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. Sat, 20 Mar 2010 16:15:13 +0100 http://www.medworm.com/index.php?rid=3342177&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F191%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342177 Mon, 08 Mar 2010 14:01:39 +0100 3342177 http://www.medworm.com/index.php?rid=3342176&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F189%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342176 Mon, 08 Mar 2010 14:01:39 +0100 3342176 http://www.medworm.com/index.php?rid=3342175&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F184%3Frss%3D1 Quality improvement (QI) is fundamental to maintaining high standards of health care. Significant debate exists concerning the necessity for an ethical approval system for those QI projects that push the boundaries, appearing more similar to research than QI. The authors discuss this issue identifying the core ethical issues in family medicine (FM), drawing upon the fundamental principles of medical ethics, including principles of autonomy, utility, justice and non-maleficence. Recent debate concerning the application of QI ethics boards is discussed with relevance to primary care and issues such as general practitioner (GP) intentions, the impact of QI on patients and the use of confidential patient data and the impact of dissemination. The authors conclude that a system of QI ethical app... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342175 Mon, 08 Mar 2010 14:01:39 +0100 3342175 http://www.medworm.com/index.php?rid=3342174&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F180%3Frss%3D1 This article tackles the current deficit in the supply of cadaveric organs by addressing the family veto in organ donation. The authors believe that the family veto matters—ethically as well as practically—and that policies that completely disregard the views of the family in this decision are likely to be counterproductive. Instead, this paper proposes to engage directly with the most important reasons why families often object to the removal of the organs of a loved one who has signed up to the donor registry—notably a failure to understand fully and deliberate on the information and a reluctance to deal with this sort of decision at an emotionally distressing time. To accommodate these concerns it is proposed to separate radically the process of information, deliberati... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342174 Mon, 08 Mar 2010 14:01:39 +0100 3342174 http://www.medworm.com/index.php?rid=3342173&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F174%3Frss%3D1 Conclusions The dying process of oxygen deprivation with helium is potentially quick and appears painless. It also bypasses the prescribing role of physicians, effectively demedicalising assisted suicide. Oxygen deprivation with a face mask is not acceptable because leaks are difficult to control and it may not eliminate rebreathing. These factors will extend time to unconsciousness and time to death. A hood method could reduce the problem of mask fit. With a hood, a flow rate of helium sufficient to provide continuous washout of expired gases would remedy problems observed with the mask. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342173 Mon, 08 Mar 2010 14:01:39 +0100 3342173 http://www.medworm.com/index.php?rid=3342172&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F170%3Frss%3D1 We examined how many patients across a whole Trust area in Wales were subject to some lack of capacity, how well documented this was and how many were potentially deprived of their liberty. We found that no patient was deprived of their liberty, but 8% lacked capacity to make either basic or complex decisions; another 5% lacked capacity to make complex decisions. Documentation was good in mental health and community directorates, but there were gaps in documentation (not practice) in the medical and surgical directorates. Routine collection of data improved documentation regarding deprivation of liberty criteria. There is a high likelihood that senior nursing staff underestimate the number of patients who lack capacity. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342172 Mon, 08 Mar 2010 14:01:39 +0100 3342172 http://www.medworm.com/index.php?rid=3342171&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F165%3Frss%3D1 This article explores the arguments concerning the apparent legal peculiarities of antidoping legislation and their ethically salient features in terms of: notions of culpability, liability and guilt; aspects of potential duplication of punishments and the limitations of athlete privacy in antidoping practice and policy. It is noted that tensions still exist between legal and ethical principles and norms that require further critical attention. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342171 Mon, 08 Mar 2010 14:01:39 +0100 3342171 http://www.medworm.com/index.php?rid=3342170&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F160%3Frss%3D1 In her 2003 article in the British Medical Journal, Ruth Macklin provocatively declared dignity to be a useless concept: either a vague restatement of other more precise values, such as autonomy or respect for persons, or an empty slogan. A recent response to Macklin has challenged this claim. Doris Schroeder attempts to rescue dignity by positing four distinct concepts that fall under the one umbrella term. She argues that much of the confusion surrounding dignity is due to the lack of disambiguation among these four concepts, but that once we understand the different values in question dignity becomes a powerful tool in the fields of human rights and bioethics. It is the goal of this paper to build upon Schroeder's insights by reconnecting the multiple strands of dignity she identifies. ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342170 Mon, 08 Mar 2010 14:01:39 +0100 3342170 http://www.medworm.com/index.php?rid=3342169&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F155%3Frss%3D1 Autonomy, an individual's right to make personal decisions regarding his/her own health, represents one of the major ethical principles of medicine. While there are many examples citing the benefits this right provides for the individual, the impact that personal healthcare decisions have on others is often neglected. Here, evidence from end-stage renal disease is reviewed to hypothesise the creation of a universal kidney donation programme that although provides unparalleled benefits to its citizens, relies on the participation of a large proportion of the society. Given that this essay also addresses the public's major concerns regarding kidney donation, one of the only remaining implementation barriers is the individuals' right not to participate. Therefore, irrespective of the humane a... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342169 Mon, 08 Mar 2010 14:01:39 +0100 3342169 http://www.medworm.com/index.php?rid=3342168&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F152%3Frss%3D1 The public discourse surrounding sex and severe disability over the past 40 years has largely focused on protecting vulnerable populations from abuse. However, health professionals and activists are increasingly recognising the inherent sexuality of disabled persons and attempting to find ways to accommodate their intimacy needs. This essay explores several ethical issues arising from such efforts. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342168 Mon, 08 Mar 2010 14:01:39 +0100 3342168 http://www.medworm.com/index.php?rid=3342167&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F148%3Frss%3D1 Ingmar Persson and Julian Savulescu argue that non-traditional forms of cognitive enhancement (those involving genetic engineering or pharmaceuticals) present a serious threat to humanity, since the fruits of such enhancement, accelerated scientific progress, will give the morally corrupt minority of humanity new and more effective ways to cause great harm. And yet it is scientific progress, accelerated by non-traditional cognitive enhancement, which could allow us to dramatically morally enhance human beings, thereby eliminating, or at least reducing, the threat from the morally corrupt minority. I argue that this apparently intractable dilemma is less difficult to resolve than Persson and Savulescu suppose. Their analysis of non-traditional cognitive enhancement overstates the risks and ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342167 Mon, 08 Mar 2010 14:01:39 +0100 3342167 http://www.medworm.com/index.php?rid=3342166&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F142%3Frss%3D1 Conclusions Kidney donors will accept a higher risk of death than is currently quoted, especially if risks are presented in terms of chance of survival. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342166 Mon, 08 Mar 2010 14:01:39 +0100 3342166 http://www.medworm.com/index.php?rid=3342165&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F138%3Frss%3D1 In this paper we argue that the responsibility for systematic community-based preventive medicine should not be made part of the role of the general practitioner (GP). Preventive medicine cannot be shown to be more effective than curative or supportive medicine. Therefore, the allocation of the large amount of general practice staff time and resources required for systematic preventive medicine should not come at the expense of the care of the sick and the suffering. The traditional healing role of the GP requires a cooperative patient-centred approach, whereas systematic preventive medicine is driven by rigid pre-set protocols and is intrinsically paternalistic. Trying to merge the two approaches is detrimental to the doctor-patient relationship. Furthermore, a number of potential pitfall... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342165 Mon, 08 Mar 2010 14:01:39 +0100 3342165 http://www.medworm.com/index.php?rid=3342164&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F132%3Frss%3D1 To investigate the current status of hospital clinical ethics committees (CEC) and how they have evolved in Canada over the past 20 years, this paper presents an overview of the findings from a 2008 survey and compares these findings with two previous Canadian surveys conducted in 1989 and 1984. All Canadian hospitals over 100 beds, of which at least some were acute care, were surveyed to determine the structure of CEC, how they function, the perceived achievements of these committees and opinions about areas with which CEC should be involved. The percentage of hospitals with CEC in our sample was found to be 85% compared with 58% and 18% in 1989 and 1984, respectively. The wide variation in the size of committees and the composition of their membership has continued. Meetings of CEC ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342164 Mon, 08 Mar 2010 14:01:39 +0100 3342164 http://www.medworm.com/index.php?rid=3342163&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F130%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342163 Mon, 08 Mar 2010 14:01:39 +0100 3342163 http://www.medworm.com/index.php?rid=3342162&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F3%2F129%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3342162 Mon, 08 Mar 2010 14:01:39 +0100 3342162 http://www.medworm.com/index.php?rid=3239066&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F126%3Frss%3D1 Discussion The low level of regrets suggests this is an acceptable procedure for patients. Trial registration The RCT was registered before initiation – registration # ISRCTN22153332. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239066 Thu, 04 Feb 2010 15:41:36 +0100 3239066 http://www.medworm.com/index.php?rid=3239065&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F121%3Frss%3D1 Conclusion Experience suggests that the active participation of students in determining which attributes are necessary for a good physician is a positive way of ensuring they embrace the importance of such qualities and attributes in themselves. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239065 Thu, 04 Feb 2010 15:41:36 +0100 3239065 http://www.medworm.com/index.php?rid=3239064&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F116%3Frss%3D1 We describe the ethical issues underpinning a placebo-controlled trial in severe malaria. To protect patients and minimise risk, all patients were referred immediately to hospital so that each had a higher chance of prompt treatment through participation. There was no difference between artesunate and placebo in patients who reached clinic rapidly; among those who could not, a single artesunate suppository significantly reduced death or permanent disability, a finding of direct and indirect benefit to patients in participating villages and elsewhere. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239064 Thu, 04 Feb 2010 15:41:36 +0100 3239064 http://www.medworm.com/index.php?rid=3239063&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F111%3Frss%3D1 The academic literature in research ethics has been marked in the past decade by a much broader focus on the need for the protection of developing communities subjected to international clinical trials. Because of the proximity of the revision of the Declaration of Helsinki, completed in October 2008, most papers have addressed the issue of a double standard of care following the use of placebo. However, other no less important issues, such as interactions between the lifestyles structures of low-income communities and the efficiency of risk-minimising procedures also deserve attention. The purpose of this paper is to discuss forms of uncertainty involved in clinical trials in poor and low-income countries that are not addressed by conventional methods of risk assessment. Furthermore, the ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239063 Thu, 04 Feb 2010 15:41:36 +0100 3239063 http://www.medworm.com/index.php?rid=3239062&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F106%3Frss%3D1 Conclusions The MacCAT-CR can be used to assess parental permission for neonatal research participation. Despite the stress of a critically ill neonate requiring surgery, parents were able to understand study-specific information and make informed decisions to permit their neonate's participation. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239062 Thu, 04 Feb 2010 15:41:36 +0100 3239062 http://www.medworm.com/index.php?rid=3239061&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F103%3Frss%3D1 To investigate how bereaved families felt about the explanation received before and after forensic autopsies, the authors conducted a cross-sectional survey of the bereaved families whose next of kin underwent a forensic autopsy at the two Departments of Forensic Medicine and a few bereaved families of crime victims. Of 403 questionnaires sent, 126 families responded. Among 81.5% of the respondents who received an explanation from policemen before the autopsy, 78.8% felt that the quality of the explanation was poor or improper. In Japan, the law has restricted disclosure of information from a forensic autopsy. Despite legal restrictions, 82% wanted to hear from the person who conducted the autopsy. However, police explained the results of autopsy to 65.2% of respondents. Among the families... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239061 Thu, 04 Feb 2010 15:41:36 +0100 3239061 http://www.medworm.com/index.php?rid=3239060&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F99%3Frss%3D1 The number of national bioethics commissions has burgeoned since the establishment of the first one in 1983. They provide an arena in which stakeholders with widely differing moral views can discuss, interact and negotiate about controversial matters. The establishment of the Brazilian committee is used as an example of how such bodies can be introduced. If such councils are to be implemented effectively and regarded as legitimate, the society as a whole should be included in the construction of the proposal and represented on the council, the council should have the benefit of specialist advice when that is needed, and the council should be linked to the elected government in an official advisory capacity. The article describes long process of planning and consultation to establish Brazil... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239060 Thu, 04 Feb 2010 15:41:36 +0100 3239060 http://www.medworm.com/index.php?rid=3239059&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F93%3Frss%3D1 Conclusion The results suggest a need for guidelines on benefit sharing, as well as trustworthy and stable measures to maintain privacy, as a means for increasing personal relevance and trust among potential participants in genetic research. Measures taken from biobanks seem insufficient in maintaining and increasing trust, suggesting that broader societal measures should be taken. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239059 Thu, 04 Feb 2010 15:41:36 +0100 3239059 http://www.medworm.com/index.php?rid=3239058&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F88%3Frss%3D1 Discussion Clinical professionals need to understand patients' need for detailed information when it comes to rationing, and to understand that they are the main gateway for this to be provided. However, disclosure could be distressing for both patients and professionals, and thus the most sensitive and acceptable ways to make this information available requires further investigation. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239058 Thu, 04 Feb 2010 15:41:36 +0100 3239058 http://www.medworm.com/index.php?rid=3239057&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F84%3Frss%3D1 One way of increasing the supply of organs available for transplant would be to switch to an opt-out system of donor registration. This is typically assumed to operate on the basis of presumed consent, but this faces the objection that not all of those who fail to opt out would actually consent to the use of their cadaveric organs. This paper defuses this objection, arguing that people's actual, explicit or implicit, consent to use their organs is not needed. It borrows David Estlund's notion of ‘normative consent’ from the justification of political authority and applies it to the case of organ donation. According to this idea, when it is wrong to withhold consent to something, the moral force of that lack of consent may be null and void. If it is wrong of a person to refuse t... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239057 Thu, 04 Feb 2010 15:41:36 +0100 3239057 http://www.medworm.com/index.php?rid=3239056&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F79%3Frss%3D1 Conclusion Financial instruments not only act as a countervailing power against providers insufficiently client-oriented, but are also used by providers to reinforce their own positions vis-à-vis demanding clients. Tailor-made finance is not the same as tailor-made care. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239056 Thu, 04 Feb 2010 15:41:36 +0100 3239056 http://www.medworm.com/index.php?rid=3239055&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F75%3Frss%3D1 Apotemnophilia is a condition that causes those who have it to not feel "correct" in their own bodies. As a result, an intense obsession develops with removing the limb; this obsession hinders tremendously the patients' social behaviour and societal integration. These patients, in some respects resembling transgendered individuals, feel that the body part (limb) in question is simply "not a part of themselves", causing them to feel uncomfortable in their own bodies. Whether amputations should be performed on apotemnophiles or not is a question that poses a significant medical ethical dilemma. It is argued that observing an apotemnophile's request for amputation is the ethical action. The major arguments opposing such amputations and supporting such amputations are examined and critically a... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239055 Thu, 04 Feb 2010 15:41:36 +0100 3239055 http://www.medworm.com/index.php?rid=3239054&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F71%3Frss%3D1 Conclusions The present study suggests that in most cases the forensic physician ignores the adolescent's word. Medical mission and ethics imply a need to listen to the claims of persons in custody, whatever the risk of false claims. This situation should prompt forensic physicians to keep up with published data on estimating the age of adolescents. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239054 Thu, 04 Feb 2010 15:41:35 +0100 3239054 http://www.medworm.com/index.php?rid=3239053&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F66%3Frss%3D1 The principle that physicians should always act in the best interests of the present patient is widely endorsed. At the same time, and often within the same document, it is recognised that there are appropriate exceptions to this principle. Unfortunately, little, if any, guidance is provided regarding which exceptions are appropriate and how they should be handled. These circumstances might be tenable if the appropriate exceptions were rare. Yet, evaluation of the literature reveals that there are numerous exceptions, several of which pervade clinical medicine. This situation leaves physicians without adequate guidance on when to allow exceptions and how to address them, increasing the chances for unfairness in practice. The present article considers the range of exceptions, illustrates ho... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239053 Thu, 04 Feb 2010 15:41:35 +0100 3239053 http://www.medworm.com/index.php?rid=3239052&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F2%2F65%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3239052 Thu, 04 Feb 2010 15:41:35 +0100 3239052 http://www.medworm.com/index.php?rid=3110752&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F63%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110752 Mon, 21 Dec 2009 18:03:48 +0100 3110752 http://www.medworm.com/index.php?rid=3110751&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F61%3Frss%3D1 The current concepts of autonomy, surrogate autonomy and informed consent often lead to futile and expensive care at the ends of life. They may impinge on the dignity of the patient as well as subject society to unwarranted expense. In order to provide affordable healthcare for all, these concepts are in need of modification. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110751 Mon, 21 Dec 2009 18:03:48 +0100 3110751 http://www.medworm.com/index.php?rid=3110750&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F55%3Frss%3D1 Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council (GMC) requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision an... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110750 Mon, 21 Dec 2009 18:03:48 +0100 3110750 http://www.medworm.com/index.php?rid=3110749&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F50%3Frss%3D1 Teaching medical ethics and law has become much more prominent in medical student education, largely as a result of a 1998 consensus statement on such teaching. Ethics is commonly taught at undergraduate level using lectures and small group tutorials, but there is no recognised method for transferring this theoretical knowledge into practice and ward-based learning. This reflective article by a Sheffield university undergraduate medical student describes the value of using a student-selected component to study practical clinical ethics and the use of a clinical ethics checklist. The ethical checklist was proposed by Sokol as a tool for use by medical staff during the ward round to prompt the consideration of important ethical principles in relation to care. This paper describes additional ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110749 Mon, 21 Dec 2009 18:03:48 +0100 3110749 http://www.medworm.com/index.php?rid=3110748&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F46%3Frss%3D1 Animal research remains a deeply controversial topic in biomedical science. While a vast amount has been written about the ethical status of laboratory animals, far less academic attention has been devoted to the public and, more specifically, to public opinion. Rather than what the public think, this article considers the role of ‘public opinion’. It draws on a recent empirical study which involved interviews with laboratory scientists who use animals in their research, and with other UK stakeholders. The first section of the paper demonstrates that public opinion has become a kind of resource in the animal research debate. Public opinion polls, in particular, are frequently cited. The second section explores this further and argues that, for all sides, appealing to public opi... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110748 Mon, 21 Dec 2009 18:03:48 +0100 3110748 http://www.medworm.com/index.php?rid=3110747&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F37%3Frss%3D1 Conclusions: We discuss the distinction drawn between motives for research participation focused upon self (personal) and others (familial/social), and observe that personal, social and familial motives can be seen as interdependent. For example, research participation that is undertaken to benefit others, particularly relatives, may also offer a number of personal benefits for self, such as enabling participants to feel that they have discharged their social or familial obligations. We argue for the need to move away from simple, static, individualised notions of research participation to a more complex, dynamic and inherently social account. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110747 Mon, 21 Dec 2009 18:03:48 +0100 3110747 http://www.medworm.com/index.php?rid=3110746&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F34%3Frss%3D1 Poor people predominate as a subgroup of those who take part in healthy volunteer research. They are subjected to minimised but unknown risks and unpleasant burdens so that the safety of new medicines can be evaluated. This is prima facie unfair especially given that the poor are often unable to access expensive medicines. Although participants in this kind of research often do receive compensation for their time, these payments are usually capped at a very low level. This paper defends a version of a reimbursement model for the payment of research subjects. This model is practical, would benefit those without an income who take part in research, and would make it possible for those in regular work to take part in phase 1 research. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110746 Mon, 21 Dec 2009 18:03:48 +0100 3110746 http://www.medworm.com/index.php?rid=3110745&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F30%3Frss%3D1 This article analyses the scope of the right not to know in the context of embryo selection against Huntington’s disease. It concludes that the right not to know implies that PGD against Huntington should be allowed by means of the exclusion test. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110745 Mon, 21 Dec 2009 18:03:48 +0100 3110745 http://www.medworm.com/index.php?rid=3110744&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F24%3Frss%3D1 Conclusions: Similar cases are not uniformly labelled. However, a physicians’ label is strongly associated with their willingness to report their acts. Differences in how physicians label similar acts impede complete societal control. Further education and debate could enhance the level of agreement about what is physician-assisted dying, and thus should be reported, and what not. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110744 Mon, 21 Dec 2009 18:03:48 +0100 3110744 http://www.medworm.com/index.php?rid=3110743&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F19%3Frss%3D1 Conclusion: These data confirm that most physicians have engaged in self-prescribing or curbside requests for prescriptions. It can be argued that curbsiding is more morally problematic than self-prescribing because it implicates a third party, and should be discouraged regardless of whether the requester is a colleague, family member or friend. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110743 Mon, 21 Dec 2009 18:03:48 +0100 3110743 http://www.medworm.com/index.php?rid=3110742&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F12%3Frss%3D1 Healthcare workers (HCWs) are often assumed to have a duty to work, even if faced with personal risk. This is particularly so for professionals (doctors and nurses). However, the health service also depends on non-professionals, such as porters, cooks and cleaners. The duty to work is currently under scrutiny because of the ongoing challenge of responding to pandemic influenza, where an effective response depends on most uninfected HCWs continuing to work, despite personal risk. This paper reports findings of a survey of HCWs (n = 1032) conducted across three National Health Service trusts in the West Midlands, UK, to establish whether HCWs’ likelihood of working during a pandemic is associated with views about the duty to work. The sense that HCWs felt that they had a duty to work d... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110742 Mon, 21 Dec 2009 18:03:48 +0100 3110742 http://www.medworm.com/index.php?rid=3110741&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F7%3Frss%3D1 Ethical guidance from the British Medical Association (BMA) about treating doctor–patients is compared and contrasted with evidence from a qualitative study of general practitioners (GPs) who have been patients. Semistructured interviews were conducted with 17 GPs who had experienced a significant illness. Their experiences were discussed and issues about both being and treating doctor–patients were revealed. Interpretative phenomenological analysis was used to evaluate the data. In this article data extracts are used to illustrate and discuss three key points that summarise the BMA ethical guidance, in order to develop a picture of how far experiences map onto guidance. The data illustrate and extend the complexities of the issues outlined by the BMA document. In particular, d... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110741 Mon, 21 Dec 2009 18:03:48 +0100 3110741 http://www.medworm.com/index.php?rid=3110740&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F2%3Frss%3D1 Conclusion: The present study provided evidence for the view that people’s ascription of intentions to others is influenced by their previous evaluative judgement of the conduct in question. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110740 Mon, 21 Dec 2009 18:03:48 +0100 3110740 http://www.medworm.com/index.php?rid=3110739&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F36%2F1%2F1%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3110739 Mon, 21 Dec 2009 18:03:48 +0100 3110739 http://www.medworm.com/index.php?rid=3044084&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F778%3Frss%3D1 Bioethicists disagree over methods, theories, decision-making guides, case analyses and public policies. Thirty years ago, the thinking of many scholars coalesced around a principlist approach to bioethics. That mid-level mode of moral reasoning is now one of many approaches to moral deliberation. Significant variation in contemporary approaches to the study of ethical issues related to medicine, biotechnology and health care raises the question of whether bioethics exists as widely shared method, theory, normative framework or mode of moral reasoning. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044084 Mon, 30 Nov 2009 18:48:24 +0100 3044084 http://www.medworm.com/index.php?rid=3044083&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F774%3Frss%3D1 It is not possible on naturalistic grounds to argue either for or against an entity such as the human embryo having full moral status and deserving our fullest moral attention. In addition, it is difficult to see the point of asserting this moral status. Instead of citing nature as the grounds for demarcating moral status, perhaps it would be better to look at the decisions and activities that demarcate nature and establish the nature–culture gap. Our decisions and activities are expressions of our understanding of ourselves and I would like to argue that when considering the human embryo the real question we should be asking is what kinds of actions are dehumanising us. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044083 Mon, 30 Nov 2009 18:48:24 +0100 3044083 http://www.medworm.com/index.php?rid=3044082&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F768%3Frss%3D1 Conclusions: The findings suggest that participants enrolled in prevention trials for mental illness are likely to hold positive attitudes (eg, high commitment, low expectation of personal gain) towards research trials. The identification of relationships between key person factors and trial-related attitudes enabled profiling of participant groups, which can inform recruitment strategies and interactions of participants and research projects in future prevention trials. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044082 Mon, 30 Nov 2009 18:48:24 +0100 3044082 http://www.medworm.com/index.php?rid=3044081&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F762%3Frss%3D1 Objectives: To investigate life scientists’ views of accountability and the ethical and societal implications of research. Design: Qualitative focus group and one-on-one interviews. Participants: 45 Stanford University life scientists, including graduate students, postdoctoral fellows and faculty. Results: Two main themes were identified in participants’ discussions of accountability: (1) the "how" of science and (2) the "why" of science. The "how" encompassed the internal conduct of research including attributes such as honesty and independence. The "why," or the motivation for conducting research, was two-tiered: first was the desire to positively impact the research community and science itself, and second was an interest in positively impacting the external community, br... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044081 Mon, 30 Nov 2009 18:48:24 +0100 3044081 http://www.medworm.com/index.php?rid=3044080&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F753%3Frss%3D1 Conclusions: Public health information systems should be carefully engineered only after a clear strategy for privacy protection has been planned, to avoid breaching current regulations and future concerns and to optimise the development of statistical routines. The BIRO (Best Information Through Regional Outcomes) project delivers a specific method of privacy impact assessment that can be conveniently used in similar situations across Europe. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044080 Mon, 30 Nov 2009 18:48:24 +0100 3044080 http://www.medworm.com/index.php?rid=3044079&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F747%3Frss%3D1 Peter Singer has argued that we should not proceed with a hypothetical life-extension drug, based on a scenario in which developing the drug would fail to achieve the greatest sum of happiness over time. However, this is the wrong test. If we ask, more simply, which policy would be more benevolent, we reach a different conclusion from Singer’s: even given his (admittedly questionable) scenario, development of the drug should go ahead. Singer’s rigorous utilitarian position pushes him in the direction of an implausible "total view" utilitarianism when it encounters the problems presented by certain thought experiments. A more pluralistic account of the nature of morality promises to solve these problems, and in this case it reaches a benevolent recommendation on life-extension t... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044079 Mon, 30 Nov 2009 18:48:24 +0100 3044079 http://www.medworm.com/index.php?rid=3044078&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F743%3Frss%3D1 In conclusion, if there are no in-principle objections against condom usage for HIV-discordant couples, then policies that deny access to condoms to such couples are indefensible. HIV-discordant couples have a right to continue consummating their marriage in a manner that is minimally risky and this right cannot be trumped by utilitarian concerns that the distribution of condoms might increase promiscuity and along with it the HIV infection rate. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044078 Mon, 30 Nov 2009 18:48:24 +0100 3044078 http://www.medworm.com/index.php?rid=3044077&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F739%3Frss%3D1 Is it possible to invoke the use of moral responsibility as part of the selection criteria in the allocation of livers for transplant? Criticism has been applied to the difficulties inherent in including such a criterion and also the effect that employing such a judgement might have upon the relationship between the physician and patient. However, these criticisms rely on speculation and conjecture and do not relate to all the arguments put forward in favour of applying moral responsibility. None of the present arguments against using moral responsibility in the allocation of livers for transplant are good enough to warrant its dismissal. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044077 Mon, 30 Nov 2009 18:48:24 +0100 3044077 http://www.medworm.com/index.php?rid=3044076&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F738%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044076 Mon, 30 Nov 2009 18:48:24 +0100 3044076 http://www.medworm.com/index.php?rid=3044075&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F733%3Frss%3D1 The Mental Capacity Act (2005) is an impressive piece of legislation that deserves serious ethical attention, but much of the commentary on the Act has focussed on its legal and practical implications rather than the underlying ethical concepts. This paper examines the approach that the Act takes to best interests. The Act does not provide an account of the underlying concept of best interests. Instead it lists factors that must be considered in determining best interests, and the Code of Practice to the Act states that this list is incomplete. This paper argues that this general approach is correct, contrary to some accounts of best interests. The checklist includes items that are unhelpful. Furthermore, neither the Act nor its Code of Practice provides sufficient guidance to carers faced... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044075 Mon, 30 Nov 2009 18:48:24 +0100 3044075 http://www.medworm.com/index.php?rid=3044074&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F729%3Frss%3D1 Conclusions: MC are underutilised even in Islamic culture, especially among female physicians. Training in western countries is favourably associated with MC use. Underutilisation appears to be related to privacy/confidentiality, understaffing and failure of patients to request a MC. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044074 Mon, 30 Nov 2009 18:48:24 +0100 3044074 http://www.medworm.com/index.php?rid=3044073&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F728%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044073 Mon, 30 Nov 2009 18:48:24 +0100 3044073 http://www.medworm.com/index.php?rid=3044072&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F722%3Frss%3D1 This study, however, is the first of its kind examining the views of hearing children of deaf adults towards preimplantation genetic diagnosis and prenatal diagnosis to select for or against deafness. Hearing children of deaf adults (or CODAs, as they call themselves, and are widely known in the deaf community) straddle both the deaf and hearing worlds, and this dual perspective makes them ideally placed to add to the academic discourse concerning the use of genetic selection for or against deafness. The study incorporated two complementary stages, using initial, semistructured interviews with key informants (CODAs and health professionals) as a means to guide the subsequent development of an electronic survey, completed anonymously by 66 individuals. The participants shared many of the sa... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044072 Mon, 30 Nov 2009 18:48:24 +0100 3044072 http://www.medworm.com/index.php?rid=3044071&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F720%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044071 Mon, 30 Nov 2009 18:48:24 +0100 3044071 http://www.medworm.com/index.php?rid=3044070&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F718%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044070 Mon, 30 Nov 2009 18:48:24 +0100 3044070 http://www.medworm.com/index.php?rid=3044069&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F12%2F717%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=3044069 Mon, 30 Nov 2009 18:48:23 +0100 3044069 http://www.medworm.com/index.php?rid=2946653&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F715%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946653 Fri, 30 Oct 2009 17:01:41 +0100 2946653 http://www.medworm.com/index.php?rid=2946652&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F713%3Frss%3D1 New empirical evidence on the long-term effects of oestrogen treatment for tall adolescent girls has shown that the intended psychosocial benefit of the treatment may not have been realised. This paper describes recent trends in the prevalence of the treatment and the results of a large Australian cohort study evaluating girls assessed between 1959 and 1993 for excessive growth. The paper concludes that oestrogen treatment to prevent extreme tallness should belong to the past, not to the future. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946652 Fri, 30 Oct 2009 17:01:41 +0100 2946652 http://www.medworm.com/index.php?rid=2946651&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F709%3Frss%3D1 Conclusion: Patients are willing to decide on their own participation in a study. If they lose their capacity to decide for themselves, in the great majority of cases, they would agree to delegate the decision to a relative. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946651 Fri, 30 Oct 2009 17:01:41 +0100 2946651 http://www.medworm.com/index.php?rid=2946650&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F701%3Frss%3D1 Background: Lay persons’ judgements of the acceptability of the not uncommon practice of ending the life of a damaged neonate have not been studied. Methods: A convenience sample of 1635 lay people in France rated how acceptable it would be for a physician to end a neonate’s life—by withholding care, withdrawing care, or active euthanasia—in 54 scenarios in which the neonate was diagnosed either with perinatal asphyxia or a genetic abnormality. The scenarios were all combinations of four factors: three levels of maturity or immaturity, three levels of severity of the health problem, three levels of parents’ preference concerning prolonging care and two levels of decision-making (with or without consulting the other caregivers). Analyses: Analyses of variance... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946650 Fri, 30 Oct 2009 17:01:41 +0100 2946650 http://www.medworm.com/index.php?rid=2946649&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F696%3Frss%3D1 Conclusions: Despite the efforts for harmonisation of the European Clinical Trial Directive, from an ethical point of view, there remains a plurality of ethics committees' systems in Europe. It is important to comprehend the individual national systems to understand the problems they are facing. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946649 Fri, 30 Oct 2009 17:01:41 +0100 2946649 http://www.medworm.com/index.php?rid=2946648&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F692%3Frss%3D1 This paper uses the case of solo doctors to explore whether working in relative isolation from one’s peers may be detrimental to ethical decision-making. Drawing upon the relevance of communication and interaction for ethical decision-making in the ethical theories of Habermas, Mead and Gadamer, it is argued that doctors benefit from ethical discussion with their peers and that solo practice may make this more difficult. The paper identifies a paucity of empirical research related to solo practice and ethics but draws upon more general medical ethics research and a study that identified ethical isolation among community pharmacists to support the theoretical claims made. The paper concludes by using the literary analogy of Soderberg’s Doctor Glas to illustrate the issues raised... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946648 Fri, 30 Oct 2009 17:01:41 +0100 2946648 http://www.medworm.com/index.php?rid=2946647&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F688%3Frss%3D1 Telecare, the provision of care through remote interaction enabled by information and communication technology, is quickly developing. Integration with other technological developments is to be expected and will create systems that enable more intense, continuous and unobtrusive monitoring of health, and more personalised feedback and instructions. One of the goals of telecare is enhancing the independence and self-management of patients. In this article three degrees of self-management are described and a distinction is made between compliant and concordant forms of self-management. It is argued that telecare merely promotes forms of self-management in which compliance to medical instructions is central. Technological developments and normative policy considerations may enforce this trend... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946647 Fri, 30 Oct 2009 17:01:41 +0100 2946647 http://www.medworm.com/index.php?rid=2946646&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F684%3Frss%3D1 In a seminal article in the Journal of Medical Ethics, Søren Holm and Tuja Takala analysed two protechnology arguments in bioethics: the hopeful principle and the automatic escalator. They showed how these arguments relate to problematic arguments such as the precautionary principle and the empirical slippery slope argument, and argued that they should be used with great caution. The present article investigates the recent debate on proton beam therapy, where the hopeful principle and the automatic escalator are identified. However, the debate reveals a series of other arguments that deserve similar caution. An analysis of these arguments indicates that the roots of their fallacies are to be found in the ignorance of the uncertainties about risks and benefits and an overly optimisti... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946646 Fri, 30 Oct 2009 17:01:41 +0100 2946646 http://www.medworm.com/index.php?rid=2946645&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F678%3Frss%3D1 Much bioethical discussion has been devoted to the subject of human enhancement through various technological means such as genetic modification. Although many of the same technologies could be, indeed in many cases already have been, applied to non-human animals, there has been very little consideration of the concept of "animal enhancement", at least not in those specific terms. This paper addresses the notion of animal enhancement and the ethical issues surrounding it. A definition of animal enhancement is proposed that provides a framework within which to consider these issues; and it is argued that if human enhancement can be considered to be a moral obligation, so too can animal enhancement. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946645 Fri, 30 Oct 2009 17:01:41 +0100 2946645 http://www.medworm.com/index.php?rid=2946644&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F672%3Frss%3D1 Conclusion: The study reveals failing procedures and thus a great potential for improvement. Both ethical and legal aspects must be addressed when considering patient autonomy. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946644 Fri, 30 Oct 2009 17:01:41 +0100 2946644 http://www.medworm.com/index.php?rid=2946643&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F668%3Frss%3D1 The British National Institute for Health and Clinical Excellence (NICE) has recently (28 January 2009) released new guidelines for the diagnosis, treatment and prevention of the psychiatric category antisocial personality disorder (ASPD). Evident in these recommendations is a broader ambiguity regarding the ontology of ASPD. Although, perhaps, a mundane feature of much of medicine, in this case, ontological uncertainty has significant ethical implications as a product of the profound consequences for an individual categorised with this disorder. This paper argues that in refraining from emphasising uncertainty, NICE risks reifying a controversial category. This is particularly problematical given that the guidelines recommend the identification of individuals "at risk" of raising antisoci... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946643 Fri, 30 Oct 2009 17:01:41 +0100 2946643 http://www.medworm.com/index.php?rid=2946642&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F662%3Frss%3D1 In conclusion, suggestions as to how ethical decision-making processes can be supported and improved in infertility practice will be made. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946642 Fri, 30 Oct 2009 17:01:41 +0100 2946642 http://www.medworm.com/index.php?rid=2946641&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F658%3Frss%3D1 In 2006, a paper in the journal Archives of Pediatric and Adolescent Medicine described a novel case of growth attenuation therapy and other treatments carried out on Ashley, a severely cognitively, neurologically and physically disabled 6-year-old girl. Some of the moral arguments that have sprung up in respect of the so-called "Ashley treatment" are considered, and it is suggested that they all miss something—that the proper treatment of Ashley may have as much to do with doctors’ duties to themselves as with their duties to her. It is suggested that the Ashley treatment may have been in violation of doctors’ self-regarding duties and that this possibility is worthy of further investigation. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946641 Fri, 30 Oct 2009 17:01:41 +0100 2946641 http://www.medworm.com/index.php?rid=2946640&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F656%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946640 Fri, 30 Oct 2009 17:01:40 +0100 2946640 http://www.medworm.com/index.php?rid=2946639&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F654%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946639 Fri, 30 Oct 2009 17:01:40 +0100 2946639 http://www.medworm.com/index.php?rid=2946638&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F11%2F653%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2946638 Fri, 30 Oct 2009 17:01:40 +0100 2946638 http://www.medworm.com/index.php?rid=2851070&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F651%3Frss%3D1 In a previous paper, I had argued that Strong’s counterexamples to Marquis’s argument against abortion—according to which terminating fetuses is wrong because it deprives them of a valuable future—fail either because they have no bearing on Marquis’s argument or because they make unacceptable claims about what constitutes a valuable future. In this paper I respond to Strong’s criticism of my argument according to which I fail to acknowledge that Marquis uses "future like ours" and "valuable future" interchangeably. I show that my argument does not rely on not acknowledging that "future like ours" and "valuable future" are interchangeable; and that, rather, it is exactly by replacing "future like ours" with "valuable future" that I construct my argument a... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851070 Wed, 30 Sep 2009 17:01:31 +0100 2851070 http://www.medworm.com/index.php?rid=2851069&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F647%3Frss%3D1 Whether treatment decision-making capacity can be meaningfully applied to patients with a diagnosis of "personality disorder" is examined. Patients presenting to a psychiatric emergency clinic with threats of self-harm are considered, two having been assessed and reviewed in detail. It was found that capacity can be meaningfully assessed in such patients, although the process is more complex than in patients with diagnoses of a more conventional kind. The process of assessing capacity in such patients is very time-consuming and may become, in itself, a therapeutic intervention. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851069 Wed, 30 Sep 2009 17:01:31 +0100 2851069 http://www.medworm.com/index.php?rid=2851068&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F644%3Frss%3D1 Locked inpatient units are an increasing phenomenon, introduced in response to unforseen abscondences and suicides of patients. This paper identifies some value issues concerning the practice of locked psychiatric inpatient units. Broad strategies, practicalities and ethical matters that must be considered in inpatient mental health services are also explored. The authors draw on the published research and commentary to derive relevant information to provide to patients and staff regarding the aims and rationales of locked units. Further debate is warranted in relation to best practice. Inpatient staff need to be aware of their practice values, be able to access education and supervision and negotiate apparent contradictions. Further patient/clinician focused enquiry is necessary to mitiga... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851068 Wed, 30 Sep 2009 17:01:31 +0100 2851068 http://www.medworm.com/index.php?rid=2851067&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F638%3Frss%3D1 This paper presents challenges facing researchers in applying basic ethical principles while conducting research with youth in a developing country context. A discussion of the cultural and social challenges to adherence to the elements of informed consent: disclosure, comprehension, capacity, voluntariness and consent is presented. The authors argue that the current institutional review board requirements that guide research reflect values and stem from western contexts that may not be fully applicable to non-western contexts. More dialogue is needed among researchers in developing world contexts on challenges of and possible revisions to requirements that maintain respect for persons, beneficence, autonomy and justice, particularly when working with youth. (Source: Journal of Medical Eth... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851067 Wed, 30 Sep 2009 17:01:31 +0100 2851067 http://www.medworm.com/index.php?rid=2851066&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F635%3Frss%3D1 One of the basic tenets of paediatric ethics is that competent parents may render healthcare decisions for children who are too young or too incapacitated to make meaningful medical choices for themselves. In the USA, many jurisdictions have expanded this principle to include the right to terminate a child's life support, including nutrition and hydration, when that child enters a persistent vegetative state. However, this approach to the withdrawal of care in the paediatric setting has been put to the test by an increasing number of cases in which one or both parents are themselves accused of causing the child's life-threatening injuries. In such "mixed-motive" situations, parents may express a desire to keep a child on life support for religious or moral reasons; at the same time, forest... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851066 Wed, 30 Sep 2009 17:01:31 +0100 2851066 http://www.medworm.com/index.php?rid=2851065&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F626%3Frss%3D1 Discussion: While a majority of respondents perceived a duty to disclose the incidental results of newborn screening, the policy implications of these attitudes are not obvious. In particular, policy must balance descriptive ethics (ie, what providers believe) and normative ethics (ie, what duty-based principles oblige), address dissenting opinion and consider the relevance of moral principles grounded in clinical obligations for public health initiatives. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851065 Wed, 30 Sep 2009 17:01:31 +0100 2851065 http://www.medworm.com/index.php?rid=2851064&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F621%3Frss%3D1 Society in the 21st century is in many ways different from society in the 1950s, the 1960s or the 1970s. Two of the most important changes relate to the level of education in the population and the balance between work and private life. These days a large percentage of people are highly educated. Partly as a result of economic progress in the 1950s and the 1960s and partly due to the fact that many women entered the labour force, people started searching for ways to combine their career with family obligations and a private life (including hobbies, outings and holidays). Medical professional ethics, more specifically: professional attitudes towards patients and colleagues, is influenced by developments such as these, but how much and in what way? It was assumed that surgery ethics would be... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851064 Wed, 30 Sep 2009 17:01:31 +0100 2851064 http://www.medworm.com/index.php?rid=2851063&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F616%3Frss%3D1 The practice of transplantation of vital organs from "brain-dead" donors is in a state of theoretical disarray. Although the law and prevailing medical ethics treat patients diagnosed as having irreversible total brain failure as dead, scholars have increasingly challenged the established rationale for regarding these patients as dead. To understand the ethical situation that we now face, it is helpful to revisit the writings of the philosopher Hans Jonas, who forcefully challenged the emerging effort to redefine death in the late 1960s. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851063 Wed, 30 Sep 2009 17:01:31 +0100 2851063 http://www.medworm.com/index.php?rid=2851062&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F611%3Frss%3D1 This article reviews the ethical and pragmatic implications of nootropic use in academia by drawing parallels with issues relevant to the drugs in sport debate. It is often argued that performance-enhancing drugs should be prohibited because they create an uneven playing field. However, this appears dubious given that "unfair" advantages are already ubiquitous and generally tolerated by society. There are concerns that widespread use will indirectly coerce non-users also to employ nootropics in order to remain competitive. However, to restrict the autonomy of all people for fear that it may influence the actions of some is untenable. The use of potentially harmful drugs for the purposes of enhancement rather than treatment is often seen as unjustified, and libertarian approaches generally ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851062 Wed, 30 Sep 2009 17:01:30 +0100 2851062 http://www.medworm.com/index.php?rid=2851061&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F607%3Frss%3D1 Body art as expressed through non-therapeutic bodily modification is extremely popular, with techniques ranging from the commonplace such as ear piercing to the more esoteric forms such as tongue splitting. Scarification is one such body art practice that is becoming popular as an alternative to tattooing and ear piercing. This paper begins by outlining the regulatory problems that scarification poses. It then goes on to argue that although there is a reasonable case for permitting competent adults to make use of scarification, the practice should not be made available to minors. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851061 Wed, 30 Sep 2009 17:01:30 +0100 2851061 http://www.medworm.com/index.php?rid=2851060&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F603%3Frss%3D1 Disabling pain or symptoms can occur at any age from many different causes. Pain and palliative specialists are able to relieve most pain and symptoms, although repeated adjustments to modalities, medications and doses may be needed. Because pain and palliative specialists comprise only a small percentage of physicians, many patients find it difficult to access them or obtain pain relief. Globally, there are too few such specialists to meet existing needs. Most are affiliated with hospice and palliative units, so their accessibility to patients without terminal conditions is negligible. Doctors outside pain and palliative specialties are often unfamiliar with pain guidelines and sceptical about patient reports of unrelieved pain. They are therefore likely to undertreat it. Undertreating pa... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851060 Wed, 30 Sep 2009 17:01:30 +0100 2851060 http://www.medworm.com/index.php?rid=2851059&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F599%3Frss%3D1 Abortion is one of the most divisive topics in healthcare. Proponents and opponents hold strong views. Some health workers who oppose abortion assert a right of conscientious objection to it, a position itself that others find unethical. Even if allowance for objection should be made, it is not clear how far it should extend. Can conscientious objection be given as a reason not to refer when a woman requests her doctor to do so? This paper explores the idea of the general practitioner (GP) who declines to make a direct referral for abortion, asking the woman to see another GP instead. The purpose is to defend the claim that an appeal to conscientious objection in this way can be reasonable and ethical. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851059 Wed, 30 Sep 2009 17:01:30 +0100 2851059 http://www.medworm.com/index.php?rid=2851058&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F594%3Frss%3D1 Unanswered questions and ethical issues associated with US biodefence medical research over the past five decades are discussed. Objective scientific standards are essential for making policy decisions that can stand the test of time. For decades, scholars have reported that the human anthrax vaccine field trials conducted in the 1950s by Brachman and his colleagues were single-blind rather than double-blind. Nevertheless, in March 2005, Dr Philip S Brachman reported in a letter to the US Food and Drug Administration that his study had been double-blind. It is here argued that, rather, the field trial of a human anthrax vaccine should continue to be deemed as single-blind unless more detailed information is provided to explain exactly how the investigators were kept unaware of which subjec... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851058 Wed, 30 Sep 2009 17:01:30 +0100 2851058 http://www.medworm.com/index.php?rid=2851057&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F592%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851057 Wed, 30 Sep 2009 17:01:30 +0100 2851057 http://www.medworm.com/index.php?rid=2851056&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F590%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851056 Wed, 30 Sep 2009 17:01:30 +0100 2851056 http://www.medworm.com/index.php?rid=2851055&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F589%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2851055 Wed, 30 Sep 2009 17:01:30 +0100 2851055 http://www.medworm.com/index.php?rid=2845969&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F651%3Frss%3D1 In a previous paper, I had argued that Strong’s counterexamples to Marquis’s argument against abortion—according to which terminating fetuses is wrong because it deprives them of a valuable future—fail either because they have no bearing on Marquis’s argument or because they make unacceptable claims about what constitutes a valuable future. In this paper I respond to Strong’s criticism of my argument according to which I fail to acknowledge that Marquis uses "future like ours" and "valuable future" interchangeably. I show that my argument does not rely on not acknowledging that "future like ours" and "valuable future" are interchangeable; and that, rather, it is exactly by replacing "future like ours" with "valuable future" that I construct my argument a... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845969 Tue, 29 Sep 2009 23:00:00 +0100 2845969 http://www.medworm.com/index.php?rid=2845968&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F647%3Frss%3D1 Whether treatment decision-making capacity can be meaningfully applied to patients with a diagnosis of "personality disorder" is examined. Patients presenting to a psychiatric emergency clinic with threats of self-harm are considered, two having been assessed and reviewed in detail. It was found that capacity can be meaningfully assessed in such patients, although the process is more complex than in patients with diagnoses of a more conventional kind. The process of assessing capacity in such patients is very time-consuming and may become, in itself, a therapeutic intervention. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845968 Tue, 29 Sep 2009 23:00:00 +0100 2845968 http://www.medworm.com/index.php?rid=2845967&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F644%3Frss%3D1 Locked inpatient units are an increasing phenomenon, introduced in response to unforseen abscondences and suicides of patients. This paper identifies some value issues concerning the practice of locked psychiatric inpatient units. Broad strategies, practicalities and ethical matters that must be considered in inpatient mental health services are also explored. The authors draw on the published research and commentary to derive relevant information to provide to patients and staff regarding the aims and rationales of locked units. Further debate is warranted in relation to best practice. Inpatient staff need to be aware of their practice values, be able to access education and supervision and negotiate apparent contradictions. Further patient/clinician focused enquiry is necessary to mitiga... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845967 Tue, 29 Sep 2009 23:00:00 +0100 2845967 http://www.medworm.com/index.php?rid=2845966&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F638%3Frss%3D1 This paper presents challenges facing researchers in applying basic ethical principles while conducting research with youth in a developing country context. A discussion of the cultural and social challenges to adherence to the elements of informed consent: disclosure, comprehension, capacity, voluntariness and consent is presented. The authors argue that the current institutional review board requirements that guide research reflect values and stem from western contexts that may not be fully applicable to non-western contexts. More dialogue is needed among researchers in developing world contexts on challenges of and possible revisions to requirements that maintain respect for persons, beneficence, autonomy and justice, particularly when working with youth. (Source: Journal of Medical Eth... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845966 Tue, 29 Sep 2009 23:00:00 +0100 2845966 http://www.medworm.com/index.php?rid=2845965&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F635%3Frss%3D1 One of the basic tenets of paediatric ethics is that competent parents may render healthcare decisions for children who are too young or too incapacitated to make meaningful medical choices for themselves. In the USA, many jurisdictions have expanded this principle to include the right to terminate a child's life support, including nutrition and hydration, when that child enters a persistent vegetative state. However, this approach to the withdrawal of care in the paediatric setting has been put to the test by an increasing number of cases in which one or both parents are themselves accused of causing the child's life-threatening injuries. In such "mixed-motive" situations, parents may express a desire to keep a child on life support for religious or moral reasons; at the same time, forest... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845965 Tue, 29 Sep 2009 23:00:00 +0100 2845965 http://www.medworm.com/index.php?rid=2845964&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F626%3Frss%3D1 Discussion: While a majority of respondents perceived a duty to disclose the incidental results of newborn screening, the policy implications of these attitudes are not obvious. In particular, policy must balance descriptive ethics (ie, what providers believe) and normative ethics (ie, what duty-based principles oblige), address dissenting opinion and consider the relevance of moral principles grounded in clinical obligations for public health initiatives. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845964 Tue, 29 Sep 2009 23:00:00 +0100 2845964 http://www.medworm.com/index.php?rid=2845963&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F621%3Frss%3D1 Society in the 21st century is in many ways different from society in the 1950s, the 1960s or the 1970s. Two of the most important changes relate to the level of education in the population and the balance between work and private life. These days a large percentage of people are highly educated. Partly as a result of economic progress in the 1950s and the 1960s and partly due to the fact that many women entered the labour force, people started searching for ways to combine their career with family obligations and a private life (including hobbies, outings and holidays). Medical professional ethics, more specifically: professional attitudes towards patients and colleagues, is influenced by developments such as these, but how much and in what way? It was assumed that surgery ethics would be... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845963 Tue, 29 Sep 2009 23:00:00 +0100 2845963 http://www.medworm.com/index.php?rid=2845962&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F616%3Frss%3D1 The practice of transplantation of vital organs from "brain-dead" donors is in a state of theoretical disarray. Although the law and prevailing medical ethics treat patients diagnosed as having irreversible total brain failure as dead, scholars have increasingly challenged the established rationale for regarding these patients as dead. To understand the ethical situation that we now face, it is helpful to revisit the writings of the philosopher Hans Jonas, who forcefully challenged the emerging effort to redefine death in the late 1960s. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845962 Tue, 29 Sep 2009 23:00:00 +0100 2845962 http://www.medworm.com/index.php?rid=2845961&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F611%3Frss%3D1 This article reviews the ethical and pragmatic implications of nootropic use in academia by drawing parallels with issues relevant to the drugs in sport debate. It is often argued that performance-enhancing drugs should be prohibited because they create an uneven playing field. However, this appears dubious given that "unfair" advantages are already ubiquitous and generally tolerated by society. There are concerns that widespread use will indirectly coerce non-users also to employ nootropics in order to remain competitive. However, to restrict the autonomy of all people for fear that it may influence the actions of some is untenable. The use of potentially harmful drugs for the purposes of enhancement rather than treatment is often seen as unjustified, and libertarian approaches generally ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845961 Tue, 29 Sep 2009 23:00:00 +0100 2845961 http://www.medworm.com/index.php?rid=2845960&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F607%3Frss%3D1 Body art as expressed through non-therapeutic bodily modification is extremely popular, with techniques ranging from the commonplace such as ear piercing to the more esoteric forms such as tongue splitting. Scarification is one such body art practice that is becoming popular as an alternative to tattooing and ear piercing. This paper begins by outlining the regulatory problems that scarification poses. It then goes on to argue that although there is a reasonable case for permitting competent adults to make use of scarification, the practice should not be made available to minors. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845960 Tue, 29 Sep 2009 23:00:00 +0100 2845960 http://www.medworm.com/index.php?rid=2845959&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F603%3Frss%3D1 Disabling pain or symptoms can occur at any age from many different causes. Pain and palliative specialists are able to relieve most pain and symptoms, although repeated adjustments to modalities, medications and doses may be needed. Because pain and palliative specialists comprise only a small percentage of physicians, many patients find it difficult to access them or obtain pain relief. Globally, there are too few such specialists to meet existing needs. Most are affiliated with hospice and palliative units, so their accessibility to patients without terminal conditions is negligible. Doctors outside pain and palliative specialties are often unfamiliar with pain guidelines and sceptical about patient reports of unrelieved pain. They are therefore likely to undertreat it. Undertreating pa... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845959 Tue, 29 Sep 2009 23:00:00 +0100 2845959 http://www.medworm.com/index.php?rid=2845958&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F599%3Frss%3D1 Abortion is one of the most divisive topics in healthcare. Proponents and opponents hold strong views. Some health workers who oppose abortion assert a right of conscientious objection to it, a position itself that others find unethical. Even if allowance for objection should be made, it is not clear how far it should extend. Can conscientious objection be given as a reason not to refer when a woman requests her doctor to do so? This paper explores the idea of the general practitioner (GP) who declines to make a direct referral for abortion, asking the woman to see another GP instead. The purpose is to defend the claim that an appeal to conscientious objection in this way can be reasonable and ethical. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845958 Tue, 29 Sep 2009 23:00:00 +0100 2845958 http://www.medworm.com/index.php?rid=2845957&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F594%3Frss%3D1 Unanswered questions and ethical issues associated with US biodefence medical research over the past five decades are discussed. Objective scientific standards are essential for making policy decisions that can stand the test of time. For decades, scholars have reported that the human anthrax vaccine field trials conducted in the 1950s by Brachman and his colleagues were single-blind rather than double-blind. Nevertheless, in March 2005, Dr Philip S Brachman reported in a letter to the US Food and Drug Administration that his study had been double-blind. It is here argued that, rather, the field trial of a human anthrax vaccine should continue to be deemed as single-blind unless more detailed information is provided to explain exactly how the investigators were kept unaware of which subjec... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845957 Tue, 29 Sep 2009 23:00:00 +0100 2845957 http://www.medworm.com/index.php?rid=2845956&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F592%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845956 Tue, 29 Sep 2009 23:00:00 +0100 2845956 http://www.medworm.com/index.php?rid=2845955&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F590%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845955 Tue, 29 Sep 2009 23:00:00 +0100 2845955 http://www.medworm.com/index.php?rid=2845954&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F10%2F589%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2845954 Tue, 29 Sep 2009 23:00:00 +0100 2845954 http://www.medworm.com/index.php?rid=2743708&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F587%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743708 Thu, 27 Aug 2009 23:00:00 +0100 2743708 http://www.medworm.com/index.php?rid=2743707&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F584%3Frss%3D1 The rapid emergence and exploding usage of online social networking forums, which are frequented by millions, present clinicians with new ethical and professional challenges. Particularly among a younger generation of physicians and patients, the use of online social networking forums has become widespread. In this article, we discuss ethical challenges facing the patient–doctor relationship as a result of the growing use of online social networking forums. We draw upon one heavily used and highly trafficked forum, Facebook, to illustrate the elements of these online environments and the ethical challenges peculiar to their novel form of exchange. Finally, we present guidelines for clinicians to negotiate responsibly and professionally their possible uses of these social forums. (Sou... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743707 Thu, 27 Aug 2009 23:00:00 +0100 2743707 http://www.medworm.com/index.php?rid=2743706&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F579%3Frss%3D1 This paper focuses on invasive therapeutic procedures, defined as procedures requiring the introduction of hands, instruments, or devices into the body via incisions or punctures of the skin or mucous membranes performed with the intent of changing the natural history of a human disease or condition for the better. Ethical and methodological concerns have been expressed about studies designed to evaluate the effects of invasive therapeutic procedures. Can such studies meet the same standards demanded of those, for example, evaluating pharmaceutical agents? This paper describes a research project aimed at examining the interplay and sometimes apparent conflict between ethical standards for human research and standards for methodological rigor in trials of invasive procedures. The paper disc... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743706 Thu, 27 Aug 2009 23:00:00 +0100 2743706 http://www.medworm.com/index.php?rid=2743705&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F573%3Frss%3D1 Conclusions: Tests showed that the TGN1412 participant information sheet may not inform participants adequately for consent. Revising its content and design led to significant improvements. Writers of materials for trial participants should take account of good practice in information design. Performance-based user testing may be a useful method to indicate strengths and weaknesses in trial materials. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743705 Thu, 27 Aug 2009 23:00:00 +0100 2743705 http://www.medworm.com/index.php?rid=2743704&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F570%3Frss%3D1 The question "what is disability" and its implications are addressed in a new book Arguing about disability: philosophical perspectives, which aims to fill the gap between disability studies and philosophy. The structure of the book has been organised roughly on the basis of three branches of philosophy: metaphysics, political philosophy and ethics. One of the main themes of the book is the characterisation of a third way of thinking about disability, a way between two extremes, the medical and social models of disability. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743704 Thu, 27 Aug 2009 23:00:00 +0100 2743704 http://www.medworm.com/index.php?rid=2743703&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F565%3Frss%3D1 The moral philosopher Dan Brock has argued that equality of health outcomes "even if achievable" is problematic as a goal in its own right—because it is open to the levelling down objection. The levelling down objection to egalitarianism has received surprisingly little attention in the bioethics literature on distribution of health and healthcare and deserves more attention. This paper discusses and accepts an example given by Brock showing that prioritarianism and egalitarianism may judge distributions of health outcomes differently. We should accept that levelling down is never a good thing, all things considered, but that equality often is. By discussing variants of Brock’s example, it is demonstrated that if equality, prioritarianism and aggregation are combined, as in a p... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743703 Thu, 27 Aug 2009 23:00:00 +0100 2743703 http://www.medworm.com/index.php?rid=2743702&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F558%3Frss%3D1 Conclusions: Current understanding of a regulated kidney market is insufficient. It is unclear whether a regulated market would result in a net gain of kidneys. Most possible kidney vendors would only sell in a particularly difficult financial situation, raising concerns about the validity of consent and inequities in the provision of organs. Further empirical and normative analysis of these issues is required. Any calls to implement and evaluate a regulated kidney market in pilot studies are therefore premature. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743702 Thu, 27 Aug 2009 23:00:00 +0100 2743702 http://www.medworm.com/index.php?rid=2743701&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F552%3Frss%3D1 Fragile states and developing countries increasingly contract out health services to non-state providers (NSPs) (such as non-governmental organisations, voluntary sector and private sector). The paper identifies ethical issues when contracts involve devolution of health services to NSPs and proposes procedures to prevent or resolve these ethical dilemmas. Ethical issues were identified by examining processes of contracting out. Health needs could be used to select areas to be contracted out and to identify service needs. Health needs comprise "disease-burden-related needs", "health-service needs", and "urgency of health-service needs". The mix of services should include an analysis of cost-effectiveness. NSPs should be selected fairly, without bias, and conflicts of interest during their w... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743701 Thu, 27 Aug 2009 23:00:00 +0100 2743701 http://www.medworm.com/index.php?rid=2743700&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F546%3Frss%3D1 The system of asylum seeker detention in Australia is one in which those seeking refuge are stripped of many of their rights, including the right to health. This presents serious ethical problems for healthcare providers working within this system. In this article we describe asylum seeker detention and analyse the role of nurses. We discuss how far an "ethics of care" and witnessing the suffering of asylum seekers can serve to improve their situation and improve ethical nursing practice. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743700 Thu, 27 Aug 2009 23:00:00 +0100 2743700 http://www.medworm.com/index.php?rid=2743699&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F541%3Frss%3D1 Patients with the controversial diagnosis of body integrity identity disorder (BIID) report an emotional discomfort with having a body part (usually a limb) that they feel should not be there. This discomfort is so strong that it interferes with routine functioning and, in a majority of cases, BIID patients are motivated to seek amputation of the limb. Although patient requests to receive the best available treatment are generally respected, BIID demands for amputation, at present, are not. However, what little has been said in the ethics literature on the subject tends to favour doing so in cases of BIID. The general argument is that BIID demands should be respected, first, because of the importance that is already placed on respecting autonomy in medical decision-making contexts and seco... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743699 Thu, 27 Aug 2009 23:00:00 +0100 2743699 http://www.medworm.com/index.php?rid=2743698&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F534%3Frss%3D1 Conclusions: Labelling with disease is probably a less important issue in the discussion about the pros and cons of early detection of COPD. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743698 Thu, 27 Aug 2009 23:00:00 +0100 2743698 http://www.medworm.com/index.php?rid=2743697&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F530%3Frss%3D1 This paper re-evaluates euthanasia and assisted suicide from the perspective of eudaimonia, the ancient Greek conception of happiness across one’s whole life. It is argued that one cannot be said to have fully flourished or had a truly happy life if one’s death is preceded by a period of unbearable pain or suffering that one cannot avoid without assistance in ending one’s life. While death is to be accepted as part of life, it should not be left to nature to dictate the way we die, and it is fundamentally unjust to grant people liberal latitude in how they live their lives while granting them little control over the conclusion of their life narratives. Three objections to this position are considered and rejected; the paper also offers an explanation of why we think killi... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743697 Thu, 27 Aug 2009 23:00:00 +0100 2743697 http://www.medworm.com/index.php?rid=2743696&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F528%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743696 Thu, 27 Aug 2009 23:00:00 +0100 2743696 http://www.medworm.com/index.php?rid=2743695&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F526%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743695 Thu, 27 Aug 2009 23:00:00 +0100 2743695 http://www.medworm.com/index.php?rid=2743694&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F9%2F525%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2743694 Thu, 27 Aug 2009 23:00:00 +0100 2743694 http://www.medworm.com/index.php?rid=2657153&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F517%3Frss%3D1 Medical confidentiality is a core concept of professionalism and should be an integral part of pregraduate and postgraduate medical education. The aim of our study was to define the factors influencing attitudes towards patient confidentiality in everyday situations in order to define the need for offering further education to various subgroups of physicians. All internists and general practitioners who were registered members of the association of physicians in Geneva or who were working in the department of internal medicine or in the medical polyclinic of the University Hospital of Geneva in 2004 received a standardised questionnaire. Physicians were asked to indicate for seven vignettes whether a violation of confidentiality had occurred and whether the violation was not important, imp... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657153 Wed, 29 Jul 2009 23:00:00 +0100 2657153 http://www.medworm.com/index.php?rid=2657152&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F512%3Frss%3D1 Conclusion: HECs in Shanghai had developed in the preceding 10 years and they played great roles in protecting the rights and welfare of human subjects and patients; some areas need improvement. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657152 Wed, 29 Jul 2009 23:00:00 +0100 2657152 http://www.medworm.com/index.php?rid=2657151&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F508%3Frss%3D1 Recent studies using functional magnetic resonance imaging of patients in a vegetative state have raised the possibility that such patients retain some degree of consciousness. In this paper, the ethical implications of such findings are outlined, in particular in relation to decisions about withdrawing life-sustaining treatment. It is sometimes assumed that if there is evidence of consciousness, treatment should not be withdrawn. But, paradoxically, the discovery of consciousness in very severely brain-damaged patients may provide more reason to let them die. Although functional neuroimaging is likely to play an increasing role in the assessment of patients in a vegetative state, caution is needed in the interpretation of neuroimaging findings. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657151 Wed, 29 Jul 2009 23:00:00 +0100 2657151 http://www.medworm.com/index.php?rid=2657150&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F502%3Frss%3D1 Conclusions: When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient’s suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657150 Wed, 29 Jul 2009 23:00:00 +0100 2657150 http://www.medworm.com/index.php?rid=2657149&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F497%3Frss%3D1 The notions of "expert" and "expertise" imply that some people have more credibility than others on certain matters. While expert authority is often taken for granted, there are questions as to whether expert power in some cases can be a form of epistemic oppression. Informed by bedside disagreements between family and clinicians as well as feminist discussions of epistemic oppression, this paper argues for a commitment to epistemic humility and the adoption of a two-way collaborative approach between clinicians and families that can help to enhance professionals’ own understanding of their theoretical framework and also promote responsive patient care. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657149 Wed, 29 Jul 2009 23:00:00 +0100 2657149 http://www.medworm.com/index.php?rid=2657148&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F488%3Frss%3D1 What are the criteria for reasonable clinical judgements? The reasonableness of macro-level decision-making has been much discussed, but little attention has been paid to the reasonableness of applying guidelines generated at a macro-level to individual cases. This paper considers a framework for reasonable clinical decision-making that will capture cases where relevant guidelines cannot reasonably be followed. There are three main sections. (1) Individual claims on healthcare from the point of view of concerns about equity are analysed. (2) The demands of responsibility and equity on professional clinical performance are discussed, and how the combination of these demands emerges into seven requirements that constitute the framework is explored. Since this framework is developed to assist... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657148 Wed, 29 Jul 2009 23:00:00 +0100 2657148 http://www.medworm.com/index.php?rid=2657147&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F483%3Frss%3D1 Conclusion: The principle of justice was violated when qualified attention was given to significant others, and through this also to patients. Attention given to significant others was influenced by the healthcare workers’ professional and personal values, attitudes and interests. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657147 Wed, 29 Jul 2009 23:00:00 +0100 2657147 http://www.medworm.com/index.php?rid=2657146&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F477%3Frss%3D1 Conclusions: Organisational issues contribute to ethical concerns that result in clinical ethics consults. Identifying and addressing organisational issues such as informal culture and communication may help decrease the recurrence of future similar ethics concerns. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657146 Wed, 29 Jul 2009 23:00:00 +0100 2657146 http://www.medworm.com/index.php?rid=2657145&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F473%3Frss%3D1 The debate over financial incentives and market models for organ procurement represents a key trend in recent bioethics. In this paper, we wish to reassess one of its central premises—the idea of organ shortage. While the problem is often presented as an objective statistical fact that can be taken for granted, we will take a closer look at the underlying framework expressed in the common rhetoric of "scarcity", "shortage" or "unfulfilled demand". On the basis of theoretical considerations as well as a socioempirical examination of public attitudes, we will argue that this rhetoric has an economic subtext that imbues the debate with normative premises that have far-reaching social and ethical consequences and need to be made explicit and discussed. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657145 Wed, 29 Jul 2009 23:00:00 +0100 2657145 http://www.medworm.com/index.php?rid=2657144&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F471%3Frss%3D1 This paper argues that the provider conscience regulation recently put into place in the USA is misguided. The rule is too broad in the scope of protection it affords, and its conception of what constitutes assistance in the performance of an objectionable procedure reveals that it is unworkable in practice. Furthermore, the regulation wrongly treats refusal of other reproductive services as on a par with conscientious objection to participation in abortion. Finally, the rule allows providers to refuse even to discuss "objectionable" options with patients and serves to protect discriminatory refusals of medical care. For all of these reasons, this regulation is unwise. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657144 Wed, 29 Jul 2009 23:00:00 +0100 2657144 http://www.medworm.com/index.php?rid=2657143&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F469%3Frss%3D1 A recent discussion on cognitive enhancers has caused some controversy in the ethics and neuroscience fields by coming out in favour of making neuropharmaceuticals with enhancing properties available for general consumption. We highlight in this brief commentary why concerns regarding efficacy and safety, demands on resources, and public health are substantive enough to warrant serious reconsideration before pharmaceutical performance enhancement can be widely supported. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657143 Wed, 29 Jul 2009 23:00:00 +0100 2657143 http://www.medworm.com/index.php?rid=2657142&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F465%3Frss%3D1 In June 2008 the UK government, supported by the Royal College of Nursing, stated that nursing care would be measured for compassion. This paper considers the implications of this statement by critically examining the relationship of compassion to care from a variety of perspectives. It is argued that the current market-driven approaches to healthcare involve redefining care as a pale imitation, even parody, of the traditional approach of the nurse as "my brother’s keeper". Attempts to measure such parody can only measure artificial techniques and give rise to a McDonald’s-type nursing care rather than heartfelt care. The arguments of this paper, although applied to nursing, also apply to medicine and healthcare generally. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657142 Wed, 29 Jul 2009 23:00:00 +0100 2657142 http://www.medworm.com/index.php?rid=2657141&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F463%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657141 Wed, 29 Jul 2009 23:00:00 +0100 2657141 http://www.medworm.com/index.php?rid=2657140&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F462%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657140 Wed, 29 Jul 2009 23:00:00 +0100 2657140 http://www.medworm.com/index.php?rid=2657139&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F8%2F461%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2657139 Wed, 29 Jul 2009 23:00:00 +0100 2657139 http://www.medworm.com/index.php?rid=2560311&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F7%2F459%3Frss%3D1 (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2560311 Mon, 29 Jun 2009 23:00:00 +0100 2560311 http://www.medworm.com/index.php?rid=2560310&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F7%2F456%3Frss%3D1 Coggon’s remarks on a previous paper on active and passive euthanasia elicit a clarification and an elaboration of the argument in support of the claim that there is a moral difference between killing and letting die. The relevant moral duties are different in nature, strength and content. Moreover, not all people who are involved in the relevant situations have the same moral duties. The particular case that is presented in support of the claim that to kill is not the same as to let die is based upon a rejection of consequentialism. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2560310 Mon, 29 Jun 2009 23:00:00 +0100 2560310 http://www.medworm.com/index.php?rid=2560309&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F7%2F450%3Frss%3D1 Based on extensive questionnaire data, this paper focuses on parents’ views about children’s right to decide about participation in research. The data originates from 4000 families participating in a longitudinal prospective screening as 1997. Although current regulations and recommendations underline that children should have influence over their participation, many parents in this study disagree. Most (66%) were positive providing information to the child about relevant aspects of the study. However, responding parents were split about whether or not children should at some point be allowed decisional authority when participating in research: 41.6% of the parents reported being against or unsure. Those who responded positively believed that children should be allowed to decid... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2560309 Mon, 29 Jun 2009 23:00:00 +0100 2560309 http://www.medworm.com/index.php?rid=2560308&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F7%2F445%3Frss%3D1 Risk–benefit assessment is a routine requirement for research ethics committees that review and oversee biomedical research with human subjects. Nevertheless, it remains unclear how to weigh and balance risks to research participants against the social benefits that flow from generating biomedical knowledge. In this article, we address the question of whether there are any reasonable criteria for defining the limit of permissible risks to individuals who provide informed consent for research participation. We argue against any a priori limit to permissible research risks. However, attention to the uncertainty of potential social benefit that can be derived from any particular study warrants caution in exposing prospective research participants to a substantial likelihood of serious h... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2560308 Mon, 29 Jun 2009 23:00:00 +0100 2560308 http://www.medworm.com/index.php?rid=2560307&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F7%2F440%3Frss%3D1 Conclusions: Current classifications of vulnerability require reinterpretation when applied to qualitative research at the end of life. We recommend that researchers and research ethics committees reconceptualise vulnerability using the domains identified in this study and consider the research context and interviewers’ skills. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2560307 Mon, 29 Jun 2009 23:00:00 +0100 2560307 http://www.medworm.com/index.php?rid=2560306&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F7%2F436%3Frss%3D1 Some background information about the context of euthanasia in Belgium is presented, and Belgian law on euthanasia and concerns about the law are discussed. Suggestions as to how to improve the Belgian law and practice of euthanasia are made, and Belgian legislators and medical establishment are urged to reflect and ponder so as to prevent potential abuse. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2560306 Mon, 29 Jun 2009 23:00:00 +0100 2560306 http://www.medworm.com/index.php?rid=2560305&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F7%2F433%3Frss%3D1 Some argue that genetic enhancements and environmental enhancements are not importantly different: environmental enhancements such as private schools and chess lessons are simply the old-school way to have a designer baby. I argue that there is an important distinction between the two practices—a distinction that makes state restrictions on genetic enhancements more justifiable than state restrictions on environmental enhancements. The difference is that parents have no settled expectations about genetic enhancements. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2560305 Mon, 29 Jun 2009 23:00:00 +0100 2560305 http://www.medworm.com/index.php?rid=2560304&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F7%2F429%3Frss%3D1 Advances in genetics may soon make possible the development of ethnic bioweapons that target specific ethnic or racial groups based upon genetic markers. While occasional published reports of such research generate public outrage, little has been written about the ethical distinction (if any) between the development of such weapons and ethnically neutral bioweapons. The purpose of this paper is to launch a debate on the subject of ethnic bioweapons before they become a scientific reality. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2560304 Mon, 29 Jun 2009 23:00:00 +0100 2560304 http://www.medworm.com/index.php?rid=2560303&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F7%2F424%3Frss%3D1 Patient self-management of disease is increasingly supported by technologies that can monitor a wide range of behavioural and biomedical parameters. Incorporated into everyday devices such as cell phones and clothes, these technologies become integral to the psychosocial aspects of everyday life. Many technologies are likely to be marketed directly to families with ill members, and families may enlist the support of clinicians in shaping use. Current ethical frameworks are mainly conceptualised from the perspective of caregivers, researchers, developers and regulators in order to ensure the ethics of their own practices. This paper focuses on families as autonomous decision-makers outside the regulated context of healthcare. We discuss some morally relevant issues facing families in their ... Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2560303 Mon, 29 Jun 2009 23:00:00 +0100 2560303 http://www.medworm.com/index.php?rid=2560302&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F7%2F419%3Frss%3D1 Conclusions: Making patients feel respected, or valued as a person, is a multi-faceted task that involves more than recognising autonomy. While patients’ views of respect do not determine what respect means, these patients expressed important intuitions that may be of substantial conceptual relevance. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2560302 Mon, 29 Jun 2009 23:00:00 +0100 2560302 http://www.medworm.com/index.php?rid=2560301&cid=s_30998_74_f&fid=30998&url=http%3A%2F%2Fjme.bmj.com%2Fcgi%2Fcontent%2Fshort%2F35%2F7%2F415%3Frss%3D1 Many inherited metabolic diseases may lead to varying degrees of brain damage and thus also to intellectual disability. Bone marrow transplantation (BMT) has been used for over two decades as a form of secondary prevention to stop or reverse the progress of the disease process in some of these conditions. At the population level the impact of BMT on the prevalence of intellectual disability is minute, but at the individual level its impact on the prognosis of the disease and the well-being of the patient can be substantial. The dark side of BMT use is the burden of side effects, complications and transplantation-related mortality in less successful cases. The ethical issues involved in this therapy are discussed in this review. (Source: Journal of Medical Ethics) Journal of Medical Ethics journals http://www.medworm.com/rss/comments.php?id=2560301 Mon, 29 Jun 2009 23:00:00 +0100 2560301