MedWorm: Medical Ethics Top 20

Informed consent for clinical trials of deep brain stimulation in psychiatric disease: challenges and implications for trial design

Journal of Medical Ethics — Fri, 20 Jan 2012 05:00:00 +0100

Advances in neuromodulation and an improved understanding of the anatomy and circuitry of psychopathology have led to a resurgence of interest in surgery for psychiatric disease. Clinical trials exploring deep brain stimulation (DBS), a focally targeted, adjustable and reversible form of neurosurgery, are being developed to address the use of this technology in highly selected patient populations. Psychiatric patients deemed eligible for surgical intervention, such as DBS, typically meet stringent inclusion criteria, including demonstrated severity, chronicity and a failure of conventional therapy. Although a humanitarian device exemption by the US Food and Drug Administration exists for its use in obsessive-compulsive disorder, DBS remains a largely experimental treatment in the psychiatr...

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Elderly patients' and residents' perceptions of 'the good nurse': a literature review

Journal of Medical Ethics — Fri, 20 Jan 2012 05:00:00 +0100

This article describes the findings of a mixed method literature review that examined the perceptions of elderly patients and residents of a good nurse in nursing homes, hospitals and home care. According to elderly patients and residents, good nurses are individuals who have the necessary technical and psychosocial skills to care for patients. They are at their disposal, promptly recognising the patients' needs. Good nurses like their job and are sincere and affectionate. They are understanding and caring. They do not hesitate to enter into a trust-based relationship with their patients. Knowing and understanding how elderly patients and nursing home residents perceive ‘the good nurse’ is crucial for providing quality care and for promoting better patient outcomes in geriatric...

The Six Most Essential Questions in Psychiatric Diagnosis: A Pluralogue. Part 1: Conceptual and Definitional Issues in Psychiatric Diagnosis

Philosophy, Ethics, and Humanities in Medicine — Fri, 13 Jan 2012 05:00:00 +0100

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the probl...

Rethinking the Body and Its Boundaries

Journal of Bioethical Inquiry — Fri, 06 Jan 2012 16:45:34 +0100

Content Type Journal ArticleCategory EditorialPages 1-6DOI 10.1007/s11673-011-9353-8Authors Leigh E. Rich, Department of Health Sciences (Public Health), Armstrong Atlantic State University, 11935 Abercorn Street, Savannah, GA 31419, USAMichael A. Ashby, Palliative Care and Persistent Pain Services, Royal Hobart, Hospital, Southern Tasmania Area Health Service, and School of Medicine, Faculty of Health Sciences, University of Tasmania, 1st Floor, Peacock Building, Repatriation Centre, 90 Davey Street, Hobart, TAS 7000 AustraliaPierre-Olivier Méthot, ESRC Centre for Genomics in Society (Egenis), University of Exeter, Byrne House, St German’s Road, Exeter, EX4 4PJ UK Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical In...

Physicians' Ethics Forum: a web-based ethics consultation service

Journal of Medical Ethics — Fri, 20 Jan 2012 05:00:00 +0100

To meet all physicians' needs for ethics consultation in Finland, a novel form of service, the Physicians' Ethics Forum, was founded in 2003. The Forum is a cost-efficient service based on electronic communication. In this paper, experiences throughout its first 6 years are described. (Source: Journal of Medical Ethics)

Findings from a Delphi exercise regarding conflicts of interests, general practitioners and safeguarding children: 'Listen carefully, judge slowly'

Journal of Medical Ethics — Fri, 20 Jan 2012 05:00:00 +0100

This article details findings from a Delphi exercise that was part of a larger study exploring the conflicts of interest that arise for UK GPs in safeguarding children. The specific objectives of the Delphi exercise were to understand how these conflicts of interest are seen from the perspectives of an expert panel, and to identify best practice for GPs. The Delphi exercise involved four iterative rounds with questionnaires completed by an expert panel. Results from each round were distilled and findings sent to panel members until consensus was reached. Panel members shared insights regarding their understanding of conflicts of interest in relation to GPs and safeguarding children and responses when conflicts of interests arise. Findings suggested a broader understanding of conflicts of i...

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Reporting on end‐of‐life matters – academic meets activists

Bioethics — Sun, 22 Jan 2012 00:57:56 +0100

(Source: Bioethics)

Donating Embryos to Stem Cell Research

Journal of Bioethical Inquiry — Wed, 04 Jan 2012 06:48:17 +0100

Abstract This paper is based on linked qualitative studies of the donation of human embryos to stem cell research carried out in the United Kingdom, Switzerland, and China. All three studies used semi-structured interview protocols to allow an in-depth examination of donors’ and non-donors’ rationales for their donation decisions, with the aim of gaining information on contextual and other factors that play a role in donor decisions and identifying how these relate to factors that are more usually included in evaluations made by theoretical ethics. Our findings have implications for one factor that has previously been suggested as being of ethical concern: the role of gratitude. Our empirical work shows no evidence that interpersonal gratitude is an important factor, b...

Making principlism practical: a commentary on gordon, rauprich, and vollmann

Bioethics — Wed, 08 Jun 2011 23:44:52 +0100

(Source: Bioethics)

The Effects of Artist Adoration and Perceived Risk of Getting Caught on Attitude and Intention to Pirate Music in the United States and Taiwan

Ethics and Behavior — Wed, 25 May 2011 23:40:56 +0100

(Source: Ethics and Behavior)

How not to save a life

Bioethics — Mon, 16 May 2011 20:00:11 +0100

(Source: Bioethics)

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Discrepancy between participants' understanding and desire to know in informed consent: are they informed about what they really want to know?

Journal of Medical Ethics — Fri, 20 Jan 2012 05:00:00 +0100

Conclusions An information discrepancy was observed between the participants' understanding and their desire to know. By putting more emphasis on under-informed elements, the quality of informed consent could be improved. (Source: Journal of Medical Ethics)

Maintaining confidentiality in prospective studies: anonymous repeated measurements via email (ARME) procedure

Journal of Medical Ethics — Fri, 20 Jan 2012 05:00:00 +0100

Respecting and protecting the confidentiality of data and the privacy of individuals regarding the information that they have given as participants in a research project is a cornerstone of complying with accepted research standards. However, in longitudinal studies, establishing and maintaining privacy is often challenging because of the necessity of repeated contact with participants. A novel internet-based solution is introduced here, which maintains privacy while at the same time ensures linkage of data to individual participants in a repeated measures design. With the use of the anonymous repeated measurements via email (ARME) procedure, two separate one-way communication systems are established through ad hoc email accounts and a secure study website. Strengths and limitations of the...

What do patients expect from their physicians? Qualitative research on the ethical aspects of patient statements

Journal of Medical Ethics — Fri, 20 Jan 2012 05:00:00 +0100

This study aimed to examine the thoughts and expectations of patients receiving healthcare from their physicians and evaluate the ethical aspects of these thoughts and expectations. To determine the ethical aspects of the thoughts and expectations of patients, an open-ended question was asked on the web page of the Turkish Armed Forces (TAF) Health Care Command, which is accessible to the users of the TAF intranet system (the internet system used within TAF institutions). The participants were asked to express their thoughts in their own words. A total of 804 participants answered the question by providing their input. The statements of the participants were classified separately by two public health specialists. The classification was made in accordance with the basic principles of patien...

A randomised controlled trial of ribavirin in Crimean Congo haemorrhagic fever: ethical considerations

Journal of Medical Ethics — Fri, 20 Jan 2012 05:00:00 +0100

The randomised controlled trial (RCT) constitutes a quantitative, comparative, controlled study of a particular treatment, and provides invaluable evidence regarding its pharmacotherapeutic efficacy. These studies are generally predicated upon the ethical principle of clinical equipoise. However, this may be insufficient to justify withholding treatment from a control group while assessing drug therapy in a potentially fatal disease. Thus, the criteria for randomisation, informed consent methodology and timing, and consideration of treatment options in such a scenario remain the province of medical ethics. This paper addresses the need for an RCT of ribavirin in the treatment of Crimean Congo haemorrhagic fever, and highlights underlying ethical concerns in light of the current medical, vi...

Reexamination of the ethics of placebo use in clinical practice

Bioethics — Thu, 02 Feb 2012 05:00:00 +0100

ABSTRACTA placebo is a substance or intervention believed to be inactive, but is administered by the healthcare professional as if it was an active medication. Unlike standard treatments, clinical use of placebo usually involves deception and is therefore ethically problematic. Our attitudes toward the clinical use of placebo, which inevitably includes deception or withholding information, have a tremendous effect on our practice regarding truth‐telling and informed consent. A casual attitude towards it weakens the current practice based on shared decision‐making and mutual trust between patients and healthcare professionals. Issues concerning the clinical use of placebo are thus intimately related to patient‐provider relationships, the public's trust in medicine, and medical educati...

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‘ethics is for bad guys!’ putting the ‘moral’ into moral enhancement

Bioethics — Thu, 02 Feb 2012 05:00:00 +0100

(Source: Bioethics)

Moral fiction or moral fact? the distinction between doing and allowing in medical ethics

Bioethics — Thu, 02 Feb 2012 05:00:00 +0100

ABSTRACTOpponents of physician‐assisted suicide (PAS) maintain that physician withdrawal‐of‐life‐sustaining‐treatment cannot be morally equated to voluntary active euthanasia. PAS opponents generally distinguish these two kinds of act by positing a possible moral distinction between killing and allowing‐to‐die, ceteris paribus. While that distinction continues to be widely accepted in the public discourse, it has been more controversial among philosophers. Some ethicist PAS advocates are so certain that the distinction is invalid that they describe PAS opponents who hold to the distinction as in the grip of ‘moral fictions’. The author contends that such a diagnosis is too hasty. The possibility of a moral distinction between active euthanasia and allowing‐to‐die has ...

Islam and New Kinship, Reproductive Technologies and the Shariah in Lebanon – By Morgan Clarke

Bioethics — Sat, 04 Feb 2012 00:58:51 +0100

(Source: Bioethics)

Rotterdam 2012: the next world congress of bioethics

Bioethics — Sat, 04 Feb 2012 00:58:36 +0100

(Source: Bioethics)