Controversial Ethical Issues Research Articles

Taking the patient's side: the ethics of pharmacogenetics.

From the perspective of current and future patients, the development of the field of pharmacogenetics is of immense interest. The encouraging vision that is now being established is that we may move from trial and error therapies to evidence-based personalized medicine in clinical practice. However, research and the application of pharmacogenetics to clinical practice are believed to raise a host of controversial ethical issues. Some of these are related to the research process, for example, confidentiality and informed consent in association with human tissue sampling. Other issues arise on a societal level, for example, issues regarding justice and the use of race or ethnicity as proxies for genotyping. In this perspective, I comment on this debate and also suggest what we may learn from previous discussions regarding DNA testing and gene transfer methods. Arguably, the most important ethical perspective in medical research and drug development is related to the interests of patients wanting medical treatment that is both effective and carries low risks of adverse effects. Risk:benefit ratios must always be compared with existing alternatives, and while the risk of adverse effects may be tolerable for some individuals, owing to genetic reasons, this may not be relevant for others. This will have consequences for regulatory policies regarding drug development. In the future, personalized medicine will also need to take epigenetic and environmental factors into consideration.

Researchers’ preferences and attitudes on ethical aspects of genomics research: a comparative study between the USA and Spain

Introduction:The use of human samples in genomic research has increased ethical debate about informed consent (IC) requirements and the information that subjects should receive regarding the results of the research....

How Christian Norms Can Have an Impact on Bioethics in a Pluralist and Democratic Europe: A Scandinavian Perspective

This article assesses the similarity and difference between the Western European style of doing bioethics and the Scandinavian one. First, it reviews the introductory article by the editor, C. Delkeskamp-Hayes in the first issue of Christian Bioethics (2008), devoted to the possibility of a specifically Christian bioethics in Europe. Second, it analyses bioethics debates in Scandinavian today. In light of Delkeskamp-Hayes' article, the main similarity is that both regions are facing secularization as a threat to basic Christian values, for example, to the Christian view of the sanctity and dignity of the human life. But the Scandinavian tends to reduce Christian bioethics to Luther's concept of the worldly kingdom, supposed to foster a dialogue between Christians and non-Christians on controversial ethical issues. Despite the positive value of the dialogue, this strategy renders Christian ethics powerless. Third, from an evangelical theological standpoint, it proposes some strategies for enhancing the influence of Christian commitments on bioethical laws and policies.

Alternative Strategies for the Derivation of Human Embryonic Stem Cell Lines and the Role of Dead Embryos

The therapeutic potential for human embryonic stem cells (hESC) drives intense public and scientific interest. However, the classical approach for derivation of hESC entails the destruction of human embryos. Controversial ethical issues and correspondingly restrictive federal policies in many countries have prompted the development of alternative approaches for the isolation of hESC. Here, several different strategies are discussed with a focus on the harvesting of live hESC from dead embryos.

Organized Obfuscation: Advocacy for Physician-Assisted Suicide

An ancient but evergreen practice with controversial political and ethical issues is to manipulate ideas and language, spinning them to serve one's ends. My example will be the current physician-assisted suicide debate, now being played out with ballot initiative in the state of Washington. The advocates for physician-assisted suicide make use of favorite method from the spin tool box, that of obfuscation, defined in dictionaries as an effort to render something unclear, evasive, or confusing. I believe that in re-Daniel Callahan, Organized Obfuscation: Advocacy for Physician-Assisted Suicide, Hastings Center Report 38, no. 5 (2008): 30-32. cent years, many (though hardly all) advocates of euthanasia and physician-assisted suicide have used organized obfuscation as political tactic, and Washington is no exception. The seeds of this interpretation were planted in my mind in the late 1980s. In the January-February 1989 issue of the Hastings Center Report we published an article by Dutch cardiologist, Richard Fenigsen, titled Case against Dutch (1) We did so with considerable trepidation. The article seemed extreme in its accusations, the only available footnotes were in Dutch, and we had no good way of independently verifying his critique. In brief, he charged that there were far more instances of euthanasia than reported, that regulations promulgated by Dutch courts to control the practice were widely ignored, and that euthanasia without informed consent of patients (called euthanasia) was common. We decided to take chance and published the article. We were almost instantly assaulted with remarkable (and obviously orchestrated) deluge of complaints from Dutch health authorities and organizations, as well as euthanasia advocacy groups. They included, among others, the Dutch Society of Health Law, twenty-five prominent medical and health care figures who joined to send us letter, and the Dutch Society for Voluntary Euthanasia. (2) Their message was uniform and unsparing: we should not have published such an irresponsible article, filled with unverifiable charges and baseless accusations and displaying gross misunderstanding of the practice of euthanasia in the Netherlands. (We Americans just didn't get it!) A few lines from those letters became memorable. One of them was that the Dutch meaning of euthanasia was that of a deliberate life-ending action ... [as the result of ] an enduring [patient] request. 'Euthanasia,' therefore, is by necessity, voluntary. (3) Another letter asserted that is impossible for people who do not want euthanasia to be forced or maneuvered into it because that would violate the definition of euthanasia. (4) The notion that one could not be forced into something because it would violate definition is surely imaginative (and philosophers of language should take note). The letters evaded the question of whether nonvoluntary euthanasia (now turned into an oxymoron) actually took place. As it turned out, however, Fenigsen was shortly proved strikingly right, even if not in all details. In series of confidential interviews with physicians and an examination of death certificates, three surveys in 1990, 1995, and 2001 found that approximately two percent of all Dutch deaths (3,500 or so) came from euthanasia and physician-assisted suicide, about 1,000 of which were without the patient's explicit request. (5) Fewer than 45 percent were reported, as required by law. But the apologists were not giving up on spin. Yes, those figures are probably correct, they seemed to say, but they did not mean what they seemed (to outsiders) to mean. Foreigners just don't understand that the Dutch doctor-patient relationship is far more intimate than in other countries. Their doctors know what their patients would want even if they have never said anything; and, besides, it is physician's ethical duty to judge the patient's quality of life and to act accordingly, even without consent. …

Medical Ethics' Appropriation of Moral Philosophy: The Case of the Sympathetic and the Unsympathetic Physician

Philosophy textbooks typically treat bioethics as a form of "applied ethics"-i.e., an attempt to apply a moral theory, like utilitarianism, to controversial ethical issues in biology and medicine. Historians, however, can find virtually no cases in which applied philosophical moral theory influenced ethical practice in biology or medicine. In light of the absence of historical evidence, the authors of this paper advance an alternative model of the historical relationship between philosophical ethics and medical ethics, the appropriation model. They offer two historical case studies to illustrate the ways in which physicians have "appropriated" concepts and theory fragments from philosophers, and demonstrate how appropriated moral philosophy profoundly influenced the way medical morality was conceived and practiced.

Ethical and legislative perspectives on liver transplantation in the People's Republic of China

Ethical and legislative perspectives on liver transplantation in the People's Republic of China

Can We Trust "Democratic Deliberation"?

Anumber of bioethicists strongly advocate a mechanism known as democratic for addressing in a way that is fair and legitimate some of the controversial ethical and policy issues related to medicine and health care policy. I am among them. Unfortunately, whether and how deliberative outcomes can actually alter public policy is not quite clear. Many will recognize the public educational value of deliberative efforts but stop far short of holding that they should have a direct and substantial role in shaping public policy. To my mind, Fukuyama and Furger are committed to only a minimalist conception of democratic deliberation. They are correct to doubt the commitment of scientists and industry leaders in reprogenetics to self-regulation. But they are excessively skeptical of the public's capacity to engage in fair and reasonable deliberations about these matters. They would welcome public input through Web-based citizen panels and very broad surveys, but they would filter the results of this input through a special reprogenetics advisory board and other standard regulatory mechanisms, which suggests they do not regard the public input as being either trustworthy or sufficiently accountable. [ILLUSTRATION OMITTED] That brings me to the central question of this essay. Could rational democratic deliberation yield a sufficiently trustworthy and politically legitimate system for national regulation of the industries and health professionals connected to reprogenetics, even given the acrimony associated with abortion (which would never be far off) and threats to professional autonomy and basic personal liberties? I think so, although I will have to mention some qualifications. In particular, the deliberative process needs to include a broad and diverse range of people, it must be transparent to the public, and it should reflect a commitment that policy proposals will be both reasonable and supported with reasons. Our key question has two dimensions--one empirical, one normative. I will say a few things pertinent to the empirical dimension, but most of what I want to say is about the normative aspects. To give a more concrete focus to my discussion, we might imagine the deliberative effort focusing on four issues: * Should there be public funding for embryonic stem cell research, including publicly provided payments to women to produce embryos for research purposes? * Should there be any restrictions on parents' use of preimplantation genetic diagnosis to choose the genetic endowment of their possible future children? * Should there be public funding for research aimed at giving us the capacity to do germline genetic engineering of eight-cell embryos? * Should therapeutic cloning research be permitted, including payments to women to produce excess ova for research purposes? Why should these questions not be answered through democratic deliberation? The short answer would be: because there would be no accountability, no assurance of neutrality or impartiality in setting the deliberative agenda or feeding information into the deliberative process, no assurance of fair representation, a risk of inflaming public passions and further polarizing the public around these issues, a risk that the public's scientific ignorance would infect the regulations, a risk that the deliberative process would be captured by special interests, a risk of irresponsible public enthusiasm for all innovative technologies, and a risk of antiliberal religious enthusiasm inappropriately constraining basic political liberties or limiting basic scientific research. Instead of democratic deliberation, then, we might rely on administrative rule-making, or presidential commissions, or judicial processes, or congressionally appointed expert committees, or self-policing by the scientific and business communities. All of these have well-known significant deficiencies that Fukuyama and Furger have conveniently rehearsed. …

Designing ethical phishing experiments

While fraud has been part of human society for as long as we know, the automated type of fraud that is known as phishing is a relatively recent phenomenon. It is becoming clear to society that phishing is a problem of quite catastrophic dimensions. Phishing is a multifaceted techno-social problem for which there is no known single silver bullet. As a result of these insights, an increasing number of researchers and practitioners are attempting to quantify risks and degrees of vulnerabilities in order to understand where to focus protective measures. When academic researchers plan phishing studies, they are faced with the reality that such studies must not only be conducted in an ethical manner, but they also must be reviewed and approved by their Institutional Review Board (IRB). This article provides an overview of the review process used by IRBs, an outline of the section of the federal regulations, 45 CFR 46, 116(d)(14), that provide the circumstances where aspects of the informed consent process can be waived. Moreover, it contains a discussion of the controversial ethical issues inherent in phishing studies that request a waiver of aspects of the informed consent requirement. Finally, this paper outlines the process of designing and analyzing phishing experiments in an ethical manner, and in accordance with the principles and regulations guiding IRBs

THE SINGAPORE APPROACH TO HUMAN STEM CELL RESEARCH, THERAPEUTIC AND REPRODUCTIVE CLONING

With the controversial ethical issues on the creation of human embryos through cloning for therapeutic research, which holds more promise of medical breakthroughs that the world could ever imagine and the acknowledgement by many scientists that this technology may not lead in the near future to therapies; this country report discusses the approach Singapore takes on human stem cell research, interjected with the authors' own arguments and suggestions especially on research compensation injuries, an often neglected important issue. International comparative viewpoints taken by the major countries in the world are also included in the appendix.

The euthanasia debate: more strong views

The increasing advances and availability of technological and biomedical means to support life has meant that clinical practitioners have to contend with many complex and controversial moral and ethical issues. Euthanasia is a particularly contentious topic so this month’s Web Words continues our look at how it is considered on the net.

Advocate's Viewpoint on Hereditary Breast/Ovarian Cancer

This paper discusses the presentation I held at the symposium on genetics during the 4th European Breast Cancer Conference held in Hamburg in March 2004.Primarily, the goals and working methods of the advocacy group specialised in Hereditary Breast/Ovarian Cancer of the Dutch Breast Cancer Patient Organisation known as BorstkankerVereniging Nederland (BVN) are explained. Furthermore, some specific individual problems that mutation carriers might encounter before and after BRCA1/2 susceptibility testing are discussed. These include: dilemmas in choosing preventive interventions, dealing with the psychological impact of knowing you are a mutation carrier, dealing with the social implications of being genetically at risk, an example of insurance discrimination. In addition, some controversial social and ethical issues that are currently under debate are highlighted, such as the issue of the European patenting of the breast cancer susceptibility genes BRCA1 and BRCA2. Since this topic could also become relevant for other gene-related diseases, society as a whole has to consider the ethical and social implications related to the patenting of human genes in general. Another ethical area of debate is the controversial issue of prenatal BRCA testing and the choice of pregnancy termination.Finally, the Working Party pleads for the international co-operation and exchange of data and experience among professionals as well as patients. It appears that professionals in different European countries tend to advise on different risk management strategies and treatments and as such, the Working Party strongly advocates the international standardisation of risk management and treatment of mutation carriers. In this respect, specific attention should be given to a group that has had a non-informative or negative BRCA test result, because this group is still considered to be at high risk to develop the disease.

Clinical factors associated with suicidality in cancer patients.

Previous epidemiological studies have indicated that the risk of suicide in cancer patients is higher than that of the general population. In addition, euthanasia and physician-assisted suicide (PAS) have recently become controversial medical, ethical and legal issues all over the world. Although suicide in cancer patients and appropriate management of cancer patients with suicidality are critical issues in clinical oncology practice, there have been very few studies to understand suicidality in cancer patients. The purpose of this study was to explore the clinical factors associated with suicidality in Japanese patients with cancer. We investigated the clinical factors associated with suicidality in cancer patients by analyzing the consultation data of patients referred to the Psychiatry Division, National Cancer Centre Hospital and Hospital East, Japan. Of 1713 psychiatric referrals, 62 (3.6%) were related to suicidality, including 44 cases with suicidal ideation, 10 suicide attempts and eight cases who had requested euthanasia and/or continuous sedation. Most of the patients suffered from physical distress and/or psychiatric disorders. The results of a multivariate analysis comparing cancer patients with a psychiatric referral related to suicidality and those referred for other reasons indicated that impaired physical functioning and major depression were significant associated factors. Our findings suggest that early detection and appropriate management of major depression and comprehensive care improving physical functioning may help to prevent suicide and manage suicidality in Japanese cancer patients.

Intrastriatal grafting of glomus cells ameliorates behavioral defects of Parkinsonian rats

Parkinson's disease is associated with severe motor dysfunctions due to a progressive loss of dopaminergic neurons in substantia nigra. Transplantation of midbrain neurons from human fetuses to the striatum of patients provides effective treatment for the disease. This type of approach, however, could not be adopted widely due to insufficient supply of fetal materials and the controversial ethical and legal issues. The carotid body is a chemoreceptive organ containing chromaffin-like glomus cells that secrete dopamine (DA) as the neurotransmitter. Here, we report the generation of a clonal dopaminergic cell line of the carotid body using the H-2K b -tsA58 transgenic mouse. Cells from the carotid body were immortalized at the permissive temperatures and in the presence of γ-interferon. The glomus cells were isolated by flow cytometry, and purified to homogeneity by a limited dilution procedure. Upon switching the culture to a nonpermissive condition, the immortal cells ceased to divide, became terminally differentiated and secreted high levels of DA. In rats rendered hemi-Parkinsonian by injection of 6-hydroxydopamine (6-OHDA) into the substantial nigra, intrastriatal grafting of the glomus cells resulted in significant recovery of motor asymmetries and sensorimotor dysfunction. The effects were apparent ∼10 days after transplantation and remained throughout the 4 months of the study. The recovery of behavioral defects was correlated with the ability of cell grafts to release DA in the brain. As none of the existing treatments for Parkinson's disease is completely satisfactory, establishment of a clonal cell line that secretes DA opens a new avenue for the effective control of this neurological disorder.

Informed consent and other ethical issues in human population genetics.

Human population genetics has entered a new era of public interest, of controversy, and of ethical problems. Population genetics raises novel ethical problems because both the individuals and the populations being studied are, in effect, "subjects" of the research. Those populations are collectively subject to possible benefits and harms from the research and have interests, somewhat different from those of the individuals, that must be considered from both ethical and practical standpoints. The chapter first describes the new setting for research in human population genetics. It then examines the most controversial ethical issue in population genetics-whether researchers must obtain the informed consent of both the individual subjects and the group as a collectivity. Other vexing issues, including special problems caused by researchers' commercial interests, confidentiality, control over research uses and materials, and return of information to the population are also considered.

Childbirth: Expectations, choices, and trends

Over the past few years information and knowledge about the psychological aspects of intrauterine fetal death prenatal diagnosis and fear of childbirth has increased substantially. This has led to the changing of attitudes among health personnel and parents in these areas. Among obstetricians there is an increased knowledge and awareness of the different phases of the grief process and most clinics have established routines to assist grieving parents. In the context of increased knowledge of psychology and ethics in the field of prenatal diagnosis efforts are being made to tackle issues surrounding screening through continuing discussions in the public arena and among professionals. Moreover womens autonomy and their right to decide the mode of their delivery is a third area where attitudes are changing. Many women suffer extreme fear of childbirth which they may associate with pain death and loss of control. The ongoing dialogue about technical and scientific development and the application of new methods in clinical practice in this field must be continued.

Medical ethics and the judicial coerced treatment of sexual abusers

The increasing demand for judicial coerced treatment of sexual abusers constitutes a new challenge for mental health professionals. The discussed controversial ethical issues are the influence of coercion on the treatment, the motivation of patient as well as therapist, confidentiality and hormonal treatment. Social control is not the primary concern of therapists and any treatment must be beneficial to the individual patient. The coerced treatment of sexual abusers requests an agreement between psychiatric and judicial authorities with respect for their respective professional ethics.

Consumers' Perceptions of the Ethics and Acceptability of Product Placements in Movies: Product Category and Individual Differences

Product placement in movies is an important emerging area of marketing and advertising communications, but it also raises controversial ethical issues. In order to investigate these issues from a consumer point of view, this paper reports on an empirical study of 1012 college students and their perceptions of the acceptability of such placements. The results indicate that while there are generally favorable attitudes toward product placement, ethically-charged products, such as alcohol, cigarettes, and guns, are perceived as less acceptable than others. Individual differences among the students, based on their related attitudes, movie watching frequency, and gender, also have an impact on product placement acceptability. Managerial and research implications reflecting these results are drawn.

British Students' Perceptions of Ethical Issues in International Marketing

ABSTRACT In today's global marketing environment, controversial ethical issues may arise due to cultural differences and to achieve a competitive edge. Recently, researchers focused more on examining business students' ethical views, since these students are the potential future business leaders. This study examined British business students' perceptions of ethical issues in marketing practices. Further, the study examined how sex, as a major factor in the demographic characteristics, may influence individuals' perceptions of ethical issues in international marketing practices. The findings show that British business students had liberal views concerning the examined international marketing practices. These views may have been influenced by the respondents cultural environment.

Ethics and psychiatry

Two controversial ethical issues are reviewed: the growing public and professional interest in the repercussions of sexual abuse, and the continuing enmeshment of forensic psychiatry in the administration of capital punishment. Both of these topics have polarized the field by the intensity of diverging opinions, and no entirely satisfactory resolution for either is in view.