MedWorm: Medical Ethics

Response

Journal of Bioethical Inquiry — Wed, 14 May 2008 06:15:41 +0100

Response Content Type Journal ArticleDOI 10.1007/s11673-008-9103-8Authors Madelyn M. Peterson, University of Queensland Philosophy Department E306 Level 3 Forgan Smith Building St. Lucia QLD 4072 Australia Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Response

Journal of Bioethical Inquiry — Wed, 14 May 2008 06:15:40 +0100

Response Content Type Journal ArticleDOI 10.1007/s11673-008-9099-0Authors Lisa Bridle, University of Queensland, Mater Hospitals Queensland Centre for Intellectual and Developmental Disability South Brisbane Q 4101 QLD Australia Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

Bioethics and disability rights: conflicting values and perspectives

Journal of Bioethical Inquiry — Wed, 14 May 2008 06:15:40 +0100

Abstract Continuing tensions exist between mainstream bioethics and advocates of the disability rights movement. This paper explores some of the grounds for those tensions as exemplified in From Chance to Choice: Genetics and Justice by Allen Buchanan and coauthors, a book by four prominent bioethicists that is critical of the disability rights movement. One set of factors involves the nature of disability and impairment. A second set involves presumptions regarding social values, including the importance of intelligence in relation to other human characteristics, competition as the basis of social organization, and the nature of the parent–child relationship. The authors’ disapproval of certain aspects of the disability rights movement can be seen to be associated with particular positions regarding these factors. Although the authors intend to use a method of ‘broad reflective equilibrium,’ we argue that their idiosyncratic commitment to particular concepts of disability and particular social values produces a narrowing of the moral significance of their conclusions regarding disability rights. Content Type Journal ArticleDOI 10.1007/s11673-008-9096-3Authors Ron Amundson, University of Hawaii at Hilo 200 West Kawili St. Hilo HI 96720 USAShari Tresky, Hilo HI USA Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

‘you say you’re happy, but…’: contested quality of life judgments in bioethics and disability studies

Journal of Bioethical Inquiry — Wed, 14 May 2008 06:15:38 +0100

Abstract In this paper, I look at several examples that demonstrate what I see as a troubling tendency in much of mainstream bioethics to discount the views of disabled people. Following feminist political theorists who argue in favour of a stance of humility and sensitive inclusion for people who have been marginalized, I recommend that bioethicists adopt a presumption in favour of believing rather than discounting the claims of disabled people. By taking their claims at face value and engaging with disabled people in open dialogue over impairment and disadvantage, bioethicists may take to heart an important lesson about human fragility and resilience. Content Type Journal ArticleDOI 10.1007/s11673-007-9076-zAuthors Sara Goering, University of Washington Department of Philosophy, Program on Values in Society 511 Condon Hall Box 353350 Seattle WA 98195 USA Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

Dis-orienting paraphilias? disability, desire, and the question of (bio)ethics

Journal of Bioethical Inquiry — Wed, 14 May 2008 06:15:37 +0100

Abstract In 1977 John Money published the first modern case histories of what he called ‘apotemnophilia’, literally meaning ‘amputation love’ [Money et al., The Journal of Sex Research, 13(2):115–12523, 1977], thus from its inception as a clinically authorized phenomenon, the desire for the amputation of a healthy limb or limbs was constituted as a sexual perversion conceptually related to other so-called paraphilias. This paper engages with sex-based accounts of amputation-related desires and practices, not in order to substantiate the paraphilic model, but rather, because the conception of these (no doubt) heterogeneous desires and practices as symptoms of a paraphilic condition (or conditions) highlights some interesting cultural assumptions about ‘disability’ and ‘normalcy’, their seemingly inherent (un)desirability, and their relation to sexuality. In critically interrogating the socio-political conditions that structure particular desires and practices such that they are lived as improper, distressing and/or disabling, the paper constitutes an exercise in what Margrit Shildrick [Beyond the body of bioethics: Challenging the conventions. In M. Shildrick and R. Mykitiuk (Eds.), Ethics of the body: Postconventional challenges (pp. 1–26). New York: MIT Press, 2005] refers to as “postconventional ethics”. Content Type Journal ArticleDOI 10.1007/s11673-008-9097-2Authors Nikki Sullivan, Macquarie University Department of Critical and Cultural Studies North Ryde NSW 2109 USA Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

The european society for philosophy of medicine and health care

Medicine, Health Care and Philosophy — Tue, 13 May 2008 21:22:02 +0100

The European Society for Philosophy of Medicine and Health Care Content Type Journal ArticleDOI 10.1007/s11019-008-9136-0 Journal Medicine, Health Care and PhilosophyOnline ISSN 1572-8633Print ISSN 1386-7423 (Source: Medicine, Health Care and Philosophy)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Books received

Medicine, Health Care and Philosophy — Tue, 13 May 2008 21:22:02 +0100

Books received Content Type Journal ArticleCategory Books ReceivedDOI 10.1007/s11019-008-9134-2 Journal Medicine, Health Care and PhilosophyOnline ISSN 1572-8633Print ISSN 1386-7423 (Source: Medicine, Health Care and Philosophy)

Espmh news

Medicine, Health Care and Philosophy — Tue, 13 May 2008 21:22:00 +0100

ESPMH News Content Type Journal ArticleCategory NewsDOI 10.1007/s11019-008-9135-1 Journal Medicine, Health Care and PhilosophyOnline ISSN 1572-8633Print ISSN 1386-7423 (Source: Medicine, Health Care and Philosophy)

Advance directives in spain. perspectives from a medical bioethicist approach

Bioethics — Tue, 13 May 2008 18:20:35 +0100

Bioethics, Volume 0, Issue 0, Page ???, OnlineEarly Articles. ABSTRACT Spain is one of the most advanced European countries in terms of the legislative and administrative development of ADs. Article 11 of Law 41/2002, concerning Patient Autonomy, regulates ‘advance directives’ and has prompted various Autonomous ... (Source: Bioethics)

Health technology assessment (hta): ethical aspects

Medicine, Health Care and Philosophy — Sat, 10 May 2008 08:15:34 +0100

Abstract HTA is a multidisciplinary process that summarizes information about medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. Its aim is to inform the formulation of safe, effective, health policies that are patient focused, and seek to achieve best value. Even though the assessment of ethical aspects of health technology is listed as one of its objectives, in practice, the integration of this dimensions into HTA remains limited. The article is focused on five points: 1. the concept of HTA; 2. the difficult relationship between ethics and HTA; 3. the ethical questions in HTA; 4. the process of producing ethical analysis; 5. the method for integrating ethical analysis into HTA. Content Type Journal ArticleCategory Scientific ContributionDOI 10.1007/s11019-008-9141-3Authors Dario Sacchini, Catholic University of the Sacred Heart Institute of Bioethics, “A. Gemelli” School of Medicine Largo F. Vito, 1 00168 Roma ItalyAndrea Virdis, Catholic University of the Sacred Heart Institute of Bioethics, “A. Gemelli” School of Medicine Largo F. Vito, 1 00168 Roma ItalyPietro Refolo, Catholic University of the Sacred Heart Institute of Bioethics, “A. Gemelli” School of Medicine Largo F. Vito, 1 00168 Roma ItalyMaddalena Pennacchini, Catholic University of the Sacred Heart Institute of Bioethics, “A. Gemelli” School of Medicine Largo F. Vito, 1 00168 Roma ItalyIgnacio Carrasco de Paula, Catholic University of the Sacred Heart Institute of Bioethics, “A. Gemelli” School of Medicine Largo F. Vito, 1 00168 Roma Italy Journal Medicine, Health Care and PhilosophyOnline ISSN 1572-8633Print ISSN 1386-7423 (Source: Medicine, Health Care and Philosophy)

The agency problem and medical acting: an example of applying economic theory to medical ethics

Medicine, Health Care and Philosophy — Sat, 10 May 2008 08:15:33 +0100

Abstract In this article, the authors attempt to build a bridge between economic theory and medical ethics to offer a new perspective to tackle ethical challenges in the physician–patient encounter. They apply elements of new institutional economics to the ethically relevant dimensions of the physician–patient relationship in a descriptive heuristic sense. The principal–agent theory can be used to analytically grasp existing action problems in the physician–patient relationship and as a basis for shaping recommendations at the institutional level. Furthermore, the patients’ increased self-determination and modern opportunities for the medical laity to inform themselves lead to a less asymmetrical distribution of information between physician and patient and therefore require new interaction models. Based on the analysis presented here, the authors recommend that, apart from the physician’s necessary individual ethics, greater consideration should be given to approaches of institutional ethics and hence to incentive systems within medical ethics. Content Type Journal ArticleCategory Review ArticleDOI 10.1007/s11019-008-9138-yAuthors Andreas Langer, Hamburg University of Applied Sciences, Economy and Social Affairs Saarlandstr. 30 22303 Hamburg GermanyPeter Schröder-Bäck, Institute of Public Health NRW Westerfeldstr. 35/37 33611 Bielefeld GermanyAlexander Brink, Bayreuth University Institute for Philosophy 95440 Bayreuth GermanyJohannes Eurich, Heidelberg University Institute for Diaconal Sciences 69117 Heidelberg Germany Journal Medicine, Health Care and PhilosophyOnline ISSN 1572-8633Print ISSN 1386-7423 (Source: Medicine, Health Care and Philosophy)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

The fallacy of the principle of procreative beneficence

Bioethics — Fri, 09 May 2008 18:20:08 +0100

Bioethics, Volume 0, Issue 0, Page ???, OnlineEarly Articles. ABSTRACT The claim that we have a moral obligation, where a choice can be made, to bring to birth the ‘best’ child possible, has been highly controversial for a number of decades. More recently Savulescu has labelled this claim the Principle of ... (Source: Bioethics)

Causality in complex interventions

Medicine, Health Care and Philosophy — Fri, 09 May 2008 06:37:32 +0100

Abstract In this paper I look at causality in the context of intervention research, and discuss some problems faced in the evaluation of causal hypotheses via interventions. I draw attention to a simple problem for evaluations that employ randomized controlled trials. The common alternative to randomized trials, the observational study, is shown to face problems of a similar nature. I then argue that these problems become especially acute in cases where the intervention is complex (i.e. that involves intervening in a complex system). Finally, I consider and reject a possible resolution of the problem involving the simulation of complex interventions. The conclusion I draw from this is that we need to radically reframe the way we think about causal inference in complex intervention research. Content Type Journal ArticleCategory Scientific ContributionDOI 10.1007/s11019-008-9140-4Authors Dean Rickles, University of Sydney Unit for History & Philosophy of Science Sydney NSW 2006 Australia Journal Medicine, Health Care and PhilosophyOnline ISSN 1572-8633Print ISSN 1386-7423 (Source: Medicine, Health Care and Philosophy)

Deaf by design: disability and impartiality

Bioethics — Thu, 08 May 2008 18:08:57 +0100

Bioethics, Volume 0, Issue 0, Page ???, OnlineEarly Articles. ABSTRACT In ‘Benefit, Disability and the Non-Identity Problem’, Hallvard Lillehammer uses the case of a couple who chose to have deaf children to argue against the view that impartial perspectives can provide an exhaustive account of the rightness and ... (Source: Bioethics)

Deciding on death: conventions and contestations in the context of disability

Journal of Bioethical Inquiry — Wed, 30 Apr 2008 07:16:07 +0100

Abstract Conflicts between bioethicists and disability theorists often arise over the permissibility of euthanasia and physician assisted suicide. Where mainstream bioethicists propose universalist guidelines that will direct action across a range of effectively disembodied situations, and take for granted that moral agency requires autonomy, feminist bioethicists demand a contextualisation of the circumstances under which moral decision making is conducted, and stress a more relational view of autonomy that does not require strict standards of independent agency. Nonetheless, neither traditional nor feminist perspectives have fully engaged with the critique of disabled people that they are consistently subjected to discriminatory, even life-threatening, practice and policy in biomedical and health care. The paper revisits some of the issues that drive the often highly polarised debate between bioethicists and disability theorists around the question of end of life decisions involving disabled people. While many bioethicists have doubtless been indifferent to the difference that disability makes, I am also concerned that the very proper demand of disability activists and theorists to scrutinise all end of life decisions for signs of discrimination and even violence has segued into something damagingly restrictive that silences internal dissension and stifles external debate. Given that euthanasia and physician assisted suicide may be issues where conventional argument on either side will founder on deeply felt convictions, I make the radical move to speculate on an entirely different, quasi-Deleuzian, approach to the value of life in order to shake up entrenched positions, and begin to think differently. Content Type Journal ArticleDOI 10.1007/s11673-007-9074-1Authors Margrit Shildrick, Queen’s University Belfast SSSPSW Belfast BT7 1NN Northern Ireland Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

Mind the gaps: intersex and (re-productive) spaces in disability studies and bioethics

Journal of Bioethical Inquiry — Wed, 30 Apr 2008 07:16:07 +0100

Abstract With a few notable exceptions disability studies has not taken account of intersexuality, and it is principally through the lenses of feminist and queer-theory oriented ethical discussions but not through ‘straight’ bioethics that modes valuing intersex difference have been proposed. Meanwhile, the medical presupposition that intersex characteristics are inherently disabling to social viability remains the taken-for-granted truth from which clinical practice proceeds. In this paper I argue against bioethical perspectives that justify extensive and invasive pre- and post-natal medical interference to eradicate intersex. I argue instead that to constitute the necessary conditions for the recognition of the intersexed child as a person, a life valid in its own right, clinicians must refrain from aggressive interference. Clinical specialists presuppose that intersexed children will be socially disabled and unrecognizable as persons; frustrated by the general failure of traditional interventions to assign a sex, clinicians are now pursuing prenatal technologies, including selective termination, to erase intersex. Content Type Journal ArticleDOI 10.1007/s11673-007-9073-2Authors M. Morgan Holmes, Wilfrid Laurier University Sociology & CAST-MA Waterloo ON Canada N2L 3C5 Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

The individualist model of autonomy and the challenge of disability

Journal of Bioethical Inquiry — Wed, 30 Apr 2008 07:16:06 +0100

Abstract In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, which focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. Content Type Journal ArticleDOI 10.1007/s11673-007-9075-0Authors Anita Ho, University of British Columbia Department of Philosophy 1866 Main Mall, E370 Vancouver BC V6T 1Z1 Canada Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

[postscript] should fertility doctors and clinical embryologists be involved in the recruitment, counselling and reimbursement of egg donors?

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

(Source: Journal of Medical Ethics)

[teaching and learning ethics] interprofessional ethics rounds concerning dialysis patients: staff's ethical reflections before and after rounds

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Objective: To evaluate whether ethics rounds stimulated ethical reflection. Methods: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to stimulate ethical reflection and promote mutual understanding between professions but not to offer solutions. Questionnaires directly before and after rounds were answered by 194 respondents. The analyses were primarily content analysis with Boyd’s framework but were also statistical in nature. Findings: Seventy-six per cent of the respondents reported a moderate to high rating regarding new insights on ethical problem identification, but the ethics rounds did not seem to stimulate the ethical reflection that the respondents had expected (p<0.001). Dominant new insights did not seem to fit into traditional normative ethics but were instead interpreted as hermeneutic ethics. This was illustrated in the extended perspective on the patient and increased awareness of relations to other professions. Regarding insights into how to solve ethical problems, the request for further interprofessional dialogue dominated both before and after rounds. Conclusion: The findings show the need for interprofessional reflective ethical practice but a balance between ethical reflection and problem solving is suggested if known patients are discussed. Further research is needed to explore the most effective leadership for reflective ethical practice. (Source: Journal of Medical Ethics)

[teaching and learning ethics] learning a way through ethical problems: swedish nurses' and doctors' experiences from one model of ethics rounds

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Objective: To evaluate one ethics rounds model by describing nurses’ and doctors’ experiences of the rounds. Methods: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to promote mutual understanding and stimulate ethical reflection, without giving any recommendations or solutions. Interviews with seven doctors and 11 nurses were conducted regarding their experiences from the rounds, which were then analysed using content analysis. Findings: The goal of the rounds was partly fulfilled. Participants described both positive and negative experiences. Good rounds included stimulation to broadened thinking, a sense of connecting, strengthened confidence to act, insight into moral responsibility and emotional relief. Negative experiences were associated with a sense of unconcern and alienation, as well as frustration with the lack of solutions and a sense of resignation that change is not possible. The findings suggest that the ethics rounds above all met the need of a forum for crossing over professional boundaries. The philosophers seemed to play an important role in structuring and stimulating reasoned arguments. The nurses’ expectation that solutions to the ethical problems would be sought despite explicit instructions to the contrary was conspicuous. Conclusion: When assisting healthcare professionals to learn a way through ethical problems in patient care, a balance should be found between ethical analyses, conflict resolution and problem solving. A model based on the findings is presented. (Source: Journal of Medical Ethics)

[teaching and learning ethics] the religious beliefs of students and the teaching of medical ethics: a comment on brassington

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

It has recently been suggested by Brassington that, when students in classes in medical ethics announce that some view that they wish to express is related to their religious convictions, the teacher is obliged to question them explicitly about the suggested link. Here, a different conclusion is reached. The view is upheld that, although the stratagem recommended by Brassington is permissible and might sometimes be desirable, it is not obligatory nor is it, in general, likely to be optimal. (Source: Journal of Medical Ethics)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

[research ethics] status of healthcare studies submitted to uk research ethics committees for approval in 2004-5

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Background: In view of the increasing complexity of research ethics committee (REC) applications and thus the time and expense involved in completing the forms, continual monitoring of outcome of clinical research studies for which ethics applications have been submitted is essential in determining whether resources are being effectively used, or alternatively whether significant numbers of research proposals are abandoned because of lack of funding or manpower. Previously published surveys for which data are available examined outcome of studies receiving REC approval 10 or more years ago. Methods: A prospective questionnaire-based survey sent out in July 2006 to all 506 principal investigators who submitted research ethics applications to nine Greater Manchester RECs between April 2004 and March 2005. Data on the outcome of REC applications, and the status of the research study were collected and analysed. Results: 288 of the 506 (57%) questionnaires were returned. 97% of REC applications were approved, and 87% of studies were in progress or had been completed 1–2 years after approval had been granted. Researchers employed by universities (51%), healthcare (43%) and the pharmaceutical industry (6%) had similar rates of success in initiating research studies. Conclusions: This survey suggests that most research studies submitted to RECs in Manchester, UK are approved and initiated. (Source: Journal of Medical Ethics)

[research ethics] payment for research participation: a coercive offer?

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Payment for research participation has raised ethical concerns, especially with respect to its potential for coercion. We argue that characterising payment for research participation as coercive is misguided, because offers of benefit cannot constitute coercion. In this article we analyse the concept of coercion, refute mistaken conceptions of coercion and explain why the offer of payment for research participation is never coercive but in some cases may produce undue inducement. (Source: Journal of Medical Ethics)

[law, ethics and medicine] the views of cancer patients on patient rights in the context of information and autonomy

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Objectives: The aim of this study is to evaluate the views of cancer patients on patient rights in the context of the right to information and autonomy according to articles related to the issue in the "Patient Rights Regulation". Methods: The research was conducted among cancer patients in the medical oncology department of a research and practice hospital using a random sampling method between June and September 2005. Data were collected during face-to-face interviews using a questionnaire. Results: There was a high rate of positive response to the items that the patients have the right to be informed (86.5%), that the physician should inform the patient on the diagnosis and the treatment (92.3%) and that the physician is obliged to inform the patient (76.9%). Only 43.3% of the patients stated that the patient has the right to refuse the treatment recommended by the physician. The participants mostly agreed that the patient should participate in decisions about the treatment and that patient consent should be given (78.8%). Conclusions: There are extensive efforts in Turkey towards making patient rights a significant supportive component of health services. For patient rights to become a natural part of medical practice it is necessary to give priority to education of both patients and physicians about patient rights and to lay emphasis on an ethical approach in the patient–physician relationship. (Source: Journal of Medical Ethics)

[global medical ethics] human rights and bioethics

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

In the first part of this article we survey the concept of human rights from a philosophical perspective and especially in relation to the "right to healthcare". It is argued that regardless of meta-ethical debates on the nature of rights, the ethos and language of moral deliberation associated with human rights is indispensable to any ethics that places the victim and the sufferer in its centre. In the second part we discuss the rise of the "right to privacy", particularly in the USA, as an attempt to make the element of personal free will dominate over the element of basic human interest within the structure of rights and when different rights seem to conflict. We conclude by discussing the relationship of human rights with moral values beyond the realm of rights, mainly human dignity, free will, human rationality and response to basic human needs. (Source: Journal of Medical Ethics)

[global medical ethics] the medical student global health experience: professionalism and ethical implications

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

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

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

[genetics] minors and informed consent in carrier testing: a survey of european clinical geneticists

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Purpose: A study was made of attitudes of clinical geneticists regarding the age at which minors should be allowed to undergo a carrier test and the reasons they provide to explain their answer. Methods: European clinical institutions where genetic counselling is offered to patients were contacted. 177 (63%) of the 287 eligible respondents answered a questionnaire. Results: Clinical geneticists were significantly more in favour of providing a carrier test to a younger person if the request was made together with the parents than if the adolescent requested the test personally. Although a large fraction of respondents (16%–30%) were "neither unwilling nor willing" to provide a carrier test to a 16-year-old adolescent who requested the test personally, for most disorders slightly more clinical geneticists were "very willing" or "willing". Conclusion: Age is not the only decisive element when considering the participation of adolescents in decisions affecting their health. The clinical geneticists referred to cognitive, emotional and sexual maturity and the support of parents as crucial elements in their comments regarding when to tell children about their genetic risk or to allow adolescents to request a carrier test. (Source: Journal of Medical Ethics)

[ethics] the perceived role of islam in immigrant muslim medical practice within the usa: an exploratory qualitative study

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Background: Islam and Muslims are underrepresented in the medical literature and the influence of physician’s cultural beliefs and religious values upon the clinical encounter has been understudied. Objective: To elicit the perceived influence of Islam upon the practice patterns of immigrant Muslim physicians in the USA. Design: Ten face-to-face, in-depth, semistructured interviews with Muslim physicians from various backgrounds and specialties trained outside the USA and practising within the the country. Data were analysed according to the conventions of qualitative research using a modified grounded-theory approach. Results: There were a variety of views on the role of Islam in medical practice. Several themes emerged from our interviews: (1) a trend to view Islam as enhancing virtuous professional behaviour; (2) the perception of Islam as influencing the scope of medical practice through setting boundaries on career choices, defining acceptable medical procedures and shaping social interactions with physician peers; (3) a perceived need for Islamic religious experts within Islamic medical ethical deliberation. Limitations: This is a pilot study intended to yield themes and hypotheses for further investigation and is not meant to fully characterise Muslim physicians at large. Conclusions: Immigrant Muslim physicians practising within the USA perceive Islam to play a variable role within their clinical practice, from influencing interpersonal relations and character development to affecting specialty choice and procedures performed. Areas of ethical challenges identified include catering to populations with lifestyles at odds with Islamic teachings, end-of-life care and maintaining a faith identity within the culture of medicine. Further study of the interplay between Islam and Muslim medical practice and the manner and degree to which Islamic values and law inform ethical decision-making is needed. (Source: Journal of Medical Ethics)

[ethics] genomics and equal opportunity ethics

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Genomics provides information on genetic susceptibility to diseases and new possibilities for interventions which can fundamentally alter the design of fair health policies. The aim of this paper is to explore implications of genomics from the perspective of equal opportunity ethics. The ideal of equal opportunity requires that individuals are held responsible for some, but not all, factors that affect their health. Informational problems, however, often make it difficult to implement the ideal of equal opportunity in the context of healthcare. In this paper, examples are considered of how new genetic information may affect the way individual responsibility for choice is assigned. It is also argued that genomics may result in relocation of the responsibility cut by providing both new information and new technology. Finally, how genomics may affect healthcare policies and the market for health insurance is discussed. (Source: Journal of Medical Ethics)

[clinical ethics] the quality of bioethics debate: implications for clinical ethics committees

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Bioethicists have recently expressed concern over a lack of quality control within the field. This apprehension focuses on bioethics expanding in ways that obscure its distinctive ethical remit and the specialist reasoning skills it requires. This thesis about the quality and conduct of bioethics may have particular relevance for clinical ethics. As one of the youngest offshoots of bioethics, the field focuses on the ethical issues that arise specifically in a clinical context. However, non-ethics specialists are increasingly involved in this field. This means that clinical ethics could be especially vulnerable to the quality control concerns articulated within bioethics. The growing public profile of clinical ethics means that concerns over quality in this area warrant specific attention by those concerned with declining standards in bioethics and those working in clinical ethics. (Source: Journal of Medical Ethics)

[clinical ethics] to what extent should older patients be included in decisions regarding their resuscitation status?

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

As medical technology continues to advance and we develop the expertise to keep people alive in states undreamt of even 20 years ago, there is increasing interest in the ethics of providing, or declining to provide, life-sustaining treatment. One such issue, highly contentious in clinical practice as well as in the media (and, through them, the public), is the use of do-not-attempt-resuscitation orders. The main group of patients affected by these orders is older people. This article explores some of the arguments regarding who should make the decision to implement such an order, with particular reference to older people and the unique issues they face in relation to resuscitation. The author concludes by arguing that official guidelines, while representing an ideal, are not easily applied in a typical acute setting where decisions regarding resuscitation are most commonly made, and makes suggestions as to how they may be implemented more successfully. (Source: Journal of Medical Ethics)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

[clinical ethics] patients' preferences for receiving clinical information and participating in decision-making in iran

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Introduction: This study, the first of its kind in Iran, was to assess Iranian patients’ preferences for receiving information and participating in decision-making and to evaluate their satisfaction with how medical information is given to them and with their participation in decision-making at present. Method and materials: 299 of 312 eligible patients admitted to general internal medicine or surgery wards from May to December 2006 were interviewed according to a structured questionnaire. The questionnaire contained questions about patients’ preferences regarding four domains of information and their participation in decision-making. Patients’ responses were measured on a visual analogue scale graded from 1 to 10. Results: The mean (SD) score for desire to receive information was 8.88 out of 10 (1.5) and for participation in medical decision-making was 7.75 out of 10 (3). The desire to receive information was greater in women than men (9.0 (1.5) vs 7.8 (1.4), p = 0.025). It was also correlated with their education (r = 0.2, p = 0.001) and their estimation of the severity of their own disease (r = 0.13, p = 0.027). The score for preference to participate in decision-making was higher in women than in men (7.95 (2.8) and 7.0 (3.2), respectively; β = 0.8, p = 0.022) and was negatively correlated with education (r = –0.14, p = 0.015). Discussion: This study shows that Iranian patients are highly interested in receiving information about their condition and participating in clinical decision-making. No predictive variable for such attitudes was found; therefore, the only way for the physician to recognise patients’ desire is to ask them explicitly. (Source: Journal of Medical Ethics)

[clinical ethics] an assessment of the process of informed consent at the university hospital of the west indies

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Objective: To assess the adequacy of the process of informed consent for surgical patients at the University Hospital of the West Indies. Method: The study is a prospective, cross-sectional, descriptive study. 210 patients at the University Hospital of the West Indies were interviewed using a standardised investigator-administered questionnaire, developed by the authors, after obtaining witnessed, informed consent for participation in the study. Data were analysed using SPSS V.12 for Windows. Results: Of the patients, 39.4% were male. Of the surgical procedures, 68.6% were scheduled, 7.6% urgent and 23.8% emergency, 35.2% were minor and 64.8% major. Information imparted/received was acceptable in 40% of cases, good in 24% and inadequate (unacceptable) in 36% of cases. Almost all (97.6%) patients stated that they understood why an operation was planned and 93.3% thought that they had given informed consent. Most (95.2%) thought that they had free choice and made up their own mind. A quarter (25.2%) of all patients were told that it was mandatory for them to sign the form. There was a discussion of possible side effects and complications in 56.7% of patients. Conclusions: This study clearly indicates that surgical patients at the University Hospital of the West Indies feel that they have given informed consent. However, it also suggests that more information should be given to patients for consent to be truly informed. (Source: Journal of Medical Ethics)

[clinical ethics] the ashley treatment: a step too far, or not far enough?

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

This "current controversies" contribution describes the recent case of a severely disabled six year old girl who has been subjected to a range of medical interventions at the request of her parents and with the permission of a hospital clinical ethics committee. The interventions prescribed have become known as "the Ashley treatment" and involve the performance of invasive medical procedures (eg, hysterectomy) and oestrogen treatment. A central aim of the treatment is to restrict the growth of the child and thus make it easier for her parents to care for her at home. The paper below discusses the main objections to the treatment. It concludes that the most serious concern raised by the case is that it may set a worrying precedent if the moral principle employed in justification of the treatment is applied again to endorse it in similar circumstances. Finally, it raises the possibility that that same moral principle may even be invoked to justify more radical interventions than those that were actually performed in the Ashley treatment. (Source: Journal of Medical Ethics)

[clinical ethics] the practicalities of terminally ill patients signing their own dnr orders--a study in taiwan

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Objectives: To investigate the current situation of completing the informed consent for do-not-resuscitate (DNR) orders among the competent patients with terminal illness and the ethical dilemmas related to it. Participants: This study enrolled 152 competent patients with terminal cancer, who were involved in the initial consultations for hospice care. Analysis: Comparisons of means, analyses of variance, Student’s t test, 2 test and multiple logistic regression models. Results: After the consultations, 117 (77.0%) of the 152 patients provided informed consent for hospice care and DNR orders. These included 21 patients (17.9%) who signed the consent by themselves, and 96 (82.1%) whose consent sheet was signed only by family members. The reasons why patients were not involved in the discussions toward the consent (n = 82) included poor physical or psychological condition (44.9%), concerns of the consultant hospice team (37.2%), and the family’s refusal (28.2%). On a multivariate analysis, patients’ awareness of their poor prognosis (odds ratio = 4.07, 95% confidence interval = 2.05 to 8.07) and their understanding of hospice care (2.27, 1.33 to 3.89) were two independent factors (p<0.01) that influenced their participation in the discussions or their personal signature in the informed consent. Conclusion: The family-oriented culture in Asian countries may violate the principles of the Patient Self-Determination Act and the requirements of the Hospice Care Law in Taiwan, which inevitably poses an ethical dilemma. Earlier truth-telling and continuing education of the public by hospice care workers will be helpful in solving such ethical dilemmas. (Source: Journal of Medical Ethics)

[clinical ethics] clinical prioritisations of healthcare for the aged--professional roles

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Background: Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians’ considerations in clinical prioritisation within this field is scarce. Objectives: To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. Design: A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. Participants: 20 physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway. Results and interpretations: The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians’ role. Conclusion: Distributing healthcare services in a fair way is generally not described as integral to the clinicians’ role in clinical prioritisations. If considerations of justice are not included in clinicians’ role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions. (Source: Journal of Medical Ethics)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

[clinical ethics] the potential impact of decision role and patient age on end-of-life treatment decision making

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Background: Recent research demonstrates that people sometimes make different medical decisions for others than they would make for themselves. This finding is particularly relevant to end-of-life decisions, which are often made by surrogates and require a trade-off between prolonging life and maintaining quality of life. We examine the impact of decision role, patient age, decision maker age and multiple individual differences on these treatment decisions. Methods: Participants read a scenario about a terminally ill cancer patient faced with a choice between an aggressive chemotherapy regimen that will extend life by two years and palliative treatments to control discomfort for one remaining month. Participants were randomly assigned to one of three decision roles (patient, physician, or an abstract other) and the scenario randomly varied whether the patient was described as 25 or 65-years old. Results: When deciding for a 65-year old patient, approximately 60% of participants selected aggressive chemotherapy regardless of decision role. When deciding for a 25-year old patient, however, participants were more likely to select chemotherapy for a patient (physician role) or another person (abstract other) than for themselves (70%, 67%, and 59%, respectively). In addition, confidence that powerful others (eg, physicians) control one’s health, as well as respondents’ age and race, consistently predicted treatment choices. Conclusions: Patient age appears to influence medical decisions made for others but not those that we make for ourselves. These findings may help to explain the discord that often occurs when younger cancer patients refuse life-extending treatments. (Source: Journal of Medical Ethics)

[clinical ethics] is truth a supreme value?

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Is truth a supreme value? At times, we doctors have to contend with a complex dilemma in which we face the value of truth on the one hand and conflict with another value on the other. Is it sometimes permissible and even necessary not to report the truth in favour of another, more important value? This is a description of an experience in which a doctor had to handle such an issue when a pregnant Muslim woman asked for a document that she wasn’t pregnant when in fact she was, in order to avert the possibility of being murdered to preserve the honour of the family. The doctor decided that the value of life was more important than the value of truth. (Source: Journal of Medical Ethics)

[clinical ethics] mexican heroism

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

(Source: Journal of Medical Ethics)

[clinical ethics] clinical ethicists' perspectives on organisational ethics in healthcare organisations

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (Source: Journal of Medical Ethics)

[editorial] should we force the obese to diet?

Journal of Medical Ethics — Wed, 30 Apr 2008 04:00:00 +0100

(Source: Journal of Medical Ethics)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Informed consent practices in nigeria

Developing World Bioethics — Tue, 29 Apr 2008 18:37:38 +0100

Developing World Bioethics, Volume 0, Issue 0, Page ???, OnlineEarly Articles. ABSTRACT Most writing on informed consent in Africa highlights different cultural and social attributes that influence informed consent practices, especially in research settings. This review presents a composite picture of informed consent in Nigeria ... (Source: Developing World Bioethics)

Clinical research without consent in adults in the emergency setting: a review of patient and public views

BMC Medical Ethics — Tue, 29 Apr 2008 04:00:00 +0100

Background: In emergency research, obtaining informed consent can be problematic. Research to develop and improve treatments for patients admitted to hospital with life-threatening and debilitating conditions is much needed yet the issue of research without consent (RWC) raises concerns about unethical practices and the loss of individual autonomy. Consistent with the policy and practice turn towards greater patient and public involvement in health care decisions, in the US, Canada and EU, guidelines and legislation implemented to protect patients and facilitate acute research with adults who are unable to give consent have been developed with little involvement of the lay public. This paper reviews research examining public opinion regarding RWC for research in emergency situations, and whether the rules and regulations permitting research of this kind are in accordance with the views of those who ultimately may be the most affected. Methods: Seven electronic databases were searched: Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews, Philosopher's Index, Age Info, PsychInfo, Sociological Abstracts and Web of Science. Only those articles pertaining to the views of the public in the US, Canada and EU member states were included. Opinion pieces and those not published in English were excluded. Results: Considering the wealth of literature on the perspectives of professionals, there was relatively little information about public attitudes. Twelve studies employing a range of research methods were identified. In five of the six questionnaire surveys around half the sample did not agree generally with RWC, though paradoxically, a higher percentage would personally take part in such a study. Unfortunately most of the studies were not designed to investigate individuals' views in any depth. There also appears to be a level of mistrust of medical research and some patients were more likely to accept an experimental treatment 'outside' of a research protocol. Conclusions: There are too few data to evaluate whether the rules and regulations permitting RWC protects - or is acceptable to - the public. However, any attempts to engage the public should take place in the context of findings from further basic research to attend to the apparently paradoxical findings of some of the current surveys. (Source: BMC Medical Ethics)

Reporting of informed consent, standard of care and post-trial obligations in global randomized intervention trials: a systematic survey of registered trials

Developing World Bioethics — Mon, 28 Apr 2008 18:14:00 +0100

Developing World Bioethics, Volume 0, Issue 0, Page ???, OnlineEarly Articles. ABSTRACT Objective: Ethical guidelines are designed to ensure benefits, protection and respect of participants in clinical research. Clinical trials must now be registered on open-access databases and provide details on ethical considerations. This ... (Source: Developing World Bioethics)

The impact of research in bioethics

Bioethics — Mon, 28 Apr 2008 17:23:15 +0100

Bioethics, Volume 22, Issue 5, Page ii, June 2008. (Source: Bioethics)

The international dimensions of neuroethics

Developing World Bioethics — Fri, 25 Apr 2008 18:30:18 +0100

Developing World Bioethics, Volume 0, Issue 0, Page ???, OnlineEarly Articles. ABSTRACT Neuroethics, in its modern form, investigates the impact of brain science in four basic dimensions: the self, social policy, practice and discourse. In this study, we analyzed a set of 461 peer-reviewed articles with neuroethics content, ... (Source: Developing World Bioethics)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Free riders and pious sons – why science research remains obligatory

Bioethics — Fri, 25 Apr 2008 18:12:38 +0100

Bioethics, Volume 0, Issue 0, Page ???, OnlineEarly Articles. ABSTRACT John Harris has previously proposed that there is a moral duty to participate in scientific research. This concept has recently been challenged by Iain Brassington, who asserts that the principles cited by Harris in support of the duty to ... (Source: Bioethics)

Why we are not morally required to select the best children: a response to savulescu

Bioethics — Fri, 25 Apr 2008 17:24:12 +0100

Bioethics, Volume 0, Issue 0, Page ???, OnlineEarly Articles. ABSTRACT The purpose of this paper is to review critically Julian Savulescu's principle of ‘Procreative Beneficence,’ which holds that prospective parents are morally obligated to select, of the possible children they could have, those with the greatest ... (Source: Bioethics)

Enhancements, easy shortcuts, and the richness of human activities

Bioethics — Fri, 25 Apr 2008 17:24:12 +0100

Bioethics, Volume 0, Issue 0, Page ???, OnlineEarly Articles. ABSTRACT One argument that is frequently invoked against the technological enhancement of human functioning is that it is morally suspect, or even wrong, to take an easy shortcut. Some things that usually take effort, endurance or struggle can come ... (Source: Bioethics)

Procreative reasons-relevance: on the moral significance of why we have children

Bioethics — Fri, 25 Apr 2008 17:24:11 +0100

Bioethics, Volume 0, Issue 0, Page ???, OnlineEarly Articles. ABSTRACT Advances in reproductive technologies – in particular in genetic screening and selection – have occasioned renewed interest in the moral justifiability of the reasons that motivate the decision to have a child. The capacity to select for desired ... (Source: Bioethics)