MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Journal of Medical Ethics' source. Mon, 06 Feb 2012 20:05:34 +0100 http://www.medworm.com/index.php?rid=5617252&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F130%3Frss%3D1 Conclusions Students encountered a wide variety of ethical and professional issues that can be used to guide pre-clinical and clinical education. Comparison of our findings with results from similar studies suggests that the wording of an assignment (specifying "ethical" issues, "professional" issues, or both) may influence the kinds of issues students identify in their experience-based clinical narratives. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617252 Fri, 20 Jan 2012 05:00:00 +0100 5617252 http://www.medworm.com/index.php?rid=5617251&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F127%3Frss%3D1 Respecting and protecting the confidentiality of data and the privacy of individuals regarding the information that they have given as participants in a research project is a cornerstone of complying with accepted research standards. However, in longitudinal studies, establishing and maintaining privacy is often challenging because of the necessity of repeated contact with participants. A novel internet-based solution is introduced here, which maintains privacy while at the same time ensures linkage of data to individual participants in a repeated measures design. With the use of the anonymous repeated measurements via email (ARME) procedure, two separate one-way communication systems are established through ad hoc email accounts and a secure study website. Strengths and limitations of the... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617251 Fri, 20 Jan 2012 05:00:00 +0100 5617251 http://www.medworm.com/index.php?rid=5617250&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F121%3Frss%3D1 Systematic reviews, which were developed to improve policy-making and clinical decision-making, answer an empirical question based on a minimally biased appraisal of all the relevant empirical studies. A model is presented here for writing systematic reviews of argument-based literature: literature that uses arguments to address conceptual questions, such as whether abortion is morally permissible or whether research participants should be legally entitled to compensation for sustaining research-related injury. Such reviews aim to improve ethically relevant decisions in healthcare, research or policy. They are better tools than informal reviews or samples of literature with respect to the identification of the reasons relevant to a conceptual question, and they enable the setting of agenda... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617250 Fri, 20 Jan 2012 05:00:00 +0100 5617250 http://www.medworm.com/index.php?rid=5617249&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F117%3Frss%3D1 The randomised controlled trial (RCT) constitutes a quantitative, comparative, controlled study of a particular treatment, and provides invaluable evidence regarding its pharmacotherapeutic efficacy. These studies are generally predicated upon the ethical principle of clinical equipoise. However, this may be insufficient to justify withholding treatment from a control group while assessing drug therapy in a potentially fatal disease. Thus, the criteria for randomisation, informed consent methodology and timing, and consideration of treatment options in such a scenario remain the province of medical ethics. This paper addresses the need for an RCT of ribavirin in the treatment of Crimean Congo haemorrhagic fever, and highlights underlying ethical concerns in light of the current medical, vi... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617249 Fri, 20 Jan 2012 05:00:00 +0100 5617249 http://www.medworm.com/index.php?rid=5617248&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F112%3Frss%3D1 This study aimed to examine the thoughts and expectations of patients receiving healthcare from their physicians and evaluate the ethical aspects of these thoughts and expectations. To determine the ethical aspects of the thoughts and expectations of patients, an open-ended question was asked on the web page of the Turkish Armed Forces (TAF) Health Care Command, which is accessible to the users of the TAF intranet system (the internet system used within TAF institutions). The participants were asked to express their thoughts in their own words. A total of 804 participants answered the question by providing their input. The statements of the participants were classified separately by two public health specialists. The classification was made in accordance with the basic principles of patien... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617248 Fri, 20 Jan 2012 05:00:00 +0100 5617248 http://www.medworm.com/index.php?rid=5617247&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F107%3Frss%3D1 Advances in neuromodulation and an improved understanding of the anatomy and circuitry of psychopathology have led to a resurgence of interest in surgery for psychiatric disease. Clinical trials exploring deep brain stimulation (DBS), a focally targeted, adjustable and reversible form of neurosurgery, are being developed to address the use of this technology in highly selected patient populations. Psychiatric patients deemed eligible for surgical intervention, such as DBS, typically meet stringent inclusion criteria, including demonstrated severity, chronicity and a failure of conventional therapy. Although a humanitarian device exemption by the US Food and Drug Administration exists for its use in obsessive-compulsive disorder, DBS remains a largely experimental treatment in the psychiatr... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617247 Fri, 20 Jan 2012 05:00:00 +0100 5617247 http://www.medworm.com/index.php?rid=5617246&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F102%3Frss%3D1 Conclusions An information discrepancy was observed between the participants' understanding and their desire to know. By putting more emphasis on under-informed elements, the quality of informed consent could be improved. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617246 Fri, 20 Jan 2012 05:00:00 +0100 5617246 http://www.medworm.com/index.php?rid=5617245&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F98%3Frss%3D1 There is a tension between the preservation of academic freedom and the economic context in which the university currently finds itself. This tension embodies serious threats to global health as a result of three overlapping phenomena which impede the production and diffusion of valuable knowledge about health. These phenomena, the privatisation, commercialisation and instrumentalisation of knowledge are identified and examined in this paper in relation to human rights and international morality. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617245 Fri, 20 Jan 2012 05:00:00 +0100 5617245 http://www.medworm.com/index.php?rid=5617244&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F93%3Frss%3D1 This article describes the findings of a mixed method literature review that examined the perceptions of elderly patients and residents of a good nurse in nursing homes, hospitals and home care. According to elderly patients and residents, good nurses are individuals who have the necessary technical and psychosocial skills to care for patients. They are at their disposal, promptly recognising the patients' needs. Good nurses like their job and are sincere and affectionate. They are understanding and caring. They do not hesitate to enter into a trust-based relationship with their patients. Knowing and understanding how elderly patients and nursing home residents perceive ‘the good nurse’ is crucial for providing quality care and for promoting better patient outcomes in geriatric... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617244 Fri, 20 Jan 2012 05:00:00 +0100 5617244 http://www.medworm.com/index.php?rid=5617243&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F87%3Frss%3D1 This article details findings from a Delphi exercise that was part of a larger study exploring the conflicts of interest that arise for UK GPs in safeguarding children. The specific objectives of the Delphi exercise were to understand how these conflicts of interest are seen from the perspectives of an expert panel, and to identify best practice for GPs. The Delphi exercise involved four iterative rounds with questionnaires completed by an expert panel. Results from each round were distilled and findings sent to panel members until consensus was reached. Panel members shared insights regarding their understanding of conflicts of interest in relation to GPs and safeguarding children and responses when conflicts of interests arise. Findings suggested a broader understanding of conflicts of i... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617243 Fri, 20 Jan 2012 05:00:00 +0100 5617243 http://www.medworm.com/index.php?rid=5617242&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F83%3Frss%3D1 To meet all physicians' needs for ethics consultation in Finland, a novel form of service, the Physicians' Ethics Forum, was founded in 2003. The Forum is a cost-efficient service based on electronic communication. In this paper, experiences throughout its first 6 years are described. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617242 Fri, 20 Jan 2012 05:00:00 +0100 5617242 http://www.medworm.com/index.php?rid=5617241&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F77%3Frss%3D1 Conclusions Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617241 Fri, 20 Jan 2012 05:00:00 +0100 5617241 http://www.medworm.com/index.php?rid=5617240&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F75%3Frss%3D1 In this reply to Wilkinson and De Wispelaere, I argue that an opt-out donation system can be regarded as tacit consent. I first separate the opt-in/opt-out issue from that of the role that the family ought to play. I then argue that what De Wispelaere calls minimal approval-tracking is not obviously necessary and that, even if it were, opt-out schemes can satisfy this requirement. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617240 Fri, 20 Jan 2012 05:00:00 +0100 5617240 http://www.medworm.com/index.php?rid=5617239&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F74%3Frss%3D1 There is much to agree with in Ben Saunders' article.1 He is right to say that presumed consent is only one, shaky, justification for opt-out organ retrieval. I believe he is also right that the value of altruism is of relatively little importance in morally assessing organ procurement schemes.2 But I am not so sure about his opt-out proposal. Saunders would, I think, describe his proposal as an improvement on the existing system in that it would increase the supply of organs while still securing adequate consent. (I should add that he does not, however, explicitly claim that the supply would increase.) This description invites two questions: (1) would the consent be adequate? and (2) would the supply of organs increase? Before saying a few things in answer to these questions, I want to ma... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617239 Fri, 20 Jan 2012 05:00:00 +0100 5617239 http://www.medworm.com/index.php?rid=5617238&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F73%3Frss%3D1 In his latest defence of opt-out organ donation, Ben Saunders argues that opt-out does not depend on presuming consent but instead entails a donor tacitly consenting to making her organs available for transplantation.1 Consent is implied, not merely presumed, in the absence of a registered objection because consent is always an act—a purposeful action or inaction—not a mental attitude of approval. Saunders' argument hinges on a strong interpretation of consent as a performative utterance in which the act is sufficient and the mental attitude is unnecessary. Once social conventions have established which (in)action constitutes consent, Saunders argues, a person who has performed the relevant act—whether expressly or tacitly—incurs the obligations pursuant to giving h... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617238 Fri, 20 Jan 2012 05:00:00 +0100 5617238 http://www.medworm.com/index.php?rid=5617237&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F69%3Frss%3D1 This paper defends an ‘opt-out’ scheme for organ procurement, by distinguishing this system from ‘presumed consent’ (which the author regards as an erroneous justification of it). It, first, stresses the moral importance of increasing the supply of organs and argues that making donation easier need not conflict with altruism. It then goes on to explore one way that donation can be increased, namely by adopting an opt-out system, in which cadaveric organs are used unless the deceased (or their family) registered an objection. Such policies are often labelled ‘presumed consent’, but it is argued that critics are right to be sceptical of this idea—consent is shown to be an action, rather than a mental attitude, and thus not something that can be presu... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617237 Fri, 20 Jan 2012 05:00:00 +0100 5617237 http://www.medworm.com/index.php?rid=5617235&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F2%2F67%3Frss%3D1 Consent and the opt-out scheme of organ donation This journal has a long tradition of promoting reasoned debate on key questions in medical ethics. In this and future issues, we hope to continue this tradition by introducing a new type of article. Feature articles will provide a longer, in-depth discussion of an original ethical idea or argument, or of an important empirical finding. These articles will be accompanied by several short commentaries by leading experts in the area who will offer their critical perspective on the article, followed by a brief reply by the author. Our first such debate is a lively exchange on organ donation. In his feature article, Ben Saunders offers a new argument for an ‘opt-out’ scheme for organ procurement (see page 69, Editor's choice). The ide... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5617235 Fri, 20 Jan 2012 05:00:00 +0100 5617235 http://www.medworm.com/index.php?rid=5512721&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F64%3Frss%3D1 Withdrawing and withholding artificial nutrition and hydration from a patient in a minimally conscious state (Re: M) In the summer of 2011 the Court of Protection ruled that it would be unlawful to withdraw artificial nutrition and hydration (ANH) from a woman, M, who had been in a minimally conscious state (MCS) for 8 years after contracting viral encephalitis at the age of 43 years.1 It was reported as the first English legal case concerning the withdrawal of ANH from a patient in a MCS. Although the judge sought to limit the judgement as closely as possible to the facts of the case, it is likely to have a significant impact on treatment decisions in relation to life-sustaining treatment for people in states of low awareness. Under the Mental Capacity Act 2005, decisions made o... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512721 Wed, 14 Dec 2011 05:00:00 +0100 5512721 http://www.medworm.com/index.php?rid=5512720&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F60%3Frss%3D1 Understanding dental ethics as a field separate from its much better known counterpart, medical ethics, is a relatively new, but necessary approach in bioethics. This need is particularly felt in dental education and establishing a curriculum specifically for dental ethics is a challenging task. Although certain topics such as informed consent and patient rights can be considered to be of equal importance in both fields, a number of ethical issues in dental practice are only remotely—if at all—relevant for medical practice. Therefore, any sound approach to education in dental ethics has to recognise the unique aspects of dental practice in order to meet the needs of dental students and prepare them for the ethical challenges they may face during their professional practice. Wit... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512720 Wed, 14 Dec 2011 05:00:00 +0100 5512720 http://www.medworm.com/index.php?rid=5512719&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F57%3Frss%3D1 The current focus on early intervention trials in Alzheimer's disease research raises particular ethical issues. These arise out of problems of validating study results and translating them into general practice for one thing and out of unwanted effects of an uncertain diagnosis for diagnosed people for another. The first addresses the demands of scientific research compared to those of medical practice, questioning how the medical value of clinical trials is evaluated. The second relates the scientific and medical value of early intervention trials to the normative value of an uncertain diagnosis. Are people who are diagnosed with a potential early form of AD in clinical studies patients proper—although they would not have been diagnosed with the given "disease" in non-research-orie... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512719 Wed, 14 Dec 2011 05:00:00 +0100 5512719 http://www.medworm.com/index.php?rid=5512718&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F53%3Frss%3D1 This article discusses the historical case of Julius Hallervorden, a distinguished German neuropathologist who conducted research on brains of mentally handicapped patients killed in the context of the Nazi ‘euthanasia’ programme. It is argued that this case constitutes a paradigm of complicity in research that is useful in assessing complicity in contemporary research ethics. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512718 Wed, 14 Dec 2011 05:00:00 +0100 5512718 http://www.medworm.com/index.php?rid=5512717&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F48%3Frss%3D1 Conclusion Researchers endorsed the obligation of communicating with research participants by providing summary findings and other research-related information in equal measure. In light of these findings, it is suggested that while the provision of summary results may contribute to efforts to discharge the obligation of respect for persons, it may be neither a necessary nor a sufficient means to this end. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512717 Wed, 14 Dec 2011 05:00:00 +0100 5512717 http://www.medworm.com/index.php?rid=5512716&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F43%3Frss%3D1 From the perspective of investigators conducting research involving pregnant women and fetuses, a woman's decision about whether to have an abortion can sometimes be relevant to the suitability of the woman and fetus as research subjects. However, prominent ethicists disagree over whether it is permissible for a woman's decision about abortion to be an inclusion or exclusion criterion for participation in research. A widely held view is that fetuses to be aborted and fetuses to be carried to term should be treated equally as research subjects. Some hold that this principle implies that a woman's decision about whether to have an abortion should not be an inclusion or exclusion criterion. This paper identifies types of research in which investigators might want to have inclusion or exclusio... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512716 Wed, 14 Dec 2011 05:00:00 +0100 5512716 http://www.medworm.com/index.php?rid=5512715&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F35%3Frss%3D1 To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of the guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guide... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512715 Wed, 14 Dec 2011 05:00:00 +0100 5512715 http://www.medworm.com/index.php?rid=5512714&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F31%3Frss%3D1 This article explores the case of In the Matter of an Appeal to the Information Tribunal under section 57 of the Freedom of Information Act 2000, concerning the decision of the Department of Health to withhold some statistical data from the publication of its annual abortion statistics. The specific data being withheld concerned the termination for serious fetal handicap under section 1(1)d of the Abortion Act 1967. The paper explores the implications of this case, which relate both to the nature and scope of personal privacy. It suggests that lessons can be drawn from this case about public interest and use of statistical information and also about general policy issues concerning the legal regulation of confidentiality and privacy in the future. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512714 Wed, 14 Dec 2011 05:00:00 +0100 5512714 http://www.medworm.com/index.php?rid=5512713&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F26%3Frss%3D1 The Israeli law of abortions (1977) legally authorises hospital committees to decide upon women's requests for selective abortion. One of the law's clauses determines that abortions can be approved in cases of an embryopathy. However, the law does not provide any clear definitions of those fetal ‘physical or mental defects’ in terms of severity and/or likelihood, which remain open to interpretation by the committee members. This paper aimed to determine which ethical methodologies are used by committee members and advisors as they face the dilemma of abortion approval due to mild to moderate possible embryopathy. Twenty interviews demonstrated that they use mainly a combination of deontology and a contextual–relational model. Their ethical considerations are both contextu... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512713 Wed, 14 Dec 2011 05:00:00 +0100 5512713 http://www.medworm.com/index.php?rid=5512712&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F22%3Frss%3D1 Conclusion Clearer guidance is needed for medical students about the issue of conscientious objection at medical school. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512712 Wed, 14 Dec 2011 05:00:00 +0100 5512712 http://www.medworm.com/index.php?rid=5512711&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F18%3Frss%3D1 This paper makes two main claims: first, that the need to protect health professionals' moral integrity is what grounds the right to conscientious objection in health care; and second, that for a given claim of conscientious objection to be acceptable to society, a certain set of criteria should be fulfilled. The importance of moral integrity for individuals and society, including its special role in health care, is advocated. Criteria for evaluating the acceptability of claims to conscientious objection are outlined. The precise content of the criteria is dictated by the two main interests that are at stake in the dilemma of conscientious objection: the patient's interests and the health professional's moral integrity. Alternative criteria proposed by other authors are challenged. The bol... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512711 Wed, 14 Dec 2011 05:00:00 +0100 5512711 http://www.medworm.com/index.php?rid=5512710&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F13%3Frss%3D1 The value of conscience in healthcare ethics is widely debated. While some sources present it as an unquestionably positive attribute, others question both the veracity of its decisions and the effect of conscientious objection on patient access to health care. This paper argues that the right to object conscientiously should be broadened, subject to certain previsos, as there are many benefits to healthcare practice in the development of the consciences of practitioners. While effects such as the preservation of moral integrity are widely considered to benefit practitioners, this paper draws on the work of Hannah Arendt to offer several original arguments in defence of conscience that may more directly benefit patients, namely that a pang of conscience may be useful in rapidly unfolding s... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512710 Wed, 14 Dec 2011 05:00:00 +0100 5512710 http://www.medworm.com/index.php?rid=5512709&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F9%3Frss%3D1 Innovative surgery raises four kinds of ethical challenges: potential harms to patients; compromised informed consent; unfair allocation of healthcare resources; and conflicts of interest. Lack of adequate data on innovations and lack of regulatory oversight contribute to these ethical challenges. In this paper these issues and the extent to which problems may be resolved by better evidence-gathering and more comprehensive regulation are explored. It is suggested that some ethical issues will be more resistant to resolution than others, owing to special features of both surgery and innovation. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512709 Wed, 14 Dec 2011 05:00:00 +0100 5512709 http://www.medworm.com/index.php?rid=5512708&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F8%3Frss%3D1 Robert Sparrow1 has assayed a response to criticisms I expressed of his arguments in my ‘Sparrows, hedgehogs and castrati: reflections on gender and enhancement’ in this journal.2 Sparrow simply re-states at some length his view that the life expectancy advantage women enjoy of between 6 or 7 years gives those like myself who believe that we have a duty to have the best children we can have good reason always to choose to produce females, and that this is embarrassing to me. I reject this on the grounds that it is to the advantage of every human being to be part of a human, or post-human, community with two genders and that almost no sane person, including almost no men, wish otherwise. The differential in life expectancy is simply not enough to outweigh the overall advant... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512708 Wed, 14 Dec 2011 05:00:00 +0100 5512708 http://www.medworm.com/index.php?rid=5512707&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F4%3Frss%3D1 In this paper, I respond to criticisms by John Harris, contained in a commentary on my article "Harris, harmed states, and sexed bodies", which appeared in the Journal of Medical Ethics, volume 37, number 5. I argue that Harris's response to my criticisms exposes the strong eugenic tendencies in his own thought, when he suggests that the reproductive obligations of parents should be determined with reference to a claim about what would enhance ‘society’ or ‘the species’. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512707 Wed, 14 Dec 2011 05:00:00 +0100 5512707 http://www.medworm.com/index.php?rid=5512706&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F3%3Frss%3D1 A recent article from Archives of Disease in Childhood outlined problems with the act of gaining child assent for research participation. However the arguments used in the article are incomplete or misguided. Rather than being harmful, assent should be seen as an ethically-appropriate way in which we can engage with the child about his participation in research. While additional clarification of the concept of assent is needed, the child's family context can provide us with a valuable guide to the way we involve him in the decision-making process. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512706 Wed, 14 Dec 2011 05:00:00 +0100 5512706 http://www.medworm.com/index.php?rid=5512705&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F2%3Frss%3D1 In an article published in the Archives of Disease in Childhood, paediatric intensivist Paul Baines criticises the conceptual and ethical basis for an assent requirement in paediatric research.1 Existing international research guidelines stipulate that children who cannot competently consent to research should ‘assent’ to their participation. However, Baines finds existing descriptions of assent both inadequate and contradictory. The guidelines also fail to provide a clear rationale for why children should assent to participation in research. Baines provides several arguments why assent in research may be harmful: it is confusing, it is not required for medical treatment, it may introduce tensions into the child's family (where the child and parents disagree) and it may be misu... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512705 Wed, 14 Dec 2011 05:00:00 +0100 5512705 http://www.medworm.com/index.php?rid=5512704&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F38%2F1%2F1%3Frss%3D1 Conscientious objection Do doctors have the right to refuse to perform certain procedures on their patients on moral or religious grounds, or does their duty to their patients override their personal moral objections? Several papers in this issue explore this perennial ethical dilemma. Paediatrician Giles Birchley (see page 13) seeks to defend the role of the doctor's conscience in all medical decision-making, not only the cases where treatment is declined by the clinician. He observes that the role of conscience has been systematically reduced in medical practice, with a small number of controversial exceptions involving late-term abortions and stem-cell research. Birchley argues that this trend ought to be reversed, so that the clinician's conscience can serve as a kind of interface betw... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5512704 Wed, 14 Dec 2011 05:00:00 +0100 5512704 http://www.medworm.com/index.php?rid=5437462&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F768%3Frss%3D1 As the frequency of internet-based research has increased, it is important for researchers to consider how the conditions in which data are collected may influence the risks to participants. In particular, because internet-based data collection often occurs outside a clinical or research setting, there may be unintentional disclosures of a participant's involvement in a research study of which the researcher is unaware. The current analysis examined the responses of men who have sex with men participating in an internet-based HIV behavioural risk study when queried about the possible disclosure of their participation in the study. Fewer than 2% of participants indicated that their participation in the research study was disclosed, and all but one indicated no negative outcomes associated w... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437462 Mon, 21 Nov 2011 05:00:00 +0100 5437462 http://www.medworm.com/index.php?rid=5437461&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F766%3Frss%3D1 David Shaw's response to Hugh McLachlan's criticism of his proposed new perspective on euthanasia is ineffectual, mistaken and unfair. It is false to say that the latter does not present an argument to support his claim that there is a moral difference between killing and letting die. It is not the consequences alone of actions that constitute their moral worth. It can matter too what duties are breached or fulfilled by the particular moral agents who are involved. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437461 Mon, 21 Nov 2011 05:00:00 +0100 5437461 http://www.medworm.com/index.php?rid=5437460&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F762%3Frss%3D1 Conclusions The majority of protocols and consent forms did not discuss plans for post-trial period surveillance. The post-trial period and the REB approval process could be improved by systematic follow-up being described in the protocol and consent form. The small number of trial protocols evaluated in the study may impair the degree to which the results can be generalised. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437460 Mon, 21 Nov 2011 05:00:00 +0100 5437460 http://www.medworm.com/index.php?rid=5437459&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F759%3Frss%3D1 Identifiable excess surgical tissue is an important resource for medical research but we have become overly restrictive about consent requirements. I suggest we devolve consent to ethics committees for ordinary research projects involving human tissue, retaining the requirement for explicit consent only for those sensitive research situations where there is significant risk of harm to individual interests in privacy. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437459 Mon, 21 Nov 2011 05:00:00 +0100 5437459 http://www.medworm.com/index.php?rid=5437458&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F752%3Frss%3D1 The internet is widely used for health information and support, often by vulnerable people. Internet-based research raises both familiar and new ethical problems for researchers and ethics committees. While guidelines for internet-based research are available, it is unclear to what extent ethics committees use these. Experience of gaining research ethics approval for a UK study (SharpTalk), involving internet-based discussion groups with young people who self-harm and health professionals is described. During ethical review, unsurprisingly, concerns were raised about the vulnerability of potential participants. These were dominated by the issue of anonymity, which also affected participant safety and consent. These ethical problems are discussed, and our solutions, which included: particip... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437458 Mon, 21 Nov 2011 05:00:00 +0100 5437458 http://www.medworm.com/index.php?rid=5437457&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F747%3Frss%3D1 In a recent case in the UK, six men stored their sperm before undergoing chemotherapy treatment for cancer in case they proved to be infertile after the treatment. The sperm was not properly stored and as a result was inadvertently destroyed. The men sued the NHS Trust that stored the sperm and were in the end successful. This paper questions the basis on which the judgement was made and the rationale behind it, namely that the men ‘had ownership’ of the sperm, and that compensation was thus due on the grounds that the men's property had been destroyed. We first argue that the claim is erroneous and enhances the tendency towards the commodification of body parts. We then suggest that the men could have been compensated for the harm done to them without granting property rights,... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437457 Mon, 21 Nov 2011 05:00:00 +0100 5437457 http://www.medworm.com/index.php?rid=5437456&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F743%3Frss%3D1 The ‘decapitation gambit’ holds that, if physical decapitation normally entails the death of the human being, then physiological decapitation, evident in cases of total brain failure, entails the death of the human being. This argument has been challenged by Franklin Miller and Robert Truog, who argue that physical decapitation does not necessarily entail the death of human beings and that therefore, by analogy, artificially sustained human bodies with total brain failure are living human beings. They thus challenge the current neurological criterion for determining death and argue for a return to the traditional criterion of the irreversible loss of circulation and respiration. In this paper, I defend the decapitation gambit and total brain failure as a criterion for determini... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437456 Mon, 21 Nov 2011 05:00:00 +0100 5437456 http://www.medworm.com/index.php?rid=5437455&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F739%3Frss%3D1 Allocating scarce organs to transplant candidates is only one stage in the long process of organ transplantation. Before being listed, all candidates must undergo a rigorous assessment by a multidisciplinary transplant team. The Department of Health and NHS Blood and Transplant (NHSBT) are responsible for the development of detailed strategies to ensure a fair and objective assessment experience for all transplant candidates. Difficulties arise when particularly vulnerable candidates, such as candidates with psychiatric illnesses, are assessed. NHSBT has already developed unique assessment guidelines for alcoholic and substance-abusing liver transplant candidates to allow for a more comprehensive evaluation, but candidates with psychiatric illnesses are still assessed against general crite... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437455 Mon, 21 Nov 2011 05:00:00 +0100 5437455 http://www.medworm.com/index.php?rid=5437454&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F735%3Frss%3D1 Although research indicates that single parenting is not by itself worse for children than their being brought up by both their parents, there are reasons why it is better for children to have more than one committed parent. If having two committed parents is better, everything else being equal, than having just one, I argue that it might be even better for children to have three committed parents. There might, in addition, be further reasons why allowing triparenting would benefit children and adults, at least in some cases. Whether or not triparenting is on the whole preferable to bi- or monoparenting, it does have certain advantages (as well as shortcomings) which, at the very least, warrant its inclusion in debates over the sorts of family structures we should allow in our societies, a... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437454 Mon, 21 Nov 2011 05:00:00 +0100 5437454 http://www.medworm.com/index.php?rid=5437453&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F727%3Frss%3D1 Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437453 Mon, 21 Nov 2011 05:00:00 +0100 5437453 http://www.medworm.com/index.php?rid=5437452&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F723%3Frss%3D1 Conclusions Most senior doctors in England and Wales feel that rational suicide is possible. There was no association with specialty. Strong religious belief was associated with disagreement, although levels of agreement were still high in people reporting the strongest religious belief. Most doctors who were opposed to physician assisted suicide believed that rational suicide was possible, suggesting that some medical opposition is best explained by other factors such as concerns of assessment and protection of vulnerable patients. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437452 Mon, 21 Nov 2011 05:00:00 +0100 5437452 http://www.medworm.com/index.php?rid=5437451&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F719%3Frss%3D1 Advances in life-saving technologies in the past few decades have challenged our traditional understandings of death. Traditionally, death was understood to occur when a person stops breathing, their heart stops beating and they are cold to the touch. Today, physicians determine death by relying on a diagnosis of ‘total brain failure’ or by waiting a short while after circulation stops. Evidence has emerged, however, that the conceptual bases for these approaches to determining death are fundamentally flawed and depart substantially from the established biological conception of death. We argue that the current approach to determining death consists of two different types of unacknowledged legal fictions. These legal fictions were developed for practices that are largely ethical... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437451 Mon, 21 Nov 2011 05:00:00 +0100 5437451 http://www.medworm.com/index.php?rid=5437450&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F715%3Frss%3D1 Multiprofessional teams have become in recent years one of the distinguishing features of services, where professionals with different competences work together. The core of our interest is addressed to the équipe of a palliative care ward; in particular, to that series of working activities that consists of communicative acts, as équipe meetings, for instance. Our research focuses on the analysis of the process by which the development of knowledge in multiprofessional practice is built to establish more information on recurrent patterns in the interaction and connect them to the specific context that these are shaped by. In this sense we will underline how components of knowing are shared among team members in constructing medical prognosis and we will analyse the connectio... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437450 Mon, 21 Nov 2011 05:00:00 +0100 5437450 http://www.medworm.com/index.php?rid=5437449&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F711%3Frss%3D1 Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437449 Mon, 21 Nov 2011 05:00:00 +0100 5437449 http://www.medworm.com/index.php?rid=5437448&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F707%3Frss%3D1 The rule of rescue describes the powerful human proclivity to rescue identified endangered lives, regardless of cost or risk. Deciding whether or not to perform a decompressive craniectomy as a life-saving or ‘rescue’ procedure for a young person with a severe traumatic brain injury provides a good example of the ethical tensions that occur in these situations. Unfortunately, there comes a point when the primary brain injury is so severe that if the patient survives they are likely to remain severely disabled and fully dependent. The health resource implications of this outcome are significant. By using a web-based outcome prediction model this study compares the long-term outcome and designation of two groups of patients. One group had a very severe injury as adjudged by the m... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437448 Mon, 21 Nov 2011 05:00:00 +0100 5437448 http://www.medworm.com/index.php?rid=5437447&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F706%3Frss%3D1 Ethics committees (ECs) have a bad reputation for impeding, rather than facilitating research. Tales abound of delays and rejections of perfectly innocuous studies. Here, I argue that many committees actually improve the quality of the research proposal to such an extent that they deserve credit as authors in any resulting publications, or at least an acknowledgement of the contribution made. One of the reasons that applicants are often angry at ECs is that they question the science of the proposal. Many researchers believe that this is not the role of the EC, and indeed the recently revised governance arrangements for research ethics committees (GAFREC) document states that:A REC need not reconsider the quality of the science, as this is the responsibility of the sponsor and will have bee... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437447 Mon, 21 Nov 2011 05:00:00 +0100 5437447 http://www.medworm.com/index.php?rid=5437446&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F12%2F705%3Frss%3D1 When is death preferable to continued existence? This question all too often faces people, such as me, who work in intensive care. We have the technical ability to sustain organ function for long periods of time—sometimes, it seems, almost indefinitely. However, in the face of severe illness, particularly severe irremediable brain injury, doctors and family members sometimes wonder whether that is the right thing to do. Several articles in this issue engage with this difficult question. Neurosurgeon Stephen Honeybul and colleagues (Editor's choice, see page 707) provide a thought-provoking insight into the practical dilemmas facing those working in neurosurgical intensive care. They ask whether it is possible to identify a subgroup of adult patients after head injury whose prognosis ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5437446 Mon, 21 Nov 2011 05:00:00 +0100 5437446 http://www.medworm.com/index.php?rid=5331017&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F702%3Frss%3D1 Social factors and the allocation of scarce resources The NHS does not ordinarily take social factors into account when considering the allocation of scarce resources. In 2011, this approach was subject to judicial review on behalf of Mr Condliff, a morbidly obese former policeman. Mr Condliff had a body mass index of 40 and, due to underlying medical conditions, was deemed ineligible for open bariatric surgery. The surgery can be undertaken laparoscopically, but North Staffordshire Primary Care Trust (PCT), in whose catchment area Mr Condliff lives, does not ordinarily provide the surgery to patients with a body mass index of below 50. The PCT does, however, allow for patients to make claims for exceptional treatment by means of an individual funding review. In relation to such a review t... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331017 Tue, 18 Oct 2011 04:00:00 +0100 5331017 http://www.medworm.com/index.php?rid=5331016&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F698%3Frss%3D1 Citizens today are increasingly expected to be knowledgeable about and prepared to engage with biomedical knowledge. In this article, I wish to reframe this ‘public understanding of science’ project, and place fresh emphasis on public understandings of research: an engagement with the everyday laboratory practices of biomedicine and its associated ethics, rather than with specific scientific facts. This is not based on an assumption that non-scientists are ‘ignorant’ and are thus unable to ‘appropriately’ use or debate science; rather, it is underpinned by an empirically-grounded observation that some individuals may be unfamiliar with certain specificities of particular modes of research and ethical frameworks, and, as a consequence, have their autonomy... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331016 Tue, 18 Oct 2011 04:00:00 +0100 5331016 http://www.medworm.com/index.php?rid=5331015&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F693%3Frss%3D1 Conclusions Quizzing during the informed consent process can be problematic for a minority of participants. These problems may be associated with the setting in which research takes place and educational level. Further research is needed to develop, test and implement alternative methods of ensuring comprehension of informed consent. Trial Registration clinicaltrials.gov number NCT00270257. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331015 Tue, 18 Oct 2011 04:00:00 +0100 5331015 http://www.medworm.com/index.php?rid=5331014&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F688%3Frss%3D1 Conclusions Many patients are put at risk by retracted studies. These are conservative estimates, as only patients enrolled in published clinical studies were tallied. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331014 Tue, 18 Oct 2011 04:00:00 +0100 5331014 http://www.medworm.com/index.php?rid=5331013&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F682%3Frss%3D1 In an online study conducted separately in the UK and the US, participants rated the acceptability and fairness of four interventions: two types of financial incentives (rewards and penalties) and two types of medical interventions (pills and injections). These were stated to be equally effective in improving outcomes in five contexts: (a) weight loss and (b) smoking cessation programmes, and adherence in treatment programmes for (c) drug addiction, (d) serious mental illness and (e) physiotherapy after surgery. Financial incentives (weekly rewards and penalties) were judged less acceptable and to be less fair than medical interventions (weekly pill or injection) across all five contexts. Context moderated the relative preference between rewards and penalties: participants from both countr... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331013 Tue, 18 Oct 2011 04:00:00 +0100 5331013 http://www.medworm.com/index.php?rid=5331012&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F677%3Frss%3D1 In this article, an ethical analysis of an educational programme on renal replacement therapy options for patients and their social network is presented. The two main spearheads of this approach are: (1) offering an educational programme on all renal replacement therapy options ahead of treatment requirement and (2) a home-based approach involving the family and friends of the patient. Arguments are offered for the ethical justification of this approach by considering the viewpoint of the various stakeholders involved. Finally, reflecting on these ethical considerations, essential conditions for carrying out such a programme are outlined. The goal is to develop an ethically justified and responsible educational programme. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331012 Tue, 18 Oct 2011 04:00:00 +0100 5331012 http://www.medworm.com/index.php?rid=5331011&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F673%3Frss%3D1 This paper will consider the right not to know in the context of psychiatric disorders. It will outline the arguments for and against acquiring knowledge about the results of genetic testing for conditions such as breast cancer and Huntington's disease, and examine whether similar considerations apply to disclosing to clients the results of genetic testing for psychiatric disorders such as depression and Alzheimer's disease. The right not to know will also be examined in the context of the diagnosis of psychiatric disorders that are associated with stigma or for which there is no effective treatment. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331011 Tue, 18 Oct 2011 04:00:00 +0100 5331011 http://www.medworm.com/index.php?rid=5331010&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F668%3Frss%3D1 A study was undertaken of the views of users of two genitourinary medicine (GUM) clinics in England on unlinked anonymous testing (UAT) for HIV. The UAT programme measures the prevalence of HIV in the population, including undiagnosed prevalence, by testing residual blood (from samples taken for clinical purposes) which is anonymised and irreversibly unlinked from the source. 424 clinic users completed an anonymous questionnaire about their knowledge of, and attitudes towards, UAT. Only 1/7 (14%) were aware that blood left over from clinical testing may be tested anonymously for HIV. A large majority (89%) said they would agree to their blood being tested, although 74% wanted the opportunity to consent. These findings indicate broad support for UAT of blood in a group of patients whose sam... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331010 Tue, 18 Oct 2011 04:00:00 +0100 5331010 http://www.medworm.com/index.php?rid=5331009&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F663%3Frss%3D1 This paper argues that, for Richard Titmuss, the rationale of the gift relationship (TGR) as a national blood policy is to reconcile liberty with social justice in the provision of an essential health resource. Underpinned by a needs-based distributive principle, TGR provides a social space for a plurality of values in which to engage with and motivate people to voluntarily give blood and other body materials as a common good. This understanding of TGR as a value pluralistic framework and its implications will be used to discuss the issue of using economic mechanisms to increase the supply of body materials or goods, including organs for transplantation. It is argued that, while TGR excludes a policy in which body goods are treated as private commodities and distributed primarily on the ba... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331009 Tue, 18 Oct 2011 04:00:00 +0100 5331009 http://www.medworm.com/index.php?rid=5331008&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F658%3Frss%3D1 Theoretical and empirical research in bioethics frequently focuses on ethical dilemmas or problems. This paper draws on anthropological and phenomenological sources to develop an alternative framework for bioethical enquiry that allows examination of a broader range of how the moral is experienced in the everyday lives of individuals and groups. Our account of moral experience is subjective and hermeneutic. We define moral experience as "Encompassing a person's sense that values that he or she deem important are being realised or thwarted in everyday life. This includes a person's interpretations of a lived encounter, or a set of lived encounters, that fall on spectrums of right-wrong, good-bad or just-unjust". In our conceptualisation, moral experience is not limited to situations that ar... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331008 Tue, 18 Oct 2011 04:00:00 +0100 5331008 http://www.medworm.com/index.php?rid=5331007&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F655%3Frss%3D1 The past two decades have seen a dramatic increase in the use of telemedicine while the information technology revolution has contributed significantly to its popularity. In addition, there has been a recent increase in the use of telemedicine in the intensive care unit (ICU), partially driven by a critical shortage of intensivists. However, the ethical questions raised by the implementation of tele-ICUs have not been adequately considered. In this essay, we will discuss the development of tele-ICUs from the perspective of autonomy, beneficence/non-malificence, justice and professionalism. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331007 Tue, 18 Oct 2011 04:00:00 +0100 5331007 http://www.medworm.com/index.php?rid=5331006&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F650%3Frss%3D1 Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors' social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331006 Tue, 18 Oct 2011 04:00:00 +0100 5331006 http://www.medworm.com/index.php?rid=5331005&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F646%3Frss%3D1 Futile treatment is one ethically challenging situation commonly encountered by junior doctors. By analysing an intern's story using a role virtues framework, I propose a set of three steps for junior doctors facing this problem. I claim that junior doctors ought always to investigate the rationale underlying decisions to proceed with apparently futile treatment and discuss their concerns with their seniors, even if such discussion will be difficult. I also suggest that junior doctors facing this ethical challenge ought always to be willing to initiate and engage in ethical dialogue, and that in some situations further action (such as taking concerns outside the team or refusing to participate in treatment) may be morally appropriate. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331005 Tue, 18 Oct 2011 04:00:00 +0100 5331005 http://www.medworm.com/index.php?rid=5331004&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F642%3Frss%3D1 The duty to procure informed consent (IC) from patients before any significant intervention is among the pillars of medical and research ethics. The provision by the doctor of relevant information about treatment and free decision-making by the patient are essential elements of IC. The paper presents cases of IC where the free decision about treatment is not causally related to the information provided, and claims that such cases pose a difficulty parallel to that presented by the Gettier Problem in epistemology. In analogy to the original problem with the concept of knowledge, these Gettier-type cases show an indeterminacy in the concept of IC: we either need to add some explicit additional condition of causal connection between information and consent, or else we should understand the co... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331004 Tue, 18 Oct 2011 04:00:00 +0100 5331004 http://www.medworm.com/index.php?rid=5331003&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F11%2F641%3Frss%3D1 ‘The moral life’ the novelist and philosopher Iris Murdoch wrote, ‘is something that goes on continually, not something that is switched off in between the occurrence of explicit moral choices. What happens in between such choices is indeed what is crucial.’1 She wrote that in the 1970s, at a time when both popular discussion and the academic study of bioethics were just getting off the starting blocks; and in the bioethical context such advice often tended to be overlooked in favour of a more exciting focus on acute moral dilemmas and quandary ethics. Today, by contrast, the significance of what ‘happens in between... explicit moral choices’ in bioethics, and especially in medical ethics, is receiving much more of the attention it deserves, and among th... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5331003 Tue, 18 Oct 2011 04:00:00 +0100 5331003 http://www.medworm.com/index.php?rid=5246584&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F637%3Frss%3D1 Conclusions The failure to include and/or identify social subgroups of the population can undermine the value of research, including, in the case of the study prison, funded health research. This can compromise associated needs assessments and service delivery, particularly important in already disadvantaged populations; this may encourage and/or perpetuate a range of health inequalities. There is a pressing need to examine cultural exclusion in other health and criminal justice settings, to assess the ways in which—and the extent to which—such exclusion may compromise the merit of proposed and completed health and social research. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246584 Wed, 21 Sep 2011 04:00:00 +0100 5246584 http://www.medworm.com/index.php?rid=5246583&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F631%3Frss%3D1 This paper argues the case for coming to see ‘medical politics’ as a topic or subject within medical education. First, its absence is noted from the wide array of paramedical subjects (medical ethics, history of medicine, the medical humanities, etc) currently given attention in both the medical education literature and in specific curricula. Second the author suggests that ‘the political’ is implicitly recognisable in the historical roots of medical ethics education, specifically in certain of the London Medical Group's activities, and also that the medical profession, or indeed any profession, cannot be understood as an apolitical form of social organisation either in its institutional or scientific (epistemic) forms. Some brief suggestions for introductory and ad... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246583 Wed, 21 Sep 2011 04:00:00 +0100 5246583 http://www.medworm.com/index.php?rid=5246582&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F627%3Frss%3D1 In January 2010, fifth year medical students in the medical programme at the University of Auckland were asked to write a 1200-word report as part of their ethics assessment. The purpose of the report was to get students to reflect critically on the ethical dimension of a clinical case or situation they had been involved in during the past 2 years. Students were required to identify and discuss the salient ethical issues that arose as they saw them, and consider what they had personally learnt from the situation. The purpose of the following discussion is twofold: first, to outline some of the ethical issues raised by year five medical students in their ethics reports; and second, to reflect on what we, as educators and health professionals can learn from their experiences and insight... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246582 Wed, 21 Sep 2011 04:00:00 +0100 5246582 http://www.medworm.com/index.php?rid=5246581&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F623%3Frss%3D1 This paper examines the ethical issues faced by health workers managing a fictional case of a female sex worker who is hepatitis B positive with a high level of virus but is asymptomatic. According to guidelines she does not require treatment herself, but is potentially highly infectious to others. Recent legal cases in the UK show it can be criminal to pass on HIV or hepatitis B infection sexually if the risk is known and the partner has not been informed. However, there is no statute or case law showing that health workers are required to intervene to prevent such a potential ‘crime’, particularly when the partners are unknown, as in this case. The health workers could respond in various ways. They could do nothing, thus making further infection probable. They could advise th... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246581 Wed, 21 Sep 2011 04:00:00 +0100 5246581 http://www.medworm.com/index.php?rid=5246580&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F616%3Frss%3D1 Conclusions are drawn about the effectiveness of students' law learning and recommendations made for further research. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246580 Wed, 21 Sep 2011 04:00:00 +0100 5246580 http://www.medworm.com/index.php?rid=5246579&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F611%3Frss%3D1 The potential for genetic engineering of enhancements to complex human traits has been the subject of vigorous debate for a number of years. Most of the discussion has centered on the possible moral consequences of pursuing enhancements, especially those that might affect complex behaviours and components of personality. Little has been written on the actual process of implementing this technology. This paper presents a ‘thought experiment’ about the likely form of final preclinical testing for a technology to enhance intelligence as a prototypical multiplex trait. The significance and the potential dangers of implementing enhancements in humans, especially to highly valued traits such as intelligence, would mandate a thorough programme of testing in animals, including non-huma... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246579 Wed, 21 Sep 2011 04:00:00 +0100 5246579 http://www.medworm.com/index.php?rid=5246578&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F606%3Frss%3D1 The purpose of this paper is to unveil the incompleteness of John Harris' view that parents have a moral obligation to genetically enhance their unborn children. Specifically, here two main conclusions are proposed: (1) at present there exist insufficient empirical data for determining whether prenatal genetic enhancement (PGE) is a moral obligation on prospective parents. Although the purpose of PGE research would be to determine the extent to which PGE is safe and effective, the task of determining the veracity of Harris' premises is impossible to achieve without begging the question; we would be forced to assume the moral permissibility of PGE in order to generate the data that are required for determining its moral standing. So, given this empirical blindness, consequence-based normati... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246578 Wed, 21 Sep 2011 04:00:00 +0100 5246578 http://www.medworm.com/index.php?rid=5246577&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F601%3Frss%3D1 Conclusion In the event that they lose mental capacity, many people will not select a surrogate to decide about medical treatments on their behalf solely on the basis that they expect their surrogate to make a substituted judgement. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246577 Wed, 21 Sep 2011 04:00:00 +0100 5246577 http://www.medworm.com/index.php?rid=5246576&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F597%3Frss%3D1 In their Principles of biomedical ethics, Tom L Beauchamp and James F Childress take ‘respect for autonomy’ to be one basic principle of contemporary biomedical ethics. There is widespread agreement that respect for autonomy is deeply rooted in modern common morality, but little agreement exists about its nature, scope or strength. This is why they emphasise right at the beginning that in principlism the principle of respect for autonomy is concerned with individuals' actions (p1031). Originally the term ‘autonomy’ referred to the self-rule or self-governance of independent (Greek) city states and later to states in general. Later, for example, in the philosophy of Kant, autonomy was ascribed to (human) persons meaning the self-ruling of practical rationality. In co... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246576 Wed, 21 Sep 2011 04:00:00 +0100 5246576 http://www.medworm.com/index.php?rid=5246575&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F592%3Frss%3D1 Specification is an integral part of Tom L Beauchamp and James F Childress' principlist approach to biomedical ethics. At the same time, the authors give much space conceding to critics that the method has significant limits. Although their pointing to limitations is not unreasonable as such, the emphasis Beauchamp and Childress put on them does not serve countering the critics' view that specification is insufficient for its intended purpose in applied ethics. This paper defends specification against Carson Strong's critique, showing that his casuistic approach shares strong structural and functional similarities with specification. It concludes with the more general point that specification or some closely related method for determining morally relevant facts of concrete cases and issues... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246575 Wed, 21 Sep 2011 04:00:00 +0100 5246575 http://www.medworm.com/index.php?rid=5246574&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F588%3Frss%3D1 From the 5th edition of Beauchamp and Childress' Principles of Biomedical Ethics, the problem of common morality has been given a more prominent role and emphasis. With the publication of the 6th and latest edition, the authors not only attempt to ground their theory in common morality, but there is also an increased tendency to identify the former with the latter. While this stratagem may give the impression of a more robust, and hence stable, foundation for their theoretical construct, we fear that it comes with a cost, namely the need to keep any theory in medical ethics open to, and thereby aware of, the challenges arising from biomedical research and clinical practice, as well as healthcare systems. By too readily identifying the moral life of common morality with rule-following behav... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246574 Wed, 21 Sep 2011 04:00:00 +0100 5246574 http://www.medworm.com/index.php?rid=5246573&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F584%3Frss%3D1 Tom Beauchamp and James Childress have always maintained that their four principles approach (otherwise known as principlism) is a globally applicable framework for biomedical ethics. This claim is grounded in their belief that the principles of respect for autonomy, non-maleficence, beneficence and justice form part of a ‘common morality’, or collection of very general norms to which everyone who is committed to morality subscribes. The difficulty, however, has always been how to demonstrate, at least in the absence of a full-blooded analysis of the concept of morality, whether the four principles are foundational, and so globally applicable, in this way. In the recently published sixth edition of Principles of Biomedical Ethics, an imaginative and non-question-begging empiric... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246573 Wed, 21 Sep 2011 04:00:00 +0100 5246573 http://www.medworm.com/index.php?rid=5246572&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F582%3Frss%3D1 In 2009, the 6th edition of Principles of biomedical ethics was published.1 Undeniably, the book is one of the most prominent and important works in biomedical ethics. When Tom L Beauchamp and James F Childress published the first edition 30 years ago,2 the field was still in a nascent state, full of hot topics but poor in method. It was, as K Danner Clouser portrayed it, ‘a mixture of religion, whimsy, exhortation, legal precedents, various traditions, philosophies of life, miscellaneous moral rules and epithets.’3 Against this background, it was a prime objective of Beauchamp and Childress to ‘bring some order and coherence to the discussion’ by means of a ‘systematic analysis of the moral principles that should apply to biomedicine’ (p vii).2 The... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246572 Wed, 21 Sep 2011 04:00:00 +0100 5246572 http://www.medworm.com/index.php?rid=5246571&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F10%2F581%3Frss%3D1 "Common Morality" and Principles of Biomedical Ethics What is morality and why does it exist? Historically, morality has been a set of norms that regulated human behavior and promoted survival of groups of human beings. Today, human beings have very sophisticated, large scale societies and advanced technologies. The world which they have carved for themselves is utterly different the world even 100 years ago. Human social and technological progress has been exponential over 10 000 years. Yet our biology and psychology has remained essentially unchanged over human history. We retain the biology and psychology of homo sapiens and our hunter gather ancestors living in the African savannah. This is important for understanding morality. Through nearly all of human history—the ti... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5246571 Wed, 21 Sep 2011 04:00:00 +0100 5246571 http://www.medworm.com/index.php?rid=5156000&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F577%3Frss%3D1 Female genital mutilation: UK Earlier this year the UK government published comprehensive multi-agency guidance to tackle and prevent female genital mutilation (FGM).1 In response to this, the British Medical Association (BMA) has undertaken a significant revision of its main guidance on FGM to focus on the role of doctors in eradicating the practice. FGM is a collective term used for a range of practices involving the removal or alteration of parts of healthy female genitalia for non-therapeutic reasons. The WHO has described FGM as ‘a form of violence against girls and women that has serious physical and psychological consequences which adversely affect health and is a reflection of discrimination against women and girls’.2 Different degrees of mutilation are practised by a v... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5156000 Thu, 18 Aug 2011 23:00:00 +0100 5156000 http://www.medworm.com/index.php?rid=5155999&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F573%3Frss%3D1 Monicelli's suicide has reawakened a political and legal dispute about the medical role in end-of-life decisions, allowing us to discuss medical, ethical, legal, religious and political debate in various paradigmatic conscious and unconscious cases of end-of-life decision. We analyse the uncertainty about the ‘a priori’ choice between different specific legislative systems, highlighting the need for a unifying model, dictated by the existing trust in the critical relationship between patient and doctor, whose primary mission should be not only ‘to cure’ but also ‘to care’. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155999 Thu, 18 Aug 2011 23:00:00 +0100 5155999 http://www.medworm.com/index.php?rid=5155998&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F571%3Frss%3D1 Luc Bovens, in his 2006 article, argues that it can be shown that the ‘rhythm' method of birth control results in a larger number of embryonic deaths than the IUD, the morning after pill or the combination oral contraceptive pill, just so long as one accepts his three ‘plausible’ assumptions. In this brief response I will argue that Boven's third assumption is not plausible when one takes into account a basic knowledge of human reproductive biology. Thus, his argument, in both of its possible reconstructions, fails. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155998 Thu, 18 Aug 2011 23:00:00 +0100 5155998 http://www.medworm.com/index.php?rid=5155997&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F567%3Frss%3D1 Conclusions Journals' retraction practices are not uniform. Some retractions fail to state the reason, and therefore fail to distinguish error from misconduct. We have used our findings to inform guidelines on retractions. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155997 Thu, 18 Aug 2011 23:00:00 +0100 5155997 http://www.medworm.com/index.php?rid=5155996&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F563%3Frss%3D1 Researchers and ethicists have long been concerned about the expectations for direct medical benefit expressed by participants in early phase clinical trials. Early work on the issue considered the possibility that participants misunderstand the purpose of clinical research or that they are misinformed about the prospects for medical benefit from these trials. Recently, however, attention has turned to the possibility that research participants are simply expressing optimism or hope about their participation in these trials. The ethical significance of this therapeutic optimism remains unclear. This paper argues that there are two distinct phenomena that can be associated with the term ‘therapeutic optimism’—one is ethically benign and the other is potentially worrisome. ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155996 Thu, 18 Aug 2011 23:00:00 +0100 5155996 http://www.medworm.com/index.php?rid=5155995&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F557%3Frss%3D1 Conclusion The brief information provided in the first level was sufficient for participants to make informed decisions, while a sizeable minority of the participants chose not to access any information at all. This study adds to the debate about how much information is required to make a decision about participation in research and the results may help inform the future development of information sheets by providing data on participants' actual needs when deciding about questionnaire surveys. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155995 Thu, 18 Aug 2011 23:00:00 +0100 5155995 http://www.medworm.com/index.php?rid=5155994&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F552%3Frss%3D1 Human dignity has long been used as a foundational principle in policy documents and ethical guidelines intended to govern various forms of biomedical research. Despite the vast amount of literature concerning human dignity and embryonic tissues, the majority of biomedical research uses non-embryonic human tissue. Therefore, this contribution addresses a notable lacuna in the literature: the relationship, if any, between human dignity and human tissue. This paper first elaborates a multidimensional understanding of human dignity that overcomes many of the shortcomings associated with the use of human dignity in other ethical debates. Second, it discusses the relationship between such an understanding of human dignity and ‘non-embryonic’ human tissue. Finally, it considers the i... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155994 Thu, 18 Aug 2011 23:00:00 +0100 5155994 http://www.medworm.com/index.php?rid=5155993&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F544%3Frss%3D1 Conclusions A tailored approach is needed when discussing research participation with parents of eligible children. While parents of healthy children may be more open to discussions of altruism, those whose children have life threatening illnesses should be given adequate information about the alternatives to, and risks of, research participation. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155993 Thu, 18 Aug 2011 23:00:00 +0100 5155993 http://www.medworm.com/index.php?rid=5155992&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F540%3Frss%3D1 Discussion of the mechanism provided by the Israel Patient's Rights Act of 1996 for ethics committees to override refusal of treatment by such patients has provided several examples in which it seems an obligation to benefit the patient can outweigh concerns regarding respect for their autonomy. However, such analyses as have been undertaken so far may be seen to omit important elements of the moral decision-making process that takes place even when the latter appears to ‘win out’. In addition to helping better prepare clinicians to meet such challenges in the future, a fuller appreciation of those elements that are present in justified cases of coercive treatment may enable them to arrive at a better understanding of what autonomy itself can mean in a medical context. (Source:... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155992 Thu, 18 Aug 2011 23:00:00 +0100 5155992 http://www.medworm.com/index.php?rid=5155991&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F535%3Frss%3D1 In medicine, racial differences are frequently presented as part of the best explanation of differences in the risk of diseases. The problem of using racial classification in biomedical research has become important because of its ethical consequences in society. However, the biological relevance of the concept of race cannot be established by any ethical argument and the epistemological role of racial categorisation requires clarification. In this paper, different issues related to the concept of race are considered. This paper analyses the semantic problem concerning the definition of race, considers the ontological problem of race, drawing attention to the biological evidence for genetic differences among human groups, and presents a promising epistemological approach to the problem of ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155991 Thu, 18 Aug 2011 23:00:00 +0100 5155991 http://www.medworm.com/index.php?rid=5155990&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F530%3Frss%3D1 Conclusion Facilitators play a substantial and evolving role in the practice of medical tourism and may be entering a period of professionalisation. Because of the key role of facilitators in determining the effects of medical tourism on patients and public health, this paper recommends a planned conversation between medical tourism stakeholders to define and shape facilitators' roles. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155990 Thu, 18 Aug 2011 23:00:00 +0100 5155990 http://www.medworm.com/index.php?rid=5155989&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F526%3Frss%3D1 It is well documented that the higher the socioeconomic status (SES) of patients, the better their health and life expectancy. SES also influences the use of health services—the higher the patients' SES, the more time and specialised health services provided. This leads to the following question: should clinicians give priority to individual patients with low SES in order to enhance health equity? Some argue that equity is best preserved by physicians who remain loyal to ‘ordinary medical fairness’ in non-ideal circumstances when health disparities persist; ie, doctors should allocate care according to needs only and treat everyone with equal regard by being neutral with respect to patients' SES. This paper furthers a discussion of this view by questioning how equitable n... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155989 Thu, 18 Aug 2011 23:00:00 +0100 5155989 http://www.medworm.com/index.php?rid=5155988&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F523%3Frss%3D1 Conclusion The results of this study show that the people we usually consult for decisions concerning patient treatment are significantly different from the patients' preferred substitute decision makers. The authors suggest patients be allowed to choose their substitute decision maker while conscious. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155988 Thu, 18 Aug 2011 23:00:00 +0100 5155988 http://www.medworm.com/index.php?rid=5155987&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F518%3Frss%3D1 Clinical ethics takes on a special cast in a rehabilitation clinic for psychosis where many patients come from severely disadvantaged backgrounds and many suffer from fluctuating decisional capacity. This paper illustrates several ethical issues—truth telling and partiality, prescribing concealed medication, questionable billing practices, industry collaboration, limits of confidentiality, grounds for abandonment and the primacy of autonomy—in the hope that discussing such matters will lead to a clearer framework for work with this population. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155987 Thu, 18 Aug 2011 23:00:00 +0100 5155987 http://www.medworm.com/index.php?rid=5155986&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F9%2F517%3Frss%3D1 When I was an intern, I saw a patient whose heart transplant had failed. She was presenting for assessment for a second transplant. The heart had failed because of continued intravenous drug abuse. She was in a desperate state. "Are you going to retransplant her if she is a drug addict?" I asked my registrar. "We can't deny her a transplant for social reasons. But we can because her prognosis is poor." Issues of justice weave throughout this month's issue of the Journal. In the Feature article, Bærøe and Bringedal address the issue of how just allocation of resources should take account of socioeconomic status, (see page 526). Higher socioeconomic status (SES) patients have better health and life expectancy, and use more health services. Bærøe and Bringedal ask: s... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5155986 Thu, 18 Aug 2011 23:00:00 +0100 5155986 http://www.medworm.com/index.php?rid=5048475&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F515%3Frss%3D1 The rapid rise of international collaborative science has enabled access to genomic data. In this article, it is argued that to move beyond mapping genomic variation to understanding its role in complex disease aetiology and treatment will require extending data sharing for the purposes of clinical research translation and implementation. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048475 Mon, 18 Jul 2011 23:00:00 +0100 5048475 http://www.medworm.com/index.php?rid=5048474&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F512%3Frss%3D1 Introduction For over 50 years, research has made an invaluable contribution to the remarkable success of clinical transplantation. Landmark scientific discoveries include the description, development and practical use of HLA tissue typing,1–3 understanding of the role of antibodies in hyperacute rejection4 and the use and application of immunosuppressive treatment to prevent graft rejection.5 6 Transplantation has saved thousands of lives. Immunosuppressive protocols are highly sophisticated and transplant outcomes are better now than they have ever been. However, complications occur and challenges remain. Transplant outcomes could still be better. Progress depends on continuing scientific study of factors in both donor and recipient which may enhance graft and patient survival... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048474 Mon, 18 Jul 2011 23:00:00 +0100 5048474 http://www.medworm.com/index.php?rid=5048473&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F510%3Frss%3D1 Background The first regulation in Turkey regarding in vitro fertilisation (IVF) procedures was legislated in 1987, and these services have been offered for married couples since 1988.1 Over time, the increasing number of centres providing such services has fuelled competition, and these centres have started to use websites in order to promote their services to the public in a more effective way. However, it should be noted that IVF procedures may have social, economical and psychological implications. Therefore, website-based promotion and advertising containing incorrect or misleading information on IVF services can lead to harmful consequences.2–5 There are no specific guidelines and regulations regarding the content of such websites and the rights of individuals visiting these si... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048473 Mon, 18 Jul 2011 23:00:00 +0100 5048473 http://www.medworm.com/index.php?rid=5048472&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F504%3Frss%3D1 Conclusion The results suggest that researchers' consent and capacity knowledge and skills vary considerably. Perceived discrepancies between ethical practice and ethics boards' requirements suggest the need for dialogue, education and possibly ethics board reforms. Furthermore we propose, where appropriate, a ‘family decision-making’ model that allows parents and their children to consent together, thereby shifting the focus from separate assent and consent procedures to approaches that appropriately engage the child and family. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048472 Mon, 18 Jul 2011 23:00:00 +0100 5048472 http://www.medworm.com/index.php?rid=5048471&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F498%3Frss%3D1 Media attention to retracted research suggests that a substantial number of papers are corrupted by misinformation. In reality, every paper contains misinformation; at issue is whether the balance of correct versus incorrect information is acceptable. This paper postulates that analysis of retracted research papers can provide insight into medical misinformation, although retracted papers are not a random sample of incorrect papers. Error is the most common reason for retraction and error may be the principal cause of misinformation as well. Still, one-quarter of retracted papers are fraudulent, and misinformation may also arise through fraud. This paper hypothesises that error and fraud are the main sources of misinformation and that error is more common than fraud. Retraction removes mis... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048471 Mon, 18 Jul 2011 23:00:00 +0100 5048471 http://www.medworm.com/index.php?rid=5048470&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F493%3Frss%3D1 Conclusions Regardless of whether hospital ethics accreditation can be a stand-alone accreditation or just part of existing hospital accreditation programmes, we hope this draft can serve as a good reference for future endeavours by hospital accreditation authorities. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048470 Mon, 18 Jul 2011 23:00:00 +0100 5048470 http://www.medworm.com/index.php?rid=5048469&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F487%3Frss%3D1 Conclusions Online consent to large-scale genetic studies is likely to be acceptable to the public. The online consent process must establish trust quickly and effectively by asserting authenticity and credentials, and provide access to a range of information to suit different information preferences. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048469 Mon, 18 Jul 2011 23:00:00 +0100 5048469 http://www.medworm.com/index.php?rid=5048468&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F483%3Frss%3D1 The aim of this pilot study was to develop a realistic clinical case for identifying Knobe's asymmetric effect, ie, the tendency to ascribe intentions to a larger extent when an act is considered wrong, as well as to compare medical students at the beginning and end of their curriculum. A vignette about a critically ill 72-year-old patient in need of an operation was used, with two different outcomes: the patient dies or the patient recovers. Approximately half of the students received the ‘recovery case’ and half the ‘death case’. The questions asked were whether it was right to perform the risky operation and whether the head of the clinic brought about the patient's death/recovery intentionally. Among students in their first term an asymmetry in response pattern ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048468 Mon, 18 Jul 2011 23:00:00 +0100 5048468 http://www.medworm.com/index.php?rid=5048467&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F479%3Frss%3D1 The genetic modification of children is becoming a more likely possibility given our rapid progress in medical technologies. I argue, from a broadly Kantian point of view, that at least one kind of such modification—modification by a parent for the sake of a child's comparative advantage—is not rationally justified. To argue this, I first characterize a necessary condition on reasons and rational justification: what is a reason for an agent to do an action in one set of circumstances must be a reason for any in those circumstances to do the action. I then show that comparatively advantageous genetic modification violates this principle since a child's "getting ahead" through genetic modification cannot be rationally justified unless other children also could receive the modific... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048467 Mon, 18 Jul 2011 23:00:00 +0100 5048467 http://www.medworm.com/index.php?rid=5048466&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F476%3Frss%3D1 This article outlines the arguments for and against the introduction of preoperatively seeking consent from patients to have their blood tested for HIV via POCT in order to improve the reporting rates of needlestick injuries incurred during surgery and to protect staff from infection. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048466 Mon, 18 Jul 2011 23:00:00 +0100 5048466 http://www.medworm.com/index.php?rid=5048465&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F472%3Frss%3D1 Conclusion Codes regarding disclosure of terminal illness to patients and families differed markedly among Islamic countries. They were silent in one-third of the codes, and tended to favour a paternalistic/utilitarian, family-centred approach over an autonomous, patient-centred approach. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048465 Mon, 18 Jul 2011 23:00:00 +0100 5048465 http://www.medworm.com/index.php?rid=5048464&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F466%3Frss%3D1 Conclusions While the Gillick guidelines provide a legal framework to help professionals make judgements about adolescents consenting to medical treatment, in practice there appears to be variable and confused interpretation of this guidance. Improved legal structures, management procedures and professional advice are needed to support those who are assessing competence and establishing consent to vaccinate adolescents in a school setting. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048464 Mon, 18 Jul 2011 23:00:00 +0100 5048464 http://www.medworm.com/index.php?rid=5048463&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F461%3Frss%3D1 In this study we explored the meaning of appeals to nature among pregnant women to whom a prenatal screening test was offered and the impact of these appeals on their choices regarding the acceptance of screening. Contrary to theoretical debates we found that appeals to the moral authority of nature do not prevent women from welcoming the possibilities of controlling the outcomes of pregnancy, neither do they provide prima facie justification for (not) intervening in the natural course of events. Both acceptors and decliners believed in an inherent morality in nature that must be respected. They welcome the possibility of knowing more about the health of the fetus and to make their own reproductive decisions. Concerns for the quality of their child's life and for their capacity to assure a... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048463 Mon, 18 Jul 2011 23:00:00 +0100 5048463 http://www.medworm.com/index.php?rid=5048462&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F456%3Frss%3D1 Conclusion There is a conditioned need for ethics support in Dutch healthcare institutions. The promotion of ethics support in healthcare can be fostered by focusing on formats which fit the needs of (practitioners in) healthcare institutions. The emphasis should be on creating a (culture of) dialogue about the complex situations which emerge daily in contemporary healthcare practice. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048462 Mon, 18 Jul 2011 23:00:00 +0100 5048462 http://www.medworm.com/index.php?rid=5048461&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F454%3Frss%3D1 In 2009, the 6th edition of Principles of biomedical ethics was published.1 Undeniably, the book is one of the most prominent and important works in biomedical ethics. When Tom L Beauchamp and James F Childress published the first edition 30 years ago,2 the field was still in a nascent state, full of hot topics but poor in method. It was, as K Danner Clouser portrayed it, ‘a mixture of religion, whimsy, exhortation, legal precedents, various traditions, philosophies of life, miscellaneous moral rules and epithets.’3 Against this background, it was a prime objective of Beauchamp and Childress to ‘bring some order and coherence to the discussion’ by means of a ‘systematic analysis of the moral principles that should apply to biomedicine’ (p vii).2 The... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048461 Mon, 18 Jul 2011 23:00:00 +0100 5048461 http://www.medworm.com/index.php?rid=5048460&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F8%2F453%3Frss%3D1 The editorial team of the JME has changed. John Harris, Soren Holm and their team have been highly successful in making the JME a top, thoroughly international medical ethics journal. But now the JME, too, will evolve again. As editors of JME, our collective aim is to shape what is already a highly prestigious and successful interdisciplinary journal into the most academically rigorous and internationally renowned journal for medical ethics in the world. Here is how we plan to do it. Feature articles A key plank of the new JME will be the introduction of a feature article every second issue. This will be a longer, more in depth article of up to 7000 words. Feature articles must make a significant original contribution to scholarship in medical ethics. They may be more philosophical in natu... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=5048460 Mon, 18 Jul 2011 23:00:00 +0100 5048460 http://www.medworm.com/index.php?rid=4944301&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F450%3Frss%3D1 The avoidance of mitochondrial disease Previous Ethics briefings reported on research developments involving mitochondrial transfer to allow women to avoid passing on a serious mitochondrial disease to their daughters.1 This update reports on the beginning of the legal process that could see the procedure used in clinical practice. The Human Fertilisation and Embryology Act 1990 (as amended) allows for regulations to be passed that permit techniques that alter the mitochondrial DNA of an egg or embryo to be used in assisted conception to prevent the transmission of serious mitochondrial disease. This involves the pronuclei (containing the genetic material from the egg and sperm) being removed from a fertilised oocyte and transferred into a fertilised donor egg that has had its own pronucle... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944301 Thu, 16 Jun 2011 23:00:00 +0100 4944301 http://www.medworm.com/index.php?rid=4944300&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F449-b%3Frss%3D1 We appreciate Dr Schuklenk's concerns. We agree that the methodology we used to collect the data did not include policies listed only on the journal's intranet (internal) website, as was the case with Bioethics and Developing World Bioethics. We apologise for this oversight. One reason why we only examined journal websites for authorship guidelines is that publication on a public website is the most effective way of informing the research community about a journal's policies, and one of the main concerns in our paper was how policies may potentially impact the larger research community. A policy that is accessible only by going through various stages of submitting a paper to a journal can provide guidance for authors submitting to that journal, but does not provide general guidance for the... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944300 Thu, 16 Jun 2011 23:00:00 +0100 4944300 http://www.medworm.com/index.php?rid=4944299&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F449-a%3Frss%3D1 The JME published an interesting article by Drs Resnik and Master.1 The article purports to report the authorship policies of a select group of major bioethics journals. The authors derived their information about authorship policies from journal websites. They conclude that ‘most bioethics journals do not have any authorship policies’. Among the journals scoring zero out of six criteria were Bioethics and Developing World Bioethics. As an editor involved with the production of both journals I should like to set the record straight on the matter of our authorship policies. Both journals have elaborate policies, both on authorship as well as conflict of interest disclosure. Our authors must address relevant questions pertaining to potential conflicts of interest as well as autho... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944299 Thu, 16 Jun 2011 23:00:00 +0100 4944299 http://www.medworm.com/index.php?rid=4944298&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F445%3Frss%3D1 Potential ethical issues can arise during the process of epidemiological classification. For example, unnatural infant deaths are classified as accidental deaths or homicides. Societal sensitivity to the physical abuse and neglect of children has increased over recent decades. This enhanced sensitivity could impact reported infant homicide rates. Infant homicide and accident mortality rates in boys and girls in the USA from 1940 to 2005 were analysed. In 1940, infant accident mortality rates were over 20 times greater than infant homicide rates in both boys and girls. After about 1980, when the ratio of infant accident mortality rates to infant homicide rates decreased to less than five, and the sum of infant accident and homicide rates became relatively constant, further decreases in infa... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944298 Thu, 16 Jun 2011 23:00:00 +0100 4944298 http://www.medworm.com/index.php?rid=4944297&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F441%3Frss%3D1 Elizabeth Fenton has criticised an earlier article by the authors in which the claim was made that, by providing humankind with means of causing its destruction, the advance of science and technology has put it in a perilous condition that might take the development of genetic or biomedical techniques of moral enhancement to get out of. The development of these techniques would, however, require further scientific advances, thus forcing humanity deeper into the danger zone created by modern science. Fenton argues that the benefits of scientific advances are undervalued. The authors believe that the argument rather relies upon attaching a special weight to even very slight risks of major catastrophes, and attempt to vindicate this weighting. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944297 Thu, 16 Jun 2011 23:00:00 +0100 4944297 http://www.medworm.com/index.php?rid=4944296&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F437%3Frss%3D1 The rule of double effect is regularly invoked in ethical discussions about palliative sedation, terminal extubation and other clinical acts that may be viewed as hastening death for imminently dying patients. Unfortunately, the literature tends to employ this useful principle in a fashion suggesting that it offers the final word on the moral acceptability of such medical procedures. In fact, the rule cannot be applied appropriately without invoking moral theories that are not explicit in the rule itself. Four tenets of the rule each require their own ethical justification. A variety of moral theories are relevant to making judgements in a pluralistic society. Much of the rich moral conversation germane to the rule has been reflected in arguments about physician-asssisted suicide and volun... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944296 Thu, 16 Jun 2011 23:00:00 +0100 4944296 http://www.medworm.com/index.php?rid=4944295&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F433%3Frss%3D1 There are four major arguments raised against wrongful life claims: first, that it is impossible to establish harm in wrongful life claims; second, that wrongful life claims are illogical or incoherent; third, that life is inviolable and sacred no matter the quality; and fourth, that there are no rights and duties towards non-existent persons. In this paper, I will examine and evaluate critically the first two arguments. I will reject these objections against wrongful life claims and demonstrate that they rely on a conceptual error/mistake. In doing so, I will reject the logic of comparing existence with non-existence in wrongful life claims. Instead, I will maintain that recognition of the infant's cause of action and recognition of the infant's harmed condition need not imply any prefere... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944295 Thu, 16 Jun 2011 23:00:00 +0100 4944295 http://www.medworm.com/index.php?rid=4944294&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F429%3Frss%3D1 The paucity of research data to guide current paediatric practice has led to children being termed therapeutic orphans. This difficulty is especially pertinent to research in emergency situations, such as acute resuscitation or critical care, where accepted ethical standards for overall research, have historically created practical difficulties for researchers. The welcome establishment of organisations to support UK paediatric research is helping to ensure safer and more effective medications for children, however as the balance between protection and access at the heart of the paediatric research ethical debate shifts to ever increasing access for researchers to children, it remains crucial to ensure the protection for these vulnerable participants. The fundamental protection for researc... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944294 Thu, 16 Jun 2011 23:00:00 +0100 4944294 http://www.medworm.com/index.php?rid=4944293&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F424%3Frss%3D1 Inappropriate authorship is a common problem in biomedical research and may be becoming one in bioethics, due to the increase in multiple authorship. This paper investigates the authorship policies of bioethics journals to determine whether they provide adequate guidance for researchers who submit articles for publication, which can help deter inappropriate authorship. It was found that 63.3% of bioethics journals provide no guidance on authorship; 36.7% provide guidance on which contributions merit authorship, 23.3% provide guidance on which contributions do not merit authorship, 23.3% require authors to take responsibility for their contributions or for the article as a whole, 20% provide guidance on which contributions merit an acknowledgement but not authorship, 6.7% require authors to... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944293 Thu, 16 Jun 2011 23:00:00 +0100 4944293 http://www.medworm.com/index.php?rid=4944292&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F420%3Frss%3D1 Conclusion Lebanese parents have perceptions of and attitudes towards children's participation in clinical trials that are similar to those reported from the industrialised world. Improving communication with parents and building trust between researchers and parents is important for successful recruitment. Investigators planning to conduct paediatric trials in developing countries need to simplify consent forms and devise new ways to explain randomisation. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944292 Thu, 16 Jun 2011 23:00:00 +0100 4944292 http://www.medworm.com/index.php?rid=4944291&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F415%3Frss%3D1 The issues of the ethics of germ line modification in general and of enhancement by germ line modification in particular have been the subject of hundreds of articles in the bioethical literature. Both because the techniques are far from perfected and because the potential long term side effects are unkown, there is a widespread consensus that germ line modification for enhancement is absolutely unethical and beyond the pale at the present time. The author considers a thought expperiment projecting into the future in which perhaps the safety and reversibility of germ line modification have been clearly demonstrated. Under such circumstances it is contended that the dividing line between treatment and enhancement is difficult and indeed perhaps impossible to maintain. The Jewish tradition i... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944291 Thu, 16 Jun 2011 23:00:00 +0100 4944291 http://www.medworm.com/index.php?rid=4944290&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F410%3Frss%3D1 Advances in the understanding of genetics have led to the belief that it may become possible to use genetic engineering to manipulate the DNA of humans at the embryonic stage to produce certain desirable traits. Although this currently cannot be done on a large scale, many people nevertheless object in principle to such practices. Most often, they argue that genetic enhancements would harm the children who were engineered, cause societal harms, or that the risks of perfecting the procedures are too high to proceed. However, many of these same people do not have serious objections to what is called ‘genetic planning’ procedures (such as the selection of sperm donors with desirable traits) that essentially have the same ends. The author calls the view that genetic engineering enh... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944290 Thu, 16 Jun 2011 23:00:00 +0100 4944290 http://www.medworm.com/index.php?rid=4944289&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F406%3Frss%3D1 In the literature on the subject there is a trend towards understanding the idea of rationing in healthcare very broadly, to include any form of restriction in supply. It is suggested in this paper that there are good reasons to resist this move, since it would both render the concept redundant through being trivially true and displace an earlier, egalitarian one that retains great moral significance for the supply of healthcare. The nature and significance of the narrower, egalitarian conception is set out, drawing particular attention to the fact that it marks a contrast with the idea of prioritising certain people or groups over others and to the fact that it is a form of rationing that is plausibly regarded as a morally desirable response to severe shortages. It is contrasted with the ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944289 Thu, 16 Jun 2011 23:00:00 +0100 4944289 http://www.medworm.com/index.php?rid=4944288&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F402%3Frss%3D1 In contemporary medicine, it is not always obvious whether the acceptance of a benefit constitutes a conflict of interest. A particular area of controversy has been the impact of small gifts or other benefits from pharmaceutical companies on physicians' behaviour. Typically, in such cases, the gift is not an explicit reward for cooperation; the physician does not perceive the gift as an attempt to influence his or her judgement; and the reward is relatively minor. Under these circumstances, physicians are generally of the view that acceptance of gifts will not affect their behaviour, notwithstanding findings from social psychology and neuroscience that the impact of gifts is often unconscious, shaping action without a person's awareness. Here, we draw on traditional texts of Jewish law per... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944288 Thu, 16 Jun 2011 23:00:00 +0100 4944288 http://www.medworm.com/index.php?rid=4944287&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F397%3Frss%3D1 Conclusions Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944287 Thu, 16 Jun 2011 23:00:00 +0100 4944287 http://www.medworm.com/index.php?rid=4944286&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F390%3Frss%3D1 Conclusion This review concludes that the quality of many ethical guidelines should and can be improved in all quality domains specified by the AGREE instrument. Furthermore, conceptual analysis indicates that a slightly modified AGREE instrument is transferable to the comprehensive evaluation of the quality of ethical guidelines. Nevertheless, future research is needed to improve the assessment of the presentation of the guidelines' normative basis. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944286 Thu, 16 Jun 2011 23:00:00 +0100 4944286 http://www.medworm.com/index.php?rid=4944285&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F7%2F389%3Frss%3D1 We have both had a long love affair with the Journal of Medical Ethics. For many years before we were appointed editors we had both been regular contributors, thinking of the JME as the obvious home for many of our best papers. We hope we have managed to give some sense of this enthusiasm during our tenure of office and our ambition has been to keep the JME high in academic stature and popularity and also high in the affections of both contributors and readers. The JME has a history of appeal to a broad range of interests and concerns, a reputation for accepting high-quality papers from across all continents and frontiers, from people diverse in culture, professional background, disciplinary approach but united in a concern for ethics and human rights in the practice of medicine and health... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4944285 Thu, 16 Jun 2011 23:00:00 +0100 4944285 http://www.medworm.com/index.php?rid=4861370&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F384%3Frss%3D1 According to Carson Strong, the future of value account of the wrongness of killing is subject to counterexamples. Ezio Di Nucci has disagreed. Their disagreement turns on whether the concepts of a future of value and a future like ours are equivalent. Unfortunately, both concepts are fuzzy, which explains, at least in part, the disagreement. I suggest that both concepts can be clarified in ways that seem plausible and that makes them equivalent. Strong claims that better accounts of the wrongness of killing exist. I show that those alternative accounts are unsatisfactory. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861370 Sun, 22 May 2011 23:00:00 +0100 4861370 http://www.medworm.com/index.php?rid=4861369&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F380%3Frss%3D1 Empathy is commonly regarded as an essential attribute for doctors and there is a conviction that empathy must be taught to medical students. Yet it is not clear exactly what empathy is, from a philosophical or sociological point of view, or whether it can be taught. The meaning, role and relevance of empathy in medical education have tended to be unquestioningly assumed; there is a need to examine and contextualise these assumptions. This paper opens up that debate, arguing that ‘empathy’, as it is commonly understood, is neither necessary nor sufficient to guarantee good medical or ethical practice. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861369 Sun, 22 May 2011 23:00:00 +0100 4861369 http://www.medworm.com/index.php?rid=4861368&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F374%3Frss%3D1 Conclusion A high percentage of each category of gender, ethnicity and drug history, gave affirmative consent at all levels. The level of detail in and the amount of time spent reviewing the informed consent, and a relationship of trust with the clinical investigator may contribute to this outcome. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861368 Sun, 22 May 2011 23:00:00 +0100 4861368 http://www.medworm.com/index.php?rid=4861367&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F368%3Frss%3D1 Conclusions The overwhelming number of source documents and standards uncovered in this study was not anticipated beforehand and confirms the extraordinary complexity of the clinical trials enterprise. This taxonomy of multinational ethical and methodological standards may help trialists and overseers improve the quality of clinical trials, particularly given the globalisation of clinical research. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861367 Sun, 22 May 2011 23:00:00 +0100 4861367 http://www.medworm.com/index.php?rid=4861366&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F364%3Frss%3D1 Conclusion Research into this sensitive area of perinatal medicine where there is a poor outcome is possible and is indeed well received by many parents. RECs should not automatically take a negative stance towards studies of this type. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861366 Sun, 22 May 2011 23:00:00 +0100 4861366 http://www.medworm.com/index.php?rid=4861365&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F362%3Frss%3D1 In an earlier article, I argued that David Estlund's notion of ‘normative consent’ could provide justification for an opt-out system of organ donation that does not involve presumptions about the deceased donor's consent. Where it would be wrong of someone to refuse their consent, then the fact that they have not actually given it is irrelevant, though an explicit denial of consent (as in opting out) may still be binding. My argument has recently been criticised by Potts et al, who argue that such a policy would involve taking organs from people whose organs should not be taken and would be a recipe for totalitarianism. The present response seeks to rebut both the ethical and political objections. I argue that people can indeed be under a moral obligation to donate their organs... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861365 Sun, 22 May 2011 23:00:00 +0100 4861365 http://www.medworm.com/index.php?rid=4861364&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F357%3Frss%3D1 The debate on responsibility for health takes place within political philosophy and in policy setting. It is increasingly relevant in the context of rationing scarce resources as a substantial, and growing, proportion of diseases in high-income countries is attributable to lifestyle. Until now, empirical studies of medical professionals' attitudes towards personal responsibility for health as a component of prioritisation have been lacking. This paper explores to what extent Norwegian physicians find personal responsibility for health relevant in prioritisation and what type of risk behaviour they consider relevant in such decisions. The proportion who agree that it should count varies from 17.1% (‘Healthcare priority should depend on the patient's responsibility for the disease&rsqu... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861364 Sun, 22 May 2011 23:00:00 +0100 4861364 http://www.medworm.com/index.php?rid=4861363&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F354%3Frss%3D1 This paper uses the imaginary case of Gemma, presented initially at the International Swine Flu Conference (London, March 2010), to discuss whether a nurse who disagrees with most ways in which animals are farmed would be wronged if she contracted swine flu. It is argued that the farm animal sector has contributed to the emergence of H1N1 flu, and that the sector in general contributes significantly to the burden of human disease. The aim of this paper is to promote debate on the question as to whether a range of systems used by the farm animal sector survive moral scrutiny in light of these concerns. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861363 Sun, 22 May 2011 23:00:00 +0100 4861363 http://www.medworm.com/index.php?rid=4861362&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F348%3Frss%3D1 Advances in genomic medicine have lead to debate about the potential inclusion of genetic tests for susceptibility to common complex disorders in newborn screening programmes. Empirical evidence concerning psychosocial reactions to genetic testing is a crucial component of both ethical debate and policy development, but while there has been much speculation concerning the possible psychosocial impact of screening newborns for genetic susceptibilities, there remains a paucity of data. The aim of the study reported here is to provide some of this missing empirical evidence, using type 1 diabetes as an example of a common disorder with multiple significant genetic contributors to its aetiology. Semi-structured interviews were conducted with 11 parents of babies who had received increased risk... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861362 Sun, 22 May 2011 23:00:00 +0100 4861362 http://www.medworm.com/index.php?rid=4861361&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F344%3Frss%3D1 The common objection to opt-out systems of postmortal organ procurement is that they allow removal of a deceased person's organs without their actual consent. However, under certain conditions it is possible for ‘silence’—failure to register any objection—conventionally and/or legally to count as genuine consent. Prominent conditions are that the consenter should be fully informed about the meaning of his or her silence and that the costs of registering dissent should be insignificant. This paper explicates this thesis and discusses some possible objections to it: (1) it cannot possibly be guaranteed that each citizen is aware of the meaning of silence; and (2) the system is slightly manipulative because it exploits a common defect in autonomous decision-making. (So... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861361 Sun, 22 May 2011 23:00:00 +0100 4861361 http://www.medworm.com/index.php?rid=4861360&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F339%3Frss%3D1 There are two contrasting views on the decision-making for life-sustaining treatment in advanced stages of dementia when the patient is deemed incompetent. One is to respect the patient's precedent autonomy by adhering to advance directives or using the substituted judgement standard. The other is to use the best-interests standard, particularly if the current judgement on what is best for the incapacitated patient contradicts the instructions from the patient's precedent autonomy. In this paper, I argue that the protracted clinical course of dementia over many years requires the extended perspective of a progressive decision-making process—extended in both social space and time. The ongoing debate between these two competing views has missed this perspective by focussing on an exclu... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861360 Sun, 22 May 2011 23:00:00 +0100 4861360 http://www.medworm.com/index.php?rid=4861359&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F333%3Frss%3D1 Conclusions This study demonstrates that the ethical issues related to deception that trouble attending physicians also exist at the resident physician level. Residents primarily lie for altruistic reasons and rarely for egoistic or self-serving purposes that may or may not result in harm to patients, insurance companies and/or physicians themselves. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861359 Sun, 22 May 2011 23:00:00 +0100 4861359 http://www.medworm.com/index.php?rid=4861358&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F327%3Frss%3D1 Conclusion The findings of this study provide information on the current state of an ethically and clinically challenging aspect of clinical practice and can serve as a starting point for further interdisciplinary research on normative and empirical aspects of treatment decision-making at the end of life. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861358 Sun, 22 May 2011 23:00:00 +0100 4861358 http://www.medworm.com/index.php?rid=4861357&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F326%3Frss%3D1 Liberalism is a big word in bioethics. It smacks of freedom—the freedom of patients from unwanted therapeutic interventions, the freedom of physicians to practice according to what they consider the state of the art, the freedom of society from unwanted regulation, everyone's freedom to form and pursue an individual idea of a good life. So far so good. Yet sometimes ‘liberal’ positions are strikingly simplistic: using enhancers is ok as long as competent individuals consent to it; selling your organs is ok if that is what you want, and women wearing a burka and having their hymen repaired after premarital intercourse are just expressing their autonomy. You do not have to be a sociologist to sense a part of the picture might be missing here. Usually we consider people from... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861357 Sun, 22 May 2011 23:00:00 +0100 4861357 http://www.medworm.com/index.php?rid=4861356&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F6%2F325%3Frss%3D1 End-of-life practices in German palliative care We know that end-of-life practices in medicine vary widely across countries. The paper by Schildman et al (see page 327) reports a questionnaire survey of all members of the German Society for Palliative Medicine using the German language version of the EURELD survey instrument.1 The study has a good response rate of 55.8% and finds that decisions to withdraw or withhold treatment are very common, but that German physicians estimate that the life-shortening effects of most of these decisions are very limited, although in 17 of 234 cases the life-shortening effect was estimated to be more than 1 month. Extended cognition and end-of-life care for patients with dementia Another interesting and somewhat provocative paper in this issue also d... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4861356 Sun, 22 May 2011 23:00:00 +0100 4861356 http://www.medworm.com/index.php?rid=4732788&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F5%2F321%3Frss%3D1 The Abortion Act: early medical abortion In England, Wales and Scotland, the vast majority of abortions take place in the first trimester of pregnancy. In 2009, for example, 91% of abortions were carried out at under 13 weeks gestation for women resident in England and Wales.1 Early abortion opens up the opportunity for a woman to have a medical abortion rather than a surgical abortion. Medical abortion is considered to be less invasive and less expensive than surgical abortion, and is increasingly becoming the preferred method.1 The proportion of medical abortions to surgical abortions has doubled in the last five years with 52% of abortions being medical abortions under 9 weeks gestation in 2009. A medical abortion typically involves taking mifepristone to block the hormones that he... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4732788 Tue, 19 Apr 2011 23:00:00 +0100 4732788 http://www.medworm.com/index.php?rid=4732787&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F5%2F318%3Frss%3D1 This article seeks to explore utilitarian conceptions of personhood which for a long time have been employed as part of a rational moral justification for the termination of pregnancy. Michael Tooley's desires-based rights approach to personhood presented in his work Abortion and Infanticide is considered and, it is argued, is found wanting when one considers unconscious adults and their ability to desire life. This article will offer that unconscious sleeping individuals only have the potential to regain the capacity to value their own life and, as such, under Tooley's formula for personhood, temporarily lose their status as a person. Following this, John Harris's utilitarian views on the status of the sleeping adult will be considered and deconstructed to show that, like Tooley, his ascr... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4732787 Tue, 19 Apr 2011 23:00:00 +0100 4732787 http://www.medworm.com/index.php?rid=4732786&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F5%2F311%3Frss%3D1 Conclusions This study shows an empirical relationship between decision-making and informed consent, on the one hand, and emotions and empathy on the other. While this study is exploratory and preliminary, the findings of a relationship between informed consent, emotions and empathy raise important neuroethical questions with regard to an emotional-social concept of informed consent and potential clinical implications for testing informed consent. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4732786 Tue, 19 Apr 2011 23:00:00 +0100 4732786 http://www.medworm.com/index.php?rid=4732785&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F5%2F303%3Frss%3D1 Conclusions There appears to be an inherent duality in the views on using surveillance technology which is rooted in the moral conflict between safety and freedom. Elaboration of this ethical issue has proved to be very difficult. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4732785 Tue, 19 Apr 2011 23:00:00 +0100 4732785 http://www.medworm.com/index.php?rid=4732784&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F5%2F299%3Frss%3D1 Researchers should be made co-responsible for the wider consequences of their research focus and the application of their findings. This paper describes a meta-reflection procedure that can be used as a tool to enhance scientific responsibility and reflective practice. The point of departure is that scientific practice is situated in power relations, has direction and, consequently, power implications. The contextual preconditions and implications of research should be stated and discussed openly. The reflection method aims at revealing both upstream elements, such as for instance preconceptions, and downstream elements, for example, public consequences of research. The validity of research might improve from such discussions. Validity should preferably be understood as a broader concept t... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4732784 Tue, 19 Apr 2011 23:00:00 +0100 4732784 http://www.medworm.com/index.php?rid=4732783&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F37%2F5%2F295%3Frss%3D1 Conclusions Since veterinary surgeons have frequent practical experience of euthanasia in animals, they do have knowledge about what euthanasia really is. Veterinary surgeons and the general public had an almost similar response pattern. Accordingly it seems difficult to maintain that knowledge about euthanasia is unambiguously associated with a restrictive attitude towards PAS. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=4732783 Tue, 19 Apr 2011 23:00:00 +0100 4732783