care will help physicians, patients, and families adequately address the end-of-life issues that are an intrinsic part of medical care. PMID:10758544

Walker

1999-03-01

366

The problem of 'thick in status, thin in content' in Beauchamp and Childress' principlism.  

PubMed

For many, Thomas Beauchamp and James Childress have elaborated moral reasoning by using the four principles whereby all substantive problems of medical ethics (and of ethics more generally) can be properly analysed and cogent philosophical solutions for the problems can be found. It seems that their 'principlism' gets updated, with better features being added during the course of the six editions of Principles of Biomedical Ethics. Nonetheless, Beauchamp and Childress seem to have been losing their way when it comes to the common-morality justification, which is the epistemological (and perhaps metaphysical) backbone of their method, and this is shown more vividly in their most recent (2009) edition of Principles of Biomedical Ethics. The author points out what he calls the problem of 'thick in status, thin in content' in principlism. The problem exists because principlism cannot adequately explain how the prescriptive sense of common morality it supports is consistent with the existence of what Beauchamp and Childress call the 'legitimate moral diversity in the world'. Because of this problem, first, the practical end that principlism allegedly accomplishes (ie, providing practical moral guidelines in a relatively 'thick' content, based on common morality) is frustrated, and, second, principlism makes itself the method of common morality de jure and of moral pluralism de facto. PMID:20817819

Lee, Marvin J H

2010-09-01

367

Imaginative ethics--bringing ethical praxis into sharper relief.  

PubMed

The empirical basis for this article is three years of experience with ethical rounds at Uppsala University Hospital. Three standard approaches of ethical reasoning are examined as potential explanations of what actually occurs during the ethical rounds. For reasons given, these are not found to be satisfying explanations. An approach called "imaginative ethics", is suggested as a more satisfactory account of this kind of ethical reasoning. The participants in the ethical rounds seem to draw on a kind of moral competence based on personal life experience and professional competence and experience. By listening to other perspectives and other experiences related to one particular patient story, the participants imagine alternative horizons of moral experience and explore a multitude of values related to clinical practice that might be at stake. In his systematic treatment of aesthetics in the Critique of Judgement, Kant made use of an operation of thought that, if applied to ethics, will enable us to be more sensitive to the particulars of each moral situation. Based on this reading of Kant, an account of imaginative ethics is developed in order to bring the ethical praxis of doctors and nurses into sharper relief. The Hebraic and the Hellenic traditions of imagination are used in order to illuminate some of the experiences of ethical rounds. In conclusion, it is argued that imaginative ethics and principle-based ethics should be seen as complementary in order to endow a moral discourse with ethical authority. Kantian ethics will do the job if it is remembered that Kant suggested only a modest, negative role of principle-based deliberation. PMID:11954992

Hansson, Mats G

2002-01-01

368

Is match ethics an oxymoron?  

Microsoft Academic Search

Background: Graduate medical education has undergone economic and structural changes—changes that have placed increasing pressure on medical students and programs to match effectively. This study documents the experiences, perceptions, and ethical dilemmas of medical students with the 1998 match process.Methods: Surveyed were 437 senior students from three medical schools. Students were questioned about: interviewing practices, communication with programs, commitments made,

Kimberly D Anderson; Donald M Jacobs; Amy V Blue

1999-01-01

369

The Ethics of Peer Review.  

ERIC Educational Resources Information Center

Discusses the need for a self-audit of the academic profession's ethics and peer culture, including clarifying the responsibilities of the profession and articulating the first principles of peer review. (EV)

Hamilton, Neil W.

2003-01-01

370

The ethics of health communication.  

PubMed

The scope of application of ethical principles in health communication is discussed with particular reference to the influence of the mass media on people's perceptions of benefit and risk in the field of health care. PMID:8018285

Strasser, T; Gallagher, J

1994-01-01

371

Ethical virtues in scientific research.  

PubMed

Most approaches to promoting integrity in research are principle-based in that they portray ethical conduct as consisting of adherence to ethical rules, duties, or responsibilities. Bruce MacFarlane has recently criticized the principle-based approach to promoting integrity in research and offered a virtue-based alternative. MacFarlane argues that principle-based approaches do not provide adequate guidance for ethical decision-making and are not very useful in moral education. In this article, I examine and critique MacFarlane's defense of the virtue-based approach. I argue that virtue-based and principle-based approaches to ethics are complementary and that they both can help promote research integrity. PMID:23074991

Resnik, David B

2012-01-01

372

Genetic counseling and the ethical issues around direct to consumer genetic testing.  

PubMed

Over the last several years, direct to consumer(DTC) genetic testing has received increasing attention in the public, healthcare and academic realms. DTC genetic testing companies face considerable criticism and scepticism,particularly from the medical and genetic counseling community. This raises the question of what specific aspects of DTC genetic testing provoke concerns, and conversely,promises, for genetic counselors. This paper addresses this question by exploring DTC genetic testing through an ethic allens. By considering the fundamental ethical approaches influencing genetic counseling (the ethic of care and principle-based ethics) we highlight the specific ethical concerns raised by DTC genetic testing companies. Ultimately,when considering the ethics of DTC testing in a genetic counseling context, we should think of it as a balancing act. We need careful and detailed consideration of the risks and troubling aspects of such testing, as well as the potentially beneficial direct and indirect impacts of the increased availability of DTC genetic testing. As a result it is essential that genetic counselors stay informed and involved in the ongoing debate about DTC genetic testing and DTC companies. Doing so will ensure that the ethical theories and principles fundamental to the profession of genetic counseling are promoted not just in traditional counseling sessions,but also on a broader level. Ultimately this will help ensure that the public enjoys the benefits of an increasingly genetic based healthcare system. PMID:22290190

Hawkins, Alice K; Ho, Anita

2012-06-01

373

Aristotle's ethical theory & modern health care.  

PubMed

The Greek physician of antiquity - Hippocrates (460-356 B.C.) is called the Father of Modern Medicine and the Hippocratic Oath to which doctors of modern medicine traditionally and formally express their allegiance, forms the basic foundation of medical ethics. The tradition of Western ethical philosophy began with the ancient Greeks. From Socrates (469-399 B.C.) and his immediate successors, Plato (427-347 B.C.) and Aristotle (384-322 B.C.), there is a clear line of continuity, through Hellenistic period (from the death of Alexander the Great (323 B.C.) to the end of Ptolemic dynasty (30 B.C.) and the Roman annexation of Egypt - broadly post-Aristotelian and medieval thought to the present day. But the society has qualitatively and quantitatively changed since the Industrial Revolution in the late 18th and 19th centuries. Society, today, is just a collection of discrete individuals, each with his or her own purposes and interests. Hence it has become almost imperative to apply the principle of autonomy to issues in the ethics of health care. The aim of this short essay is, therefore, an attempt to explore the relevance, if any, of Aristotelian ethical theory to the modern health care. PMID:11619400

Majumdar, S K

1996-01-01

374

Ethics and Culture in Mental Health Care  

Microsoft Academic Search

This article examines the complex relationship between culture, values, and ethics in mental health care. Cultural competence is a practical, concrete demonstration of the ethical principles of respect for persons, beneficence (doing good), nonmaleficence (not doing harm), and justice (treating people fairly)—the cornerstones of modern ethical codes for the health professions. Five clinical cases are presented to illustrate the range

Jinger G. Hoop; Tony DiPasquale; Juan M. Hernandez; Laura Weiss Roberts

2008-01-01

375

Resolving Ethical Issues When Conducting Sexuality Education  

Microsoft Academic Search

Ethical issues about conducting sexuality education often arise. This paper describes one system of ethics and how the sexuality educator can use that system to determine whether an action is moral or immoral and, therefore, the appropriate action to take for that sexuality educator to be consistent with his or her values. Ethical principles are presented along with examples of

Clint E. Bruess; Jerrold S. Greenberg

2008-01-01

376

Ethical Relationships between Instructor, Learner and Institution  

ERIC Educational Resources Information Center

Ethical relationships arise from the interaction of the student, instructor and institution. Teaching is viewed here as leadership based upon moral and ethical principles, as opposed to technical ones. Student participation in a course involves recognizing and resolving various ethical issues, some of which focus on the instructor's actions. The…

Haughey, Denis J.

2007-01-01

377

Medical marijuana: should minors have the same rights as adults?  

PubMed

After reviewing the pertinent scientific data, it is clear that there is more than sufficient medical and ethical evidence to warrant the Bush Administration to authorize the Drug Enforcement Agency to reclassify marijuana as a Schedule II drug so that it can be used for medical purposes. Failure to give an effective therapy to seriously ill patients, either adults or children, violates the core principles of both medicine and ethics. Medically, to deny physicians the right to prescribe to their patients a therapy that relieves pain and suffering violates the physician-patient relationship. Ethically, failure to offer an available therapy that has proven to be effective violates the basic ethical principle of nonmaleficence, which prohibits the infliction of harm, injury, or death and is related to the maxim primum non nocere ('above all, or first, do no harm'), which is widely used to describe the duties of a physician. Therefore, in the patient's best interest, patients and parents/surrogates, have the right to request medical marijuana under certain circumstances and physicians have the duty to disclose medical marijuana as an option and prescribe it when appropriate. The right to an effective medical therapy, whose benefits clearly outweigh the burdens, must be available to all patients including children. To deny children the use of medical marijuana when appropriate is a grave injustice which violates the basic foundational beliefs of both medicine and PMID:12824939

Clark, Peter A

2003-06-01

378

Ethics in practice: managed care and the changing health care environment: medicine as a profession managed care ethics working group statement.  

PubMed

Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues. PMID:15262669

Povar, Gail J; Blumen, Helen; Daniel, John; Daub, Suzanne; Evans, Lois; Holm, Richard P; Levkovich, Natalie; McCarter, Alice O; Sabin, James; Snyder, Lois; Sulmasy, Daniel; Vaughan, Peter; Wellikson, Laurence D; Campbell, Amy

2004-07-20

379

Council Adopts New AERA Code of Ethics: Ethics Committee to Emphasize Ethics Education  

ERIC Educational Resources Information Center

At its February 2011 meeting, the AERA Council adopted unanimously a new Code of Ethics. The Code articulates a set of standards for education researchers in education and provides principles and guidance by which they can build ethical practices in professional, scholarly, and scientific activities. The Code reflects the Association's strong…

Herrington, Carolyn D.

2011-01-01

380

Relational ethics and psychosomatic assessment.  

PubMed

The main ethical perspective in the clinical relationship takes into consideration the vulnerability of the clinical condition before threats and risks that can undermine the integrity and dignity of the person. Psychosomatic medicine faces complex cases whose ethical problems cannot only be solved by applying top-down deontological or utilitarian approaches, principlism, which is limited mainly to easing ethical tensions, or a bottom-up approach, the casuistic model, case-based reasoning. In introducing vulnerability as the core of ethical questioning as a principle ontological priority over other principles, relational ethics refers to the appreciation of the responsibility of health professionals through which a health care professional and the patient 'together' can construct more reasonable and prudential courses of action with, for, and by the patient. The model of relational ethics is based on three main aspects, clinically integrated approach, science/philosophy partnership, and deliberative process, that when taken together, form an intermediate model that ensures prudent and reasonable decision-making. The three structural elements and characteristics of relational ethics create and maintain a responsible relationship between the professional and the patient being aware that the mutual vulnerability of health professional and the patient has a moral value and recognizing that their relationship will allow for personal development of each. I conceptualized the model of relational ethics as one that embraces the meta-ethical principles of vulnerability, dignity, responsibility, and respect for autonomy as they are considered by many international declarations or conventions. This model integrates three key polarities: ensure conditions of authenticity, facilitate a process of cooperative mutuality, and promote opportunities for growth and development. Relational ethics can be used to solve major ethical problems in psychosomatic medicine, capacity , informed consent, and confidentiality. PMID:22056907

Barbosa, António

2012-01-01

381

A Study in Engineering and Military Ethics  

NSDL National Science Digital Library

Human nature and social awareness can often cause individuals to act or make decisions that are not considered moral or proper by the majority. Merriam-Webster defines ethics as a set of moral principles or a system of moral values.1 Most occupations that require the trust of the general public are held to high ethical standards. These professions include law, medical, engineering, and military, all of which have adopted systems that guide subscribed individuals through moral decision making processes. Most learned professions that uphold such standards prescribe a system of non-mandatory codes of conduct.2 Perhaps the most recognized professional code of ethics was reported by the National Society of Professional Engineers, which defines fundamental canons and includes explicit guidance on professional conduct. Because ethical behavior is essential to the profession of engineering, ABET Inc., has addressed this topic in Criterion 3, outcome (f): graduates will have an understanding of professional and ethical responsibility. The environmental engineering program criteria (ABET Criterion 9) also requires an understanding of professional practice issues.3 There are numerous examples in the literature on how professional practice issues might be included in engineering curricula, but limited data on methods for assessment. The United States Military Academy (USMA) Environmental Engineering Program has a robust military ethical education and training program that spans the entire four year West Point experience. It is thought that the moral character development programs at USMA strongly support the professional practice requirements of EC2000.3 The USMA environmental engineering program has been assessing attainment of ethics and other professional practice requirements since ca. 1999. Because all graduates of the USMA environmental engineering program (unless granted a waiver by the program director) are required to take the Fundamentals of Engineering Exam (FEE), it has been used as a metric for this purpose since FEE subject data has been available. Longitudinal data on ethics questions, from the FEE, is presented in Figure 1. The USMA Environmental Engineering cadets have been tracking with the national average (for environmental engineers) on ethics since 2002.

Butkus, Michael; David, Gayle

2009-09-10

382

Social justice and sexual ethics: An evaluation of official Church teachings on homosexuality using principles of social justice derived from the papal encyclicals and documents of Vatican II  

Microsoft Academic Search

This study is conceived as an exercise in contemporary sexual and social ethics. It presents and analyzes official Church teachings (papal encyclicals and documents from Vatican II) on sexuality, and evaluates them in light of modern theological method and the social justice tradition as found in similarly authoritative documents.^ Drawing on the research in both social and biological sciences, the

Kenneth Joseph Zanca

1988-01-01

383

Care and Concern: An Ethical Journey in Participatory Action Research.  

ERIC Educational Resources Information Center

Reviews the four basic principles of an ethical framework as outlined by the Code of Ethical Conduct for Research Involving Humans in light of the requirements of a participatory action research approach. Discusses the ethics of participatory action research in regard to care and concern. Argues that the ethics of morality and justice are…

Stuart, Carol A.

1998-01-01

384

Ethical dilemmas in clinical genetics  

Microsoft Academic Search

This paper discusses the results of a survey of medical and paramedical opinion relating to various difficult ethical issues in clinical genetics. These include the confidentiality of the doctor-patient relationship, prenatal diagnosis and termination, and Huntington's chorea. It is suggested that this method provides a useful means of assessing what is ethically acceptable in contemporary society.

I D Young

1984-01-01

385

A History of Ethics and Law in the Intensive Care Unit  

PubMed Central

Synopsis Because they provide potential benefit at great personal and public cost, the intensive care unit (ICU) and the interventions rendered therein have become symbols of both the promise and the limitations of medical technology. At the same time, the ICU has served as an arena in which many of the ethical and legal dilemmas created by that technology have been defined and debated. In this essay, we outline major events in the history of ethics and law in the ICU. We cover 10 areas: 1) the evolution of ICUs, 2) ethical principles, 3) informed consent and the law, 4) medical decision-making, 5) cardiopulmonary resuscitation, 6) withholding and withdrawing life-sustaining therapy, 7) legal cases involving life support, 8) advance directives, 9) prognostication, and 10) futility and the allocation of medical resources. We emphasize that advancement of the ethical principle of respect for patient autonomy in ICUs increasingly is conflicting with physicians’ concern about their own prerogatives and with the just distribution of medical resources. PMID:19268804

Luce, John M.; White, Douglas B.

2009-01-01

386

Ethics and the University. Professional Ethics Series.  

ERIC Educational Resources Information Center

This book brings together the closely related topics of the practice of ethics in the university, "academic ethics," and the teaching of practical, or applied, ethics in the university. The volume considers practical ethics, research ethics, the teaching of ethics, and sexual ethics as related to the university. The chapters are: (1) "The Ethics

Davis, Michael

387

The Ethical Practice of Podiatric Medicine.  

ERIC Educational Resources Information Center

A close examination of the Hippocratic Oath and the Code of Ethics of the American Podiatry Association is proposed as a outline for the parameters of ethical professional conduct. Ethical challenges facing the medical community, such as euthanasia, are discussed. (LBH)

McCarthy, Daniel J.

1978-01-01

388

Should teachers of medical ethics and health professionals remain value neutral in order to respect the autonomy of students and patients?  

PubMed

This article describes the pedagogical and ethical problems that ensue when ethical neutrality is mandated as the sole acceptable stance for teachers of ethics and health professionals (especially in public institutions). This paper argues that such a mandate can (1) violate public employees' own ethical integrity by forcing them to adopt the current legal order as their own ethical code; (2) erode trust, by requiring that the professional or teacher betray the honesty that patients and students commonly expect; and, finally, (3) undermine--by affirming that all opinions are equally acceptable--he pedagogical aim of generating critical thinking. Nevertheless, the article warns teachers and professionals against defending their own convictions by appealing to authority or the power of public office. The correct way to avoid ethical neutrality, this article asserts, is by distinguishing "opinion" from "argument": by not merely articulating, but providing convincing arguments for, one's own professional ethical opinions. PMID:24340483

Bøgeskov, Benjamín Olivares

2013-09-01

389

The ethics of human stem cell research.  

PubMed

The medical and clinical promise of stem cell research is widely heralded, but moral judgments about it collide. This article takes general stock of such judgments and offers one specific resolution. It canvasses a spectrum of value judgments on sources, complicity, adult stem cells, and public and private contexts. It then examines how debates about abortion and stem cell research converge and diverge. Finally, it proposes to extend the principle of "nothing is lost" to current debates. This extension links historical discussions of the ethics of direct killing with unprecedented possibilities that in vitro fertilization procedures yield. A definite normative region to inhabit is located, within a larger range of rival value judgments. The creation of embryos for research purposes only should be resisted, yet research on "excess' embryos is permissible by virtue of an appeal to the "nothing is lost" principle. PMID:12476917

Outka, Gene

2002-06-01

390

Ethical intercultural technical communication: Looking through the lens of Confucian ethics  

Microsoft Academic Search

Studies of intercultural communication focus little on the ethical principles that inspire specific communication practices. The ethics of Confucius (including the virtues of goodness, righteousness, wisdom, faithfulness, reverence, and courage), however, genuinely illuminate communication behaviors within China. Analysis of a cultural artifact of technical communication reveals the substantial insight offered by the lens of ethics. A comprehensive understanding of differences

Sam Dragga

1999-01-01

391

Ethics courses: Their impact on the values and ethical decisions of criminal justice students  

Microsoft Academic Search

Numerous articles and books advocate the importance of ethics as an essential component of a criminal justice curriculum. While there are several approaches suggested, one of the most popular methods of assuring coverage of this important topic is to add an ethics course to the curriculum either as a required or an elective course. Teaching students ethical theories, principles and

Vivian B. Lord; Beth E. Bjerregaard

2003-01-01

392

Ethical aspects of clinical chemistry.  

PubMed Central

The work performed by the clinical chemist may deeply affect the decisions of the doctor and the well-being of the patient. Yet in contrast to the doctor and to the nurse the clinical chemist usually has no personal relationship with the patient. Being encumbered by much technology and anonymity is itself a reason for scrutinising his involvement in issues of health care ethics. This is an attempt at clarifying some major aspects: the relationship of his professional ethics to medical ethics as a whole, his ethical obligations to the patient and to society, and other aspects. PMID:6199500

BenGershom, E

1983-01-01

393

The Social and Ethical Implications of Changing Medical Technologies: The Views of People Living with Genetic Conditions  

Microsoft Academic Search

This article presents empirical data on subjective levels of health and quality of life for individuals with early- or late-onset genetic conditions. Twelve adults with an early-onset condition (cystic fibrosis) and 12 adults with a late-onset condition in the family (Huntington’s disease) participated in semi-structured interviews. Questions investigated perceptions of the body, quality of life and views on medical technology

Elizabeth Chapman

2002-01-01

394

Journalism Ethics  

Microsoft Academic Search

Journalism ethics, the norms of responsible journalism, can be traced back to the beginning of modern journalism in Europe during the seventeenth century. This chapter provides an overview of contemporary journalism ethics by following its evolution, by reviewing and critiquing major approaches, and by suggesting future work. The chapter begins with a view of ethics as practi- cal normative activity

Stephen J. A. Ward

2008-01-01

395

Marketing Ethics  

Microsoft Academic Search

Saucier examines marketing ethics, focusing on the nature of new ethical breaches made possible by the increasing capabilities of technology. Chapter topics include the use of fear appeals, intrusive advertising in daily lives, the American materialistic culture, body image advertising, and puffery and deceptive advertising practice. Appendices include the American Marketing Association Code of Ethics, the Parents' Bill of Rights,

Rick D. Saucier

2008-01-01

396

Ethical Issues in Pharmacogenetics  

NSDL National Science Digital Library

The issue-focused, peer-reviewed article illustrates how pharmacogenetics promises drugs specific to an individual's condition. However, it poses some ethical concerns: invasion of medical privacy, unequal distribution of benefits, discrimination because it involves genetic tests, and research/business conflict-of-interest.

Carol Isaacson Barash (Genetics, Ethics & Policy Consulting, Inc.;)

2001-02-01

397

Statistics, ethics, and probiotica  

Microsoft Academic Search

A randomized clinical trial comparing an experimental new treatment to a standard therapy for a life-threatening medical condition should be stopped early on ethical grounds, in either of the following scenarios: (1) it has become overwhelmingly clear that the new treatment is better than the standard; (2) it has become overwhelmingly clear that the trial is not going to show

Richard D. Gill

2008-01-01

398

EthicsConRep  

Cancer.gov

The authors also gratefully acknowledge the copy editing assistance of Leslie Alter, MPH and Steve Brown. The Ethical Force Program’s initiative on patient-centered communication is funded in part by the American Medical Association Foundation, The California Endowment, the Commonwealth Fund and the Connecticut Health Foundation.

399

Ethical issues in integrative oncology.  

PubMed

Integrative oncology relates to an emerging dialog between complementary and alternative medicine (CAM) scholars, oncologists, family practitioners, and other health care providers who envision an extended and holistic patient-centered approach to oncology care. The multiple commitments of integrative oncology to a medical humanistic approach and to a strong evidence-based foundation may impose considerable ethical concerns and dilemmas. The authors use narrative ethics to present a case study that exemplifies the ethical challenges confronting physicians and health care providers who wish to provide an integrative approach for their patients. An ethical analysis of the narrative is provided to help clarify the ethical issues and conflicts within it. Finally, a framework that may transform ethical constraints to a communication tool is proposed. PMID:18638699

Ben-Arye, Eran; Schiff, Elad; Golan, Ofra

2008-08-01

400

Ethics and gastrointestinal artificial feeding.  

PubMed

Medical ethics is the study of human values as they relate to the practice of medicine. Ethics intersects with gastroenterology primarily involving issues of gastric and intestinal artificial feeding at the end of life. Language imparts meaning. Gastric artificial feeding is not the same as eating. Recent data suggest that gastric artificial feeding does not prolong life in patients with dementia and dysphagia. Given the lack of documented benefit of gastrointestinal feeding in these patients, the literature has focused on selection of appropriate patients for this medical intervention. Ethical care involves compassion, communication, consultation, and collaboration in dealing with emotionally difficult circumstances. PMID:15245701

Lipman, Timothy O

2004-08-01

401

Review of national research ethics regulations and guidelines in Middle Eastern Arab countries  

PubMed Central

Background Research ethics guidelines are essential for conducting medical research. Recently, numerous attempts have been made to establish national clinical research documents in the countries of the Middle East. This article analyzes these documents. Methods Thirteen Arab countries in the Middle East were explored for available national codes, regulations, and guidelines concerning research ethics, and 10 documents from eight countries were found. We studied these documents, considering the ethical principles stated in the Declaration of Helsinki, the Council for International Organizations of Medical Sciences (CIOMS) guidelines, and the International Conference of Harmonization - Guidelines for Good Clinical Practice (ICH-GCP). Our paper comprises a complete list of protections, such as confidentiality, informed consent, ethics committees, and others. Results This study found different levels and kinds of research ethics regulations and guidelines in the countries examined. Two groups can be distinguished: the countries in the first group have one or more research ethics regulations or guidelines, while the countries in the second group have not yet established any. Most of the documents showed various degrees of deficiencies in regard to ethical protection. The majority of the documents that were examined refer to one or more international documents on biomedical research ethics. Conclusions Recently, a lot of efforts have been made in many countries in the Middle East. However, compared with international documents, most of the research ethics documents in use in this region demonstrate numerous deficiencies. As it relates to these documents, extensive differences could be observed in regard to development, structure, content, and reference to international guidelines. PMID:23234422

2012-01-01

402

Graduate Student Ethics: What and Why? A Guide for Computer Science Students  

E-print Network

, with religion at the top, morality next, ethics after that, and etiquette---a set of principles designedGraduate Student Ethics: What and Why? A Guide for Computer Science Students January 26, 2004 Ethics Ethics provide guidelines for the behavior of every civilized group. Ethics are not absolute

Moret, Bernard

403

Ethical considerations during times of conflict: challenges and pitfalls for the psychiatrist.  

PubMed

Despite the advances of civilization, conflict remains in many areas around the world. Often psychiatry finds itself playing an essential role in dealing with the consequences of conflict or influencing the process. Along with this involvement comes great responsibility as well as many associated ethical dilemmas. Although bound by professional medical oaths, many physicians disregard fundamental medical ethical principles during times of conflict and situations of "dual loyalty." The phenomenon should be addressed so that ethical awareness and sensitivity to these issues are nurtured. Important factors for psychiatrists during times of conflict to consider include their "social contract" with the community, dangers of boundary violations, the ethics of media contact, involvement in governmental and political activities and confidentiality. In addition, their role in conflict resolution and unique ethical considerations in the military should be considered. While as regular citizens, psychiatrists in their individual capacity may involve themselves in political activism, at an organizational level it should be discouraged. A physician's skills should only be exploited to save lives and provide comfort as entrusted by society, and any other pursuit, even in the name of the state, should be proscribed. Rather than engage in political activism, psychiatrists can promote the rights of patients, especially if these rights are limited during conflict. Responsibility and ethically-driven commitment needs to be primary for the psychiatrist who involves himself either directly or indirectly with patients during times of conflict. Trauma and its effects during conflict should be addressed without any unbalanced attention to pathological responses. PMID:24225440

Strous, Rael D

2013-01-01

404

Treating war detainees and terror suspects: legal and ethical responsibilities of military physicians.  

PubMed

Several international legal instruments and ethical guidelines bestow rights and impose duties on detainees and military physicians, respectively. Ideological totalism, moral disengagement, and victim blame can facilitate the abuse of detainees, and this mindset must be avoided by military physicians. Physicians should report suspected violations of detainee rights to the U.N. Special Rapporteur on Torture or organizations such as the International Committee of the Red Cross, Médecins Sans Frontières, Amnesty International, Physicians for Human Rights, or Human Rights Watch. To discourage victimization of physician whistleblowers on detainee abuse, domestic medical associations should pressure their respective governments to explicitly endorse their codes of ethics. Domestic medical communities should regard it as their ethical duty to pressure their respective governments to accede to the Optional Protocol to the Convention Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment, if their governments have not already done so. They should also regard it as their ethical duty to pressure their governments to afford "prisoner of war" status to persons they detain. If faced with a conflict between following national policies and following universally accepted, multilateral principles of international law and ethics, military physicians should consider themselves ethically bound to follow the latter. The duty of care must supercede any blanket notion of loyalty, obligation, allegiance, or patriotism that the physician may feel is owed to his or her station. This is the true ethos of service to humankind. PMID:18214130

Singh, Jerome Amir

2007-12-01

405

Patients' ethical obligation for their health.  

PubMed Central

In contemporary medical ethics health is rarely acknowledged to be an ethical obligation. This oversight is due to the preoccupation of most bioethicists with a rationalist, contract model for ethics in which moral obligation is limited to truth-telling and promise-keeping. Such an ethics is poorly suited to medicine because it fails to appreciate that medicine's basis as a moral enterprise is oriented towards health values. A naturalistic model for medical ethics is proposed which builds upon biological and medical values. This perspective clarifies ethical obligations to ourselves and to others for life and health. It provides a normative framework for the doctor-patient relationship within which to formulate medical advice and by which to evaluate patient choice. PMID:6502640

Sider, R C; Clements, C D

1984-01-01

406

Taking ethical photos of children for medical and research purposes in low-resource settings: an exploratory qualitative study  

PubMed Central

Background Photographs are commonly taken of children in medical and research contexts. With the increased availability of photographs through the internet, it is increasingly important to consider their potential for negative consequences and the nature of any consent obtained. In this research we explore the issues around photography in low-resource settings, in particular concentrating on the challenges in gaining informed consent. Methods Exploratory qualitative study using focus group discussions involving medical doctors and researchers who are currently working or have recently worked in low-resource settings with children. Results Photographs are a valuable resource but photographers need to be mindful of how they are taken and used. Informed consent is needed when taking photographs but there were a number of problems in doing this, such as different concepts of consent, language and literacy barriers and the ability to understand the information. There was no consensus as to the form that the consent should take. Participants thought that while written consent was preferable, the mode of consent should depend on the situation. Conclusions Photographs are a valuable but potentially harmful resource, thus informed consent is required but its form may vary by context. We suggest applying a hierarchy of dissemination to gauge how detailed the informed consent should be. Care should be taken not to cause harm, with the rights of the child being the paramount consideration. PMID:23835013

2013-01-01

407

Professional Ethics for Astronomers  

NASA Astrophysics Data System (ADS)

There is a growing recognition that professional ethics is an important topic for all professional scientists, especially physical scientists. Situations at the National Laboratories have dramatically proven this point. Professional ethics is usually only considered important for the health sciences and the legal and medical professions. However, certain aspects of the day to day work of professional astronomers can be impacted by ethical issues. Examples include refereeing scientific papers, serving on grant panels or telescope allocation committees, submitting grant proposals, providing proper references in publications, proposals or talks and even writing recommendation letters for job candidates or serving on search committees. This session will feature several speakers on a variety of topics and provide time for questions and answers from the audience. Confirmed speakers include: Kate Kirby, Director Institute for Theoretical Atomic and Molecular Physics - Professional Ethics in the Physical Sciences: An Overview Rob Kennicutt, Astrophysical Journal Editor - Ethical Issues for Publishing Astronomers Peggy Fischer, Office of the NSF Inspector General - Professional Ethics from the NSF Inspector General's Point of View

Marvel, K. B.

2005-05-01

408

Ethical map reading in neonatal care.  

PubMed Central

This paper suggests that medical ethics is often based on assumptions, commonly shared in modern medicine, which can cause problems and which need to be questioned. Two contrasting yet complementary ways of thinking about ethical dilemmas in neonatal care are described as the 'separation' and the 'attachment' approaches. The contribution of medical ethics to the substance and quality of discussions between doctors and parents is considered. PMID:2952801

Alderson, P

1987-01-01

409

Ethics and the treatment of sexual offenders.  

PubMed

Clinicians in sex offender treatment programs always encounter the need to balance the best interests of sex offenders and the safety needs of the community. The protection of the community often takes primacy, resulting in violation of traditional mental health codes of ethics. These ethical dilemmas have generated debates in the academic community. To minimize ethical dilemmas, clinicians in sex offender treatment programs need to acknowledge the conflicts, adhere to safeguards, and thoughtfully address the challenges with profession-specific ethical values and codes. This article reviews ethical principles in relation to conceptualization of sex offenders and their assessment and treatment and research involving sex offenders. PMID:24877710

Mela, Mansfield; Ahmed, A G

2014-06-01

410

Towards a Definition of Health Informatics Ethics Hamman W. Samuel  

E-print Network

Society (BCS), Inter- national Medical Informatics Association (IMIA), Associa- tion for ComputingTowards a Definition of Health Informatics Ethics Hamman W. Samuel Department of Computing Science in medicine leads to new ethical issues that are not covered by medical or computing ethics. We define

Zaiane, Osmar R.

411

[Research developments in neurostimulation after 1945: historical and ethical aspects of medical manipulations of the human brain].  

PubMed

For nearly fifteen years, the impact of modern neuroscience has become a central focus of public debate, not just following the Decade of the Brain in the United States. Newly developed options for manipulating the central nervous system (CNS) are not only of primary medical concern but have come to be regarded as extremely questionable in recent bioethical discourse. This article provides an in-depth comparison between modern neuromanipulative approaches from "Deep Brain Stimulation" (DBS) with methods from earlier historical periods. After World War II, electrophysiological stimulation was developed, which changed the functional capacity of the human brain. It is argued that many contemporary debates questioning neuroethical applications are flawed in significant respects: A unique neuroethical position can neither be upheld philosophically nor with regard to consumer-oriented clinical practice. By drawing on individual case examples from the contemporary and recent history of neuroscience, some related problem fields and consequences are mapped out and discussed. They show an increasingly blurred conceptual boundary furnished by the complex relations between clinical research, physiological restitution, and functional enhancement inherent in modern biomedicine. PMID:19230376

Stahnisch, Frank

2008-01-01

412

Is the non-respect of ethical principles by doctors during Down's syndrome screening by first-trimester ultrasound damaging to  

E-print Network

-- concerns about possible miscarriage, the use of chorionic villus sampling for sex selection -- whereas abortion, social and medical pressure and pressure from insurance companies (3). In this context, we

Boyer, Edmond

413

[Respect for self-determination and use of coercion in the treatment of mentally ill persons : An ethical position statement of the DGPPN].  

PubMed

Respect for patient self-determination is a central ethical principle of medical care. Every person has the right to make decisions regarding his or her health autonomously, even if these decisions appear irrational to third parties. Free and informed consent is the necessary prerequisite for every diagnostic and therapeutic procedure. A patient's ability for self-determination is one requirement for valid consent. In illness, the ability for self-determination may be limited or absent in individual cases. An ethical dilemma arises if severely ill patients who are unable to make autonomous decisions put their health at significant risk and refuse medical procedures in this situation. While non-treatment can be severely detrimental to health, forced procedures can result in traumatization and can damage the relationship of trust between the doctor and patient. The dilemma is intensified in cases of danger to others. In these difficult situations doctors, therapists and nursing staff require ethical guidance for the professional conduct. The primary objective thereby is to avoid coercion. For this purpose recommendations for medical practice are formulated that can reduce the use of forced procedures (e.g. de-escalation procedures, communication competency, clinical ethics counseling, treatment agreements and patient living wills) or if they are unavoidable, that allow them to be conducted in an ethically and legally appropriate way. Further and continued education must pay greater attention to this ethical objective; therefore, for ethical reasons adequate personnel, spatial and structural are vital in hospitals. PMID:25388831

2014-11-01

414

Clinical ethics support services: an evolving model.  

PubMed

Ethical issues arising in clinical practice are complex and clinicians must be able to manage the needs of ethically vulnerable patients and families. This paper describes a model for providing Clinical Ethics Support Services as a broad spectrum of care for management of conflict and ethically difficult situations in health care and describes how an ethics consultation process was transformed to a Holistic Care Continuum for managing the needs of ethically vulnerable patients. During a 4-year journey at a regional medical center, a Family Support Team played a central role in identification of ethically vulnerable patients/family, interdisciplinary connectivity, and iterative engagement in the clinical milieu. Concepts of professional advocacy and interdisciplinary perspectives resulted in a model for ethically sound patient care promoting communication among patients/family, staff, and professionals; clarification of interdisciplinary roles and responsibilities; establishment of mutually derived goals and shared solutions; and implementation of interventions maximizing institutional resources. PMID:22357314

Schlairet, Maura C; Kiser, Ken; Norris, Stephen

2012-01-01

415

The Ethics and Reality of Rationing in Medicine  

PubMed Central

Rationing is the allocation of scarce resources, which in health care necessarily entails withholding potentially beneficial treatments from some individuals. Rationing is unavoidable because need is limitless and resources are not. How rationing occurs is important because it not only affects individual lives but also expresses society’s most important values. This article discusses the following topics: (1) the inevitability of rationing of social goods, including medical care; (2) types of rationing; (3) ethical principles and procedures for fair allocation; and (4) whether rationing ICU care to those near the end of life would result in substantial cost savings. PMID:22147821

Scheunemann, Leslie P.

2011-01-01

416

Sustainability and the principle of respect for community as a means of enhancing healthcare equality.  

PubMed

Global short-term dental or medical volunteerism has grown significantly in recent years. Dental and medical schools, their faculty, and students, are becoming increasingly interested in the experience of providing care to individuals in low-resource communities around the world. A laudable goal of such care is to provide care to individuals in low-resource communities and to work to achieve equity in health for all people. These goals are consistent with the American Dental Association's ethical principles of justice, beneficence, and nonmaleficence. This paper will discuss ethical guidelines for conducting these volunteer experiences with an emphasis placed on sustainability--the provision of ongoing collaborative care, between the institution overseeing the experience and the local community, after the visiting group has departed. The ultimate goal, global health care equity, requires transforming these shortterm efforts into long-term sustainable solutions. This goal is based on an ethical principle entitled respect for communities. This ethic can be likened to a community-wide application of the ethic of respect for autonomy as routinely applied to individuals such as patients. A tripartite model is proposed as a means for transforming short-term efforts into long-term sustainable solutions. PMID:25080668

Schloss, Alexander J; Bavishi, Rini M; Garetto, Lawrence P; Shah, Mihir

2014-01-01

417

An African ethic for nursing?  

PubMed

This article derives from a doctoral thesis in which a particular discourse was used as a 'paradigm case'. From this discourse an ethic set within a South African culture arose. Using many cultural 'voices' to aid the understanding of this narrative, the ethic shows that one can build on both a 'justice' and a 'care' ethic. With further development based on African culture one can take the ethic of care deeper and reveal 'layers of understanding'. Care, together with compassion, forms the foundation of morality. Nursing ethics has followed particular western moral philosophers. Often nursing ethics has been taught along the lines of Kohlberg's theory of morality, with its emphasis on rules, rights, duties and general obligations. These principles were universalistic, masculine and noncontextual. However, there is a new ethical movement among Thomist philosophers along the lines to be expounded in this article. Nurses such as Benner, Bevis, Dunlop, Fry and Gadow--to name but a few--have welcomed the concept of an 'ethic of care'. Gilligan's work gave a feminist view and situated ethics in the everyday aspects of responsiveness, responsibility, context and concern. Shutte's search for a 'philosophy for Africa' has resulted in finding similarities in Setiloane and in Senghor with those of Thomist philosophers. Using this African philosophy and a research participant's narrative, an African ethic evolves out of th