Areas Of Medical Ethics Research Articles

Disgust or Dignity? The Moral Basis of Harm Reduction.

Harm reduction has been advocated to address a diverse range of public health concerns. The moral justification of harm reduction is usually presumed to be consequentialist because the goal of harm reduction is to reduce the harmful health consequences of risky behaviors, such as substance use. Harm reduction is contrasted with an abstinence model whose goal is to eradicate or reduce the prevalence of such behaviors. The abstinence model is often thought to be justified by 'deontological' considerations: it is claimed that many risky behaviors are morally unacceptable, and therefore that we have a moral obligation to recommend abstinence. Because harm reduction is associated with a consequentialist justification and the abstinence model is associated with a deontological justification, the potential for a deontological justification of harm reduction has been overlooked. This paper addresses this gap. It argues that the moral duty to protect autonomy and dignity that has been advocated in other areas of medical ethics also justifies the public health policy of harm reduction. It offers two examples-the provision of supervised injection sites and the Housing First policy to address homelessness-to illustrate the argument.

An organized approach to complex ethical cases on a surgical service.

Ethical scenarios, such as the one above, frequently arise in surgical specialties. The surgical environment often is saturated with complicated decisions, critically ill patients, and delivering bad news. Ethics is central to both medical and surgical practice. However, surgical ethics is different from other areas of medical ethics in that surgeons are necessarily an active part of the patient’s treatment. When a surgical plan is created, there is always an action by a person, the surgeon, upon another person, the patient. If the surgeon is removed from the operative plan, the treatment falls apart. The fact that a surgeon is required to complete surgical procedures differs greatly from other medical specialties where once a plan is generated, it can continue without the direct involvement of the physician. Across the field of bioethics, four principles can frequently be identified as central to most ethical situations and decisions: respect for persons—allowing the patient to play an active role in making decisions regarding their own medical care [1]; nonmaleficence—avoiding harm to a patient; beneficence—maximizing benefits and minimizing harms to patients; and justice—being fair and equitable [2]. These principles guide the evaluation and interpretation of the ethical issues in patient care. Surgical care most commonly occurs when a patient is sick and vulnerable as patients often present when acutely ill or with a malignancy or other condition that requires operative resolution. The vulnerability of the patient requires the surgeon to exercise additional caution in caring for patients who are in dire need of assistance and may be willing to consent to extreme procedures. When the surgeon and patient discuss an operative plan, it is the surgeon’s responsibility to effectively communicate the indications, risks, and alternatives of the operation to the patient. Although official documentation of informed consent occurs through signing a form, the actual consent process is the conversation between the surgeon and patient [3]. This conversation is a critical component of any surgical procedure. It is in this interaction that the relationship is established with the patient; confidence and trust are instilled, the usual postoperative course defined, and possible complications are explained. For high-risk procedures, the surgeon should go further than the informed consent conversation and discuss what the patient might want done if complications arise. This conversation should outline what the patient would want in specific and unlikely, but still possible scenarios; e.g., not regaining baseline mental status or not being able to be extubated. Beyond the consent process itself, surgeons must continually communicate with patients S. C. Wightman (&) P. Angelos Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Avenue, MC6040, Chicago, IL 60637, USA e-mail: sean.wightman@uchospitals.edu

Identification of areas of medical ethics for development of teaching modules using medical student's perception

Identification of areas of medical ethics for development of teaching modules using medical student's perception

Complex Medical Ethical Problems

Jana Wandrowski et al. published an informative article on physicians’ knowledge and awareness of medical ethics. On the basis of our experience in patient care as well as continuing medical education in medical ethics, we think that some additional comments are warranted. Better ethics in clinical practice requires more training in medical ethics. Even though one might intuitively agree that this hypothesis expressed by the authors is correct, the presented empirical data are too weak to support such a far-reaching statement. Others have rightly pointed out that the method used by the authors, of questions with predefined responses on a scale, does not do justice to the complexity of medical ethical problems (1). The superficial case description given in the questionnaire can test merely knowledge of the terminology of medical ethics, but does not promote deeper understanding of ethical positions. In contrast to the authors’ assertions, non-insertion of a percutaneous endoscopic gastrostomy (PEG) tube does not automatically equate to passive assistance in dying since patients can also be fed intravenously. The term “passive assistance in dying” is actually outdated. The article lacks a clear definition for the term “medical ethical knowledge”. The authors’ tacit understanding is led by the topic and focuses exclusively on autonomy. The subject of medical ethics entails more than just autonomy. Physicians’ ethical positions partly change as their professional experience grows. This finding is made clear in the study. Since we recognized this fact at an earlier stage, we initiated a special seminar course that is available to physicians (2). We agree with the authors in that an increased need for training exists at all levels of medical education in questions and problems in the area of medical ethics and law. The subject matter should be taught with the target audience in mind so that they can be applied in clinical practice.

Forensic Nanotechnology, Biosecurity and Medical Professionalism: Improving the Australian Health Care System's Response to Terrorist Bombings

This chapter explores how medical professionalism in forensic bioterrorist investigations may be influenced by the enhanced surveillance, detection and data storage capacities offered by nanotechnology. It draws on the author's experience treating patients injured in the 2002 Bali bombings. It is now well accepted that health professionals involved in forensic investigations may experience conflict of interest problems with moral, ethical, legal and human rights dimensions. Physicians acquiring information, for example, about crimes from patients may have to breach ethical and legal obligations of confidentiality in disclosing that information to justice authorities. The professional obligations of physicians involved in forensic investigations extend to the collation of evidence and provision of testimony within an adversarial legal system. Many of these duties have the potential to create dilemmas for a physician's sense of professionalism, which is generally characterised by an emphasis on public service, rather than profit-earning, by an occupation with State-recognised special skill. Physicians treating terrorist suspects or involved in investigating allegations of massacres, may be assisted in resolving any resultant conflict of interest dilemmas by reference not only to basic principles of medical ethics, but to relevant United Nations guidelines. International humanitarian law is another important source of professional norms by which physicians can calibrate legislation or other obligations to the state requiring their involvement in such areas. It is an aggregation of customary and treaty-based principles and rules concerned with the treatment of wounded, civilians and prisoners in war, and overlapping with many areas of medical ethics. Article 7 of the ICCPR, as well as prohibiting torture or cruel, unusual or degrading treatment or punishment also provides that 'no one shall be subjected without his free consent to medical or scientific experimentation'.

Risk Evaluation and Mitigation Strategies for Drugs with Abuse Liability

Risk evaluation and mitigation strategies (REMS) formerly known as Risk Minimization Action Plans (RiskMAPs) are a regulatory technique for dealing with anticipated risks of new medications and are especially important for new drugs with abuse potential. This paper describes the origin and history of risk-management plans for drugs that might be abused, the proper use of these plans in minimizing the risk to the public, and the special difficulties inherent in managing risks for drugs with abuse potential. Drugs with abuse liability are distinctive since the risks inherent in manufacture and distribution include not only risks to patients prescribed the medications, but also risks to the general public including subgroups in the population not intended to get the drug and who receive no medical benefit from the medication. The crafting of risk-management plans intended to protect nonpatient populations is unique for these products. The content, extent, and level of intensity of these plans affect areas of medical ethics, civil liability, and criminal prosecution. The need for risk-management plans for drugs with abuse liability can potentially act as a deterrent to investment and is a factor in decisions concerning the development of new medications for the treatments of pain, ADHD, anxiety disorders, and addictions. This paper provides a framework for moving the process of REMS development forward and criteria for evaluating the probity and adequacy of such programs.

A critical examination of the health workers\' civil and criminal liabilities

This paper set out to examine the subject matter of health and welfare administration and the human resources thereto to achieve the set objectives of health and welfare policies of the Government. It also aimed at examining the behaviour of the professionals in the hospitals, the ethical principles, law guiding their behavior and the consequential effect of the act of negligence or omission or commission of the health professionals in the course of their duties. Primary and secondary sources of data were utilized. The primary data were sourced from the conduct of interview of nurses, doctors and pharmacists respectively. The secondary data were garnered from medical journals, hospital records case law and statutory provisions. The information gathered were descriptively analysed and the study principally revealed over 60% of the health professionals are ignorant of the consequences of their negligence, omission, malafide, and commission during the course of their duties. The study further revealed that, most of the departments where these professionals were trained abinitio do not teach medical ethics, law of medicine and the effects of these principles on the behavior of the health workers. In view of this vital omission in their curriculum, the students who later become health professionals are ill-equipped at least in the area of medical ethics and rudimentary knowledge of law of medicine. The paper therefore recommended that law of medicine and professional medical ethics be included and made compulsory for would be health professionals in the public and private hospitals respectively in Nigeria. Nigerian Journal of Health and Biomedical Sciences Vol. 7 (1) 2008 pp. 47-58

End-of-life decisions

Abstract Few areas of medical ethics raise such strong and diverse views as issues concerned with the end of life. National debates flare over concerns such as euthanasia and advance directives (living wills). Within the medical profession, there is continuing questioning of the right policies for ‘do-not-resuscitate' orders, and concern over the distinctions in both theory and practice between easing and hastening death. Some members of the public appear worried that doctors may try too hard to keep them alive, whereas others fear the reverse. Clear thinking is a prerequisite to good policy and good practice. Medical care of patients close to the end of their life requires not only a thorough understanding of the scientific aspects of medicine, but also a clear analysis of values and an understanding of the law.

Developing an Ethics Curriculum for an Internal MedicineResidency Program: Use of a Needs Assessment

Background: Residency programs are required to teach and evaluate trainees in the area of professionalism and medical ethics. Prior to developing a curriculum in this area, residents and fellows were surveyed to assess learning needs. Description: A case-based survey was developed based on published curricula. Residents and fellows were asked to describe their comfort level in 11 clinical scenarios on a Likert-type scale ranging from 1 (not at all comfortable) to 10 (extremely comfortable). Evaluation: 151 surveys were returned for an overall response rate of 73%. Comfort levels ranged from a low of 3.1 to a high of 8.5 on the 10-point scale. Despite additional years of clinical training, fellows only reported an increased comfort level in 1 case. Conclusion: Learning needs exist in residents and fellows in the area of medical ethics. Use of a needs assessment was instrumental in planning and designing an ethics curriculum.

Teaching medical ethics: implementation and evaluation of a new course during residency training in bahrain.

This paper describes the development, implementation and evaluation of a new biomedical ethics course. The major educational goal was to enable the participants to critically analyse and resolve ethical dilemmas based on sound ethical and moral reasoning. The course was developed and implemented in the Family Practice Residency Program (FPRP) in the Kingdom of Bahrain. Thirty-six family physician trainees participated in this course in May 2002 and January 2003. The curriculum was divided into five sessions, and each session had specific objectives, contents and teaching methods. The course was evaluated using pre- and post-tests, direct observation of participants and overall course assessment. Evaluations demonstrated that the participants scored higher in the post-test than in the pre-test. There was a significant statistical difference between the mean scores of both tests. After completing the course, participants produced more justifiable decisions than those generated at the beginning and felt more confident discussing and reasoning their decisions based on sound ethical and moral concepts. Our experience had demonstrated that the trainees benefited from a structured curriculum in biomedical ethics. We believe that the development and implementation of our course may serve as a case study for training and teaching postgraduates in the area of medical ethics.

Genetics of gastrointestinal and hepatobiliary disorders: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

Genetics of gastrointestinal and hepatobiliary disorders: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

Resources Available for the Practitioner

According to a recent survey, there are over 375 million people worldwide with Internet access along with an estimate of over 2 billion web pages, and growing at a rate of over 7 million per day. The rapid evolution of the Internet and the World Wide Web has provided health care practitioners with an overwhelming source of information. Although the Internet has enormous potential for practitioners, it also has probable drawbacks. The purpose of this presentation will be to provide an overview of Internet and computer based resources available to health care practitioners in the areas of information management, research, education, telemedicine, clinical practice and patient information. The emphasis will be to provide practitioners with an overview of present and future applications of Web technology in health care provision. There will be a discussion of resources available to practitioners and patients regarding the evaluation of web based information for content accuracy. Some recent studies have shown that although there are often times a number of web pages devoted to a topic, the content is often of a commercial nature and of dubious quality. The trend towards telemedicine (e-healthcare, tele-health) holds promise, however it may offer challenges in the area of medical ethics, regulation, and confidentiality. The use of the Internet by patients will offer exciting opportunities for enhanced communication between practitioner and patient, as well as challenges regarding accuracy of information that is available to patients. One of the areas that will be of particular interest to practitioners is in the computerization of medical records. Clinics now utilize this approach to submit individualized patient information into a centralized database that can be analyzed in aggregate to look at costs and outcomes for particular diagnoses. The potential for multi-site research using this approach may hold great promise for practitioners. Examples of this application will be discussed. For practitioners, the Internet offers the opportunity for continuing education, access to medical journals and information services as well as research. Practitioners may choose to be consumers of or vendors for medical information. One of the web based software packages (Blackboard) will be reviewed as to its potential for use by practitioners as well as how we utilize it at our University. An overview of a variety electronic databases and journals will be presented. Electronic versions of the references and the websites used for this presentation will be downloadable from our University website at: http://www.medicine.nodak.edu/pt.

Zasada nieszkodzenia w etyce medycyny

There are some reasons to treat the principle of beneficence and the principle of nonmaleficence as separates. One of these reasons is, that they may sometimes stay in opposition. Then the question arises: to which of the two priority should be given. To resolve this in the area of medical ethics, a definition of the principle of nonmaleficence, considering its meaning and importance, seems to be necessary.