Central Ethical Problem Research Articles

Desafios e problemas éticos da Vigilância em Saúde: tensão dialética entre riscos e necessidades em saúde

The Health Services are under a dialectic tension between two directives: the collective control of risks and individual care, whose needs are shaped by social determinants of health. The surveillance, as a service, centers on the biopolitical governing of collective risks and focusses on a certain population, living in a specific area, defined as a social space, where the health needs are evident, demanding healthcare. The responses depend on the surveillance data taken from the societal processes that make up the risks. The central ethical problem is if these data cause facilitate emancipation or perpetuate the risks.

Eroding students' rural motivation: first do no harm?

Migration of health professionals is one of the drivers of vast inequalities in access to healthcare, as medical graduates tend to move away from both poorer countries and rural areas. One of the central ethical problems raised in attempting to alleviate these inequalities is the tension between the healthcare needs of under-served patients and the rights of medical graduates to choose their place of work and specialty. If medical graduates had greater motivation to work in under-served rural areas, this tension would decrease accordingly. Medical schools have a duty to avoid eroding existing motivation for such training and practice. This duty has practical implications. Medical students' motivation regarding their choice of specialty changes during medical training, turning them away from choices such as primary care and rural practice towards more highly specialised, more hospital based specialties. Although students may be victims of a number of biases in the initial assessment, this is unlikely to be the whole story. Students' priorities are likely to change based on their admiration for specialist role models and the visibility of the financial and non-financial rewards attached to these specialties. Students may also have a false expectation upon admission that they will be proficient in rural medicine on graduation, and change their mind once they realise the limits of their skills in that area. Although the measures required to reverse this effect currently lack a solid evidence base, they are plausible and supported by the available data.

Ethical Evaluation of Social Services and the Need for Ethics Committees

Abstract The central ethical problem: we propose to treat the importance of establishing committees of ethics (of research) in social work organizations. We refer here to the ethical analysis of individualized service plans and intervention strategies that case managers apply to beneficiaries, the central ethical problem being represented by the analysis of conditions of ethical acceptability of social intervention. Argumentative structure: the ethical evaluation of services should consider the principles of beneficence, autonomy, non-maleficence and justice, as treated by Beauchamp and Childress (2001) , as a variant of the principles stipulated in the Belmont report (1979). We will treat tangentially the need for ethical supervision, which refers to the effective supervision of the organization's ethical practices. The paper has an argumentative character, the central premise being that intervention in social work is a form of action research and thus it should be based on the same rules of research on human subjects. The second premise is that according to which as medical assistance, social intervention changes the quality of life of the beneficiary, and this change requires ethical evaluation in order to analyze the conditions in which ethics is perceived and accepted as defining part of the social intervention. Conclusions Both theoretical and practical arguments, presented in the paper, in favour of the establishment of committees of ethics, are acceptable and we could not find counterarguments to invalidate them.

What should we share?

The aim of Intercultural Information Ethics (IIE), as Ess aptly puts, is to "(a) address both local and global issues evoked by ICTs / CMC, etc., (b) in a ways that both sustain local traditions / values / preference, etc. and (c) provide shared, (quasi-) universal responses to central ethical problems? (Ess 2007a, 102). This formulation of the aim of IIE, however, is not unambiguous. In this paper, I will discuss two different understandings of the aim of IIE, one of which advocates "shared norms, different interpretations" and another proposes "shared norms, different justifications". I shall argue that the first understanding is untenable, and the second understanding is acceptable only with qualification. Finally, I shall briefly suggest an alternative way to understand the aim of IIE.

Free time as a necessary condition of free life

Human life is finite. Given that lifetime is necessarily limited, the experience of time in any given society is a central ethical problem. If all or most of human lifetime is consumed by routine tasks (or resting for the resumption of routine) then human beings are dominated by the socially determined experience of time. This article first examines time as the fundamental existential framework of human life. It then goes on to explore the determination of time today by the ruling value system that underlies advanced capitalist society. It concludes that the equation ‘time is money’ rules the contemporary experience of time, and goes on to argue that this experience deprives those who live under this ruling value system of a central requirement of free human life: the experience of time as an open matrix of possibilities for action (or free time).

The Patient's Work

In The Healer's Power, Howard Brody placed the concept of power at the heart of medicine's moral discourse. Struck by the absence of “power” in the prevailing vocabulary of medical ethics, yet aware of peripheral allusions to power in the writings of some medical ethicists, he intuited the importance of power from the silence surrounding it. He formulated the problem of the healer's power and its responsible use as “the central ethical problem in medicine.” Through the prism of power he refracted a wide range of ethical problems, from informed consent to truth-telling, from confidentiality to futility, from the physician's fantasies to the physician's virtues. At times this prism shed new light on old problems, enabling us to see from an unexpected angle the elements of which the problem was composed. At other times it exposed issues of ethical significance that had been neglected in the bioethics literature.

Genetic Testing and Private Insurance – A Case of “Selling One’s Body”?

Arguments against the possible use of genetic test results in private health and life insurance predominantly refer to the problem of certain gene carriers failing to obtain affordable insurance cover. However, some moral intuitions speaking against this practice seem to be more fundamental than mere concerns about adverse distributional effects. In their perspective, the central ethical problem is not that some people might fail to get insurance cover because of their 'bad genes', but rather that some people would manage to get insurance cover because of their 'good genes'. This paper tries to highlight the ethical background of these intuitions. Their guiding idea appears to be that, by pointing to his favourable test results, a customer might make an attempt to 'sell his body'. The rationale of this concept is developed and its applicability to the case at issue is critically investigated. The aim is to clarify an essential objection against the use of genetic information in private insurance which has not yet been openly addressed in the academic debate of the topic.

Euthanasia: History, Definitions and Clinical Guidelines from Classical Jewish Sources.

Background: End-of-life care is a central ethical problem for clinicians. The definition of euthanasia is complex and difficult causing confusion for its practical application. Historically, the term was abused leading to medical atrocities. We trust that during medical training and in continuous medical education programs ethical topics relevant for clinical practice should be addressed systematically in their cultural context. The awareness for these crucial topics will improve clinical performance.Objective: To define philosophical concepts, to present historical events, to discuss classical attitudes in modern bioethics and to analyze classical Jewish sources which are helpful to elaborate practical guidelines for clinicians in euthanasia and end-of-life care. Reflection on these concepts by discussing classical Jewish sources might help clinicians in their judgment and process of decision-making.Methods: A historical overview with philosophical definitions of the concepts of active versus passive euthanasia, physician assisted suicide etc are given. Sources from the classical Jewish literature are presented and analyzed also according to later traditional interpretation. Their relevance and application in modern clinical medicine is elaborated.Results: Philosophically, the distinction between active versus passive euthanasia is crucial. Jewish sources certainly support the obligation to ease the ongoing process of dying; there is no duty to prolong the agony of the actively dying patient, which is actually prohibited. On the other hand, no practical involvement is allowed to actively induce death of the terminal patient.Conclusion: The historical overview and the review of the literature support the need to define concepts of euthanasia for clinicians dealing with end-of-life issues, since this term caused historically and philosophically major confusion. Therefore, ethical issues should be included in formal training for physicians and other health care providers, in order to improve the clinical approach for these challenging aspects of clinical medicine. We believe, that classical Jewish sources might contribute to elaborate clinical definitions and to provide meaningful approaches for practical guidelines for clinicians.

Adaptive Designs, Informed Consent, and the Ethics of Research

The ethical tension in research design is often characterized as that between individual and collective ethics. While adaptive clinical trials (ACTs) are generally considered to be more sensitive to individual ethics, the concomitant loss of statistical power associated with them is often used to justify randomized clinical trials (RCTs). This paper challenges this characterization of the central ethical problem in research design. It argues that the key consideration in clinical research hinges on the process of informed consent. When the research context is such that the subject is able to provide informed consent, RCTs can be justified and may be required. However, in desperate medical situations the process of informed consent is often undermined. It is argued that in such situations ACTs are ethically required. We introduce “the principle of interchangeability” and argue that it must be satisfied if research in desperate medical situations is to be justified. Control Clin Trials 2001;22:203–210