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This case was developed to teach first-year medical students the basics of medicalethics. 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 ethicalprinciples of autonomy, beneficence, non-maleficence, and justice. Students then develop a rationale for the physician acting according to one of the ethicalprinciples identified, and prepare a debate for the class supporting the rationale.
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 medicalethics (ACME), then makes a comparison between ACME and the 4PBE with
In this presentation, I will discuss the principles of biomedical and Islamic medicalethics and an interfaith perspective on end-of-life issues. I will also discuss three cases to exemplify some of the conflicts in ethical decision-making.
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.
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 medicalethics 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.
The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. We here offer such an ethical assessment using the four principles of medicalethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. PMID:23355225
This article examines the special relation between common morality and particular moralities in the four-principles approach and its use for global ethics. It is argued that the special dialectical relation between common morality and particular moralities is the key to bridging the gap between ethical universalism and relativism. The four-principles approach is a good model for a global bioethics by
This paper explores the ethical implications of economic medicalization: where non-medical problems are transformed into medical problems in order to achieve the objective of shareholder wealth maximization. After considering differences between business ethics and medicalethics, economic medicalization arising from corporate marketing strategies is detailed. Both direct-to-consumer and more traditional physician centred marketing methods are considered. In addition, the economic
Medical knowledge and technology have advanced at a spectacular rate. This voyage of discovery has led to a wealth of ethical issues unimaginable to the original followers of the Hippocratic oath. Steeped in the history of philosophy and religion, the development of medicalethics has been an attempt to unravel and resolve the moral complexities and dilemmas that have faced
Abstract The medical management of differences of sex development (DSD)/intersex in early childhood has been criticized by patients’ advocates as well as bioethicists from an ethical point of view. Some call for a moratorium of any feminizing or masculinizing operations before the age of consent except for medical emergencies. No exhaustive ethical guidelines have been published until now. In particular, the role of the parents as legal representatives of the child is controversial. In the article, we develop, discuss, and present ethicalprinciples and recommendations for the medical management of intersex/DSD in children and adolescents. We specify three basic ethicalprinciples that have to be respected and substantiate them. The article includes a critical discussion of the best interest of the child and of family privacy. The argumentation draws upon recommendations by the working group “Bioethics and Intersex” within the German Network DSD/Intersex, which are presented in detail. Unlike other recommendations with regard to intersex, these guidelines represent a comprehensive view of the perspectives of clinicians, patients, and their families. Conclusion The working group identified three leading ethicalprinciples that apply to DSD management: (1) to foster the well-being of the child and the future adult, (2) to uphold the rights of children and adolescents to participate in and/or self-determine decisions that affect them now or later, and (3) to respect the family and parent–child relationships. Nine recommendations for the management of DSD indicate how these ethicalprinciples can spelled out and balanced against each other in the clinical setting.
Ude-Koeller, Susanne; Sinnecker, Gernot H. G.; Thyen, Ute
Justice, in the sense of fair adjudication between conflicting claims, is held to be relevant to a wide range of issues in medicalethics. Several differing concepts of justice are briefly described, including Aristotle's formal principle of justice, libertarian theories, utilitarian theories, Marxist theories, the theory of John Rawls, and the view--held, for example, by W.D. Ross--that justice is essentially a matter of reward for individual merit. PMID:3926121
This article examines the special relation between common morality and particular moralities in the four-principles approach and its use for global ethics. It is argued that the special dialectical relation between common morality and particular moralities is the key to bridging the gap between ethical universalism and relativism. The four-principles approach is a good model for a global bioethics by virtue of its ability to mediate successfully between universal demands and cultural diversity. The principle of autonomy (i.e., the idea of individual informed consent), however, does need to be revised so as to make it compatible with alternatives such as family- or community-informed consent. The upshot is that the contribution of the four-principles approach to global ethics lies in the so-called dialectical process and its power to deal with cross-cultural issues against the background of universal demands by joining them together. PMID:22073817
There is no specific psychiatric ethic. The ethicalprinciples for practical actions in psychiatry have to be adapted on the basis of the generally accepted ethicalprinciples, which are based on psychobiologically developed ethic of love: honesty, discretion, empathy, patience, distance, consistency, accountability, tolerance, economic neutrality. PMID:24983582
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 ethicalprinciples 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 ethicalprinciples 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
Reviews the literature regarding the teaching of ethics in medical schools. Defines medicalethics and attempts to determine the scope of medicalethics teaching. Discusses ways medicalethics could be taught and how that teaching can be assessed. Calls for increased attention into the teaching of medicalethics. (TW)
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.
The main object of criticism of present-day medicalethics is the standard view of the relationship between theory and practice. Medicalethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the
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)
\\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
In the matter of health, the care of a patient is not the same as that of a population. With regards to medicalethics, it is essential to differentiate that which is for the patient's well being, and that which relies on knowledge and responsibility, the principle of which is not to do harm. The health sector has become an important economic actor in our society. Any decision made must take into account the principle of well being and responsibility. The physicians' role, when making a decision, is to integrate not only the patient's quality of life but also the Public Health aspects, and to apply these notions to a well thought-out choice and shared with the patient. A triangle can be constructed with, at its base the percentage of the population concerned and at its peak the cost per beneficiary. This triangle can then be segmented at varying distance from its base, in current decisions applicable to the greatest number, and depending on the amount of resources available. PMID:12148129
Despite the numerous policies, regulations and laws aimed at promoting and ensuring ethical practice in healthcare, ethical misconduct remains rampant. Perhaps something more is needed to encourage a genuine and sustained moral attitude and behaviour. To a casual reader, the regulations on ethics read merely as a list of do's and don'ts and their philosophical foundation is not clear. In actuality, morality is often grounded in philosophy. Traditionally, religious and theistic philosophies drove moral behaviour. However, this is changing due to the current trend of secularism. Hindu philosophies are among the oldest philosophies that are still thriving, and this article explores these philosophies and compares and contrasts them with some of the contemporary ethical theories to assess if they can add value to the field of medicalethics. The main theme of the article is dharma or righteous conduct, the concepts related to it and how these can have a bearing on the development of an ethical attitude and the practice of medicalethics. PMID:24152344
Presents the statement of EthicalPrinciples and Standards revised and approved by the American College Personnel Association in 1992. Includes preamble to the standards and sections delineating the purpose and use of the statement, ethicalprinciples, and ethical standards. (NB)
The dominant conception of medicalethics 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 medicalethics a secure place in the curriculum, they go wrong in treating it like a scientific body of knowledge. Ethics is
Neither law nor religion, bioethics absorbs and applies elements of both. Its theories, principles, and methods stem from various philosophical schools. Practitioners use case-based reasoning to apply bioethics to clinical situations, usually giving most weight to patients' autonomy and values, but also incorporating other relevant bioethical principles, including those encompassed in professional oaths and codes. Emergency clinicians must be able to recognize bioethical dilemmas, have action plans based on their readings and discussions, and have a method through which to apply ethicalprinciples in clinical settings. This article provides an overview of ethical considerations and guidelines for emergency clinicians. PMID:16877128
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 MedicalEthics. Beginning with a definition of Islamic MedicalEthics, the reader will be introduced to the scope of Islamic MedicalEthics 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 medicalethics and thereby positively affect patient care. PMID:17845488
Abstract:Narrative ethics has recently been advanced as an alternative to more "principled" and "theoretical" approaches to medicalethics. This turn prompts reflection on the distinctive activity of writing medicalethics. When writing medicalethics is recognized as a distinct activity, the forms of care it accomplishes can be distinguished from medical care. This distinction enables analysis of how caring for one's own needs as a writer of medicalethics is in productive tension with the ends of caring in medicine. One important good of writing medicalethics is that the act of writing forces one to reflect on the common mortal reality that is a condition of medical experience. Because it provides occasions for reflection on one's own mortality, medicalethics may no longer need immediate medical application in order to claim its contribution to caring. PMID:18453722
The teaching of medicalethics is not yet characterised by recognised, standard requirements for formal qualifications, training and experience; this is not surprising as the field is still relatively young and maturing. Under the broad issue of the requirements for teaching medicalethics are numerous more specific questions, one of which concerns whether medicalethics can be taught in isolation from considerations of the law, and vice versa. Ethics and law are cognate, though distinguishable, disciplines. In a practical, professional enterprise such as medicine, they cannot and should not be taught as separate subjects. One way of introducing students to the links and tensions between medicalethics and law is to consider the history of law via its natural and positive traditions. This encourages understanding of how medical practice is placed within the contexts of ethics and law in the pluralist societies in which most students will practise. Four examples of topics from medicalethics teaching are described to support this claim. Australasian medicalethics teachers have paid less attention to the role of law in their curricula than their United Kingdom counterparts. Questions like the one addressed here will help inform future deliberations concerning minimal requirements for teaching medicalethics. PMID:22558898
The amount of research using health information has increased dramatically over the last past years. Indeed, a significative number of healthcare institutions have extensive Electronic Health Records (EHR), collected over several years for clinical and teaching purposes, but are uncertain as to the proper circumstances in which to use them to improve the delivery of care to the ones in need. Research Ethics Boards in Portugal and elsewhere in the world are grappling with these issues, but lack clear guidance regarding their role in the creation of and access to EHRs. However, we feel we have an effective way to handle MedicalEthics if we look to the problem under a structured and more rational way. Indeed, we felt that physicians were not aware of the relevance of the subject in their pre-clinical years, but their interest increase when they were exposed to patients. On the other hand, once EHRs are stored in machines, we also felt that we had to find a way to ensure that the behavior of machines toward human users, and perhaps other machines as well, is ethically acceptable. Therefore, in this article we discuss the importance of machine ethics and the need for machines that represent ethicalprinciples explicitly. It is also shown how a machine may abstract an ethicalprinciple from a logical representation of ethical judgments and use that principle to guide its own behavior.
Machado, José; Miranda, Miguel; Abelha, António; Neves, José; Neves, João
It is hypothesised and argued that “the four principles of medicalethics” can explain and justify, alone or in combination, all the substantive and universalisable claims of medicalethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that
Health care practitioners in prison face the challenge of providing high standards of health care within the unique peculiarities and restraints of the prison environment. The strict adherence to principles of medicalethics by the prison health care staff and the knowledge and acceptance of these principles by the whole prison community not only results in ethical conduct but also
Hungarian medicalethics committees were established at the end of the 1950s. They came into being on the Communist Party's initiative. They could hardly be called "interdisciplinary" since their membership was made up of high-ranking physicians and a few head nurses. Their main task was to counter the practice of "tipping." Medicalethics and "tipping" were practically synonymous. These committees did not confront or try to resolve ethical problems concerning such issues as patient rights, informed consent, refusal of treatment, human experimentation, abortion, etc. These committees - whether it is believable or not - belonged to the Physicians Health Workers Trade Union. They were under the guidance and supervision of this social organization. The public was excluded from their meetings, and the committees' duty was to follow the health laws which were supposed to have given excellent ethical guidance. Even in a textbook on medicalethics used at one of the medical universities, written by a psychiatrist, the health laws were presented and explained back and forth. Of the 88 pages only 23 dealt with morals in general and the Hippocratic tradition. The Hungarian National Health Service as well as its medicalethics committees are similar in many respects to the Soviet and Eastern European countries' health care system and ethics committees. Since radical changes have taken place in these so-called "former" communist countries, it can only be hoped that these committees will eventually develop into groups who will deal directly with the moral questions or medicine and health care. PMID:10115138
The concept of human dignity and the respect to it have issued from various sources--philosophical, religious and cultural. The text deals with the thinking of some philosophers (intrinsic dignity versus attributed dignity), with religious thoughts (explaining the dignity of man as being created in God's image) and discusses the important declarations, especially the Universal Declaration of Human Rights. This declaration (UN, 1948) recognizes, in consent with both--the best philosophical tradition and biblical faith, the inherent dignity and worth of every human being (person); it is the first principle and the inescapable grounding for all human rights. The term human dignity is hotly debated in the present bioethics arena; nevertheless it is the source of considerable and dangerous confusion as well. Some bioethicists deny implicitly or even explicitly the dignity of every human being (they conflate intrinsic and attributed dignity), and others proclaim that dignity is a useless concept. But the respect to human dignity is the cornerstone of all medicalethics--this discipline will be changed into ethical parody without it. It is therefore necessary to see the problems in the broader context and to stand firmly on the right side of the dispute: on the side of each and every patient. PMID:22132618
Major advances in the medical sciences enable the physician to prolong life, detect genetic defects in the embryo, and transplant organs. The physician is also becoming increasingly involved in the social, economic, legal, and ethical problems that affect...
Alternatives to the Hippocratic tradition for the resolution of problems in medicalethics include the major Western religious systems, Western secular philosophy, and non-Western systems of religion and theory. Five essays in this issue of the Journal of Medicine and Philosophy are introduced and summarized to emphasize the real differences in medicalethical theories and the challenge presented by a comparative study of their competing claims. PMID:3199046
We critically evaluate the ways in which competence in medicalethics 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 medicalethics. This instrument can be used to evaluate the impact of medicalethics education programmes and to assess whether medical students have achieved
We critically evaluate the ways in which competence in medicalethics 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 medicalethics. This instrument can be used to evaluate the impact of medicalethics education programmes and to assess whether medical students have achieved a satisfactory level of performance of core skills and knowledge in medicalethics, within and across institutions.
Despite the Supreme Court decision in 1973, Roe v. Wade, making abortion legally available without impedi ment during the first two trimesters of pregnancy, neither the legal nor ethical problems of abortion have been solved. Congressional opposition to federal financial support of abor tion, as well as a wide disparity in availability of abortion, indicates the still unsettled state of
Throughout history, the treatment of infants born with serious neurological and physical medical ailments has been debated:\\u000a to treat or not to treat? In the early nineteenth century, little could be done for these infants who often either died during\\u000a the perinatal period or succumbed to the natural progression of their disease. With improvements in medical diagnosis and\\u000a treatment, a
This extensive literature review examining the influence of K. S. Kitchener's (1984) introduction of principleethics on counseling and psychology ethics notes the ultimate practicality of principleethics. The authors maintain that although a strong influence of principleethics in the area of counselor education emerges through the review, there…
Urofsky, Robert I.; Engels, Dennis W.; Engebretson, Ken
Since the publication of the first edition of Tom Beauchamp and James Childress's Principles of Biomedical Ethics there has been much debate about what a proper method in medicalethics should look like. The main rival for Beauchamp and Childress's account, principlism, has consistently been casuistry, an account that recommends argument by analogy from paradigm cases. Admirably, Beauchamp and Childress have modified their own view in successive editions of Principles of Biomedical Ethics in order to address the concerns proponents of casuistry and others have had about principlism. Given these adjustments to their view, some have claimed that principlism and casuistry no longer count as distinct methods. Even so, many still consider these two conceptions of bioethical methodologies as rivals. Both accounts of the relationship between casuistry and principlism are wrong. These two conceptions of methodology in biomedical ethics are significantly different, but the differences are not the ones pointed out by those who still claim that they are distinct positions. In this article, I explain where the real similarities and differences lie between these two views. PMID:24846659
Cost analyses in medical education are rarely straightforward, and rarely lead to clear-cut conclusions. Occasionally they do lead to clear conclusions but even when that happens, some stakeholders will ask difficult but valid questions about what to do following cost analyses-specifically about distributive justice in the allocation of resources. At present there are few or no debates about these issues and rationing decisions that are taken in medical education are largely made subconsciously. Distributive justice 'concerns the nature of a socially just allocation of goods in a society'. Inevitably there is a large degree of subjectivity in the judgment as to whether an allocation is seen as socially just or ethical. There are different principles by which we can view distributive justice and which therefore affect the prism of subjectivity through which we see certain problems. For example, we might say that distributive justice at a certain institution or in a certain medical education system operates according to the principle that resources must be divided equally amongst learners. Another system may say that resources should be distributed according to the needs of learners or even of patients. No ethical system or model is inherently right or wrong, they depend on the context in which the educator is working. PMID:24203859
Objective: Despite the acknowledged importance of ethics education in medical school, little empirical work has been done to assess the needs and preferences of medical students regarding ethics curricula. Methods: Eighty-three medical students at the University of New Mexico participated in a self-administered written survey including 41 scaled…
Lehrmann, Jon A.; Hoop, Jinger; Hammond, Katherine Green; Roberts, Laura Weiss
Society has shifted issues of subjective and social reality of the population into the medical field, with the obsession with perfect health becoming a predominant pathogenic factor in the increase in the number of diseases and patients, while the level of health in the population is improving. The power of medicine has made the idea of «medicalising» various aspects of life that can be perceived as medical problems as attractive even when it is not the case. Living entails times of unhappiness and anguish but, should we treat these episodes? We are in the health culture of «everything, here and now». In this article, the ethical implications of unnecessary interventions are analysed, along with the different alternatives that the professionals involved may perform to redirect this situation. It is reflected if we want a world where we all risk wearing labels for this or that disease. PMID:23768567
Tovar-Bobo, M; Cerecedo-Pérez, M J; Rozadilla-Arias, A
Describes the American Psychological Association's EthicalPrinciples of Psychologists and Code of Conduct, focusing on introduction and applicability; preamble; general principles; and ethical standards (resolving ethical issues, competence, human relations, privacy and confidentiality, advertising and other public statements, record keeping and…
Almost all articles on education in medicalethics present proposals for or describe experiences of teaching students in different health professions. Since experienced staff also need such education, the purpose of this paper is to exemplify and discuss educational approaches that may be used after graduation. As an example we describe the experiences with a five-day European residential course on ethics for neonatal intensive care personnel. In this multidisciplinary course, using a case-based approach, the aim was to enhance the participants' understanding of ethicalprinciples and their relevance to clinical and research activities. Our conclusion is that working with realistic cases encourages practising nurses and physicians to apply their previous knowledge and new concepts learnt in the course, thus helping them to bridge the gap between theory and practice. Key Words: Case method • medicalethics education • neonatal intensive care personnel
Obstetric ultrasound is the well-recognized prenatal test used to visualize and determine the condition of a pregnant woman and her fetus. Apart from the clinical application, some businesses have started promoting the use of fetal ultrasound machines for nonmedical reasons. Non-medical fetal ultrasound (also known as 'keepsake' ultrasound) is defined as using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication. Notwithstanding the guidelines and warnings regarding ultrasound safety issued by governments and professional bodies, the absence of scientifically proven physical harm to fetuses from this procedure seems to provide these businesses with grounds for rapid expansion. However, this argument is too simplistic because current epidemiological evidence is not synchronous with advancing ultrasound technology. As non-medical fetal ultrasound has aroused very significant public attention, a thorough ethical analysis of this topic is essential. Using a multifaceted approach, we analyse the ethical perspective of non-medical fetal ultrasound in terms of the expectant mother, the fetus and health professionals. After applying four major theories of ethics and principles (the precautionary principle; theories of consequentialism and impartiality; duty-based theory; and rights-based theories), we conclude that obstetric ultrasound practice is ethically justifiable only if the indication for its use is based on medical evidence. Non-medical fetal ultrasound can be considered ethically unjustifiable. Nevertheless, the ethical analysis of this issue is time dependent owing to rapid advancements in ultrasound technology and the safety issue. The role of health professionals in ensuring that obstetric ultrasound is an ethically justifiable practice is also discussed. PMID:19671649
As medicalethics has evolved over the past several decades, it has come to be regarded as a domain of applied ethics, that is, the application of a rationally based, philosophical theory to moral problems in health care. But an array of difficulties arise in the attempt to apply general moral theories or norms to concrete problems, difficulties that expose
Whether to treat or not to treat a high neural tube lesion presents a significant ethical dilemma. In the past two decades, the medical practice regarding the approach to a neonate with a neural tube defect has gone through a series of philosophical and therapeutic changes. Medical, ethical, religious, and legal systems have grappled inconclusively with the various aspects of these issues in recent years. In this article, the pros and cons of relevant medical and ethical considerations are analyzed, and a decision-making process is outlined. It is suggested that in order to enhance the ability of the responsible care provider and the parents to reach reasonable and morally defensible decisions, a properly organized decision-making process ought to be adhered to. Each individual patient should be analyzed according to the following major categories: medical data, basic ethical and religious principles, legal and/or institutional regulations, and physician-parents relationship. Based on current medical knowledge and on pertinent ethical reasoning, it is argued and recommended that almost always, if possible, aggressive management should be favored. PMID:2037891
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 ethicalprinciples 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
Business ethics is presently a major component of the business school curriculum. Although there has been much attention focused on the impact of such coursework on instilling ethical decision-making (Nguyen et al., 2008), there is sparse research on how business students view the major ethicalprinciples that serve as the foundation of business…
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
Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medicalethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility
Robert A. Pearlman; Steven H. Miles; Robert M. Arnold
The ethics of a people, as demonstrated through public policy, are generally thought to inform that people's legal system and its decisions. The converse is also true: decisions within a legal system inform, or impact, ethics -specifically medicalethics ...
A. R. Burton K. W. Zucker M. J. Boyle T. L. Allen V. S. Smyth
For nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethicalprinciples for deliberating about moral problems in medicine and research, referred to in the pejorative sense as "principlism", has come under scrutiny. In this paper we argue that these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that (1) principles should be understood as heuristics that can be "specified" as described by De Grazia (1992), and (2) that the principle-based approach should be supplemented by formally incorporating "sensitivity to context" into the evaluation of clinical trials. PMID:11653257
Meslin, Eric M; Sutherland, Heather J; Lavery, James V; Till, James E
Anne Jones has pointed out that over the last three decades, stories have been important to medicalethics in at least three ways: (1). Stories as cases for teaching principle-based medicalethics (2). Narratives for moral guides on what is considered living a good life (3). Stories as testimonials written by both patients and physicians. A pioneer in this effort, particularly in regard to using narratives as moral guides, has been the ethicist and philosopher Stanley Hauerwas. Heavily influenced by virtue ethics, Hauerwas believes that it is a person's particular narrative tradition that provides one with convictions that form the basis of one's morality. Befitting a Protestant theologian, he is particularly concerned with the Christian narrative. From a Jewish perspective, there has been much less written on the use of narrative in medicalethics. However, it is a mistake to think that narrative has little, if any, role in Rabbinic ethical decision making. The purpose of this article is to demonstrate the centrality of narrative in the thought of Orthodox Jewish decisors and the problems inherent in this methodology. PMID:22395754
The 1982-1983 annual report of the medicalethics section of the British Medical Association Council outlines the Council's responses to the pending Police and Criminal Evidence Bill and the pending Data Protection Bill. Provisions in the former piece of legislation might require physicians to violate medicalprinciples of confidentiality and informed consent, while a clause in the Data Protection Bill would allow transfer of personal data between government agencies without public disclosure of the transfer. Among other issues briefly covered in the report are computerized patient information, cosmetic surgery, insurance certificates, and adoption records. PMID:11652379
Most bioethical advice has focused on the individual physician-patient relationship. But the ethical dilemmas confronting occupational medicine are more complex, because of the influence of institutional and organizational structure. For example, consider conflicts of interest in managed care: Concerns about costs to employers are not just economic, to be outweighed by commitments to employee health, but also legitimate ethical concerns about fair allocation of resources among all employees. Furthermore, in occupational health research, rather than thinking of employees as a "vulnerable population" it may be more useful to regard them as a distinct community and apply the 23 specified protections of communities. PMID:12225926
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 medicalethics course.
The article offers an approach to inquiry about, the foundation of medicalethics by addressing three areas of conceptual presupposition basic to medicalethical theory. First, medicalethics must presuppose a view about the nature of medicine. it is argued that the view required by a cogent medical morality entails that medicine be seen both as a healing relationship and
Since its inception contemporary medicalethics has been regarded by many of its practitioners as 'applied ethics', that is, the application of philosophical theories to the moral problems that arise in health care. This 'applied ethics' model of medicalethics is, however, beset with internal and external difficulties. The internal difficulties point out that the model is intrinsically flawed. The
A discussion of four aspects of the legislation and of the medicalethics of the transplants is presented: the concept of death, the donation of organs, the selection of receivers and the future of the therapeutic transplants. The prominent paragraphs of the General Law of Health of the country about cerebral death, the two legal forms and organs donors' ethics, the criteria and more frequent problems for the selection of receivers, and the character of medical technology of transition of the therapeutic transplants are included. PMID:16524056
In this column, the associate editor of The Journal of Perinatal Education (JPE) discusses the decision to devote an issue of JPE to the ethics of childbirth and maternity care. The current crisis in maternity care mandates a careful look at the ethicalprinciples that provide the foundation for practice. The contents of this special issue include: a broad overview of ethics of childbearing, historical perspectives and contemporary understanding of informed decision making, the ethical issues faced by childbirth educators, and the challenges and moral distress experienced by childbirth educators and other maternity care providers when their values, beliefs, and ethical standards are in conflict with standard maternity care practices. PMID:19415107
As cognitive systems technologies emerge, so too do the ethical issues surrounding their development and use. To develop cognitive systems technologies responsibly, Sandia National Laboratories is establishing a framework to proactively address both real and potential ethical issues. This report contains the principles and guidelines developers can use to guide them as they are confronted with ethical issues related to developing cognitive systems technologies as they apply to U.S. national security. A process to apply these principles offers a practical way to transfer these principles from paper to a working strategy. Case studies are presented to reflect upon potential scenarios and to consider resolution strategies.
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 ethicalprinciples 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
The rules and principles approach for developing educators' ethical judgment may be less effective than a centered approach. A centered approach being one that focuses solely on the elementary and junior high teachers. Educators understand the moral and ethical convolution of their role; possess expertise in interpreting their behavior and…
The basis of ethical practice for the medical community in general and for nuclear medicine technology in particular is described as follows: 1) Know and use current guidelines for safe work procedures; 2) Establish and maintain a quality assurance program for equipment and radiopharmaceuticals; 3) Develop work habits incorporating the philosophy of the ALARA concept (radiation dose as low as reasonably achievable); 4) Establish and use protocols for routine procedures; 5) Make exceptions to accepted practices when benefit vs risk warrants these exceptions; 6) Make periodic audits to determine if ethical standards are being applied. (JMT)
The U.S. Department of Health and Human Services Office of Human Research Protection (OHRP) has mandated that all research sites outside the United States that participate in research funded by the U.S. Government must file documentation certifying that each research site observes the Declaration of Helsinki on EthicalPrinciples for Medical Research Involving Human Subjects and has an independent ethics committee. Sites participating in trials sponsored by the U.S. National Cancer Institute (NCI) must also undergo regular on-site audits.
For a number of reasons, casuistry has come into vogue in medicalethics. Despite the frequency with which it is avowed, the application of casuistry to issues in medicalethics has been given virtually no systematic defense in the ethics literature. That may be for good reason, since a close examination reveals that casuistry delivers much less than its advocates
The issue of assessing priorities is one that has become the subject of much debate in the National Health Service particularly in the wake of various documents on priorities from central Government. It has become even more so with the prospect of real cuts in expenditure. Economists claim that their science, or perhaps more accurately art can assist in determining not only how best to achieve various ends but also whether and to what extent competing objectives should be pursued. Such choices cannot be made in the absence of some ethical considerations and it is important that health service decision makers (and in particular the medical profession) are aware if the relationship between economics (and especially cost-benefit analysis) and medicalethics.
The risks associated with the techniques of medically assisted procreation (MAP) rapidly became well-known, and in such a short space of time that no biomedical domain remained untouched by the great deal of thinking and the expression of a multitude of opinions it provoked. MAP is evolving between two poles: quality\\/misuse (even violation) and evidence\\/fantasy. The ethics will be evoked
This guide compiles information reported by medical schools on their efforts to help students develop a sound code of professional ethics. The introduction opens with background information on an Association of American Medical Colleges (AAMC) 1992 survey of medical schools and on why it is imperative that schools assist medical students' ethical…
Reports the amended ethicalprinciples 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;…
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.
A case is described of a fifty year old single man who made disclosures about criminal sexual practices during a psychiatric assessment. In common practice with other professional men, a doctor is under a duty not to disclose, without the consent of his patient, information which he has gained in his professional capacity other than in exceptional circumstances. We discuss the ethical and legal considerations surrounding issues of medical confidentiality and the dilemma that sometimes face clinicians, when they feel obliged, in the public interest, to disclose information they have gained in confidence. Breach of confidences can have deleterious consequences; particularly for the doctor-patient relationship, but failure to disclose in some situations could have serious implications for the well-being of the wider society. Doctors should be aware of the basic principles of confidentiality and the ethical and legal framework around which they are built. PMID:19135004
Many of the ethical challenges associated with medically assisted reproduction are societal. Should the technique be restricted to only ordinary couples or could it be used also to single females or couples of same sex? Should the future child be entitled to know the identity of the gamete donor? Should there be age limits? Can embryos or gametes be used after the death of the donor? Can surrogate mothers be part of the process? Can preimplantation diagnostics be used to select the future baby's sex? In addition, there are several clearly medical questions that lead to difficult ethical problems. Is it safe to use very premature eggs or sperms? Is the risk for some rare syndromes caused by imprinting errors really increased when using these techniques? Do we transfer genetic infertility to the offspring? Is the risk for multiple pregnancies too high when several embryos are implanted? Does preimplantation diagnosis cause some extra risks for the future child? Should the counselling of these couples include information of all these potential but unlikely risks? The legislation and practices differ in different countries and ethical discussion and professional guidelines are still needed.
Kaeaeriaeinen, Helena [Department of Medical Genetics, University of Turku, Kiinamyllynkatu 10, 20520 Turku (Finland) and Department of Clinical Genetics, Turku University Hospital, Turku (Finland)]. E-mail: email@example.com; Evers-Kiebooms, Gerry [Department of Human Genetics, University of Leuven (Belgium); Coviello, Domenico [Laboratory of Medical Genetics, ICP, University Hospital of Milan (Italy)
50 years ago, in Nuremberg, 23 German doctors were accused of crimes against humanity. The anniversary is a solemn reminder of the dark origins of medical research ethics. Many researchers today believe that the medical experiments carried out under Hitler "vaccinated" postwar researchers against abuse. A review of the practices of postwar research shows that the "vaccination" had limited effect and that there is no reason to believe that the events which took place under Hitler were unique and will never happen again. After the war various measures were introduced to protect research subjects: informed consent, self regulation and independent research ethics committees. The measures have undoubtedly limited the abuse of subjects substantially. Nevertheless, in the Armed Forces, where abuse has been most rampant after the war, informed consent is not always practised and independent review is seldom carried out. With the support of grant institutions, journals and industry the protection of research subjects can be improved. It is recommended that medical faculties arrange an annual commemoration of the victims of medical research in order to raise consciousness and awareness among teachers and students. PMID:9456583
The absolute refusal of sham surgery as control in clinical trials can not be justified from professional, ethical point of view. Introduction of any new surgical treatment should be evidence based in the form of sufficient scientific approval to support a novel method. It has to be decided whether sham surgery or any other control modality could be an optimal baseline reference for a clinical trial. The feasibility and the ethical acceptability of sham surgery controlled clinical trials should be approved individually. At the risk evaluation of any (sham) surgery controlled clinical trial, we should contemplate the outcome of the opposite scenario as well; that is, the consequences of not pursuing a "lege artis" controlled clinical project to estimate the efficacy and safety of the invasive procedure. It is possible and obligatory to reconcile two basic medical goals: the treatment of the individual patient and the need of the society for proven, safe and effective treatments. PMID:17984012
In research ethics there is a canon regarding what ethical rules ought to be followed by investigators vis-à-vis their treatment of subjects and a canon regarding what fundamental ethicalprinciples apply to the endeavor. What I aim to demonstrate here is that several of the rules find no support in the principles. This leaves anyone who would insist that we not abandon those rules in the difficult position of needing to establish that we are nevertheless justified in believing in the validity of the rules. I conclude by arguing that this is not likely to be accomplished. The rules I call into question are the rules requiring: - that studies be designed in a scientifically valid way - that risks to subjects be minimized - that subjects be afforded post-trial access to experimental interventions - that inducements paid to subjects not be counted as a benefit to them - that inducements paid to subjects not be 'undue' - that subjects must remain free to withdraw from the study at any time for any reason without penalty. Both canons, the canon on principles and the canon on rules, are found in the overlap among ethical pronouncements that are themselves canonical: the Nuremberg Code, the Declaration of Helsinki, the Belmont Report, CIOMS's International Ethical Guidelines for Biomedical Research Involving Human Subjects, and NBAC's 2001 report, Ethical Issues in International Research: Clinical Trials in Developing Countries. PMID:19659855
This practical guide will sensitize the professional school counselor to legal and ethical issues involved in working with minors in school settings. Using a case study approach and more than 100 cases representing school counselors daily dilemmas, chapters help the reader connect the reality of school counseling to critical federal and state…
The massive adoption of technology in learning processes comes with an equally large capacity to track learners. Learning analytics aims at using the collected information to understand and improve the quality of a learning experience. The privacy and ethical issues that emerge in this context are tightly interconnected with other aspects such as…
This report describes a study undertaken to assess student choices in medicalethical dilemmas. Medicalethical 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…
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…
BACKGROUND: This study presents an empirical investigation of the ethical reasoning and ethical issues at stake in the daily work of physicians and molecular biologists in Denmark. The aim of this study was to test empirically whether there is a difference in ethical considerations and principles between Danish physicians and Danish molecular biologists, and whether the bioethical principles of the
SETTING: Medicalethics 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 medicalethics 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 medicalethics 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 medicalethics 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.
First codes of medicalethics appeared between 18th and 19th century. Their formation was inspired by changes that happened in medicine, positive in general but with some negative setbacks. Those negative consequences revealed the need to codify all those ethical duties, which were formerly passed from generation to generation by the word of mouth and individual example by master physicians. 210 years has passed since the publication of "MedicalEthics" by Thomas Percival, yet essential ethical guidelines remain the same. Similarly, ethical codes published in Poland in 19 century can still be an inspiration to modem physicians. PMID:24720115
Ethics tells us: do good and do no harm and invokes the norms of justice, equity and respect for autonomy in protecting and promoting health and well-being. The Precautionary Principle, a contemporary re-definition of Bradford Hill's case for action, gives us a common sense rule for doing good by preventing harm to public health from delay: when in doubt about
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.
This paper examines two topics in Japanese medicalethics: non-disclosure of medical information by Japanese physicians, and the history of human rights abuses by Japanese physicians during World War II. These contrasting issues show how culture shapes our view of ethically appropriate behavior in medicine. An understanding of cultural context reveals that certain practices, such as withholding diagnostic information from
In this text, we present and elaborate ethical challenges in transplant medicine related to organ procurement and organ distribution, together with measures to solve such challenges. Based on internationally acknowledged ethical standards, we looked at cases of organ procurement and distribution practices that deviated from such ethical standards. One form of organ procurement is known as commercial organ trafficking, while in China the organ procurement is mostly based on executing prisoners, including killing of detained Falun Gong practitioners for their organs. Efforts from within the medical community as well as from governments have contributed to provide solutions to uphold ethical standards in medicine. The medical profession has the responsibility to actively promote ethical guidelines in medicine to prevent a decay of ethical standards and to ensure best medical practices.
In this text, we present and elaborate ethical challenges in transplant medicine related to organ procurement and organ distribution, together with measures to solve such challenges. Based on internationally acknowledged ethical standards, we looked at cases of organ procurement and distribution practices that deviated from such ethical standards. One form of organ procurement is known as commercial organ trafficking, while in China the organ procurement is mostly based on executing prisoners, including killing of detained Falun Gong practitioners for their organs. Efforts from within the medical community as well as from governments have contributed to provide solutions to uphold ethical standards in medicine. The medical profession has the responsibility to actively promote ethical guidelines in medicine to prevent a decay of ethical standards and to ensure best medical practices. PMID:23444249
The major trends in the growth of prospective payment and the corporatization of medical practice in the United States are examined. In particular, the ethical implications of these changes in the context of the multiple system goals of access, cost containment, and quality are considered. Considerable concern is being expressed that with the dominant emphasis on cost containment, the principles
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 ethicalprinciples 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.
In Israel, as in the Western world, the use of different methods of complementary and alternative medicine ICAM) is spreading. CAM raises ethical questions of concern to healthcare providers and to the public: Can physicians recommend a treatment that has no scientific evidence? Should the government include such therapies in the health budget? Can complementary therapists receive protection against lawsuits if their treatment is recognized? The purpose of this article is to present a Jewish perspective on these issues. The fundamental sources that deal with the subject are based on the approach of rabbinic authorities toward unproven medicine, as expressed in the "Mishnah" and "Talmud" (200-500 C.E). The great Jewish scholar who discusses the subject in detail is Maimonides (1135-1204), who defines what "medicine" is and claims that medicine has to rely on reason or experience. Contemporary Jewish commentators present their position based on the interpretation of Maimonides' texts. In this article we claim that treatments can be divided into four groups, each group having a different halachic status: (1) Treatment that might be dangerous--should not be used. (2) Treatment that is safe--can be used, but has no other special status. (3) Treatment recognized by alternative therapists--has consequences for the observant Jew, such as laws of Kashrut and Shabbat. (4) Treatment that was tested and proven using modern medical methods has public significance--the therapist is entitled to legal defense if he made a reasonable mistake; the government can consider funding such treatment using public money. This article presents the Jewish halachic sources upon which we propose an ethical-practical approach to CAM. PMID:21939123
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 ethicalprinciples 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.
The annual report of the Council of the British Medical Association comments on several issues related to medicalethics. A government White Paper on confidentiality of medical records will be published soon; during a conference on data protection in 1981, serious concern was expressed over the Home Office's authority in this area. The Council approved additional guidance related to the doctor's responsibility for treatment when a patient consults a doctor or specialist other than his usual practitioner. Advertising and publicity, cosmetic surgery, in vitro fertilization, confidentiality of school medical records, and revisions to the BMA's Handbook of MedicalEthics were also touched upon in the Council report. PMID:11652369
Persons with disabilities are diving, as are individuals with such conditions as asthma and epilepsy. A review considers relevant medical and ethical implications of such activity among disabled persons. (Author/CB)
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 medicalethics 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 medicalethics. 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 medicalethics 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 medicalethics. 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 medicalethics so as to maintain historic continuity and yet, at the same time, add on the new contents of medicalethics 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 medicalethics that can meet the requirements of the outside world and the future.
Background This study presents an empirical investigation of the ethical reasoning and ethical issues at stake in the daily work of physicians and molecular biologists in Denmark. The aim of this study was to test empirically whether there is a difference in ethical considerations and principles between Danish physicians and Danish molecular biologists, and whether the bioethical principles of the American bioethicists Tom L. Beauchamp and James F. Childress are applicable to these groups. Method This study is based on 12 semi-structured interviews with three groups of respondents: a group of oncology physicians working in a clinic at a public hospital and two groups of molecular biologists conducting basic research, one group employed at a public university and the other in a private biopharmaceutical company. Results In this sample, the authors found that oncology physicians and molecular biologists employed in a private biopharmaceutical company have the specific principle of beneficence in mind in their daily work. Both groups are motivated to help sick patients. According to the study, molecular biologists explicitly consider nonmaleficence in relation to the environment, the researchers' own health, and animal models; and only implicitly in relation to patients or human subjects. In contrast, considerations of nonmaleficence by oncology physicians relate to patients or human subjects. Physicians and molecular biologists both consider the principle of respect for autonomy as a negative obligation in the sense that informed consent of patients should be respected. However, in contrast to molecular biologists, physicians experience the principle of respect for autonomy as a positive obligation as the physician, in dialogue with the patient, offers a medical prognosis based upon the patients wishes and ideas, mutual understanding, and respect. Finally, this study discloses utilitarian characteristics in the overall conception of justice as conceived by oncology physicians and molecular biologists from the private biopharmaceutical company. Molecular biologists employed at a public university are, in this study, concerned with allocation, however, they do not propose a specific theory of justice. Conclusion This study demonstrates that each of the four bioethical principles of the American bioethicists Tom L. Beauchamp & James F. Childress – respect for autonomy, beneficence, nonmaleficence and justice – are reflected in the daily work of physicians and molecular biologists in Denmark. Consequently, these principles are applicable in the Danish biomedical setting.
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 ethicalprinciples 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.
Education needs assessment is one of the essential components of curriculum development. In this study, we aimed to assess the educational needs of general physicians for medicalethics. We conducted a three-stage Delphi study of general physicians’ views on important ethical issues in their practice. In the item generation stage we retrieved 45 important educational items from a survey of general physicians, patients, well known ethical clinicians, and a review of other universities’ curricula and international literature. The questionnaire was designed to ask the importance of each generated item. We then sent the questionnaire to general physicians. Items scored as highly important by more than 80% of the respondents in the first or second consensus development surveys were considered as educational priorities. Four academic medicalethics teachers reviewed and commented on the findings. The response rate to the first consensus development survey was 38%, of whom 77% also responded to the second survey. We developed consensus on 24 medicalethics items for inclusion in medicalethics curriculum. All items were also considered important by medicalethics teachers, and they added four further items to the list. Despite the attention given to ethical issues originating from technological advances, the most important educational needs of general physicians in medicalethics are still the traditional issues concerning the doctor-patient relationship and professionalism.
In this article, the authors attempt to build a bridge between economic theory and medicalethics to offer a new perspective to tackle ethical challenges in the physician-patient encounter. They apply elements of new institutional economics to the ethically relevant dimensions of the physician-patient relationship in a descriptive heuristic sense. The principal-agent theory can be used to analytically grasp existing action problems in the physician-patient relationship and as a basis for shaping recommendations at the institutional level. Furthermore, the patients' increased self-determination and modern opportunities for the medical laity to inform themselves lead to a less asymmetrical distribution of information between physician and patient and therefore require new interaction models. Based on the analysis presented here, the authors recommend that, apart from the physician's necessary individual ethics, greater consideration should be given to approaches of institutional ethics and hence to incentive systems within medicalethics. PMID:18470634
Langer, Andreas; Schröder-Bäck, Peter; Brink, Alexander; Eurich, Johannes
An Association of American Medical Colleges working group on student professional ethics suggests improving (1) admission criteria; (2) the medical school learning climate, including consideration of cultural diversity; and (3) communication of expectations to students. An AAMC initiative for instruction, instructional material development, and…
Health care institutions must decide whether to inform the patient of a medical error. The barriers to disclosure are an aversion to admitting errors, a concern about implicating other practitioners, and a fear of lawsuits and liabil- ity. However, admission of medical errors is the ethical thing to do and may be required by law. When examined, the barriers to
Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these two needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes
Amitai Ziv; Paul Root Wolpe; Stephen D. Small; Shimon Glick
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 ethicalprinciples 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: firstname.lastname@example.org
This descriptive, cross-sectional study was conducted to assess the knowledge of and attitudes towards medicalethics 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 medicalethics 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
Objectives: To characterise UK undergraduate medicalethics curricula and to identify opportunities and threats to teaching and learning.Design: Postal questionnaire survey of UK medical schools enquiring about teaching and assessment, including future perspectives.Participants: The lead for teaching and learning at each medical school was invited to complete a questionnaire.Results: Completed responses were received from 22\\/28 schools (79%). Seventeen respondents deemed
Global medicalethics 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 medicalethics 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 medicalethics such as gene therapy and human cloning, which are controversially discussed. Military medicalethics 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
Recent scholarship argues that successful international medical collaboration depends crucially on improving cross-cultural understanding. To this end, this study analyzes recent writings on medicalethics 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
Can we fulfill our responsibilities and obligations while we are working? Today, professional ethics is a necessity for each occupation. As teachers are directly responsible for children's growth, professional ethics and ethical decision making are important for them. Although many countries, particularly the United States, have prepared ethics…
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.
Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. This article describes some of the common situations with ethical underpinnings encountered by EMS personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider duty hours to prevent fatigue, substance abuse by EMS providers, disaster triage and difficulty in switching from individual care to mass-casualty care, and the challenges of child maltreatment recognition and reporting. A series of ethical questions are proposed, followed by a review of the literature and, when possible, recommendations for management. PMID:23890578
Becker, Torben K; Gausche-Hill, Marianne; Aswegan, Andrew L; Baker, Eileen F; Bookman, Kelly J; Bradley, Richard N; De Lorenzo, Robert A; Schoenwetter, David J
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
In order to shorten queues to healthcare, the Swedish government has introduced a yearly "queue billion" that is paid out to the county councils in proportion to how successful they are in reducing queues. However, only the queues for first visits are covered. Evidence has accumulated that queues for return visits have become longer. This affects the chronically and severely ill. Swedish physicians, and the Swedish Medical Association, have strongly criticized the queue billion and have claimed that it conflicts with medicalethics. Instead they demand that their professional judgments on priority setting and medical urgency be respected. This discussion provides an interesting illustration of some of the limitations of new public management and also more generally of the complicated relationships between medicalethics and public policy. PMID:24887153
The Hippocratic Coprus recognized the interaction of 'business' and patient-health moral considerations, and urged that the former be subordinated to the latter. During the 1800s with the growth of complexity in both scientific knowledge and the organization of health services, the medicalethical codes addressed themselves to elaborate rules of conduct to be followed by the members of the newly
Following the influential Gifford and Reith lectures by Onora O’Neill, this paper explores further the paradigm of individual autonomy which has been so dominant in bioethics until recently and concurs that it is an aberrant application and that conceptions of individual autonomy cannot provide a sufficient and convincing starting point for ethics within medical practice. We suggest that revision of
We report the results of a randomized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme, as well as their responses to a simulated clinical case. Twenty-five per cent of the house officers received a lecture series (Limited Intervention or LI), 25 per cent
A dialysis unit's introduction of automated recycling of dialysers is described. The responses of the staff and the patients are outlined, along with the pertinent ethical issues. Suggestions regarding the educational processes necessary with any innovation in long-term medical care are discussed.
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
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
The value and dignity of the medical profession commence right from the entry of the medical students into the medical school. They have to go through a strict and highly selective system in the aspect of learning capability which consists of namely, merit of Phromviharn 4 still suspicious that the process of the medical student selective system, is it included
Health-worker migration, commonly called "medical brain drain", refers to the mass migration of trained and skilled health professionals (doctors, nurses, midwives) from low-income to high-income countries. This is currently leaving a significant number of poor countries, particularly in sub-Saharan Africa, with critical staff shortages in the healthcare sector. A broad consensus exists that, where medical brain drain exacerbates such shortages, it is unethical, and this review presents the main arguments underpinning this view. Notwithstanding the general agreement, which policies are justifiable on ethical grounds to tackle brain drain and how best to go about implementing them remains controversial. The review offers a discussion of the specific ethical issues that have to be taken into account when deciding which policy measures to prioritise and suggests a strategy of policy implementation to address medical brain drain as a matter of urgency. PMID:24163012
Hospitals in the United States have been engaging in the practice of returning immigrant patients, usually undocumented immigrant patients, to their country of origin when the patient has long-term medical needs for which no reimbursement is available. I argue that for such an action to be ethical, it must be done in accordance with the mission and values of hospitals. I describe three standards that an individual instance of repatriation must meet to be ethical: (1) patient best interests, (2) medical due diligence, and (3) informed consent. I argue that these should form the basis for best practices in regard to medical repatriation for all hospitals in the United States. PMID:22881842
A standard application form for the ethical review of health-related research studies has recently been adopted by many Irish medical research ethics committees. In order to assess the impact of the new form, we reviewed all comments made by the Beaumont Hospital Ethics Committee during two six-month periods, immediately prior to adoption of the new form (2010), and soon afterwards (2011). Neither volume nor comment type differed significantly between the two observation periods. Participant documentation (information leaflets and consent forms) accounted for the largest proportion of comments (2010; 44%, 2011; 37%). Other common areas prompting queries were study administration (7%), design (12%) and procedures (13%), participant selection and recruitmen (8%), and lastly data protection (9%). Because of these findings, the standard operating procedures of the committee have been revised--use of provided template participant documentation is strongly encouraged, and a "Recurring Review Themes" checklist is highlighted to all applicants. PMID:23909158
Conflicts can occur between the principle of freedom of information treasured by librarians and ethical standards of scientific research involving the propriety of using data derived from immoral or dishonorable experimentation. A prime example of this conflict was brought to the attention of the medical and library communities in 1995 when articles claiming that the subjects of the illustrations in the classic anatomy atlas, Eduard Pernkopf's Topographische Anatomie des Menschen, were victims of the Nazi holocaust. While few have disputed the accuracy, artistic, or educational value of the Pernkopf atlas, some have argued that the use of such subjects violates standards of medicalethics involving inhuman and degrading treatment of subjects or disrespect of a human corpse. Efforts were made to remove the book from medical libraries. In this article, the history of the Pernkopf atlas and the controversy surrounding it are reviewed. The results of a survey of academic medical libraries concerning their treatment of the Pernkopf atlas are reported, and the ethical implications of these issues as they affect the responsibilities of librarians is discussed. PMID:11209801
Conflicts can occur between the principle of freedom of information treasured by librarians and ethical standards of scientific research involving the propriety of using data derived from immoral or dishonorable experimentation. A prime example of this conflict was brought to the attention of the medical and library communities in 1995 when articles claiming that the subjects of the illustrations in the classic anatomy atlas, Eduard Pernkopf's Topographische Anatomie des Menschen, were victims of the Nazi holocaust. While few have disputed the accuracy, artistic, or educational value of the Pernkopf atlas, some have argued that the use of such subjects violates standards of medicalethics involving inhuman and degrading treatment of subjects or disrespect of a human corpse. Efforts were made to remove the book from medical libraries. In this article, the history of the Pernkopf atlas and the controversy surrounding it are reviewed. The results of a survey of academic medical libraries concerning their treatment of the Pernkopf atlas are reported, and the ethical implications of these issues as they affect the responsibilities of librarians is discussed.
Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these two needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training. PMID:12915366
Ziv, Amitai; Wolpe, Paul Root; Small, Stephen D; Glick, Shimon
Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these 2 needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training. PMID:19088599
Ziv, Amitai; Wolpe, Paul Root; Small, Stephen D; Glick, Shimon
Transplanting a uterus has unique characteristics, since a successful outcome is represented only by the birth of a viable healthy child. For this reason, critical issues in this type of transplantation differ profoundly from those of other solid organs and, beside a functioning uterus, involve 3 additional steps. First, at the time of implantation, the quality of embryo is tested by specialized decidual cells surrounding the implanting embryo; such testing is aimed at allowing the development of a normal embryo. Second, from early gestation onward, blood supply to the uterus increases from 45 to 750mL per minute. Vascular anastomoses should support such a marked increase in blood flow. Third, full transformation of spiral arterioles in the placental bed is required to direct 75% of the uterine blood flow to the intervillous space. Unfortunately, no suitable animal model is available for experimentation. Three overarching ethical issues must be considered. Should organ transplant be conducted when it is not absolutely necessary as a life-saving or quality-of-life-saving measure? To what extent should medicine delimit its potential in spite of societal desires? Should society demand from medicine the application of whichever technology can be developed and, if so, to what extent? PMID:23987733
Benagiano, Giuseppe; Landeweerd, Laurens; Brosens, Ivo
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.
This paper considers ethical dilemmas associated with research with male sex offenders. It examines two particular areas in detail: dealing with the disclosure of previously undisclosed offences and managing the distress of research participants during interview. Within these areas there is discussion of ethical approaches to research. Principle-based approaches offer abstract guidelines that help to resolve certain issues, but at
Kantian deontology is one of three classic moral theories, among virtue ethics and consequentialism. Issues in medicalethics are frequently addressed within a Kantian paradigm, at least – although not exclusively – in European medicalethics. At the same time, critical voices have pointed to deficits of Kantian moral philosophy which must be examined and discussed. It is argued that
Pursuit of pharmaceutical purity of the blood in the bag has led to a shrinking donor base and a significantly more expensive product. Decisions regarding new infectious marker testing and donor deferrals have typically been made emphasizing decreasing one specific risk without considering the effect the intervention will have on the overall safety and availability of blood transfusion. Regulations have been formulated by governmental agencies with limited input from the medical community. The decision making process has lacked risk benefit analyses and has not had the robustness associated with spirited discussions. Policies made in this manner may result in certain risks being decreased but can also have adverse unintended consequences. Being guided by the ethicalprinciples of nonmaleficence, beneficence, autonomy, and justice, we need to evaluate our actions in the context of overall blood safety rather than narrowly focusing on any one area.
For centuries, death has been defined, medically speaking, as the irreversible cessation of breathing and of nervous and cardiac activity. What radically changed this definition was the introduction of the concept "brain death" in 1968, by the "Ad Hoc Committee of the Harvard Medical School". According to it, the irreversible coma was associated with brain death and considered to be a criterion for the diagnosis of the deceased individual. The evergrowing need for transplant organs (provided this respects the dead honor rule, stipulating that organs can't be harvested unless someone is deceased) lead to making arbitrary decisions regarding the establishment of the exact time of death during the process of "losing life". What actually triggers the controversy related to the concept of brain death is the dilemma of associating this concept with that of biologic death or death of the person, the difference between the two being made by whether the mental characteristics are accepted or not in defining and individualizing the death of the human being. Given these circumstances, a dilemma appears--that of defining the death of the individual: we define death, as it has been for centuries, as the moment when the cardio-respiratory function no longer exists, which leads to the loss of tens of thousands of lives that might have been saved through transplant. Yet, this may lead to manipulating the border between life and death, with the risk of trespassing each individual's right to life. PMID:23272519
The American Library Association's Library Bill of Rights states that "Materials should not be excluded because of the origin, background, or views of those contributing to their creation." Medical ethicists question the use of data derived from experimentation that may have involved inhuman and degrading treatment of subjects or disrespect of a human corpse. Thus conflict between the upholding of ethical standards of research and freedom of information occurs. This conflict was brought to attention of the medical and library communities when journal articles purported that the source of the subjects for the illustrations in the classic anatomy atlas, Eduard Pernkopf's Topographische Anatomie des Menschen, were victims of the Nazi holocaust. While there has never been any dispute about the accuracy or educational value of the work, efforts were made to remove the book from medical libraries. Were these efforts a violation of the Library Bill of Rights or is it the responsibility of the library to discard those items that do not meet current standards of medicalethics? Librarians made different choices about what to do with the controversial Pernkopf title. PMID:11143883
The advances in internet and mobile technologies and their increased use in healthcare led to the development of a new research field: health web science. Many research questions are addressed in that field, starting from analysing social-media data, to recruiting participants for clinical studies and monitoring the public health status. The information provided through this channel is unique in a sense that there is no other written source of experiences from patients and health carers. The increased usage and analysis of health web data poses questions on privacy, and ethics. Through a literature review, the current awareness on ethical issues in the context of public health monitoring and research using medical social media data is determined. Further, considerations on the topic were collected from members of the IMIA Social Media Working group. PMID:24825685
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
Background Even though we are now well into the 21st century and notwithstanding all the abuse to individuals involved in clinical studies that has been documented throughout History, fundamental ethicalprinciples continue to be violated in one way or another. Discussion Here are some of the main factors that contribute to the abuse of subjects participating in clinical trials: paternalism, improper use of informed consent, lack of strict ethical supervision, pressure exerted by health institutions to increase the production of scientific material, and the absence of legislation regarding ethics in terms of health care and research. Are researchers ready to respect fundamental ethicalprinciples in light of the ample window of information provided by individual genomes, while defending the rights of the subjects participating in clinical studies as a major priority? Summary As one of the possible solutions to this problem, education regarding fundamental ethicalprinciples is suggested for participants in research studies as an initial method of cognitive training in ethics, together with the promotion of ethical behavior in order to encourage the adoption of reasonable policies in the field of values, attitudes and behavior.
The changing context of medical practice-bureaucratic, political, or economic-demands that doctors have the knowledge and skills to face these new realities. Such changes impose obstacles on doctors delivering ethical care to vulnerable patient populations. Modern medicalethics education requires a focus upon the knowledge and skills necessary to close the gap between the theory and practice of ethical care. Physicians and doctors-in-training must learn to be morally sensitive to ethical dilemmas on the wards, learn how to make professionally grounded decisions with their patients and other medical providers, and develop the leadership, dedication, and courage to fulfill ethical values in the face of disincentives and bureaucratic challenges. A new core focus of medicalethics education must turn to learning how to put ethics into practice by teaching physicians to realistically negotiate the new institutional maze of 21st-century medicine. PMID:24802645
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.
Background To determine the knowledge and ethical perception regarding organ donation amongst medical students in Karachi- Pakistan. Methods Data of this cross sectional study was collected by self administered questionnaire from MBBS students of Ziauddin University from 2010 to 2011. Sample size of 158 (83 First years and 75 Fourth years) were selected by convenient sampling and those students who were present and gave consent were included in the study. The data was analyzed by SPSS version 20. Results A total of 158 participants from Ziauddin Medical University filled out the questionnaire out of which 83(52.5%) were first years and 75(47.5%) were fourth year medical students. Mean age of sample was 20 ± 1.7. Majority of students were aware about organ donation with print and electronic media as the main source of information. 81.6% agreed that it was ethically correct to donate an organ. In the students’ opinion, most commonly donated organs and tissues were kidney, cornea, blood and platelet. Ideal candidates for donating organ were parents (81%). Regarding list of options for preference to receive an organ, most of the students agreed on young age group patients and persons with family. Willingness to donate was significantly associated with knowledge of allowance of organ donation in religion (P=0.000). Conclusion Both 1st year and 4th year students are aware of Organ Donation, but there is a significant lack of knowledge regarding the topic.
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 medicalethics 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
Judgment This study was done in order to evaluate the effectiveness of the revisions made in the course of medicalethics for undergraduate medical students. Medical Students of Tehran University of Medical Sciences who took the course of medicalethics in a semester before the implementation of the revision and those who took the course after the implementation of the revision at the beginning and at the end of course responded to two questionnaires (one for evaluating knowledge and the other for assessing their moral judgment). Response rate was between 70 to 93.1 percent. Students’ knowledge was significantly higher in the semester after the course revision (mean ± SD: 6.12 ± 1.3) in comparison with the semester before the reform (mean ± SD: 3.63 ± 1.7) (P=0.001). Students’ knowledge after taking this course showed an increase of about 60% when compared with their knowledge level before starting the course (P=0.001). There was no significant difference in the level of moral judgment before and after taking the revised course of medicalethics while moral judgment level of students in two semester[before (21.21 ± 4.0) and after 15.25 ± 2.87) reform] were significantly different (P=0.02). The revisions made in the course of medicalethics for medical students were effective in improving students’ knowledge but could not improve their moral judgment. This could be due to the short length of this course and also the small sample size in this study. We suggest that this study should be repeated with larger sample size and also with other methods of a course evaluation.
This article in the series describes how UK law and medicalethics 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?
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
Background Due to the important role of depression in major illnesses, screening measures for depression are commonly used in medical research. The protocol for managing participants with positive screens is unclear and raises ethical concerns. The aim of this article is to identify and critically discuss the ethical issues that arise when a positive screen for depression is detected, and offer some guidance on managing these issues. Discussion Deciding on whether to report positive screens to healthcare practitioners is both an ethical and a pragmatic dilemma. Evidence suggests that reporting positive depression screens should only be considered in the context of collaborative care. Possible adverse effects, such as the impact of false-positive results, potentially inappropriate labelling, and potentially inappropriate treatment also need to be considered. If possible, the psychometric properties of the selected screening measure should be determined in the target population, and a threshold for depression that minimises the rate of false-positive results should be chosen. It should be clearly communicated to practitioners that screening scores are not diagnostic for depression, and they should be informed about the diagnostic accuracy of the measure. Research participants need to be made aware of the consequences of the detection of high scores on screening measures, and to be fully informed about the implications of the research protocol. Summary Further research is needed and the experiences of researchers, participants, and practitioners need to be collated before the value of reporting positive screens for depression can be ascertained. In developing research protocols, the ethical challenges highlighted should be considered. Participants must be agreeable to the agreed protocol and efforts should be made to minimise potentially adverse effects.
OBJECTIVE: To determine whether a workshop on medicalethics 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.
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.
Mentoring programs pair youth who are perceived to be at risk for poor outcomes with volunteers who are trained to provide support. Although mentoring has experienced tremendous growth in recent years, the ethical challenges inherent in relationship-based interventions have been given insufficient attention among researchers and practitioners. Rarely acknowledged is the potential for harm that poorly implemented mentoring relationships can
Discharges against medical advice (AMA) account for approximately 1% of discharges for general medical patients. Patients discharged AMA have longer eventual hospital stays and worse health outcomes. These patients are also less likely to have an established relationship with a physician, tend to have poorer social supports, and are more likely to abuse alcohol and other substances. These discharges are also distressing for physicians and other health professionals. How should physicians manage their conflicted obligations to respect patients' choices and to prevent harms from befalling their patients? What are physicians' obligations to their patients who leave accepting only partial or inadequate treatment plans or no treatment at all? When should physicians question the decision-making capacity of patients who make dangerous judgments to leave the hospital? This article examines the ethical and professional implications of discharge AMA. PMID:18951403
Recent interest in global health among medical students has grown drastically, and many students now spend time abroad conducting short-term research projects in low-resource settings. These short-term stints in developing countries present important ethical challenges to US-based students and their medical schools as well as the institutions that host such students abroad. This paper outlines some of these ethical issues and puts forth recommendations for ethically mindful short-term student research.
An american expert on Jewish medicalethics explained the nuances of these rules during a recent address in Ottawa. Although Jewish and secular rules concerning medicalethics often coincide, they diverge in several important areas, including the subject of patient autonomy.
OBJECTIVE: To examine the long-term effects of an innovative curriculum on medical house officers' (HOs') knowledge, confidence, and attitudes regarding medicalethics. 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
There is much discussion on medicalethics literature regarding the importance of the patients' right for self-determination. We discuss some of the limitations of patient's autonomy with the aim to draw attention to the ethical complexity of medical decision making in the everyday clinical practice.
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.
MedicalEthics has many unsung heros and heroines. Here we celebrate one of these and on telling part of her story hope to place modern medicalethics and bioethics in the UK more centrally within its historical and human contex.
Social work and public health are different but mutually connected. Both are professions with their own ethical foundations. Despite all differences, they have the same goal: to protect and to enhance the well-being of people. This is, in part, why the fundamental ethicalprinciples of social work are salient for developing public health ethics. As a human rights profession, social work respects the personal autonomy of clients, supports solidarity-based relationships in families, groups or communities, and attempts to uphold social justice in society. Social workers need to adopt special professional attitudes: sensibility for the vulnerabilities of clients, care and attentiveness for their resources and strengths, assistance instead of paternalistic care and advocacy in decision making for clients' well-being when clients are not able to decide for themselves. These fundamental ethicalprinciples are the basis for discussion of special topics of social work ethics as public health ethics, for example, in justifying intervention in individual lifestyles by public services without the participation or consent of the affected persons. PMID:19360384
The precautionary principle is a useful strategy for decision-making when physicians and patients lack evidence relating to the potential outcomes associated with various choices. According to a version of the principle defended here, one should take reasonable measures to avoid threats that are serious and plausible. The reasonableness of a response to a threat depends on several factors, including benefit vs. harm, realism, proportionality, and consistency. Since a concept of reasonableness plays an essential role in applying the precautionary principle, this principle gives physicians and patients a decision-making strategy that encourages the careful weighing and balancing of different values that one finds in humanistic approaches to clinical reasoning. Properly understood, the principle presents a worthwhile alternative to approaches to clinical reasoning that apply expected utility theory to decision problems. PMID:15512973
Sociologists who do field work in medical settings face an intractable tension between their disciplinary field, which takes a critical perspective toward medicine, and their ethnographic field, which often includes physicians. This paper explores the ethical problems that result from the collision of the two fields. While in the field, ethnographers are forced to choose between sociology and their obligations to host members, as they decide whether to disclose their actual research agendas, whether to ask tough questions or to reveal their concerns, and whether to give advice. The tension persists when field workers leave the field to write, forcing them to choose between competing interpretations and to decide what to reveal or conceal in the interests of confidentiality. Through these moral choices about what to ask, record or present to the reader, ethnographers shape the academic field even as it shapes them. PMID:17184414
The writer physicians of Islamic medicine have given top priority to the Islamic MedicalEthics in their valuable writings and left the ineffaceable footsteps in the field. Such as, Abul Hasan Ahmed bin Mohammad At-Tabari has devoted the 35th chapter of Maqala l of his precious book entitled 'Moalejat-e-Buqratiya' to medicalethics. The entire chapter reflects the Islamic approach of the scholar. In the following pages, an attempt has been made to highlight some salient features of Islamic MedicalEthics in ancient literature of Islamic Medical with special reference to Moalejat-e-Buqratiya. PMID:12585282
Mark Mason, in his "A Justification, After the Postmodern Turn, of Universal EthicalPrinciples 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…
This study looked at information on ethics reporting and authorship in the "instructions to authors" section of Indian medical journals. Instructions to authors in 59 Indian medical journals were examined for guidance on ethics reporting and authorship. Guidance regarding ethics was mentioned in 43 (72.8%) journals; assent from minors was mentioned in 9 (15.2%) journals; approval from an animal ethics committee was mentioned in 10 (16.9%) journals; authorship criteria were mentioned in 38 (64.5%) journals. Authorship criteria according to the International Committee of Medical Journal Editors were mentioned in 35 (59.3%) journals. Guidance regarding contributors' details was mentioned in 30 (50.8%) journals. These findings suggest that many editors of Indian medical journals must upgrade their instructions to authors to include ethical requirements. PMID:22106597
Jaykaran; Yadav, Preeti; Chavda, Nilesh; Kantharia, N D
Illness is not just something that persons have or get--it is something that they experience. They live this experience fully with their entire being--emotionally, psychologically, spiritually, and physiologically. Any method of ethical analysis must take care to not simplify the process of dealing with morally troubling cases. The multidimensional nature of human life is so complex that the decisions made in these situations are seldom if ever strictly medical decisions--they are also social, emotional, religious, and moral ones. Ethical dilemmas present in today's health care settings compel members of HECs to engage in and contribute toward meaningful dialogue in ethics that is collaborative, multidisciplinary, and mutually respectful. The inevitability of change in the way in which the health needs of people are going to be handled in the future demands this proactive approach. Individuals who accept this responsibility must equip themselves for ethical analysis that deals effectively with the inevitably complex questions that will arise. PMID:10153740
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
As medical education increasingly acknowledges the importance of the ethical and professional conduct of practitioners, and moves towards more formal assessment of these issues, it is important to consider the evidence base which exists in this area. This article discusses literature about the health needs and problems experienced by medical practitioners as a background to a review of the current efforts in medical education to promote ethical conduct and develop mechanisms for the detection and remediation of problems.
Summary Questions under study: We conducted a survey among Swiss health care professionals on the reception and implementation of a number of selected ethical guidelines of the Swiss Academy of Medical Sciences (SAMS). The following guidelines were chosen for evaluation: \\
In this paper some of the general issues surrounding recently published guidelines for the practice of research ethics committees are outlined, concentrating in particular on the difficulties raised by research with psychiatric patients. Research is distinguished from ordinary clinical practice by the intention to advance knowledge. So defined, research with psychiatric patients should be governed by the same four principles as research with any other group--knowledge, necessity, benefit and consent. In applying these principles, however, particularly the principle of consent, many acute difficulties are raised by psychiatric patients. A number of proposals for addressing these difficulties are discussed. It is suggested that, notwithstanding the value of published guidelines, and the help that may be available from research ethics committees, the primary responsibility for maintaining high standards of practice in research rests with research workers themselves.
We sought to answer two questions via this exploratory study. First, we investigated whether or not individual differences in moral principle selection/preference existed in response to six moral dilemmas. Second, we sought to find out whether they were r...
Background Researching sensitive topics, such as the rationing of treatments and denial of care, raises a number of ethical and methodological problems. Aim To describe the methods and findings from a number of focus group discussions that examined how GPs apply ethicalprinciples when allocating scarce resources. Design of study A small-scale qualitative study involving purposive sampling, semi-structured interviews and focus groups. Setting Twenty-four GPs from two contrasting areas of London: one relatively affluent and one relatively deprived. Method Initial interviews asked GPs to identify key resource allocation issues. The interviews were transcribed and themes were identified. A number of case studies, each illustrative of an ethical issue related to rationing, were written up in the form of vignettes. In focus group discussions, GPs were given a number of these vignettes to debate. Results With respect to the ethical basis for decision making, the findings from this part of the study emphasised the role of social and psychological factors, the influence of the quality of the relationship between GPs and patients and confusion among GPs about their role in decision making. Conclusion The use of vignettes developed from prior interviews with GPs creates a non-threatening environment to discuss sensitive or controversial issues. The acceptance by GPs of general moral principles does not entail clarity of coherence of the application of these principles in practice.
The Socratic method has a long history in teaching philosophy and mathematics, marked by such names as Karl Weierstrass, Leonard Nelson and Gustav Heckmann. Its basic idea is to encourage the participants of a learning group (of pupils, students, or practitioners) to work on a conceptual, ethical or psychological problem by their own collective intellectual effort, without a textual basis and without substantial help from the teacher whose part it is mainly to enforce the rigid procedural rules designed to ensure a fruitful, diversified, open and consensus-oriented thought process. Several features of the Socratic procedure, especially in the canonical form given to it by Heckmann, are highly attractive for the teaching of medicalethics in small groups: the strategy of starting from relevant singular individual experiences, interpreting and cautiously generalizing them in a process of inter-subjective confrontation and confirmation, the duty of non-directivity on the part of the teacher in regard to the contents of the discussion, the necessity, on the part of the participants, to make explicit both their own thinking and the way they understand the thought of others, the strict separation of content level and meta level discussion and, not least, the wise use made of the emotional and motivational resources developing in the group process. Experience shows, however, that the canonical form of the Socratic group suffers from a number of drawbacks which may be overcome by loosening the rigidity of some of the rules. These concern mainly the injunction against substantial interventions on the part of the teacher and the insistence on consensus formation rooted in Leonard Nelson's Neo-Kantian Apriorism. PMID:11080988
This narrative review focuses on ethics related to nutrition-specific community-based research, within the framework of science for society, and focusing on the rights and well-being of fieldworkers and research participants. In addition to generally accepted conditions of scientific validity, such as adequate sample size, unbiased measurement outcome and suitable study population, research needs to be appropriate and feasible within the local context. Communities' suspicions about research can be overcome through community participation and clear dialogue. Recruitment of fieldworkers and research participants should be transparent and guided by project-specific selection criteria. Fieldworkers need to be adequately trained, their daily schedules and remuneration must be realistic, and their inputs to the study must be recognized. Fieldworkers may be negatively affected emotionally, financially and physically. Benefits to research participants may include physical and psychological benefits, minimal economic benefit, and health education; while risks may be of a physical, psychological, social, or economic nature. Targeting individuals in high-risk groups may result in social stigmatization. The time burden to the research participant can be minimized by careful attention to study procedures and questionnaire design. Potential benefits to the community, fieldworkers and research participants and anticipated knowledge to be gained should outweigh and justify the potential risks. Researchers should have an exit strategy for study participants. For effective dissemination of results to individual research participants, the host community and nutrition community, the language, format and level of presentation need to be appropriate for the target audience. PMID:22591024
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
A three-year curriculum in medicalethics operates at Rhode Island Hospital and Brown University as part of the general internal medicine residency program. The six major topics covered are co-taught as seminars by one or more members of the multidisciplinary ethics faculty (philosopher, internist, and communications specialist) and experienced…
\\u000a Both the efficient application of a marketed psychotropic drug to mentally ill persons in practice and the assessment of effectiveness and safety of a potentially therapeutic drug through research imply ethical problems. The basic ethical issue is to find an optimum of the relationship between the benefits and risks\\u000a of a medication with regard to major ethicalprinciples.\\u000a \\u000a \\u000a The therapeutic
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.
"I will not relinquish old age, if it leaves my better part intact. But, if it begins to shake my mind, if it destroys its faculties one by one, if it leaves me not life but breath, I will depart from the putrid or tottering edifice. If I must suffer without hope or relief, I will depart, not through fear of the pain itself, but because it prevents all for which I would live." Seneca, the great Roman statesman of 1st century AD, spoke these words 2 millennia before the Netherlands became, on November 28, 2000, the first country in the world to legalize euthanasia. The decisions pertaining to end of life, whether legalized or otherwise, are practiced in many parts of the world but not reported on account of legal implications. Lack of awareness regarding the distinction between different procedures on account of legal status granted to them in some countries is the other area of concern. Debate among the medical practitioners, lawmakers, and the public taking into consideration the cultural, social, and religious ethos will lead to increased awareness, more safeguards, and improvement of medical decisions concerning the end of life. PMID:15322464
This study used semi-structured interviews and content analysis to examine moral principles that street drug users apply to three hypothetical addiction research ethical dilemmas. Participants (n = 90) were ethnically diverse, economically disadvantaged drug users recruited in New York City in 2009. Participants applied a wide range of contextually sensitive moral precepts, including respect, beneficence, justice, relationality, professional obligations, rules, and pragmatic self-interest. Limitations and implications for future research and the responsible conduct of addiction research are discussed.
Physicians have been required to possess high ethical standards, as medical practice is directly involved with patients' lives. Although ethics arise out of an individual's consciousness, ethical regulations imposed by the nation/government together with self-regulation by physician groups are important in the practice of ethics, for which reason countries around the world undertake various initiatives. This paper investigates physician licensure, organizations governing physician status, the role of physician groups, and the actual conditions of lifelong learning and ethics education in developed countries worldwide, in contrast with which it throws problems in the situation in Japan into relief. Organizations governing physician status, the form of medical associations, and the improvement of lifelong learning are pointed out as critical issues especially in Japan.
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 medicalethics.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
The pluralism of methodologies and severe time constraints pose important challenges to pedagogy in clinical ethics. We designed a step-by-step student handbook to operate within such constraints and to respect the methodological pluralism of bioethics and clinical ethics. The handbook comprises six steps: Step 1: What are the facts of the case?; Step 2: What are your obligations to your
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.
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 medicalethics 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 medicalethics 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 medicalethics. 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.
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.
In conclusion, several points are worth emphasizing at this juncture: 1. Clinical researchers must attend to a set of ongoing concerns in new ways and reconsider how best to explain research protocols to potential subjects. Consent procedures and documents 5 or 10 years old may not be considered adequate by current standards. It is clearly important to ensure that consent documents, and the process by which informed consent is obtained and maintained, are state-of-the-art. 2. Many valuable sources of information are available to help researchers, family members, and potential participants learn about proper informed consent. NIMH is taking steps to improve this educational process. Members of IRBs are educated through conferences, newsletters, case books, etc. OPRR (May 1994) has also provided considerable information relevant to informed consent in clinical research. OPRR and NIMH staff may be useful sources of information concerning informed consent. 3. Research on competency and the consent process itself is needed so we can compare what was explained with what was understood and learn what research subjects want to know, what they believe has occurred, and why. 4. Progress in discovering the underlying causes of schizophrenia and other severe mental disorders, and improving their treatment, will require scientifically rigorous studies involving people affected by these disorders. Attempts to prohibit competent people with mental disorders from making decisions about participating in research protocols seem misguided, paternalistic, and stigmatizing. If we are to improve the treatment of severe mental disorders, clinical research is essential, including research that is not likely to directly benefit each individual participating. 5. This is a time of great opportunity for clinical research. New medications being tested have the potential to revolutionize the treatment of severe mental disorders. During recent years, a number of large scale projects have been focusing on underlying genetic vulnerability factors that may shed light on the etiology of these disorders, with profound implications for diagnosis, treatment, and eventually even prevention. Unfortunately, clinical research is also under attack on several fronts, including concerns about consent and the protection of human subjects with mental disorders. If we do not take steps now to ensure that the process by which we protect and inform research participants is state-of-the-art, the very progress we seek will be at risk. PMID:8927678
In this project, we aimed to revise the medicalethics curriculum at the School of Medicine, Tehran University of Medical Sciences, in order to promote the level of students’ ethical awareness and enable them to make ethical decisions. Ideal and long term educational objectives were set to determine directions for future reforms and to provide a baseline for future evaluation of the project. However, based on limited available recourses, the first stage of the reform was planned and implemented with a 3 years scope. In revising the curriculum, which was done according to the Harden’s ten questions, we focused on moral attitude and ethical reasoning skill in addition to academic knowledge base by using methods such as case discussions, portfolio, and clinical ethics rounds. The revised curriculum was implemented during the first semester of the 2006–2007 academic year for the first time. The student feedback indicated that the new curriculum was successful in increasing the students’ awareness of ethical issues and enabled them to understand and accept their professional obligations. Revising the curriculum and its evaluation should be considered as an ongoing process. The present project was a successful experience that motivated faculty members to pursue the next steps of improving the curriculum on medicalethics and proved to be convincing for the authorities and policy makers to support it.
Asghari, Fariba; Mirzazadeh, Azim; Samadi, Aniseh; Safa, Aliakbar Nejati; Jafarian, Ali; Farahani, Ali Vasheghani; Razavi, Seyed Hasan Emami
In this project, we aimed to revise the medicalethics curriculum at the School of Medicine, Tehran University of Medical Sciences, in order to promote the level of students' ethical awareness and enable them to make ethical decisions. Ideal and long term educational objectives were set to determine directions for future reforms and to provide a baseline for future evaluation of the project. However, based on limited available recourses, the first stage of the reform was planned and implemented with a 3 years scope. In revising the curriculum, which was done according to the Harden's ten questions, we focused on moral attitude and ethical reasoning skill in addition to academic knowledge base by using methods such as case discussions, portfolio, and clinical ethics rounds. The revised curriculum was implemented during the first semester of the 2006-2007 academic year for the first time. The student feedback indicated that the new curriculum was successful in increasing the students' awareness of ethical issues and enabled them to understand and accept their professional obligations. Revising the curriculum and its evaluation should be considered as an ongoing process. The present project was a successful experience that motivated faculty members to pursue the next steps of improving the curriculum on medicalethics and proved to be convincing for the authorities and policy makers to support it. PMID:23908750
Asghari, Fariba; Mirzazadeh, Azim; Samadi, Aniseh; Safa, Aliakbar Nejati; Jafarian, Ali; Farahani, Ali Vasheghani; Razavi, Seyed Hasan Emami
The statutory and regulatory requirements governing medical device development and approval are reviewed. Some of the procedures that the US Food and Drug Administration has implemented to loosen the strictures that impede development and approval of new medical devices are discussed. Some of the ethical issues associated with these procedures are examined. PMID:18238327
The new Israeli Organ Transplant Law grants priority in organ allocation to candidates for transplantation who have registered as organ donors at least 3 years prior to being listed or have been Live organ donors or have a first degree relative who has been a deceased donor. This unique law resurrects the old ethicalprinciple of reciprocal altruism in which each partner in society helps the other while he helps himself. The altruist benefits because in time he, in turn, is helped. The law aims to eliminate the "free riding" phenomenon of candidates for organ transplantation who do not accept brain death and therefore object to organ donation after death yet do not abstain from waiting for such donation. The morality of such behavior is discussed along with the ethical appraisal of its solution in the law, suggesting it to be just and fair. PMID:24791557
The purpose of this study was to examine how ethical approval and competing interests are addressed by medical journals in Iran. In a cross-sectional study, 151 journals accredited by the Publications Commission of the Ministry of Health and Medical Education were reviewed. Data collection was carried out by assessing journal guidelines and conducting structured phone interviews with journal managers, focusing on how ethical considerations and conflicts of interest (COI) are addressed. Overall, 135 of the 151 journals (89.4 percent) examined some aspect of ethical considerations of submitted articles. Authors were required to disclose their financial sponsors by 98 journals (64.9 percent), while COI disclosure was required by 67 journals (44.4 percent). We conclude that the rate of addressing ethical considerations is not far from ideal, but the requirement for COI disclosure needs more attention. PMID:23188405
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.
Background: During the last three decades, ethics committees have been formed with a growing trend. These committees have a satisfactory and effective impact on the pattern of patient care and its performance. The medicalethics committee is considered one of the most active committees in hospitals, having the aim of providing necessary approaches for the optimal use of the findings in empirical science and diagnostic treatment and observance of Islamic noble values in performing medical affairs. Objectives: The aim of this study is to assess the performance of the ethics committees, in the teaching hospitals affiliated with Mashhad University of Medical Sciences, in Mashhad. Patients and Methods: Subjects of this study include teaching hospitals in Mashhad, affiliated with Mashhad University of Medical Sciences and the tool used in gathering the data was a questionnaire, completed based on the information provided by the proceedings of the meetings held by the ethics committees. Also, for the purpose of gathering the suggestions, specifically on the improvement of the performance, a meeting was held with the representatives from hospitals' ethics committees. During the meeting, work reports were presented and recommendations made, based on those presentations. . Results: Findings of the present study suggest that all hospitals under study, have an ethics committee, of which 85.7% operate in combination with other committees. The composition of the members of the committees, in 57.1% of the hospitals, was based on the guidelines for hospital evaluation. Conclusions: For the performance of the medicalethics committees to improve, it is recommended that the hospital administration and evaluation section, hold regular meetings and oblige members to participate more actively.
The Living Will is an ethically acceptable document that serves to convey a patient's attitude toward terminal illness and to facilitate a physician's decision not to prolong the dying process. But in a Christian context, the Christian Affirmation of Life is a superior document by which to express and aid such decision making. Because the Living Will advances the concept of negative euthanasia--an ethical, legal, and political misnomer--and abets the effort to legalize positive or direct euthanasia, it should not be given legal recognition. As a legal document, the Living Will could seriously affect both patients and physicians. PMID:1270060
The authors co-organized (Snyder and Crooks) and gave a keynote presentation at (Turner) a conference on ethical issues in\\u000a medical tourism. Medical tourism involves travel across international borders with the intention of receiving medical care.\\u000a This care is typically paid for out-of-pocket and is motivated by an interest in cost savings and\\/or avoiding wait times for\\u000a care in the patient’s
A significant number of asylum seekers who largely survived torture live in the United States. Asylum seekers have complex social and medical problems with significant barriers to health care access. When evaluating and providing care for survivors, health providers face important challenges regarding medicalethics and professional codes. We review ethical concerns in regard to accountability, the patient-physician relationship, and moral responsibilities to offer health care irrespective of patient legal status; competing professional responsibility toward society and the judiciary system; concerns about the consistency of asylum seekers' claims; ethical concerns surrounding involving trainees and researching within the evaluation setting; and the implication of broader societal views towards rights and social justice. We discuss contributing factors, including inadequate and insufficient provider training, varying and inadequate institutional commitment, asylum seekers' significant medical and social problems, and the broader health and social system issues. We review existing resources to address these concerns and offer suggestions. PMID:23767428
This paper describes the change of emphasis that occurred in the teaching of ethics to small groups of clinical students. Although the original focus of the course was on the analysis of ethical dilemmas associated with individual patients known to the students, it soon became evident that there were, for the students themselves, more fundamental ethical dilemmas in their new
Palliative cancer treatment is a system of care that seeks to relieve suffering in patients with progressive cancer. Given the intractable symptoms with which certain malignancies manifest, palliative care offers a practical approach towards improving the patient’s quality of life. However, there are an array of ethical issues associated with this treatment strategy such as particular methods of pain relief, a reliable assessment of suffering, autonomy, and multi-specialist care. While these principles are important to increase and improve the network of palliative care, the resource-poor Indian environments present numerous barriers for these principles to be practically applied. As the infrastructure of comprehensive cancer centers develop, paralleled with an increase in training of palliative care professionals, significant improvements need to be made in order to elevate the status of palliative cancer care in India.
With the emergence of new information and communication technologies (NICT) in the daily practice of medicine, personal medical data have become exportable. Certainly, they represent an interesting source for epidemiologists who were often lacking complete data sets all the way through to morbidity data; but once these data leave the confines of the structure of a medical office, they must be protected in order to respect the fundamental ethicalprinciples which form the basis of the doctor-patient relationship. Given the fact that medical data are not considered merchandise, there is the need to lead a process of reflection which aims to adapt the existing ethical rules and regulations to norms which conform to this new environment. There is also a need to compile a report on the overall European situation, and more specifically the French case. PMID:16676718
MedicalEthics has many unsung heros and heroines. Here we celebrate one of these and on telling part of her story hope to place modern medicalethics and bioethics in the UK more centrally within its historical and human contex. PMID:22518049
Several patients with end-stage renal disease went to Bombay for renal transplantation from nonrelated living donors and then returned to Turkey for posttransplantation follow-up. The aims of this study are to evaluate the long-term results of renal transplantation from nonrelated living donors in Turkish patients with end-stage renal disease and to discuss the ethical and social aspects of nonrelated kidney
Müjdat Yenicesu; Tekin Akpolat; Abdülgaffar Vural; Turgay Arinsoy; Ünal Yasavul; Çetin Turgan
A literature review was carried out in relation to general medical research and radiation protection research. A large number of documents were found concerning the subject of ethics in general medical research. For radiation protection research, the number of documents and the information available is very limited. A review of practices in 13 European countries concerning general medical research and radiation protection research was carried out by sending a questionnaire to each country. It was found that all countries reviewed were well regulated for general medical research. For research that involves ionising radiation, the UK and Ireland are by far the most regulated countries. For other countries, there does not seem to be much information available. From the literature review and the review of practices, a number of existing ethical issues were identified and exposed, and a number of conclusions were drawn. PMID:18440965
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 medicalethics 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
Carol Gilligan has identified two orientations to moral understanding; the dominant 'justice orientation' and the under-valued 'care orientation'. Based on her discernment of a 'voice of care', Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medicalethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medicalethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others. PMID:1492344
The use of genome-wide association studies (GWAS) in medical research and the increased ability to share data give a new twist to some of the perennial ethical issues associated with genomic research. GWAS create particular challenges because they produce fine, detailed, genotype information at high resolution, and the results of more focused studies can potentially be used to determine genetic
Jane Kaye; Paula Boddington; Jantina de Vries; Naomi Hawkins; Karen Melham
The use of genome-wide association studies (GWAS) in medical research and the increased ability to share data give a new twist to some of the perennial ethical issues associated with genomic research. GWAS create particular challenges because they produce fine, detailed, genotype information at high resolution, and the results of more focused studies can potentially be used to determine genetic
Jane Kaye; Paula Boddington; Jantina de Vries; Naomi Hawkins; Karen Melham
Carol Gilligan has identified two orientations to moral understanding; the dominant ‘justice orientation’ and the under-valued ‘care orientation’. Based on her discernment of a ‘voice of care’, Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medicalethical theory. Specifically,
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
The growth of the Internet over the last 10 years as a medium of information and as a communication technology has provided the opportunity for selling medical products and services online directly to the public. This chapter investigates on- line medical consultations used for the purpose of prescribing and hence selling prescription drugs via the Internet. With consumers in mind,
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.
Making ethical decision rarely involves a simple yes or no answer. Matters of confidentiality are no different. This article examines how school counselors must draw the line between protecting a student's privacy and providing information to parents and administrators. (GCP)
The authors present an account of the main ethical and technical aspects relating to the measurement of medical publication activities and the compilation of publications lists. It is demonstrated that the Anglo-American scientometric system (Institute for Scientific Information, USA) is currently gaining stable ground in Hungary. At the same time, however, there continues to be a place for a national publication index used to assess Hungarian-language publication activity, for the two systems conveniently supplement one another. The criterion system of medical publishing established by the International Committee of Medical Journal Editors (ICMJE) is described in detail, and is recommended for wide-ranging application in Hungary. PMID:11778357
The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants (empathy focused). The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols (analytic focused). Compared to controls, those in
Laura Weiss Roberts; Teddy D. Warner; Laura B. Dunn; Janet L. Brody; Katherine A. Green Hammond; Brian B. Roberts
The fear of pain is common among cancer patients. The management of cancer pain can raise troubling ethical issues for medicine and society. Medical caregivers have an ethical duty to provide therapy that benefits patients by achieving one or more goals of medicine at all points. Pain and symptom relief may be the only achievable goal when curative therapy has failed. Relief of pain can restore decision-making capacity and enhance the patient's right to self-determination. The underpinning ethicalprinciples and extensions of these principles in the medical context of pain control with varying medical goals in cancer care, including dying patients, is explored. PMID:7516956
Those who make decisions employ a moral component in the process of rationalizing a chosen course of action - ethics. Military flight surgeons often find themselves making decisions involving competing interests, those of the military service whose missio...
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 \\
Objectives: Survey on the current medical approach to and the economic issues affecting infants with primary hyperoxaluria type 1. Methods: Questionnaire to specialized centers worldwide. Results: Seventy-eight infants were identified: 44% were of Muslim origin and 56% were not. The consanguinity rate was 76% and 0%, respectively. Thirty-three percent were treated in developing countries (group 1) and 67% in developed
Pierre Cochat; Paulo C. Koch Nogueira; M. Ayman Mahmoud; Neville V. Jamieson; Jon I. Scheinman; Marie-Odile Rolland
Describes simulation-based learning in medical education and presents four these that make a framework for simulations: (1) best standards of care and training; (2) error management and patient safety; (3) patient autonomy; and (4) social justice and resource allocation. (SLD)
Ziv, Amitai; Wolpe, Paul Root; Small, Stephen D.; Glick, Shimon
A general rationale is presented for withholding and withdrawing medical treatment in end-of-life situations, and an argument is offered for the moral irrelevance of the distinction, both in the context of pharmaceutical treatments, such as chemotherapy in cancer, and in the context of life-sustaining treatments, such as the artificial ventilator in lateral amyotrophic sclerosis. It is argued that this practice is not equivalent to sanctioning voluntary active euthanasia and that it is not likely to favour it.
The author's experience of ethical review over six years as an academic member and chairperson of a university human ethics committee has been largely positive and educative. The account brings together archival records and personal experience to create a "transactive" account of the practical experience of doing ethical review in one university…
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…
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.
The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline. PMID:22811556
Janssens, Rien; van Delden, Johannes J M; Widdershoven, Guy A M
Medicalethics nowadays is dominated by a conception of ethics as the application of moral theories and principles. This conception is criticized for its depreciation of the internal morality of medical practice and its narrow view of external morality. This view reflects both a lack of interest in the empirical realities of medicine and a neglect of the socio-cultural value-contexts
Lecture is the most common teaching method used in ethics education, while problem-based learning (PBL) and small group discussion (SGD) have been introduced as more useful methods. This study compared these methods in teaching medicalethics. Twenty students (12 female and 8 male) were randomly assigned into two groups. The PBL method was used in one group, and the other group was taught using the SGD method. Twenty-five open-ended questions were used for assessment and at the end of the course, a course evaluation sheet was used to obtain the students' views about the advantages and disadvantages of each teaching method, their level of satisfaction with the course, their interest in attending the sessions, and their opinions regarding the effect of teaching ethics on students' behaviors. The mean score in the PBL group (16.04 ± 1.84) was higher than the SGD group (15.48 ± 2.01). The satisfaction rates in the two groups were 3.00 ± 0.47 and 2.78 ± 0.83 respectively. These differences were not statistically significant. Since the mean score and satisfaction rate in the PBL group were higher than the SGD group, the PBL method is recommended for ethics education whenever possible. PMID:23908762
Starting from an epistemological position of individualized medicine this article deals with the ethical analysis of this complex topic. The need for evidence-based decisions--as opposed to interest-driven decisions--is emphasised. Based on the argument of social justifiability it can be first stated as an intermediate result that genome-based research, which aims to promote individualisation of medicine, does not exclude research that uses other diagnostic markers, and the appropriate ethical standards can be applied. Second, the development of individualised preventive medicine in the field of multifactorial diseases should increasingly study the potential cost savings of genetic risk diagnosis compared to the costs for the actual treatment options. For proper, medically reasonable, ethically justifiable and socially desired implementation of all areas of individualised medicine, clear separation between research and care as well as the simultaneous implementation of ethical, legal, methodological and technical standards is desirable; however these must be continuously developed in order to respond to possible boundary changes that may arise. Finally, the challenge remains to make the efficacy, operationalisation, performance, and affordability of individualised medicine plausible in the context of social justifiability. PMID:24170076
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.
The European Commission is one of the most important international funding bodies for research conducted in Europe and beyond, including developing countries and countries in transition. Through its framework programmes for research and development, the European Union finances a vast array of projects concerning fields affecting the citizens' health, as well as the researchers' mobility, the development of new technologies or the safeguard of the environment. With the agreement of the European Parliament and of the Council of Ministers, the two decisional authorities of the European Union, the 7th framework programmes was started on December 2006. This program has a budget of 54 billion Euros to be distributed over a 7-year period. Therefore, the European Union aims to fully address the challenge as stated by the European Council of Lisbon (of March 2000) which declared the idea of providing 3% of the GDP of all the Member States for the purpose of research and development. One of the important conditions stated by the Members of the European Parliament to allocate this financing is to ensuring that "the funding research activities respect the fundamental ethicalprinciples". In this article, we will approach this aspect of the evaluation. PMID:19765393
This article examines for the first time the theologically based medicalethics of the late sixteenth-century English Calvinist minister William Perkins. Although Perkins did not write a single focused book on the subject of medicalethics, 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 medicalethics authors and his writings were influential in guiding the moral thinking of many pious medical practitioners and laypersons.
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.
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 factor is that they all have an element of contact and hence the potential for interaction between the researcher and the subject. In our experience (with the exception of some ethnographers) few if any social researchers will have had adequate training about the interactional aspects of their work. As a result they are unprepared for the ethical dilemmas and conflict of loyalties which they might experience. To understand these issues it is important to look at the context within which such research is undertaken. PMID:7992127
Medical criteria rooted in evidence-based medicine are often seen as a value-neutral 'trump card' which puts paid to any further debate about setting priorities for treatment. On this argument, doctors should stop providing treatment at the point when it becomes medically futile, and that is also the threshold at which the health purchaser should stop purchasing. This paper offers three kinds of ethical criteria as a counterweight to analysis based solely on medical criteria. The first set of arguments concerns futility, probability and utility; the second, justice and fairness; the third, consent and competence. The argument is illustrated by two recent case studies about futility and priority-setting: the U.S. example of 'Baby Ryan' and the U.K. case of 'Child B'. PMID:15968967
In the South African health care system patients/consumers are divided into those who can afford private care and those who rely on state medical assistance. The system is under pressure to fund delivery of medical care to its beneficiaries. We consider the effects of different funding models on medicolegal liability of health professionals serving the private sector. Medical reasons should determine the service rendered. However, financial implications of services rendered and defensive practice of medicine also contribute to treatment received by a patient and its remuneration. Practitioners who commit to delivering a predetermined set of services within a particular time for a predetermined 'lump sum' are only paid for the service specifically requested. Should disease be found other than those contracted for, we argue that inaction with regard to that disease would be deemed to be negligent or unethical according to legal and ethical considerations. PMID:23034204
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 known that lack of sensitivity can alter our judgment and lead us to sacrifice basic ethicalprinciples such as autonomy, beneficence, non?maleficence and justice. Only emotions can turn a decision into an ethical one, but they can also turn it into an unreasonable one. To avoid this contradiction, suggest integrating emotions with the decisional factors of the process of “retrospective thinking”. During this thinking, doctors usually try to identify the nature and impact of feelings on the decision they have just made. In this retrospective moment of analysis of the decision, doctors also question themselves on the feelings they did not experience. They do this to estimate the consequences of this lack of feeling on the way they behaved with the patient.
Abraham Flexner was commissioned by the Carnegie Foundation for the Advancement of Teaching to conduct the 1910 survey of all U.S. and Canadian medical schools because medical education was perceived to lack rigor and strong learning environments. Existing proprietary schools were shown to have inadequate student scholarship and substandard faculty and teaching venues. Flexner's efforts and those of the American Medical Association resulted in scores of inadequate medical schools being closed and the curricula of the survivors being radically changed. Flexner presumed that medical students would already be schooled in the humanities in college. He viewed the humanities as essential to physician development but did not explicitly incorporate this position into his 1910 report, although he emphasized this point in later writings. Medicalethics and humanities education since 1970 has sought integration with the sciences in medical school. Most programs, however, are not well integrated with the scientific/clinical curriculum, comprehensive across four years of training, or cohesive with nationally formulated goals and objectives. The authors propose a reformation of medical humanities teaching in medical schools inspired by Flexner's writings on premedical education in the context of contemporary educational requirements. College and university education in the humanities is committed to a broad education, consistent with long-standing tenets of liberal arts education. As a consequence, premedical students do not study clinically oriented science or humanities. The medical school curriculum already provides teaching of clinically relevant sciences. The proposed four-year curriculum should likewise provide clinically relevant humanities teaching to train medical students and residents comprehensively in humane, professional patient care. PMID:20107362
Doukas, David J; McCullough, Laurence B; Wear, Stephen
As medicalethics 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 medicalethics, it should be implemented by Iranian policy makers.
Objectives: This article explores ethical and practical issues associated with the Liaison Committee on Medical Education (LCME) provision that states health professionals who provide psychiatric/psychological care to medical students must have no involvement in the academic evaluation or promotion of students receiving those services. Method: The…
Kavan, Michael G.; Malin, Paula Jo; Wilson, Daniel R.
The purpose of this study was to assess the ethical and professional learning needs of medical trainees on clinical placements at a care-based facility, as they shifted from acute care to care-based philosophy. Using qualitative data analysis and grounded theory techniques, 12 medical learners and five clinical supervisors were interviewed. Five…
Hall, Pippa; O'Reilly, Jane; Dojeiji, Sue; Blair, Richard; Harley, Anne
In 1902, Albert Moll, who at that time ran a private practice for nervous diseases in Berlin, published his comprehensive book on medicalethics, 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.
In 1902, Albert Moll, who at that time ran a private practice for nervous diseases in Berlin, published his comprehensive book on medicalethics, 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
For pt.I see ibid., vol.9, no.2, p.79-81 (1990). The ethical issues raised by the fact that patients/subjects are less protected in non-investigational-device-exemption (non-IDE) use of unapproved medical devices than in IDE use are examined. Practice, research, and nonvalidated practice, an intervention that falls into the region between pure practice and pure research, are defined and examined with respect to non-IDE use of unapproved medical devices. Two types of non-IDE use are considered: that which would be permitted under the feasibility studies mechanism, and emergency use. Ethical issues in both cases are discussed. It is concluded that the Food and Drug Administration (FDA) must not only expand the freedom of scientific investigators to develop new medical devices, allowing flexibility in defined non-IDE contexts that will not jeopardize the safety or welfare of patients, but also clearly and concisely define the procedures which outline this expanded freedom. PMID:18238337
The use of genome-wide association studies (GWAS) in medical research and the increased ability to share data give a new twist to some of the perennial ethical issues associated with genomic research. GWAS create particular challenges because they produce fine, detailed, genotype information at high resolution, and the results of more focused studies can potentially be used to determine genetic variation for a wide range of conditions and traits. The information from a GWA scan is derived from DNA that is a powerful personal identifier, and can provide information not just on the individual, but also on the individual's relatives, related groups, and populations. Furthermore, it creates large amounts of individual-specific digital information that is easy to share across international borders. This paper provides an overview of some of the key ethical issues around GWAS: consent, feedback of results, privacy, and the governance of research. Many of the questions that lie ahead of us in terms of the next generation sequencing methods will have been foreshadowed by GWAS and the debates around ethical and policy issues that these have created.
Notes that business today is concerned with the translation and application of ethicalprinciples into everyday business life. Offers a list of Web sites on ethics and business ethics at various colleges and universities. (SR)
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 medicalethics, 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.
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
This essay addresses a moral and cultural challenge facing health care in the People's Republic of China: the need to create an understanding of medical professionalism that recognizes the new economic realities of China and that can maintain the integrity of the medical profession. It examines the rich Confucian resources for bioethics and health care policy by focusing on the Confucian tradition's account of how virtue and human flourishing are compatible with the pursuit of profit. It offers the Confucian account of the division of labor and the financial inequalities this produces with special attention to China's socialist project of creating the profession of barefoot doctors as egalitarian peasant physicians and why this project failed. It then further develops the Confucian acknowledgement of the unequal value of different services and products and how this conflicts with the current system of payment to physicians which has led to the corruption of medical professionalism through illegal supplementary payments. It further gives an account the oblique intentionality of Confucian moral psychology that shows how virtuous persons can pursue benevolent actions while both foreseeing profit and avoiding defining their character by greed. This account of Confucian virtue offers the basis for a medical professionalism that can function morally within a robustly profit-oriented market economy. The paper concludes with a summary of the characteristics of Confucian medical professionalism and of how it places the profit motive within its account of virtue ethics. PMID:17136438
Hume's is/ought distinction has long limited the role of empirical research in ethics, saying that data about what something is cannot yield conclusions about the way things ought to be. However, interest in empirical research in ethics has been growing despite this countervailing principle. We attribute some of this increased interest to a conceptual breakdown of the is/ought distinction. MacIntyre, in reviewing the history of the is/ought distinction, argues that is and ought are not strictly separate realms but exist in a close relationship that is clarified by adopting a teleological orientation. We propose that, instead of recovering a teleological orientation, society tends to generate its own goals via democratic methods like those described by Rousseau or adopt agnosticism about teleology such as described by Richard Rorty. In both latter scenarios, the distinction between is and ought is obscured, and the role for empirical research grows, but for controversial reasons. MacIntyre warns that the is/ought distinction should remain, but reminds ethicists to make careful arguments about when and why it is legitimate to move from is to ought. PMID:21339390
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
Vesicovaginal fistula was a catastrophic complication of childbirth among 19th century American women. The first consistently successful operation for this condition was developed by Dr J Marion Sims, an Alabama surgeon who carried out a series of experimental operations on black slave women between 1845 and 1849. Numerous modern authors have attacked Sims's medicalethics, arguing that he manipulated the institution of slavery to perform ethically unacceptable human experiments on powerless, unconsenting women. This article reviews these allegations using primary historical source material and concludes that the charges that have been made against Sims are largely without merit. Sims's modern critics have discounted the enormous suffering experienced by fistula victims, have ignored the controversies that surrounded the introduction of anaesthesia into surgical practice in the middle of the 19th century, and have consistently misrepresented the historical record in their attacks on Sims. Although enslaved African American women certainly represented a “vulnerable population” in the 19th century American South, the evidence suggests that Sims's original patients were willing participants in his surgical attempts to cure their affliction—a condition for which no other viable therapy existed at that time.
Although American Psychological Association (APA) Ethical Standards make it clear that instructors cannot require students to disclose personal information in class-related activities, an APA learning goal for undergraduate psychology students is that they reflect on their experiences to develop insight into their behavior and mental processes.…
In response to national trends calling for increasing accountability and an emerging dialogue within bioethics, we describe an effort to credential clinical ethicists at a major academic medical center.This effort is placed within the historical context of prior calls for credentialing and certification and efforts currently underway within organized bioethics to engage this issue.The specific details, and conceptual rationale, behind the NewYork-Presbyterian Hospital's graduated credentialing plan are shared as is their evolution and ratification within the context of institutional policy. While other programs will design their credentialing schema consistent with their local context and demographics, the description of one such effort is offered to be instructive to others who want to bring additional standardization to the assessment of the readiness and credentials of those who will engage in the practice of clinical ethics case consultation. PMID:22822704
Acres, Cathleen A; Prager, Kenneth; Hardart, George E; Fins, Joseph J
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.
This Task Force document revisits the debate about the ethics of sex selection for non-medical reasons in the light of relevant new technological developments. First, as a result of improvement of the Microsort® flow cytometry method, there is now a proven technique for preconception sex selection that can be combined both with IVF and IUI. Secondly, the scenario where new approaches that are currently being developed for preimplantation genetic screening (PGS) may lead to such screening becoming a routine part of all IVF treatment. In that scenario professionals will more often be confronted with parental requests for transfer of an embryo of a specific sex. Thirdly, the recent development of non-invasive prenatal testing based on cell-free fetal DNA in maternal plasma allows for easy and safe sex determination in the early stages of pregnancy. While stressing the new urgency that these developments give to the debate, the Task Force did not come to a unanimous position with regard to the acceptability of sex selection for non-medical reasons in the context of assisted reproduction. Whereas some think maintaining the current ban is the best approach, others are in favour of allowing sex selection for non-medical reasons under conditions that take account of societal concerns about the possible impact of the practice. By presenting these positions, the document reflects the different views about this issue that also exist in the field. Specific recommendations include the need for a wider delineation of accepted 'medical reasons' than in terms of avoiding a serious sex-linked disorder, and for a clarification of the legal position with regard to answering parental requests for 'additional sex selection' in the context of medically indicated preimplantation genetic diagnosis, or routine PGS. PMID:23578946
Dondorp, W; De Wert, G; Pennings, G; Shenfield, F; Devroey, P; Tarlatzis, B; Barri, P; Diedrich, K
Some principles of medical assessment in phoniatric and audiological diseases are critically discussed. The necessity of preliminary qualifying examination to voice profession is underline. Attention is paid to the importance of adequate medical documents in judgement of professional voice and hearing diseases. PMID:9499866
Pain management is a societal problem because of concerns about the use of drugs, the belief that patients are not good judges of the severity of their pain, and an alarming level of ignorance about pain and its treatment among physicians, nurses, and other healthcare providers. The result is that patients suffer pain unnecessarily, even up to the point of their death. Pain management is also a clinical-practice problem. Courses in pain and symptom management are not readily available to medical and nursing students. And in clinical practice, good pain assessment is not easy to accomplish because pain is so subjective. Fortunately, with education, doctors and nurses can vastly improve their ability to assess and manage patients' pain. Additional problems in pain management relate to the manner in which healthcare is provided today: an acute disease-oriented model of hospital care, frequent transfers, fragmented care, inadequate reimbursement, market forces that drive up costs, and maldistribution of clinical services. In improving their ability to manage pain, professionals must understand the difference between pain and suffering, acute and chronic pain, and the sensory and emotional aspects of pain. Guiding principles include Church teaching and ethicalprinciples, such as patient self-determination, holistic care, the principle of beneficence, distributive justice, and the common good. Pain management strategies that will be instrumental in formulating effective responses to these problems include expanding professional and community education, affording pain funding priority, establishing institutional policies and protocols, forming clinical teams, encouraging hospice and home care, and requiring accreditation in pain and symptom management. PMID:10145758
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.
The paper provides a short overview of key problems of medicalethics 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
This paper raises the questions: 'What do we expect from nursing ethics?' and 'Is the literature of nursing ethics any different from that of medicalethics?' It is suggested that rather than develop nursing ethics as a separate field writers in nursing ethics should take a lead in making the patient the central focus of health care ethics. The case
Across Europe the protection of research subjects with dementia has to meet a variety of national legislation and ethical codes. This research project compared how in different EU countries one single descriptive multinational study on dementia treatment strategies was evaluated by medicalethical committees and how the issues of informed consent and capacity to consent were dealt with. The study
M. G. M. Olde Rikkert; S. Lauque; L. Frolich; B. Vellas; W. J. M. Dekkers
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…
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.
There is a need for evidence-based usability principles to support the design of usable medication-related computerized CDS functions and systems. Such evidence requires establishing scientific relationships between usability principles, their violation in terms of usability flaws, issuing usage problems and their consequences or outcomes in the clinical work and patient care. This kind of evidence is not currently directly available in scientific evaluation studies of medication CDS functions. A possible proxy to seek evidence is systematic review of existing scientific evaluation reports. We rely on a four-stage framework describing the chain of consequences and inferences linking usability principles to clinical outcomes to design the systematic review methodology and interpretation principles. This paper describes the four-stage framework and the resulting consequences for the systematic review design. PMID:23920590
Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011). The American Association for Marriage and Family Therapy (AAMFT) represents a mental health profession with a long track record in integrated primary care, particularly with family medicine. The authors begin by affirming several core themes in the joint principles-behavioral health (JP-BH) statement. They then offer a systemic/relational perspective on the patient-centered medical home that goes beyond the focus of the JP-HP. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:24955682
Doherty, William J; Hodgson, Jennifer L; Lamson, Angela L; Mendenhall, Tai J; Todd, Tracy
The Association of American Medical Colleges (AAMC) is urging academic medical centers to ban pharmaceutical detailing. This policy followed from a consideration of behavioral and neuroeconomics research. I argue that this research did not warrant the conclusions drawn from it. Pharmaceutical detailing carries risks of cognitive error for physicians, as do other forms of information exchange. Physicians may overcome such risks; those determined to do so may ethically engage in pharmaceutical detailing. Whether or not they should do so is a prudential judgment about which reasonable people may disagree. The AAMC's ethical condemnation of detailing is unwarranted and will subvert efforts to maintain a realm of physician discretion in clinical work that is increasingly threatened in our present practice environment. PMID:20077321
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
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.
To provide a basis for international discussion of ethical problems, we studied responses of medical geneticists in 18 countries to questionnaires about 14 clinical cases and five screening situations. Of 1,053 asked to participate, 677 (64%) responded. There was greater than or equal to 75% consensus on five cases involving (1) disclosure of (1) conflicting diagnostic findings, (2) disclosure of ambiguous results, (3) disclosure of controversial interpretations, (4) protection of mother's confidentiality in cases of false paternity, and (5) nondirective counseling about 45,X and XYY syndrome. A majority (51%-60%) would disclose the diagnosis to relatives at risk for Huntington disease or hemophilia A, against the patient's wishes; would disclose which parent carries a translocation causing Down syndrome; and would disclose XY genotype in a female. As reproductive options for patients with disorders not diagnosable prenatally, 84% would discuss artificial insemination by a donor, 66% would discuss in vitro fertilization with donor egg, and 46% would discuss surrogate motherhood. In all, 85% would perform prenatal diagnosis for (or would refer) parents who refuse abortion, 75% for maternal anxiety, and 42% for selection of fetal sex. Screening questions showed that 72% believed that workplace screening should be voluntary and that results should be confidential.
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 ethicalprinciples regarding decisionmaking “standards” and their translation into research decisions.
Dunn, Laura B.; Fisher, Stephanie Reyes; Hantke, Melinda; Appelbaum, Paul S.; Dohan, Daniel; Young, Jenifer P.; Roberts, Laura Weiss
There has been considerable debate about the ethics of human germ-line gene modification. As a result of recent advances in the micromanipulation of embryos and the laboratory development of transgenic mice, a lively discussion has begun concerning both the technical feasibility and the ethical acceptability of human germ-line modification for the prevention of serious disease. This article summarizes some of
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
Ethics in clinical research focuses largely on identifying and implementing the acceptable conditions for exposure of some individuals to risks and burdens for the benefit of society at large. Ethical guidelines for clinical research were formulated only after discovery of inhumane behaviour with participants during research experiments. The Nuremberg Code was the first international code laying ethicalprinciples for clinical research. With increasing research all over, World Health Organization formulated guidelines in the form of Declaration of Helsinki in 1964. The US laid down its guidelines for ethicalprinciples in the Belmont Report after discovery of the Tuskegee's Syphilis study. The Indian Council of Medical Research has laid down the 'Ethical Guidelines for Biomedical Research on Human Subjects' in the year 2000 which were revised in 2006. It gives twelve general principles to be followed by all biomedical researchers working in the country. The Ethics Committee stands as the bridge between the researcher and the ethical guidelines of the country. The basic responsibility of the Ethics Committee is to ensure an independent, competent and timely review of all ethical aspects of the project proposals received in order to safeguard the dignity, rights, safety and well-being of all actual or potential research participants. A well-documented informed consent process is the hallmark of any ethical research work. Informed consent respects individual's autonomy, to participate or not to participate in research. Concepts of vulnerable populations, therapeutic misconception and post trial access hold special importance in ethical conduct of research, especially in developing countries like India, where most of the research participants are uneducated and economically backward. PMID:22303053
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.
Publication of medical research is both a monitor of the researcher's ethics and an audit of the local or regional ethics committee that approved it. Selectivity of publication or of the intention to publish lessens this audit. Opinions differ about what is ethically allowable in clinical and benchtop medical research. Ethical permission and ethical monitoring of medical research are subject to a hierarchy of pyramidal controls, starting in hospital and ending with the local, institutional, or regional ethics committee. Currently, such committees function with widely varying degrees of efficiency and quality of output, and with differing viewpoints on many ethical issues. Without an a priori insistence by institutional ethics committees that there be an intention to publish all medical research involving human subjects, ethics committees cannot routinely be subject to the scrutiny or audit which they themselves demand of researchers.
Medical education research and medical education practice both involve being methodical, innovative, self-observing, forward-looking, and open to peer review, and both are scholarly activities. For these reasons, distinguishing between these two activities is often difficult. There are three important reasons to clarify the distinctions: the moral difference between education research and education practice; federal regulations governing education research that require more safeguards than often exist in education practice; and the fact that student participants in research have characteristics in common with members of special populations. The authors explain why attention to issues of safeguards in education research and practice is likely to grow at academic health centers, yet maintain that these issues are neglected in the medical education literature. They demonstrate this with findings from their review of 424 education research reports published in 1988 and 1989 and in 1998 and 1999 in two major medical education journals. Each article was evaluated for documentation of six ethically important safeguards and features (e.g., informed consent). The rates of reporting the six features and safeguards were relatively low (3-27%). Nearly half (47%) of the empirical reports offered no indication of ethically important safeguards or features, and no article mentioned all six. Furthermore, those rates did not increase substantially after ten years. The authors discuss a number of implications of their findings for faculty, training institutions, students, and editors and peer reviewers, and conclude with the hope that their findings will raise awareness of these neglected issues in medical education and will stimulate all those involved to reflect upon the issues and set standards on the ethical aspects of research and scholarly practice. PMID:11553501
Roberts, L W; Geppert, C; Connor, R; Nguyen, K; Warner, T D
Two papers, Legal and Ethical Issues in the Regulation and Development of Engineering Achievements in Medical Technology parts I and II were written in 1990 by three authors of diverse backgrounds and published in the IEEE Engineering in Medicine and Biology Magazine in March of the same year. Part I of the paper discusses the existing Food and Drug Administration (FDA) requirements that existed in 1990 to regulate the clinical trial process for medical devices, obtaining Marketing Approval and exceptions that may allow the use of unapproved devices. The paper discusses how the FDA has loosened some of the stringent regulations to further its goal of encouraging new development while protecting public health and maintaining ethical standards. Part H of the paper focuses on the ethical implications of the process of introducing a new technology to the market place, specifically in the usage of unapproved technologies for emergency use and feasibility studies. This paper discusses the topics covered in the two papers and the changes that have been made to the FDA guidelines since their publication in 1990. PMID:17959479
The enabling legislation for the President's Commission directs it to study the ethical and legal implications of the matter of defining death, including the advisability of developing a uniform definition of death. In performing its mandate, the Commissi...
Palliation of pain is universally regarded as a cardinal aspect of end-of-life care. In the early days of the palliative care and hospice movement there was concern that aggressive pain control with opioids could potentially hasten the death of the patient primarily through respiratory depression. For many ethicists and theologians who were opposed to active euthanasia, this raised the difficult question of whether it is permissible to use these potentially harmful medications. Traditional Jewish decisors also addressed this question and their writings can shed light on their attitudes toward terminal care. The purpose of this article is to analyze the view of three highly respected authorities on the use of pain medications with potentially significant side effects in terminal patients. The Jewish position demonstrates how an ancient tradition struggles to develop an ethic consistent with modern sensibilities. Religious decisors scour the ancient sources to find precedents and then apply that wisdom to contemporary questions. Jewish medicalethics by its very nature is highly pluralistic because there is no central body that determines policy and a wide spectrum of opinions are usually found. However, regarding pain treatment there appears to be a broad consensus mandating its aggressive use even at the risk of significant side effects as long as the motivation is relief of suffering. PMID:19827965
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.
...Development of Pediatric Medical Countermeasures...pediatric research on medical countermeasures...biologics, and devices for children in the medical countermeasure...Person: Cindy de Sales, (240) 316-3207...site to register online:...
Psychopathology can render people strange and difficult to understand. Communication can lead to empathic understanding, which in turn can guide compassionate action. But communication depends on a shared conceptual world. How can language convey meanings that are not shared, that mark a divide between human beings or whole communities? A consideration of the poetics of Paul Celan sheds light on the power of language to bridge disparate worlds and on the ethical stance needed when empathy fails. Celan's poetics of alterity has implications for our efforts to understand individuals' illness experience as a grounding for the ethics of the clinical encounter. PMID:20433094
Intended for professionals and others in the field of philanthropy, this book applies ethics and ethical decision-making to fund raising. Its primary aim is to enhance the level of ethical fund raising throughout the nonprofit sector by equipping those involved with frameworks for understanding and taking principled actions and preventing…
Although widespread support favors prospective planning for altered standards of care during mass casualty events, the literature includes few, if any, accounts of groups that have formally addressed the overarching policy considerations at the state level. We describe the planning process undertaken by public health officials in the Commonwealth of Massachusetts, along with community and academic partners, to explore the issues surrounding altered standards of care in the event of pandemic influenza. Throughout 2006, the Massachusetts Department of Public Health and the Harvard School of Public Health Center for Public Health Preparedness jointly convened a working group comprising ethicists, lawyers, clinicians, and local and state public health officials to consider issues such as allocation of antiviral medications, prioritization of critical care, and state seizure of private assets. Community stakeholders were also engaged in the process through facilitated discussion of case scenarios focused on these and other issues. The objective of this initiative was to establish a framework and some fundamental principles that would subsequently guide the process of establishing specific altered standards of care protocols. The group collectively identified 4 goals and 7 principles to guide the equitable allocation of limited resources and establishment of altered standards of care protocols. Reviewing and analyzing this process to date may serve as a resource for other states. PMID:19755912
Levin, Donna; Cadigan, Rebecca Orfaly; Biddinger, Paul D; Condon, Suzanne; Koh, Howard K
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)
Medicalethics education remains an important venue of moral education. In spite of the intensity of these efforts, the desired outcomes of medicalethics education remain obscure, undefined and largely untested. In the first part of this study, the goals of medicalethics are operationalized along cognitive, behavioral and attitudinal dimensions. This includes a written moral judgment test, a survey
Clinical research is guided by ethicalprinciples promulgated in several statements, principally the Nuremberg Code, the Helsinki Declaration of the World Medical Association etc. In Japan, clinical research of medical products, principally trial of new pharmaceutical products is regulated by GCP (good clinical practice). Other types of clinical research are regulated by some ethical guidelines for clinical researches. The result is a regulatory position that is a complex combination of legislation and ethical guidelines. In the Ethical Guideline for Clinical Studies revised in 2008, clinical research is classified into intervention research and observational research. When researchers plan clinical research, they must determine the type of clinical research and appropriate ethical guideline for the type of clinical research. Advances in health informatics and genetic research have produced a new and very rich body of raw material for clinical research in the form of gene banks and genome-wide association study etc. The use of human tissue and medical information in the course of clinical research raises issues under the ethical regulations for research with human subjects. PMID:22277384
Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011). The American Psychiatric Association Workgroup on Integrated Care supports the recommendations made in these Joint Principles and recognizes the significant benefit of treating behavioral and general medical conditions concurrently. The workgroup offers comments on this effort as it pertains to health care in general and psychiatric practice. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:24955687
Raney, Lori; Pollack, David; Parks, Joe; Katon, Wayne
Psychiatric home care offers nurses new ethical challenges. Client autonomy, caregiver beneficence, and client safety often combine to create ethical dilemmas that require much deliberation and inventive decision making. Utilitarian and deontological theories and principles of ethics provide guidelines that can help caregivers work through complex ethical problems. Conflict resolution theory also offers ways of resolving dilemmas that occur when
Purpose The increasing gap between numbers of individuals awaiting organ replacement surgery and the supply of organs available for\\u000a transplant underpins attempts to increase the number of organs available. One practice, used in other countries, is the recovery\\u000a of organs from non-heart-beating organ donors (NHBD). The purpose of this review is to discuss ethical issues surrounding\\u000a the use of organs from
Objective: To determine how couples prefer to dispose of their extra embryos and to establish a donor embryo program for the treatment of infertile couples.Design: Cohort study.Setting: University-based IVF program.Patient(s): Patients (n = 365) with cryopreserved embryos in storage for >2 years and eight patients who desired donated embryos for transfer.Intervention(s): An IVF ethics committee was formed to discuss the
Bradley J Van Voorhis; Dan M Grinstead; Amy E. T Sparks; Janice L Gerard; Robert F Weir
Sport and physical activity is an area that remains relatively unexplored by contemporary bioethics. It is, however, an area in which important ethical issues arise. This paper explores the case of the participation of people with anorexia nervosa in exercise. Exercise is one of the central features of anorexia. The presence of anorexics in exercise classes is becoming an increasingly sensitive issue for instructors and fitness professionals. The ethics of teaching exercise to anorexics has, however, seldom, if ever, been addressed. Codes of ethics and legislation do not offer guidelines pertinent to the case and it is left unclear whether anorexics should be allowed to participate in exercise classes. It is shown by this paper that there are strong ethical reasons to let anorexics participate in exercise classes. However, the paper also explains why, despite these apparently cogent ethical reasons, there is no moral obligation to allow a person with anorexia to take part in exercise/sports activities.
Sport and physical activity is an area that remains relatively unexplored by contemporary bioethics. It is, however, an area in which important ethical issues arise. This paper explores the case of the participation of people with anorexia nervosa in exercise. Exercise is one of the central features of anorexia. The presence of anorexics in exercise classes is becoming an increasingly sensitive issue for instructors and fitness professionals. The ethics of teaching exercise to anorexics has, however, seldom, if ever, been addressed. Codes of ethics and legislation do not offer guidelines pertinent to the case and it is left unclear whether anorexics should be allowed to participate in exercise classes. It is shown by this paper that there are strong ethical reasons to let anorexics participate in exercise classes. However, the paper also explains why, despite these apparently cogent ethical reasons, there is no moral obligation to allow a person with anorexia to take part in exercise/sports activities. PMID:15634747
In 1846, a group of about 100 American doctors convened in New York City a national convention to change medical education,\\u000a to produce a body of standards that would demarcate the ideals of the “regular” medical profession from that of sectarians\\u000a (such as homeopaths) who threatened its hegemony, and to restore a luster that abuses of education and practice had
In recent years, early intervention services have attempted to identify people with a first episode of psychosis as early as possible, reducing the duration of untreated psychosis and changing the timing of delivery of interventions. The logic of early intervention is based partly on accessing people in a more treatment responsive stage of illness in which psychosocial damage is less extensive, and partly on remediating a putatively active process of neuroprogression that leads to pathophysiological, symptomatic and structural changes, hence improving symptomatic and functional outcomes. However, as in other areas of health care, earlier identification of new patients may mean that different treatment approaches are indicated. The corollary of early detection is that the sequence and complexion of treatment strategies for first episode psychosis has been revaluated. Examples include the minimal effective dosage of antipsychotic medication and the content of psychosocial interventions. With the substantial reductions of DUP now seen in many early psychosis services, based on clinical staging and stepped care principles, it is even possible that the immediate introduction of antipsychotic medication may not be necessary for all first episode psychosis cases, but that potentially safer interventions, which may be more acceptable to many patients, such as comprehensive psychosocial intervention, may constitute effective treatment at least for a subgroup of patients. In this paper, we review this theoretical background and describe a randomised controlled trial currently underway at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne designed to test outcomes for first episode psychosis patients in response to two different treatments: intensive psychosocial intervention plus antipsychotic medication versus intensive psychosocial intervention plus placebo. This is a theoretically and pragmatically novel study in that it will provide evidence as to whether intensive psychosocial intervention alone is sufficient for a subgroup of first episode psychosis patients in a specialised early intervention service, and provide a test of the heuristic clinical staging model. By experimentally manipulating duration of untreated psychosis, the study will also provide a methodologically strong test of the effect of delaying the introduction of antipsychotic medication, as well as helping to disentangle the effects of antipsychotic medications and the putative neurobiological processes associated with brain changes and symptom profiles in the early phase of psychotic disorders. The study has been carefully crafted to satisfy critical ethical demands in this challenging research domain. PMID:20347270
Francey, S M; Nelson, B; Thompson, A; Parker, A G; Kerr, M; Macneil, C; Fraser, R; Hughes, F; Crisp, K; Harrigan, S; Wood, S J; Berk, M; McGorry, P D
Problems encountered by a young, unmarried woman who, as a result of a spinal injury in an automobile accident, loses use of all four limbs and requires complex home health care services delivered by a network of health and social service agencies in a rural area of Kentucky. Economic, psychosocial, ethical, preventive, and medical aspects of health care are discussed.
Lewis, B. R.; Flanigan, R. C.; Blomquist, G. C.; Tempkin, A. R.; Fuhrer, M. J.; Thompson, J. S.; Engelberg, J.
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
Analyzing William Beaumont's relationship with his experimental subject, Alexis St. Martin, this article demonstrates how the "research ethics" of antebellum America were predicated on models of employment, servitude, and labor. The association between Beaumont and St. Martin drew from and was understood in terms of the ideas and practices of contract labor, informal domestic servitude, indentures, and military service. Beaumont and St. Martin lived through an important period of transition in which personal master-servant relations existed alongside the "free" contract labor of market capitalism. Their relationship reflected and helped constitute important developments in nineteenth-century American labor history. PMID:20657054
Turkey and Iran are two Near East countries that are developing ethical regulation systems for animal experiments, following significant developments in this field in neighbouring Europe. In Turkey, legislation was passed between 2004 and 2006 to mandate ethical review of experiments which involve the use of laboratory animals. Today, one central and 73 local ethics committees exist, to evaluate the use of animals and the numbers of animals used, and to consider applications for animal experimentation. In Iran, Animal Ethics Committees (AECs) were established in 2004 in approximately 50 medical universities. The objective of the AECs is to preserve animal welfare and ethics, taking into account Islamic principles, and to be cognisant of world trends for the improvement of laboratory animal welfare. The recent establishment of animal ethical review in the Near East could benefit from experiences in Western countries, in their evolution toward high standards of experimental animal ethics. PMID:20822325
Izmirli, Serdar; Aldavood, S Javid; Yasar, Askin; Phillips, Clive J C
This presentation focuses on ethical issues that need to be addressed within the gerontological nursing curriculum for preparing nurses to become change agents and catalysts in the health care of the older population. Ethics and ethicalprinciples are defined, and three ethicalprinciples are discussed: justice; beneficence; and autonomy.…
BackgroundConducting ethically sound research is a fundamental principle of scientific inquiry. Recent research has indicated that ethical concerns are insufficiently dealt with in dissertations.PurposeTo examine which research ethical topics were addressed and how these were presented in terms of complexity of reasoning in Swedish nurses' dissertations.MethodsAnalyses of ethical content and complexity of ethical reasoning were performed on 64 Swedish nurses'
Recent debates in the ethics of forensic psychiatry have centered on the applicability of traditional medicalethics to forensic practice. Two prominent theories, one taking a principled approach and another taking a narrative approach, have attempted to resolve the tension between medical and legal settings. In this article we contend that the two theories are related closely and work at two different levels: principles at the level of theory and narrative at the level of application. We offer an approach to forensic ethics that reconciles competing theoretical views by relating professional role and personal integrity. PMID:11471782
In emergency medicine, a significant difference rightfully persists between the withholding and withdrawal of life-sustaining medical treatment. The justification for this difference stems in part from the nature of emergency medical practice and the unique manner in which clinicians apply many ethicalprinciples. In the usual setting, the decision to withhold further medical treatment is done quietly, often without input
The new Consumer Alliance agreement between the American Academy of Family Physicians (AAFP) and The Coca-Cola Company provides a valuable opportunity to illustrate AAFP's adherence to its ethical foundation, demonstrate the AAFP's commitment to serving physicians and the public, and maintain the trust Americans put in their family physicians and the organization that represents them. Throughout the development of this program, as well as in all business interactions, the AAFP consistently addresses possible conflict of interest openly and directly, sharing with our members and the public exactly what measures we take to ensure that, in fact, no unethical conduct or breach of trust would--or will in the future--occur. In this case, the AAFP saw a public health and education need that was both unmet and undermined by the barrage of marketing messages and confusing information, and acted to fill that need. In so doing, the AAFP hewed to its high ethical standards, its core values, and its mission in the decisions made and the actions that followed. PMID:20644192
The historiographical prejudice that sees in Jean-Jacques Rousseau an implacable opponent of scientific knowledge has long prevented an objective evaluation of the important influence that medical thought exerted over his philosophy. The aim of this paper is to show not only Rousseau's familiarity with the most important expressions of eighteenth-century medical literature, but also his willingness to incorporate some medical suggestions in his philosophical and literary production. In the first part of this article, I try to show how Rousseau's sensibility theory presupposes precise medical ideals, related to Montpellier School of vitalism. In the second part, I stress how Rousseau's philosophy of alimentation (which has clear anthropological and political implications) can be regarded as a genuine application of an ambition typical of vitalism: to use medical hygiene, also and above all, for moral purpose. PMID:23035396
Challenging issues confront emergency physicians routinely when performing cardiopulmonary resuscitation. Ethical issues surrounding resuscitation may include issues of futility, withholding or withdrawing interventions, advance directives, family presence, practising procedures on the newly dead, palliative care, and communication. Principles of bioethics can be valuable in assessing and debating ethical dilemmas. In many cases where curative care is not possible or is not desired, the goal of medical care at the end of life is to provide comfort to the patient and family, rather than initiating technological interventions that are unlikely to benefit the patient. PMID:16143694
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.
In this article the author addresses some of the ethical and moral challenges embodied in the global era. He considers the case of European universities and their heritage, particularly in light of the massification of West European, and now East and Central European, higher education systems. It is argued that European integration rests on…
Increasingly research carried out in university medical centers is funded by biotechnology firms. This collaboration raises the issue of conflict between a researcher's dedication to advancing medical knowledge and a researcher's desire to increase his or her income. This report by the AMA's Council on Scientific Affairs and the Council on Ethical and Judicial Affairs discusses the risks and benefits of a collaborative relationship to each party. It describes the different types of arrangements that exist between researchers and industry, and identifies the problems that may arise when a researcher or a medical center has a direct financial interest in a research program. The report concludes with ethical guidelines and recommendations for avoiding potential or actual conflicts of interest. PMID:2332923
Group psychotherapists in their everyday practice confront a series of ethical problems, some of which rise to the level of ethical dilemmas. This two-part special series will address how the group psychotherapist can address these problems and dilemmas in a way that leads to an ethical course of conduct. This article introduces the series by examining ethicalprinciples and decision-making processes that are relevant to the wide range of issues that confront the group psychotherapist. The article also considers the person of the group psychotherapist him or herself and notes that certain personal qualities might create a foundation for ethical thinking and behavior. PMID:17040180
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 rela- tionship to trainees, with special attention to ethical implications. Results: A spectrum of ethical acceptability is represented in the
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
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
While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology, there is often a disconnect in the perception of value between a technology's promoters and those responsible for the ultimate decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five Canadian medical device manufacturers, via their websites, frame the corporate "value proposition" of their innovation and seek to respond to what they consider the key expectations of their customers. Our analysis shows that the manufacturers' framing strategies combine claims that relate to valuable socio-technical goals and features such as prevention, efficiency, sense of security, real-time feedback, ease of use and flexibility, all elements that likely resonate with a large spectrum of health care system stakeholders. The websites do not describe, however, how the innovations may impact health care delivery and tend to obfuscate the decisional trade-offs these innovations represent from a health care system perspective. Such framing strategies, we argue, tend to bolster physicians' and patients' expectations and provide a large set of stakeholders with powerful rhetorical tools that may influence the health policy arena. Because these strategies are difficult to counter given the paucity of evidence and its limited use in policymaking, establishing sound collective health care priorities will require solid critiques of how certain kinds of medical devices may provide a better (i.e., more valuable) response to health care needs when compared to others. PMID:21290189
Lehoux, P; Hivon, M; Williams-Jones, B; Miller, F A; Urbach, D R
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.
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.
Background The Italian code of medical deontology recently approved stipulates that physicians have the duty to inform the patient of each unwanted event and its causes, and to identify, report and evaluate adverse events and errors. Thus the obligation to supply information continues to widen, in some way extending beyond the doctor-patient relationship to become an essential tool for improving the quality of professional services. Discussion The new deontological precepts intersect two areas in which the figure of the physician is paramount. On the one hand is the need for maximum integrity towards the patient, in the name of the doctor’s own, and the other’s (the patient’s) dignity and liberty; on the other is the physician’s developing role in the strategies of the health system to achieve efficacy, quality, reliability and efficiency, to reduce errors and adverse events and to manage clinical risk. Summary In Italy, due to guidelines issued by the Ministry of Health and to the new code of medical deontology, the role of physicians becomes a part of a complex strategy of risk management based on a system focused approach in which increasing transparency regarding adverse outcomes and full disclosure of health- related negative events represent a key factor.
Medicalethics are the values and guidelines that govern decisions made in medical practice. Four prima facie moral principles can serve as a framework to help physicians analyze problems and make ethical decisions: (1) respect for autonomy, (2) beneficence, (3) non-maleficence, and (4) justice. With the cost of health care rising, all parties involved in the delivery of health care need to work to reduce costs, while continuing to provide quality care to our patients. One mechanism to reduce costs is to increase utilization of generic medications in daily practice, but there are many ethical issues inherent in utilizing brand name versus generic medications in dermatology. PMID:24160285
This module was designed to equip UK medical students to respond ethically and sensitively to requests encountered as qualified doctors regarding euthanasia and assisted dying. The aim was to expose students to relevant opinions and experiences and provide opportunities to explore and justify their own views and rehearse ethical decision making in a safe learning environment.The module is delivered by a multidisciplinary team, providing students with the working knowledge to actively discuss cases, articulate their own views and practice ethical reasoning. Visits to intensive care units, palliative care wards and hospices are integrated with theory. Student assessment comprises a dissertation, debate and reflection. Module impact was evaluated by analysis of student coursework and a questionnaire.Students greatly appreciated the clinical context provided by the visits and opportunities to apply ethical reasoning to cases and debate issues with peers. They reported increased discernment of the ethical and legal position and practical considerations and greater awareness of the range of professional and lay viewpoints held. Many participants were less strongly in favor of euthanasia and assisted dying on module completion than at the outset, but all of them believed they were better equipped to justify their own viewpoint and respond to patient requests. The multi-disciplinary nature of this course helps to prepare students to deal effectively and sensitively with ethical dilemmas they will encounter in their medical career. Use of an integrated, learner-centred approach equips students to actively engage with their peers in discussion of such issues and to formulate and defend their own position. PMID:21941154
Medical students at the University of Otago are now required to sign a 'student code' on beginning medical school. This new requirement has been put in place in response to changes to the medical curriculum that have resulted in earlier and increased contact with patients, healthcare staff and the general public, and in order to recognise and formalise the students' own learning needs. While a student code can most obviously be useful for disciplinary and assessment purposes, the authors make a claim for the code to be used as educational tool to assist students to internalise their obligations to others. The student code, while having common values espoused in other extant codes, is framed with the student experience in mind. The authors discuss the process of development, implementation and proposed review. PMID:20651867
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.
Background Physicians treating patients in the vegetative state (VS) must deal with uncertainty in diagnosis and prognosis, as well as ethical issues. We examined whether physicians’ attitudes toward medical and ethical challenges vary across two national medical practice settings. Methods A comparative survey was conducted among German and Canadian specialty physicians, based on a case vignette about the VS. Similarities and differences of participants’ attitudes toward medical and ethical challenges between the two samples were analyzed with non-parametric tests (Mann-Whitney-U-Test). Results The overall response rate was 13.4%. Eighty percent of all participants correctly applied the diagnostic category of VS with no significant differences between countries. Many of the participants who chose the correct diagnosis of VS attributed capabilities to the patient, particularly the ability to feel pain (70%), touch (51%) and to experience hunger and thirst (35%). A large majority of participants (94%) considered the limitation of life-sustaining treatment (LST) under certain circumstances, but more Canadian participants were in favor of always limiting LST (32% vs. 12%; Chi-square: p?0.001). Finding long-term care placement was considered more challenging by Canadian participants whereas discontinuing LST was much more challenging for German participants. Conclusions Differences were found between two national medical practice settings with respect to physicians’ experiences and attitudes about treatment limitation about VS in spite of comparable diagnostic knowledge.
Opponents of physician-assisted suicide (PAS) maintain that physician withdrawal-of-life-sustaining-treatment cannot be morally equated to voluntary active euthanasia. PAS opponents generally distinguish these two kinds of act by positing a possible moral distinction between killing and allowing-to-die, ceteris paribus. While that distinction continues to be widely accepted in the public discourse, it has been more controversial among philosophers. Some ethicist PAS advocates are so certain that the distinction is invalid that they describe PAS opponents who hold to the distinction as in the grip of 'moral fictions'. The author contends that such a diagnosis is too hasty. The possibility of a moral distinction between active euthanasia and allowing-to-die has not been closed off by the argumentative strategies employed by these PAS advocates, including the contrasting cases strategy and the assimilation of doing and allowing to a common sense notion of causation. The philosophical debate over the doing/allowing distinction remains inconclusive, but physicians and others who rely upon that distinction in thinking about the ethics of end-of-life care need not give up on it in response to these arguments. PMID:22296611
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
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
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 medicalethics 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.
The euthanasia debate is really the backdrop for a discussion within our society about the very nature of human life and meaning. Because the origin of life is in God, human beings do not have dominion over life but are stewards of life. The powerful combination of sanctity and stewardship is expressed in the foundational ethicalprinciple. This principle says that no person has the right to directly take innocent human life and in fact there is a positive obligation to nurture and protect life. In our secular society there is a need to develop a "natural" metaphysic of sacredness. Such a metaphysic can serve as bedrock from which a foundational principle can be developed and then applied in concrete moral norms. It can show that life contributes to the full dignity of the human person. For this perspective to be effective in countering the movement to legalize euthanasia, this sense of integral wholeness of human personhood must be demonstrated in a convincing manner. It can be because a dualistic philosophical bias has been found wanting by Western culture. We must arrive at what ethicists would call concrete norms that guide individual choices. At issue is how we translate our foundational principle--Do not directly attack innocent human life--into a concrete norm when confronted with the possibility of death. Some persons question whether the concrete norm opposing euthanasia should be a matter of public morality. To answer this question, we must turn to our foundational principle.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10124303
We know little about perceptions, practices, or constraints of ethics in occupational health because little research has been done. Opinions about the field, however, are abundant. Existing codes of ethical practice in occupational health have not consciously been derived from the fundamental principles of “freedom” and “well-being” or from philosophical premises and methods; rather, they are based on consensus among practitioners. The author outlines useful concepts and methods for making decisions about ethical questions in occupational health.
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.
The enormous destructive power of present stocks of nuclear weapons poses the greatest threat to public health in human history. Technical changes in weapons design are leading to an increased emphasis on the ability to fight a nuclear war, eroding the concept of deterrence based on mutually assured destruction and increasing the risk of nuclear war. Medical planning and civil defence preparations for nuclear war have recently been increased in several countries although there is little evidence that they will be of significant value in the aftermath of a nuclear conflict. These developments have raised new ethical dilemmas for those in health professions. If there is any risk of use of weapons of mass destruction, then support for deterrence with these weapons as a policy for national or global security appears to be incompatible with basic principles of medicalethics and international law. The primary medical responsibility under such circumstances is to participate in attempts to prevent nuclear war.
Mismatches between provision of paediatric cardiopulmonary resuscitation (CPR) and potential to benefit are examined. Deficiencies are most likely to occur in peripheral maternity units but futile CPR is more common in emergency departments where the child is unknown. Decision making in individual cases is best retained by the medical profession for the sake of the child and family. American style intervention by the legislature is likely to dissipate scarce resources and perhaps harm infants not capable of benefiting. PMID:1489234
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
To maintain the readers' trust and to uphold the journal's reputation, it is paramount for the entire research, peer reviewer and publication process to follow ethicalprinciples and decisions. Studies involving humans, animals, medical records and human tissues/organs need to be conducted ethically, and the appropriate approvals obtained. The privacy and confidentiality of patients, authors and reviewers should be respected. When required, rights and permissions should be sought. Common forms of scientific misconduct include misappropriation of ideas, violation of generally accepted research practices, failure to comply with legislative and regulatory requirements, falsification of data, and inappropriate behaviour in relation to misconduct. Authors can expect editorial action to be taken, should duplicate publication, plagiarism and other forms of scientific misconduct be attempted or detected. PMID:21221494
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 medicalethics 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.”
Medicalethics as a scholarly discipline and a system of moral principles that apply values and judgments to the practice of medicine encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, anthropology and sociology. As such there are a number of values in medicalethics such as autonomy, non-maleficence, confidentiality, dignity, honesty, justice and beneficence, among others. These values act as guidelines for professionals in the medical fraternity and are therefore used to judge different cases in the fraternity. For purposes of this work, this paper examines the principle of beneficence in biomedicine. Using both hypothetical cases and others in real life situations, the paper reflects on the implications of beneficence in biomedicine. It argues that the principle of beneficence is a prima facie obligation that should "always be acted upon unless it conflicts on a particular occasion with an equal or stronger principle". PMID:22514763
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…
SUMMARY Healthcare research is haunted by a history of unethical studies in which profound harm was caused to vulnerable individuals. Official systems for gaining ethical approval for research, designed to prevent a repetition of these shameful examples, can prove bureaucratic and inflexible in practice. The core ethicalprinciples of respect for autonomy, prevention of harm, promotion of benefit, and justice
Anne Slowther; Petra Boynton; Sara Shaw; Trisha Greenhalgh
The Collaborative Family Healthcare Association (CFHA) welcomes the opportunity to comment on the complementary set of Joint Principles underscoring the Integration of Behavioral Health Care Into the Patient-Centered Medical Home (The Working Party Group on Integrated Behavioral Healthcare et al., 2014). CFHA is an organization that promotes comprehensive and cost-effective models of health care delivery that integrate mind and body, individual and family, patients, providers, and communities. CFHA appreciates that the Joint Principles do not explicitly endorse any single model of collaboration between behavioral health and medical practice. Rather, they broadly emphasize integration, affirming the only way to have a whole person orientation is to adopt a biopsychosocial-spiritual perspective. This commentary will highlight areas of notable strength within the Joint Principles, as well as challenge the language, if not perspective, on a few critical elements. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:24955686
Pharmacy is an ethical profession. The aim of this study was to investigate the history of pharmacy ethics in Iran. In the ancient Persia, medical and pharmaceutical ethics were related to religious rules, and everybody had to respect it. The ethical rules were similar to some current pharmacy ethics. During Islamic era, the pharmacy ethics were edited according to the Islamic rules. After introduction of European pharmacy into Iran, the pharmacy ethics did not change and was regarded as before. By presentation of bioethics and medicalethics in recent years, new activities are carried out for better manipulation of their rules in health professions including pharmacy.
Each profession has its own code of ethics. The Merriam-Webster Online Dictionary (2008) defines professional ethics as "the principles of conduct governing an individual or a group." The Code of Ethics of the American Library Association (ALA Council 2008) has served librarians for seventy years and reflects the ideals toward which all librarians…
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.
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
This curriculum for a medical assistant program is designed for students interested in caring for the sick, injured, convalescent, or disabled under the direction of the family, physicians, and credentialed nurses. The curriculum is divided into 12 units: orientation to medical assisting; principles of medicalethics; risk management; infection…
Ohio State Dept. of Education, Columbus. Div. of Career-Technical and Adult Education.
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…
The Medical Education Scholars Program (MESP) at the University of Michigan Medical School was established in 1998 to develop educational leadership, improve teaching skills, and promote educational scholarship among medical school faculty. The Department of Medical Education designed and implemented the program. Eighty-one scholars have completed the MESP, with 15 more currently enrolled. While most scholars have been clinical faculty, some have been basic science faculty or from other allied health fields. The selection process emphasizes potential for contributing to the educational mission of the medical school. Each cohort is limited to two participants per department. The curriculum of the MESP is designed to provide an overview of a wide range of topics in education. It is divided into five broad domains: principles and theories of education, teaching methods, educational research methods, assessment and evaluation, and educational leadership. During the sessions, active learning of content is expected and encouraged. For instance, scholars share responsibility with the session presenters for planning and evaluating individual program sessions. To graduate, scholars are expected to attend the sessions regularly, and to make a final presentation of their project, which demonstrates near-completion or substantial progress toward that goal. Over its eight years, the MESP has evolved in response to environmental changes and ongoing evaluation of the program. Overall, the Medical Education Scholars Program has proven effective in developing faculty skills and educational leadership locally at the University of Michigan Medical School and nationally. PMID:17065859
Frohna, Alice Z; Hamstra, Stanley J; Mullan, Patricia B; Gruppen, Larry D
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…
What are the ethical issues or situations Air Force Nurse Practitioners (AFNPs) experience in clinical practice. Which moral or ethicalprinciples are reflected. Little has been written about the ethical issues faced by AFNPs in clinical practice. The des...
A characteristic feature of transplanting organs from living donors is that not only patients in need for treatment but also healthy individuals are submitted to medical interventions. Ethical considerations in this field have to deal with the question of property attributes of the human body and conflicts with traditional medicalprinciples. Altruistic organ donation, appreciated by Christianity as a sign of charity, is indeed contradictory to the classic maxim of medicalethics "primum nihil nocere, " meaning "first of all, do not harm." The autonomous choice of a potential donor has to be balanced thoroughly against his personal physical and psychological risks. Apart from organ donation with altruistic motives, commercial incentives or payment for organ donation, which are increasingly under discussion in many nations, need profound ethical reflection. Organ selling does not lead to long-term economic benefit for individual donors in developing countries and is associated with a decline in health. A market system of organ sales would foster exploitation of the poor, and it is substantially doubtful whether autonomy and self determination are valid under circumstances of poverty and coercion. Commodification of the human body risks viewing persons as marketable objects. The human body,however, is an integral element of an individual's personality and not a resource to be removed. It is therefore fundamental that the social good of altruism is preserved as the major principle in organ donation. PMID:12883802
Neuroethics applies cognitive neuroscience for prescribing alterations to conceptions of self and society, and for prescriptively judging the ethical applications of neurotechnologies. Plentiful normative premises are available to ground such prescriptivity, however prescriptive neuroethics may remain fragmented by social conventions, cultural ideologies, and ethical theories. Herein we offer that an objectively principled neuroethics for international relevance requires a new meta-ethics: understanding how morality works, and how humans manage and improve morality, as objectively based on the brain and social sciences. This new meta-ethics will simultaneously equip neuroethics for evaluating and revising older cultural ideologies and ethical theories, and direct neuroethics towards scientifically valid views of encultured humans intelligently managing moralities. Bypassing absolutism, cultural essentialisms, and unrealistic ethical philosophies, neuroethics arrives at a small set of principles about proper human flourishing that are more culturally inclusive and cosmopolitan in spirit. This cosmopolitanism in turn suggests augmentations to traditional medicalethics in the form of four principled guidelines for international consideration: empowerment, non-obsolescence, self-creativity, and citizenship.
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
This resource is a PDF that provides a short introduction to ethical questions and strategies having to do with Ethics instruction. The PDF describes an overview of ethical questions and develops student understanding of ethical questions through three different worksheets.
... without review. Q: Will proposals addressing medical or biomedical ethics be considered? A: No, the ... focused on ethics for medical students or in medical education. EESE will not consider proposals ...
The principle of proportionality is used in many different contexts. Some of these uses and contexts are first briefly indicated. This paper focusses on the use of this principle as a moral principle. I argue that under certain conditions the principle of proportionality is helpful as a guide in decision-making. But it needs to be clarified and to be used with some flexibility as a context-dependent principle. Several interpretations of the principle are distinguished, using three conditions as a starting point: importance of objective, relevance of means, and most favourable option. The principle is then tested against an example, which suggests that a fourth condition, focusing on non-excessiveness, needs to be added. I will distinguish between three main interpretations of the principle, some primarily with uses in research ethics, others with uses in other areas of bioethics, for instance in comparisons of therapeutic means and ends. The relations between the principle of proportionality and the precautionary principle are explored in the following section. It is concluded that the principles are different and may even clash. In the next section the principle of proportionality is applied to some medical examples drawn from research ethics and bioethics. In concluding, the status of the principle of proportionality as a moral principle is discussed. What has been achieved so far and what remains to be done is finally summarized. PMID:22042598
Discusses the teaching of business ethics. Draws conclusions about teaching business ethics noting that such instruction must start with the principles of capitalism and the functions of a market economy. (SG)
To the uninitiated researcher, bioethics can be a confusing and sometimes bureaucratic process. The recent debates in international research ethics have both increased understanding of contentious issues while extending confusion to the international arena. Here, we attempt to demystify bioethics, or more specifically international research ethics, by defining ethics in the context of morality, reviewing core Western ethicalprinciples, and highlighting challenges in international research ethics. PMID:11815276
This article approaches the medical arts at a time in which therapies are based on empirical knowledge, dictated by the fallacy of the authority ofunshakeable traditions. "Madness" and "eccentricities" perpetuated by Old School medical craftsmen are prevalent today in the strange practices of the new charlatanism, such as trunk cell technologies. PMID:19824332
Fictional stories about physicians and patients are increasingly used as a powerful teaching resource for medical students. Very often, but not exclusively, stories of physicians as positive role models are selected to teach students virtues and ethical values. Negative role models are rarely used and if so, physicians are rather described as medical quacks in such fiction then exhibiting primarily a corrupted character. I suggest that a fictional story that presents exclusively a negative role model of a physician could also be a valuable, admittedly difficult, teaching resource to demonstrate the consequences of absolute loss of ethical standards and virtues in physicians. A not widely known example of this genre is Louis-Ferdinand Céline's (1894-1961) novel Voyage au bout de la nuit (Journey to the End of the Night), published in 1932. Having a strong autobiographical background, the novel described the adventures of the medicine student, Ferdinand Bardamu, during the first world war, in the African colonies as a trader, in the United States of America as factory worker, and later after finishing his education, as a doctor for the poor. Unfortunately, Dr Bardamu develops an unprofessional, even criminal behaviour, and may serve as a negative role model for the virtues of physicians. This article will familiarise the reader with the novel and its physician author. PMID:16461481
A program that brings together students entering demanding professions (law, medicine, and nursing) to explore issues of ethics and professionalism is described. The course uses thought-provoking stories, classroom discussion, student journals, and collaborative teaching. Lessons learned from teaching the course a number of times are also…
A description is given of the ethical issues encountered by the US Food and Drug Administration (FDA) in its regulation of new life-saving devices. Issues related both to clinical investigation and to marketing approval of the devices are examined. The potential role of engineers in addressing these issues is discussed. PMID:18244066
\\u000a Judgments based on ethicalprinciples are part of the daily routine of transplant professionals. This is driven by the unique\\u000a circumstances in transplantation where vital human organs are removed from one person and placed into a second human being.\\u000a This chapter discusses basic tenets that can be used to guide an ethical practice of transplantation. The issues covered include\\u000a the
An interdisciplinary physiology and pharmacology course presented by the Medical Interaction Laboratory at the University of Tennessee College of Veterinary Medicine provides interaction among faculty, conserves faculty time and animal expense, and presents a coordinated laboratory experience. (BH)
Nurses' daily care for patients is imbued with moral questions. Ethics distinguish various movements that intend to solve the problem of how to deal with such questions. This article discusses two variants, namely ethics of rules and ethics of care. Ethics of rules present a rational model of thinking in which universal principles are applied to practical moral problems. According to ethics of care, an attitude of responsibility and involvement and, accordingly, the attention to the complex situation of a patient is considered moral. Both kinds of ethics are attached to a case from the practice of nursing care for oncology patients. The thinking of the nurses concerned is in line with ethics of care. It also involves principles of ethics of rules. These principles, however, only make sense in the complex situation of the patient. By virtue of this quality they are taken into consideration by nurses as one of the details from the context. This makes ethics of care function as a kind of 'breeding ground' for ethics of rules. PMID:9397926
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.
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
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
Ethics education that prepares students to address ethical challenges at work is a multifaceted and long-term endeavor. In this article, the authors propose an inductive ethics pedagogy that begins the process of ethics education by grounding students in their own individual ethicalprinciples. The approach centers on developing students' ethical…
Background: Alternative medical therapies are widely practiced in many countries. In the United Arab Emirates, the Ministry of Health has encouraged research in this area. The medical graduate needs to understand the principles of current alternative medicine techniques and the ethical basis of the relationship between the various systems of healing.Description: A course was delivered through problem?based learning; which aimed
Mandira Das; Mohamed Y. Hasan; John Campbell Murdoch
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
OBJECTIVE: To monitor the conduct of medical research projects that have already been approved by the local medical research ethics committee. DESIGN: Follow up study of ethically approved studies (randomly selected from all the studies approved in the previous year) by examination of patients' case notes, consent forms, and research records and by interview of the researchers at their workplace. SETTING: Tayside, Scotland (mixed rural and urban population). SUBJECTS: 30 research projects approved by Tayside local medical research ethics committee. MAIN OUTCOME MEASURES: Adherence to the agreed protocol, particularly for recruitment (obtaining and recording informed consent) and for specific requirements of the ethics committee, including notification of changes to the protocol and of adverse events. RESULTS: In one project only oral consent had been obtained, and in a quarter of the studies one or more consent forms were incorrectly completed. Inadequate filing of case notes in five studies and of consent forms in six made them unavailable for scrutiny. Adverse events were reported, but there was a general failure to report the abandoning or non-starting of projects in two studies the investigators failed to notify a change in the responsible researcher. CONCLUSIONS: Monitoring of medical research by local medical research ethics committees promotes and preserves ethical standards, protects subjects and researchers, discourages fraud, and has the support of investigators. We recommend that 10% of projects should undergo on-site review, with all others monitored by questionnaire. This would require about six person hours of time and a salary bill of 120 pounds per study monitored.
Fetal tissue transplantation has been attempted for a limited number of clinical disorders, including Parkinson's disease, diabetes, immunodeficiency disorders, and several metabolic disorders. Fetal tissue has intrinsic properties--ability to differentiate into multiple cell types, growth and proliferative ability, growth factor production, and reduced antigenicity--that make it attractive for transplantation research. At this time the results from fetal tissue grafts for Parkinson's disease and diabetes have not demonstrated significant long-term clinical benefit to patients with these disorders. Further research will be necessary to determine the potential value of fetal tissue transplantation. For these clinical investigations to proceed, specific ethical guidelines are needed to ensure that fetal tissue derived from elective abortions is used in a morally acceptable manner. These guidelines should separate, to the greatest extent possible, the decision by a woman to have an abortion from her consent to donate the postmortem tissue for transplantation purposes. Such ethical guidelines are offered in this report. PMID:2294329
While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology,\\u000a there is often a disconnect in the perception of value between a technology’s promoters and those responsible for the ultimate\\u000a decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five
P. Lehoux; M. Hivon; B. Williams-Jones; F. A. Miller; D. R. Urbach
The delivery of holistic care should incorporate patient empowerment through the promotion of health and self-help measures, including pain relief. In this article, the author, a newly qualified independent prescriber, explains why she believes that encouraging patients to buy over-the-counter medication is morally acceptable and based on the principles of beneficence and non-malevolence. She also reflects on her prescribing decisions in the context of ethics, health economics and personal perspective for four patients with similar injuries. The author works in Wales, where prescriptions are free to residents. PMID:20527454
A consideration of ethicalprinciples has been at the heart of international polilitical economy from the beginning. Nicolo Machiavelli addressed what a wise ruler ought to do. Adam Smith wrote The Theory of Moral Sentiments before he wrote The Wealth of Nations. Much recent discussion on ethics in IPE has focused on distributive justice, especially in terms of a north-south
The treatment of brain tumors in very young children poses both a therapeutic challenge and a bioethical quandary. The administration of craniospinal radiation after surgery offers the greatest chance for cure but causes severe neurocognitive damage. As a result, current practice does not offer parents the option of full-dose post-operative craniospinal radiation. Some may regard this approach as inappropriate medical paternalism, while others may consider it an example of responsible therapeutics. Evaluation of this dilemma reveals principles which can guide clinicians in determining which treatment options to present to their patients or surrogates, in the context of shared medical decision-making.
Ethics is an essential dimension of newer reproductive technologies. In this rapidly evolving field, there is a need for an ethical framework to guide both clinical practice and research. In this article, we provide such a framework that incorporates ethicalprinciples, professional virtues, and the concept of the fetus as a patient. We then apply this framework to an important
Frank A. Chervenak; Laurence B. McCullough; Zev Rosenwaks
Traces the evolution of ethical norms, principles, and standards in social work during four stages in the profession's history: (1) morality period, (2) values period, (3) ethical theory and decision-making period, and (4) ethical standards and risk-management period. Recent developments in the profession include complex conceptual frameworks and…
In treating dying patients, who by virtue of their physical and emotional situation are frail and vulnerable, physicians must meet a high standard of professional, ethical care. Such a standard is based upon a philosophy of care that recognizes the patients' inherent worth as human beings and their uniqueness as individuals. The ethical and virtuous physician will practice in accordance with the principles of biomedical ethics that form the foundations of thought and treatment approaches in this area and will seek to do the best for the patient and the family. "Doing the best" includes respecting autonomy through gentle truth-telling, helping the patient and family to set treatment goals, and providing for symptom control, continuing attentive care and accompaniment throughout the course of the illness. Total care includes physical, emotional and spiritual aspects, is sensitive to cultural values and is best provided by an interdisciplinary team. Practices of symptom control in routine care and in crisis situations, as well as the cessation and non-initiation of treatment, will have as their goals the relief and comfort of the patient. The ethical physician will not act with the intention of bringing about the death of the patient, whether by ordering medication in excess of that required for symptom control, administering a lethal injection or any other means. PMID:9676552
Good medical practice requires evidence of effectiveness to address deficits in care, strive for further improvements, and justly apportion finite resources. Nevertheless, the potential of palliative care is still held back by a paucity of good evidence. These circumstances are largely attributable to perceived ethical challenges that allegedly distinguish dying patients as a special client class. In addition, practical limitations compromise the quality of evidence that can be obtained from empirical research on terminally ill subjects. This critique aims to appraise the need for focused research, in order to develop clinical and policy decisions that will guide health care professionals in their care of dying patients. Weighted against this need are tenets that value the practical and ethical challenges of palliative care research as unique and insurmountable. The review concludes that, provided investigators compassionately apply ethicalprinciples to their work, there is no justification for not endeavouring to improve the quality of palliative care through research.
In siege and blocked Sarajevo, in 40 months, in primary care unit and than in Emergency Department 42,075 injured and ill persons have got the first aid. Out of that, 37% were injures 16% acute surgical conditions, 23% internal urgent conditions (since October 1994). There were 24% non-urgent cases from the surgical field. In this period of time 107,453 patients were treated hospitably, with an average of 2.108 hospital beds. In 1996, the primary care was given in 21,708 urgent cases, or 60% of 36,312 hospitably treated persons in total. There were 29% injuries, 24% of acute surgical cases, and 47% of internal medicine cases. Urgent centre received 53% individual paints who came by themselves without any medical aid; 25% from health centres where they have bog a primary care, and 22% came after received first aid of primary care in the Emergency department. By applying war surgical doctrine and general medical doctrine, with appropriate services for prompt diagnostics and treatment, with qualified specialists and consultancy services, a good quality of adequate treatment and care has been achieved, the mortality has been reduced, the hospitalisation has been rationalised, and treatment length has been reduced. Analysis demonstrates the reasons for existence of such medical centres in large hospitals. We have recognised the problems we are facing with, and which have to be solved progressively, as well as those concerning the functioning health services in Sarajevo Canton, and Federation of B&H. On the basis of all these knowledge's we believe that a well organised urgent medicine implemented in practice has great importance in the overall treatment. Basic objectives for establishing the urgent medicine as a system are: The first priority is to organise a modern system of urgent medicine, based on the principles of general medical doctrine and complementing with health care system. Urgent medicine programme should be incorporated in the process of medical education of the medical staff, giving a priority to the activities in practice. Provide modern equipment and adequate working space. Develop already developed co-operation with institutions and professionals from Europe and USA. Improve the low level of the first aid training of the population through the first aid courses. PMID:9601776
Registered nurses spend up to 40% of their professional clinical practice engaged in the art and science of medication dosage calculation problem-solving (MDC-PS). In advancing this patient safety critical discipline it is our position that as a profession we must first situate MDC-PS within the context of the wider features of the nursing numeracy, medicines management and clinical pharmacokinetic domains that inform its practice. This paper focuses on the essential relationship between numeracy, healthcare numeracy, medicines management, pharmacokinetics and MDC-PS. We present a taxonomy of generic numerical competencies for the pre-registration curriculum, with examples of essential medication dosage calculation requirements mapped to each skills domain. This is followed by a review of the symbols and measurement units that represent essential components of calculation competence in healthcare and medicines management practice. Finally we outline the fundamental pharmacokinetic knowledge that explains how the body deals with medication and we illustrate through clinical correlations why numeric and scientific knowledge and skills must be mastered to ensure safe dosage calculation and medicines management practice. The findings inform nurse education practice via advancing our understanding of a number of issues, including a unified taxonomy of generic numerical competencies mapped to the 42 revised UK Nursing and Midwifery Council (NMC) Essential Skills Clusters (NMC, 2010a; NMC, 2010b). PMID:23273945
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-ethicalprinciples 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
Although the U.S. Supreme Court justices frequently alluded to ethical concepts in delivering their opinions in the Cruzan decision, no clear or consistent ethical framework supported this jargon. The decision, in fact, resolves none of the ethical and professional questions that initially brought the case to the courts. The various arguments about whether and when it is ethical to terminate treatment are the first source of ethical confusion in questions about death and dying. Individuals arriving at the same conclusion can begin from significantly different ethicalprinciples. An added complexity arises as a result of differences among medical professionals regarding what constitutes a fatal pathological condition. A resolution of these differences would clarify a number of ethical questions. The biggest problem with the Missouri Supreme Court's decision was that it gave absolute precedence to the state's interest in preserving life, excluding quality-of-life considerations and disregarding personal, familial, and professional values that should have affected the decision. In fact, since a medically well-informed family is in most cases in the best position to make a decision that would conform with a family member's wishes, applying the "clear and convincing" evidence standard in the Cruzan case shifts the burden of proof to the wrong party. Instead, the state should be obliged to give convincing evidence of why it has intervened in a decision for which the patient's family and physician should have authority. PMID:10107438
California voters recently approved $3 billion over 10 years for public funding of stem cell research through the California Institute for Regenerative Medicine (CIRM). Geoffrey Lomax and colleagues discuss the principles that guided the CIRM regulations.
Introduction According to the Declaration of Helsinki and other guidelines, clinical studies should be approved by a research ethics committee and seek valid informed consent from the participants. Editors of medical journals are encouraged by the ICMJE and COPE to include requirements for these principles in the journal’s instructions for authors. This study assessed the editorial policies of psychiatry journals regarding ethics review and informed consent. Methods and Findings The information given on ethics review and informed consent and the mentioning of the ICMJE and COPE recommendations were assessed within author’s instructions and online submission procedures of all 123 eligible psychiatry journals. While 54% and 58% of editorial policies required ethics review and informed consent, only 14% and 19% demanded the reporting of these issues in the manuscript. The TOP-10 psychiatry journals (ranked by impact factor) performed similarly in this regard. Conclusions Only every second psychiatry journal adheres to the ICMJE’s recommendation to inform authors about requirements for informed consent and ethics review. Furthermore, we argue that even the ICMJE’s recommendations in this regard are insufficient, at least for ethically challenging clinical trials. At the same time, ideal scientific design sometimes even needs to be compromised for ethical reasons. We suggest that features of clinical studies that make them morally controversial, but not necessarily unethical, are analogous to methodological limitations and should thus be reported explicitly. Editorial policies as well as reporting guidelines such as CONSORT should be extended to support a meaningful reporting of ethical research.
On March 31, 2005, Terri Schiavo (born December 3, 1963) died -- the final complication of a cardiac arrest on February 25, 1990. Her death was preceded by the withdrawal of artificially administered hydration and nutrition through a feeding tube. Prior to her death, Terri's saga was the focus of intense medical, ethical, and legal debates in the United States (US) and elsewhere. These debates were characterized by confusion about the facts, ethicalprinciples, and laws relevant to the case. Much of the confusion revolved around a number of ethical and legal questions including: Is it ethically and legally permissible to withhold or withdraw life-sustaining treatments from patients who do not want the treatments? Is withholding or withdrawing life-sustaining treatments the same as physician-assisted suicide or euthanasia? Is artificially administered hydration and nutrition a medical treatment or mandatory care akin to bathing? What were Terri's values, preferences, and goals regarding life-sustaining treatments? In this article, the medical, ethical, and legal data related to the case and the aforementioned ethical and legal questions raised by it are reviewed. Finally, the clinical implications of the saga, such as the need for clinicians to be more proactive in educating patients about their rights related to making health care decisions, end-of-life care options, and advance care planning (e.g., completing an advance directive) are discussed. Notably, given that the Schiavo saga occurred in the US, this article is written from a US perspective. PMID:19776703
The practice of genetic counselling gives rise to many ethical dilemmas, and counsellors need to be familiar with the principles of biomedical ethics. The primary principles include respect for autonomy, beneficence, non-maleficence and justice. A case of identical twins at 50% risk for Huntington's disease, in which only one twin sought predictive testing for this dominantly inherited disease, created several ethical dilemmas. Another case where predictive testing was carried out on two young children, at high risk, by a laboratory at the request of an adoption agency and a doctor, with a view to giving information to the foster parents, also posed many ethical conundrums for the counsellor. The ethical issues that arose in these cases are discussed in this paper. PMID:24300652
Ethical issues at the interface between the medical profession and the pharmaceutical industry have generally been approached from the vantage point of medical professionalism, with a focus on conflict of interest as the key ethical concern. Although conflicts of interest remain important, other ethical issues may be obscured unless a wider perspective is adopted. Besides medical professionalism, the ethics of the clinical therapeutic relationship, ethics of public health, and business ethics all provide additional insights. PMID:23047778
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)
The “Universal Declaration of Human Rights” and the “Geneva Declaration” by the World Medical Association, both in 1948, were\\u000a preceded by the foundation of the United Nations in New York (1945), the World Medical Association in London (1946) and the\\u000a World Health Organization in Geneva (1948). After the end of World War II the community of nations strove to achieve
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) ethicalprinciples, 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 ethicalprinciple 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.
Background It is widely acknowledged that there is a global divide on health care and health research known as the 10/90 divide. Methods A retrospective survey of articles published in the BMJ, Lancet, NEJM, Annals of Internal Medicine & JAMA in a calendar year to examine the contribution of the developing world to medical literature. We categorized countries into four regions: UK, USA, Other Euro-American countries (OEAC) and (RoW). OEAC were European countries other than the UK but including Australia, New Zealand and Canada. RoW comprised all other countries. Results The average contribution of the RoW to the research literature in the five journals was 6.5%. In the two British journals 7.6% of the articles were from the RoW; in the three American journals 4.8% of articles were from RoW. The highest proportion of papers from the RoW was in the Lancet (12%). An analysis of the authorship of 151 articles from RoW showed that 104 (68.9%) involved authorship with developed countries in Europe or North America. There were 15 original papers in these journals with data from RoW but without any authors from RoW. Conclusions There is a marked under-representation of countries in high-impact general medical journals. The ethical implications of this inequity and ways of reducing it are discussed.
This article presents the psychometric qualifications of a new video-based measure of school professionals' ethical sensitivity toward issues of racial intolerance in schools. The new scale, titled the Quick-Racial and Ethical Sensitivity Test (Quick-REST) is based on the ethicalprinciples commonly shared by school-based professional…
Sirin, Selcuk R.; Rogers-Sirin, Lauren; Collins, Brian A.
Three recent Canadian legal cases have dealt with the proposed blood transfusion of adolescent members of Jehovah’s Witness (JW) families. In each case, the court permitted transfusions if medically necessary. Much critical analysis of the issue of forced treatment of decisionally competent adolescents focuses exclusively on competence and questions why mature minors may not decide for themselves. The authors argue that a focus on decision-making competence alone is too narrow. Before one may legally give or refuse consent to medical treatment, three conditions must be met: competence, adequate information and lack of coercion. In striving to find agreement on medical treatment, physicians, patients and JW family members seek and, in fact, often achieve mutual understanding and cooperation. Coercion by actual or threatened shunning and excommunication can occur, and these factors may affect adolescent decision-making. In this context, a court order authorizing medical treatment can, therefore, be seen as enhancing patient freedom. The authors suggest that, in addition to fulfilling existing statutory duties to report a child in need of protection, health care professionals caring for acute patients of JW families should actively look for evidence that the patient has accurate medical information and is acting without coercion. The authors also explore suggestions on how to deal with the unusual complexities of such cases.
Nursing ethics in the 21st century will continue to be concerned with describing and communicating the characteristics of the “good” nurse, and describing nurses’ ethical practices. However, there is a growing concern that what constitutes nurses’ ethical practices is changing as patients are experiencing, by virtue of reduced reimbursements for health care services, limited time to be in a nurse-patient
Today, trichology as a science is offered by reputed institutes worldwide with a planned curriculum of theory and clinical exposure. Non-medical trichologists, with rare exceptions, continue to lure the public with unscientific methods. A qualified dermatologist equipped with knowledge of hair biology is undoubtedly the most competent to deal with hair problems. We are all indisputably governed by a basic code of medicalethics as we are doctors first and last. Hence, a dermatologist/trichologist cannot have another set of ethics. Having said that, we cannot discount the fact that there are special clinical situations where guidelines already exist or need to be established with compliance to the base code of ethics.
The history of ideas and a philosophical investigation into normative ethics and some of its applications focus in this book on environmental concerns. Part one explores moral traditions, which may appear deficient because traditions have been misrepresented. Attitudes and ideas toward ecological problems have a basis in Jewish and Christian stewardship traditions. Part two re-examines moral principles in light of scientific discoveries that have generated and revealed new side effects of human actions on the complex systems of nature. If all worthwhile life is of intrinsic value, it is necessary to reassess and broaden the human obligation to ecology. The author disagrees with the movement to focus environmental ethics on the biosphere as an organic whole rather than on fellow creatures, although his principles embody constraints in the interests of future creaters. The book concludes with an assessment of principles on pollution, resources, population, and preservation. 302 references.
Abstract Combined therapy presents ethical quandaries that occur in individual psychotherapy and group psychotherapy, and dilemmas specifically associated with their integration. This paper examines two types of ethical frameworks (a classical principle-based framework and a set of context-based frameworks) for addressing the ethical hot spots of combined therapy: self-referral, transfer of information, and termination. The principle-based approach enables the practitioner to see what core values may be served or violated by different courses of action in combined therapy dilemmas. Yet, the therapist is more likely to do justice to the complexity and richness of the combined therapy situation by supplementing a principle analysis with three additional ethical frameworks. These approaches are: virtue ethics, feminist ethics, and casuistry. An analysis of three vignettes illustrates how these contrasting ethical models not only expand the range of features to which the therapist attends but also the array of solutions the therapist generates. PMID:19113976
Nursing faculty must not only teach ethics to prospective nurses but also demonstrate it in relationships with students. Principles for ethical educational practice include mutual respect, open communication, boundary setting, consistent behaviors, and personal values. (SK)
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.
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.;)
Medicalethics 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
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 ethicalprinciples 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.
OBJECTIVES Improving nurses' competence in resolving clinical ethical issues must start with ethics education in training and clinical practice. However, many students complain that they cannot apply classroom learning to actual clinical scenarios. This study explored ethical issues and dilemmas, and their impact experienced by student nurses in clinical practice. METHODS Focus groups were conducted with 44 first-year student nurses from a 2-year college course in northern Taiwan. Interviews were tape-recorded and verbatim transcripts were analysed using content analysis. RESULTS Students expressed and discussed their views in eight focus groups. Analysis of interviews revealed five themes: frustration at inability to help some patients; oppression caused by lower status; lack of honesty and ethical courage; powerlessness, and self-encouragement in adversity. CONCLUSIONS Taiwanese nurse ethics training was only recently introduced and the curriculum has not addressed the clinical reality in Taiwan. This reality includes limitations arising from the medical hierarchy and the socio-cultural role of families in medical decision making, which may inhibit ethical judgements and decision making. In clinical dilemmas, the most common problems faced by Taiwanese nursing students involved not knowing how to handle some situations, inability to abide by principles, and a lack of appropriate role models. Hence, we suggest that nursing ethics education should: (i) integrate scenarios involving ethical dilemmas into daily routines; (ii) give students opportunities to discuss their feelings about their experiences; (iii) allow teachers and students to talk about scenarios with ethical implications, and (iv) provide students with opportunities to reflect on clinical scenarios in order to clarify their values and learn how to respect the value of life. PMID:20345695
A prescription is a health-care program implemented by a physician or other qualified practitioner in the form of instructions that govern the plan of care for an individual patient. Although the algorithmic nature of prescriptions is axiomatic, this insight has not been applied systematically to medication safety. We used software design principles and debugging methods to create a “Patient-oriented Prescription
SM Belknap; H Moore; SA Lanzotti; PR Yarnold; M Getz; DL Deitrick; A Peterson; J Akeson; T Maurer; RC Soltysik; GA Storm; I Brooks
Clinical organ transplantation 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. It is emphasized 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. PMID:15859919
Created in 1994 by Professor Lawrence M. Hinman of the University of San Diego, the Ethics Updates site is designed primarily to be used to ethics instructors and their students. However, the site is rather interesting, so members of the general public may find themselves making a few return visits. Visitors can use the drop-down tabs on the top of the homepage to make their way through sections that cover some of the basic theories of ethics and also learn more about applied ethics in relation to such issues as animal rights, torture, and world hunger. Moving on, the "Resources" area includes case studies for discussion, a glossary of terms, classic texts in ethics, and ethics surveys. The site is rounded out by a search engine and a selection of videos that deal with various topics in ethics.
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
In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and assisted reproductive technology (ART), and published an extended background paper, recommendations and two Editorials. Seven years later, in March 2012, a follow-up interdisciplinary workshop was held, involving representatives of both professional societies, including experts from the European Union Eurogentest2 Coordination Action Project. The main goal of this meeting was to discuss developments at the interface between clinical genetics and ARTs. As more genetic causes of reproductive failure are now recognised and an increasing number of patients undergo testing of their genome before conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and preimplantation genetic diagnosis (PGD) may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from randomised clinical trials to substantiate that the technique is both effective and efficient. Whole-genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (International Standards Organisation – ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving but still remains very heterogeneous and often contradictory. The lack of legal harmonisation and uneven access to infertility treatment and PGD/PGS fosters considerable cross-border reproductive care in Europe and beyond. The aim of this paper is to complement previous publications and provide an update of selected topics that have evolved since 2005.
Ethical issues are present at each stage in the vaccine product life cycle, the period extending from the earliest stages of research through the eventual design and implementation of global vaccination programs. Recent developments highlight fundamental principles of vaccine ethics and raise unique issues for ongoing vaccination activities worldwide. These include the 2009-10 H1N1 pandemic influenza vaccination campaign, renewed attention to the potential global eradication of polio, and the ongoing evaluation of vaccine risk controversies, most notably the alleged link between childhood vaccines and autism. These cases present ethical challenges for public health policy-makers, scientists, physicians, and other stakeholders in their efforts to improve the health of individuals, communities, and nations through vaccination. PMID:22440783
How can we make ethical decisions about our environment in the face of increasingly conflicting needs and opinions This collection of essays offers a wide range of viewpoints representing many of the world's cultural and religious traditions to help readers better make such determinations for themselves. In this paper, the authors seek to clarify the ethicalprinciples surrounding the concept of sustainable development. They provide a synoptic overview of the contemporary moral challenge of sustainable development and the similarities and differences in its interpretation throughout the world. In bringing together contributions by authorities in environmental ethics and developmental ethics, and by those who are addressing these questions from the perspectives of religion and humanistic philosophy, the book develops the concept of sustainability as the ethical approach to reconciling the needs of environmental conservation with economic development.
This article explores ethical concerns and emerging dilemmas associated with the proliferation of information resulting from the extraordinary advances in molecular genetics. It provides an overview of the ethical and legal challenges associated with predictive testing for inherited disease currently being addressed in the literature. Finally, it offers a framework of ethicalprinciples that can be used to guide nurses and other practitioners in the appropriate application of research findings to the clinical practice setting. The ethical guidelines of self-determination, benefit-burden ratio, and justice promulgated in The Belmont Report are interpreted in the new context of predictive genetic testing. The author concludes by discussing how to balance the technical imperative to advance genetic knowledge for the sake of human health with the ethical imperative to preserve the fundamental rights and liberties of both individuals and communities who are its recipients. PMID:11885910
Socioeconomic pressures on medicine have redefined traditional relationships between physicians and patients, researchers and regulatory bodies, and consultants and device companies. Physicians are disheartened that the public perception of medicine, reinforced by the media, is often negative. Ethical lapses are frequently the focus of criticism. A recent example that received considerable attention is the inextricable link between physicians and medical device companies. Although both groups have clear codes defining the ethical interaction between them, expediency and loose adherence to those guidelines has been problematic. In a climate of skepticism, the house of medicine needs to reverse and not feed that skepticism. PMID:19410982
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
Although many studies have explored the experiences of doctors in their first postgraduate year, few have focused on the ethical issues encountered by this group. Based on an extensive literature review of research involving house officers, we argue that these doctors encounter a broad range of ‘everyday’ ethical challenges, from truth-telling to working in non-ideal conditions. We propose a typology of house officers' ethical issues and advocate prioritizing these issues in undergraduate medicalethics and law curricula.
Professor Lawrence M. Hinman of the University of San Diego provides ethics students with a unique kind of meta-page where the user can choose from a wide array of information formats within each of the 23 topics under the main sub-headings of ethical theory and applied ethics. Topics covered include ethical relativism, utilitarianism, race and ethnicity, and euthanasia, among others. Information formats include links to web sites, bibliographies, court decisions, legislation, relevant documents, and articles in popular and professional literature. Much of the site content is adapted from Hinman's books.
BACKGROUND: The value of ethics education have been questioned. Therefore we did a student survey on attitudes about the teaching of ethics in Swedish medical schools. METHODS: Questionnaire survey on attitudes to ethics education with 409 Swedish medical students participating. We analyzed > 8000 words of open-ended responses and multiple-choice questions using classic grounded theory procedures. RESULTS: In this paper
Hans O Thulesius; Karl Sallin; Niels Lynoe; Rurik Löfmark
Accurate criteria for death are increasingly important as it becomes more difficult for the public to distinguish between patients who are still alive from those who, through the aid of medical technology, merely look like they are alive even though they are dead. Patients and their families need to know that a clear line can be drawn between life and death, and that patients who are alive will not be unintentionally treated as though they are dead. For the public to trust the pronouncements of medical doctors as to whether a patient is dead or alive, the criteria must be unambiguous, understandable, and infallible. It is equally important to physicians that accurate, infallible criteria define death. Physicians need to know that a clear line can be drawn between life and death so that patients who are dead are not treated as though they are alive. Such criteria enable us to terminate expensive medical care to corpses. Clear criteria for death also allow us to ethically request the gift of vital organs. Clear, infallible criteria allow us to assure families and society that one living person will not be intentionally or unintentionally killed for the sake of another. The pressure of organ scarcity must not lead physicians to allow the criteria for life and death to become blurred because of the irreparable harm this would cause to the patient-physician relationship and the devastating impact it could have on organ transplantation. As the cases presented here illustrate, anesthesiologists have an important responsibility in the process of assuring that some living patients are not sacrificed to benefit others. Criteria for declaring death should be familiar to every anesthesiologist participating in organ retrieval. Before accepting the responsibility of maintaining a donor for vital organ collection, the anesthesiologist should review data supplied in the chart supporting the diagnosis of brain death and seriously question inconsistencies and inadequate testing conditions. Knowledge of brain death criteria and proper application of these criteria could have changed the course of each of the cases presented. PMID:10422953
A panel of the American Psychological Association (APA) has developed a simple, user friendly process to facilitate ethical and clinical decision making in cases involving HIV disease. The model is based on the five ethicalprinciples of autonomy, beneficence, nonmaleficence, fidelity, and justice. This article examines how the model could be applied to a hypothetical case of a private practice client and his therapist. The ethical question in this case concerns whether to reveal a patient's serostatus to his wife. PMID:11366639
According to the Code of Ethics of the American Society for Photogrammetry and Remote Sensing (ASPRS), the principles on which ethics are founded consist of honesty, justice, and courtesy, forming a moral philosophy associated with mutual interest among men. We will cover in particular the ethical problems of publication of photogrammetric material in the various media. There are many such problems, and we often face a dilemma in selecting a course which is the right thing to do.
Making ethical decisions is of the utmost importance, because peoples' lives depend on those decisions. As illustrated in the case studies, it is the individual engineering manager who ultimately decides if he or she is going to ethically make the complex decisions created by a competitive environment.
The purpose of a company is contribution to society by operating activities. Therefore, it has a company principle and “Business ethics” conduct codes in each. On the other hand, many engineers with specialties are performing business toward the same purpose at the same company. And it will produce new inconsistency by introducing “Engineer ethics” and “the ethics of each professional” all at once in the situation of that company. Then, the engineer ethics education in company needs to carry out by arranging company conduct codes and Engineer ethics. This paper proposes what the company ethics education should be from exemplifying results by make activities and engineer ethics education of the corporate ethics observance in the Tokyo Electric Power Co., Inc.
The relation is considered between ethical choices, morals and deontology in plastic surgery of the male external genitals. Ethics dictates the behavioural model applied by an individual or group in their actions. Professional ethics--deontology--is the collection of duties governing the exercise of a certain profession. Morals are the set of rules governing an individual's life in society. Ethics, deontology and morals do not always convey the same message, since environmental, racial and religious situations, custom, and even fashion can influence a patient's demands, reflecting his desire to improve his quality of life, even only from the purely hedonistic viewpoint, and the specialist's attitude. Surgeons are increasingly tending to bend to these demands or--much worse--even encourage and foster them, with a view to financial considerations. The attitude and ethical choices available are examined in relation to surgery to lengthen or enlarge the penis. PMID:9882901
The Ethics CORE Digital Library, funded by the National Science Foundation, "brings together information on best practices in research, ethics instruction and responding to ethical problems that arise in research and professional life." It's a remarkable site where visitors can make their way through ethics resources for dozens of different professions and activities. The Resources by Discipline area is a great place to start. Here you will find materials related to the biological sciences, business, computer & information science, along with 14 additional disciplines. The Current News area is a great place to learn about the latest updates from the field. Of note, these pieces can easily be used in the classroom or shared with colleagues. The dynamism of the site can be found at the Interact with Ethics CORE area. Active learning exercises can be found here, along with instructional materials and visitors' own lessons learned.
QS has generated debates that are ultimately grounded in various principles, norms, and values. Through a careful analysis of opposing arguments, this paper focuses on two ethicalprinciples claimed by both sides, namely: respect for life and beneficence. Though issues surrounding QS are complex, from the common ground of these two principles, this paper proposes a course of action that
Medicalethics is the study of human values as they relate to the practice of medicine. Ethics intersects with gastroenterology\\u000a primarily involving issues of gastric and intestinal artificial feeding at the end of life. Language imparts meaning. Gastric\\u000a artificial feeding is not the same as eating. Recent data suggest that gastric artificial feeding does not prolong life in\\u000a patients with
This article presents the author's response to Gary Miller's essay entitled "Ethical Realism and Continuing Education." In his essay, Dr. Miller has provided a valuable opportunity to reflect on the practice of continuing education (CE) leadership. Dr. Miller reviews six principles that are encapsulated in the concept of ethical realism, but are…
Basic moral principles and patient’s rights are always top of mind in planning and conducting clinical trials. Browse the conversations in this area to find information about ethical issues such as conflict of interest, and informed consent. Or to learn more about Ethical Issues, click here.
There are five basic ethicalprinciples: truth, honesty, trustworthiness; respect for human life; welfare; and posterity; fair play; openness; and competence. A process has to be established to avoid ethical crises. The NRC procedure for differing professional opinions is outlined. (DLC)
Many of John Dewey's ideas concerning ethics and the universalization of democratic habits of thought and action are especially relevant to a discussion of adult literacy as a means of developing social intelligence in a democratic society. Dewey's basic ethicalprinciples are manifest in approaches to adult literacy education such as those…
This document is a compilation of materials from a presentation on ethical decision making. These components are included: (1) four sample moral dilemmas; (2) graphs of Kohlberg's six stages of moral growth; (3) graphs of Gilligan's Theory of Moral Judgments; (4) graphs of Kitchner's Theory of EthicalPrinciples; (5) a discussion of the four…
All evaluators face the challenge of striving to adhere to the highest possible standards of ethical conduct. Translating the AEA's Guiding Principles and the Joint Committee's Program Evaluation Standards into everyday practice, however, can be a complex, uncertain, and frustrating endeavor. Moreover, acting in an ethical fashion can require…
An examination of leading textbooks suggests the predominance of a principle-based model in the teaching of business ethics. The model assumes that by teaching students the rudiments of ethical reasoning and ethical theory, we can hope to create rational, independent, autonomous managers who will apply such theory to the many quandary situations of the corporate world. This paper challenges these
An ethics game involves nursing students in defending actions in ethics-based scenarios. Benefits include increased confidence, ability to see multiple perspectives, values clarification, and exposure to decision-making models, professional responsibilities, ethicalprinciples, social expectations, and legal requirements. Difficulties include…
The role of ethics in institutional management and instruction and the need for ethics codes have been identified as major issues currently facing community colleges in the United States. In general, ethics codes represent professional ideals, serving as guides for behavior and establishing principles of performance. A study was recently conducted…
This monograph contains 13 papers on the ethics of planning, conducting, and reporting research in health sciences education. It includes four background papers and nine perspective papers. The titles are: (1) "The Imperative for Ethical Conduct in Scientific Inquiry" (Steve M. Dorman); (2) "Fundamental Principles of Ethical Research in Health…
Proposes an "ethics of evidence" as an approach to medical uncertainty and a vital component of biomedical ethics. Calls for use of the best possible scientific evidence for every phase of medical decision making. (SLD)
Reviews macro and micro issues in determining research priorities for nursing education. Illustrates how decisions can be shaped by such ethicalprinciples as caring, utility, justice, and faithfulness. Considers distributive justice as a guide for resource allocation. (SK)
Research that includes non-human animal experimentation is fundamentally a dilemmatic enterprise. Humans use other animals in research to improve life for their own species. Ethicalprinciples are established to deal with this dilemma. But despite this ethical apparatus, people who in one way or another work with animal experimentation have to interpret and understand the principles from their individual points of view. In interviews with members of Swedish animal ethics committees, different views on what the term ethics really means were articulated. For one member, the difficult ethical dilemma of animal experimentation is the lack of enriched cages for mice. For another, the ethical problem lies in regulations restraining research. A third member talks about animals' right not to be used for human interests. These different views on "ethics" intersect once a month in the animal ethics committee meetings. There is no consensus on what constitutes the ethical problem that the members should be discussing. Therefore, personal views on what ethics means, and hierarchies among committee members, characterise the meetings. But committee traditions and priorities of interpretation as well are important to the decisions. The author discusses how "ethics" becomes situated and what implications this may have for committees' decisions. PMID:19332584
In today's climate and environment, the conventional relationship between caring, economic, and administrative practices no longer serves the interest of patients, clinicians, or systems. A shift toward human caring values and an ethic of authentic healing relationships is required as systems now have to value human resources and life purposes, inner meaning, and processes for providers and patients alike. The costs of unethical behavior can be even greater for followers. When we assume the benefits of leadership, we also assume ethical burdens. It is the assertion and experience of the author that the triangle of ethics and ethical behavior, followers, and patient's outcomes are closely interrelated and affect each other in a very intimate and direct way. Unethical leadership may lead to follower disappointment and distrust, leading to lack of interest and commitment, consequently negatively impacting patient outcomes and organizational effectiveness. PMID:22864295
Students examine some examples of ethical issues that have resulted from our expanded knowledge of neuroscience. They are asked to write a position paper describing their own point of view on one of these controversial topics.
The decision-making process in childbearing women regarding birth preferences raises ethical dilemmas related to caring for women during labor and birth. Giving birth is a powerful, life-changing event that leaves a lasting impact on the childbearing woman. The birth experience may be perceived positively or negatively or with feelings of ambivalence. This descriptive qualitative study asked what factors influence a woman's change in her stated birth preference from an unmedicated birth to a medicated birth. A purposive convenience sample of 33 primiparous and multiparous childbearing women who had changed their stated birth preference for pain management during labor participated in interviews conducted within a month of giving birth. Themes included wanting an unmedicated birth; changing to a medicated birth; feeling disappointed, ambivalent, or satisfied; and reflecting on the change. Changing birth preferences is a result of many complex factors, including the influence of professional support by nurses. Ethicalprinciples such as autonomy, veracity, beneficence, informed consent, standard of best interest, and obligations should be applied when caring for laboring women, framed by the ethics of caring. PMID:15923964
Carlton, Troy; Callister, Lynn Clark; Stoneman, Eva
Through a questionnaire distributed to 300 physicians in the Toronto area, three aspects of their ethical awareness were examined: the formal codes, the need for consultation in making decisions and the need for training in medicalethics. Most of the physicians (81%) felt that they were facing ethical problems in their daily practice. A majority of these would try to solve the problems either themselves (30%) or through discussion with a colleague (43%). When they turned outside the profession it was sometimes to a lawyer (12%), which suggests concern with the legalities of some situations. Only a small proportion of the respondents were found to be familiar with two of the established codes of ethics, yet 13% would still turn to the code of the Canadian Medical Association for guidance. Finally, there was widespread recognition of the need for proper training in medicalethics and for the establishment of a specialty in this field.
HIV/AIDS patients with medication adherence problems are vulnerable to developing drug resistance, immune system degradation, and opportunistic infections. Poor adherence to antiretroviral medication regimens can be aggravated by psychiatric problems, including depression and posttraumatic stress disorder. This article presents the case study of a…
Mental health researchers are now expected to include racial and ethnic diversity in their study samples. These studies meet ethics requirements, but the tendency to focus on deontological ethical objectives has not been sufficient to ensure ethical or equitable outcomes for research participants. To ensure these outcomes, we need to emphasize utilitarian ethicalprinciples that take into account the historical