Issues In Medical Ethics Research Articles

Guidance for Healthcare Ethics Committees

This particular book, as indicated by the title, is intended for health care ethics committees (HCECs), which in most instances function in a hospital. The work is divided into four sections and has chapters to support each section's given theme. Small cases are given along with objectives at the beginning of each chapter, which helps give focus and direction to the chapters. There are discussion questions that either help direct a further conversation on the topic or add focus and depth to the chapter. Section one covers the HCEC functions. The four chapters include definition of an HCEC, ethics, ethical theory, and the law related to ethics. Cultural and religious issues are also presented. The fifteen chapters in section two cover the actual consultation. This section is the largest content area of the book and delves into the vital service provided by an ethics consultant or ethics consultation committee. It starts with the mission, vision, and goals of an ethics consultation and progresses on to the consultation process, informed consent, decision-making capacity and its many facets, and the family and the surrogate decision maker. Confidentiality is discussed as it relates to the patient, regulations, and content or timing of disclosure that may have occurred. Medical futility, reproduction, neonatology, and pediatrics ethical issues are also touched on in this section. Section three discusses the ethical world of policy development and organizational issues. The four chapters on this topic present ethics and distributive justice, development of an ethics policy, an ethics policy beyond the hospital in the community, and the place of organizational ethics in the HCEC. The last section is on education, which means education for the committee, for the consultant, and about the pedagogy of ethics. This book has a different author for each chapter. While this may present a wider variety of ideas, it can create a disjointed or uneven flow of content for the reader. As an ethics committee member for several years, I feel that some chapters are very well done. Other areas may cause newcomers to the field to question what their role is or whether they even want to participate in ethics. Ongoing education is vital along with discussion and reflection, which this book provides. A disagreement I have with this book is that several times authors state or imply that the ethics consultant would make recommendations. I have been trained that listening, observing, mediating, and documenting are the parts of an ethics consultation, and that the consultant is the neutral party for all sides. This ethics book differs vastly from Gary Comstock's Research Ethics (Cambridge University Press; 2012; ISBN: 978-0-521-18708-4), also reviewed in this issue of the Journal of the Medical Library Association. The books serve two different foci of the ethics field. I would add both books to my collection for use in education and reference. Both would serve academics or practitioners in their respective areas and, in some cases, would lead to some lively discussion on ethics and research.

German law on circumcision and its debate: How an ethical and legal issue turned political

The article aims to illuminate the recent debate in Germany about the legitimacy of circumcision for religious reasons. The aim is both to evaluate the new German law allowing religious circumcision, and to outline the resulting conflict between the surrounding ethical and legal issues. We first elucidate the diversity of legal and medical views on religious circumcision in Germany. Next we examine to what extent invasive and irreversible physical interventions on infant boys unable to given their consent should be carried out for non-medical reasons. To this end, the potential benefits and harms of circumcision for non-medical reasons are compared. We argue that circumcision does not provide any benefits for the 'child as a child' and poses only risks to boys. We then set out to clarify and analyse political (rather than ethical) justifications of the new circumcision law. We demonstrate through this analysis how the circumcision debate in Germany has been transformed from a legal and ethical problem into a political issue, due at least in part to Germany's unique historical context. Although such a particular political sensibility is entirely comprehensible, it raises particular problems when it comes to framing and responding to medical ethical issues - as in the case of religious circumcision.

Medical Ethics in Victorian Fiction

AbstractStudies on 19th‐century British literature have, in the last decade, become increasingly aware of the literary representations of medicine in general and medical ethics in particular. The Romantic and Victorian periods are the beginning of the professionalization of both science and medicine; it is important, therefore, to study the ways in which the literature of those periods both reflected and informed emerging public debates on medical ethics. Medicine, during Victoria's reign, became standardized, professionalized, and, eventually, specialized. Medical research and the medical technology made tremendous advancements including germ theory and the stethoscope. Given the amount of progress made during the period, Victorian studies contributing to medical humanities can and should further research how Victorian literature shaped contemporary conceptions of medical ethics. Issues of patient privacy that we recognize today did not exist for Victorian medical professionals, and, therefore, the study of ethical implementation of medical research is a more productive line of inquiry for Victorian studies. While Gothic fiction like Wells' The Island of Dr. Moreau and Stevenson's The Strange Case of Dr. Jekyll and Mr. Hyde (1886) are fruitful starting points for this continuance, it is also crucial to consider issues of medical ethics as they appear in other novel genres of the same period. Lesser‐studied works – including Eliot's The Lifted Veil (1859), Charles Dicken's “A Curious Dance Round a Curious Tree” (1852), Charles Reade's Hard Cash (1870), Anthony Trollope's The Fixed Period (1882), and Mary Augusta Ward's Marcella (1894) – warrant further scholarly consideration of their engagement with medical ethics.

Effectiveness of oncogenetics training on general practitioners’ consultation skills: a randomized controlled trial

Purpose:General practitioners are increasingly called upon to deliver genetic services and could play a key role in translating potentially life-saving advancements in oncogenetic technologies to patient care. If general practitioners are to make an effective contribution in this area, their genetics competencies need to be upgraded. The aim of this study was to investigate whether oncogenetics training for general practitioners improves their genetic consultation skills.Methods:In this pragmatic, blinded, randomized controlled trial, the intervention consisted of a 4-h training (December 2011 and April 2012), covering oncogenetic consultation skills (family history, familial risk assessment, and efficient referral), attitude (medical ethical issues), and clinical knowledge required in primary-care consultations. Outcomes were measured using observation checklists by unannounced standardized patients and self-reported questionnaires.Results:Of 88 randomized general practitioners who initially agreed to participate, 56 completed all measurements. Key consultation skills significantly and substantially improved; regression coefficients after intervention were equivalent to 0.34 and 0.28 at 3-month follow-up, indicating a moderate effect size. Satisfaction and perceived applicability of newly learned skills were highly scored.Conclusion:The general practitioner–specific training proved to be a feasible, satisfactory, and clinically applicable method to improve oncogenetics consultation skills and could be used as an educational framework to inform future training activities with the ultimate aim of improving medical care.

Knowledge of confidentiality, consent and information disclosure is not affected by position or experience in adult critical care

Teaching of medical ethical issues including confidentiality and consent have long been a small part of the medical curriculum. These issues are more complex in an ICU where patients may lack capacity. Documents such as Good Medical Practice 1995, Confidentiality 2009 and the Mental Capacity Act 2005 give guidance to medical professionals in these matters in the UK.

Changing Human Face to a Dog Face: Medical Ethical Issue

Changing Human Face to a Dog Face: Medical Ethical Issue

Ethics and medicine: Jehovah's Witnesses and the new blood transfusion rules

AbstractIt is against the doctrine of The Watchtower and Bible Tract Society for their followers, the Jehovah's Witnesses, to accept blood transfusions. For this reason, this topic remains a critical issue in medical practice and ethics. Few patients can survive a haemoglobin level of less than 5 g per decilitre without transfusion. In the medical field, Jehovah's Witnesses are widely known for their prohibition against the receipt of blood transfusions. The Watchtower Bible and Tract Society, as the church's legislating body introduced the policy on refusal of blood in 1945, stating that blood transfusion defies divine precepts. This article reviews the ethics of blood transfusion in the Jehovah's witnesses and the new blood transfusion rules in South Africa.

Student perspectives on a course on medical ethics in Saudi Arabia

Medical students face ethical issues as early as the first year of medical school. Teaching bioethics is challenging because medical students and some teachers make a distinction between hard science and so-called ‘soft’ ones like bioethics. Courses in ethics were taught in the first and third years at the College of Medicine at King Saud University, Riyadh, Saudi Arabia, at the time this study was conducted. The objective of this study was to determine the students’ perspectives of the courses and their attitudes towards teaching ethics. A predesigned, self-administered, piloted questionnaire was administered to all students in the third year. The questions covered the curriculum, the methods of instruction and the content of the course. The response rate to 327 questionnaires distributed was 77%. Most students were satisfied with the course and its timing (84%), but more than 85% considered that the method of instruction should be changed to case-based teaching. A majority (89%) agreed that ethical issues based on Islamic fiqh (jurisprudence) should continue to be discussed, and they wished to discuss issues related to the doctor–patient relationship and professionalism. The students’ preferences for the topics to be covered were: brain death (76.8%), organ transplantation (72.4%), cosmetic surgery (68.8%), abortion (66.8%), terminal care (61.6%), reproduction (59.6%), doctors’ rights (56.4%), end-of-life issues (56%) and medical errors (45%). The medical students were satisfied with the course and its content but were dissatisfied with the method of instruction. This was taken into consideration in subsequent years.

Ethical Considerations in Internet Use of Electronic Protected Health Information

ABSTRACT.Caregivers, patients, and their family members are increasingly reliant on social network websites for storing, communicating, and referencing medical information. The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule seeks balance by protecting the privacy of patients' health information and assuring that this information is available to those who need it to provide health care. Though federal and state governments have created laws and policies to safeguard patient privacy and confidentiality, the laws are inadequate against the rapid and innovative use of electronic health websites. As Internet use broadens access to information, health professionals must be aware that this information is not always secure. We must identify and reflect on medical ethics issues and be accountable for maintaining privacy for the patient.

American College of Physicians Ethics Manual

Medicine, law, and social values are not static. Reexamining the ethical tenets of medicine and their application in new circumstances is a necessary exercise. The sixth edition of the American College of Physicians (ACP) Ethics Manual covers emerging issues in medical ethics and revisits older ones that are still very pertinent. It reflects on many of the ethical tensions in medicine and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession.

Organ transplantation: Legal, ethical and Islamic perspective in Nigeria

Organ transplantation dates back to the ancient times and since then it has become one of the important developments in modern medicine; saving the lives, as well as improving the quality of life of many patients. As the demand for organ transplantation far exceeds the organ availability, the transplant program is often saddled with complex legal and ethical issues. This review article highlights the legal and ethical issues that might arise regarding organ transplantation and appraises the existing legal frame work governing organ transplantation in Nigeria. Information on legal, cultural, religious and medical ethical issues regarding organ transplantation in Nigeria was obtained by searching the PubMed and Google Scholar, conference proceedings, seminar paper presentations, law library and other related publications were collated and analyzed. In decision making for organ transplantation, the bioethical principles like autonomy, beneficence and justice must be employed. It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of Totality. Among Muslim scholars and researchers, there are those who throw legal support as to its permissibility while the other group sees it as illegal. Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with right to dignity of the human person. Worldwide, the researchers and government bodies have agreed on informed consent for organ/tissue donation and for recipient should be obtained without coercion before embarking on such medical treatment Worldwide organ transplantation has become the best medical treatment for patients with end stage organ failure. However, there is no law/legislation backing organ/tissues transplantation in Nigeria. The government should take measures to combat transplantation tourism and the problem of national and international trafficking in human tissues and organs, ethics commission and National Transplant registry should be established in order to monitor and regulate the programme in the country.

Constructing embryos, constructing politics: Connecting politics and technology in the Netherlands and Germany

This article presents an innovative approach to interpreting and mending political discussions on sensitive medical-ethical issues. It adopts the idiom of co-production, which presumes that technological and political choices shape our world simultaneously, and in turn cannot be seen apart from the background that they themselves help shape. By developing the idea of a nexus, this connection between technological and political practices is further conceptualized. Through an analysis of debates on pre-implantation genetic diagnosis (PGD), this article describes the constitution of the embryo in two countries. In Germany, the embryo is seen as a full member of the human community. In contrast, in the Netherlands the embryo is largely invisible. This difference connects to radically divergent moral decisions, technological configurations and political arrangements. In turn, these different configurations reproduce particular constitutions of the embryo. The article concludes that discussions about PGD gain transparency by breaking down the relations between political and technological practices into various levels. Each of these levels offers its own way to see the embryo as a nexus between practices of politics and practices of science and technology.

James McKenna, Farhat Manzoor and Greta Jones, Candles in the Dark: Medical Ethical Issues in Northern Ireland during the Troubles (London: Nuffield Trust, 2009), pp. v + 149, no price given, paperback, ISBN: 978-1-905030-32-3.

This is an important book that will appeal, not only to historians of medicine, but to social historians and those interested in the history of the Troubles in Northern Ireland. The authors have given an insightful account, which at times makes difficult reading, but which, nevertheless, is significant in its contribution to the history of the Troubles, encompassing the period from 1969 until the second ceasefire in 1998. The research conducted for this book is a momentous achievement: the authors conducted oral history interviews with over two hundred people over a three-year period, with the chief objective of trying to find out how difficult it was to conduct medical work in Northern Ireland in the period, and ‘to maintain the medical codes of ethics governing health care’ (p. 2). The interviewees consisted of health professionals, patients, ex-prisoners and medical staff working in prisons. The authors draw attention to the particular problems of oral history in the case of Northern Ireland, but in spite of these, the book as a whole gives a balanced view of the issues of both sides of the Divide, and the oral history accounts are compelling and give a personal insight into the experiences of men and women during the Troubles. Following the introduction and a chapter on the background to the history of the Troubles in Northern Ireland, the main part of the book opens with two chapters that deal with the experiences of health professionals and patients. The first of these examines the effects of the Troubles on the work of general practitioners in Northern Ireland in the period, in particular, focusing on the difficulties that they encountered while trying to go about their daily work, such as unofficial roadblocks and the increased demand on mental health skills. In addition, the chapter examines the effects on patients, such as the difficulties they experienced in travelling to hospital and how their political and religious persuasions may have affected their choice of hospital and/or GP. The next chapter gives an insight into the particular problems that hospital staff and patients had to contend with during the Troubles. Notably, Northern Irish hospitals, such as the Mater Infirmorum, which straddles ‘one of the most fraught community interfaces in Belfast’, witnessed a great deal of civil strife and violence during the Troubles (p. 43). The chapter also addresses the issues of staff and patient security in Northern Irish hospitals in the period, indicating how these factors ‘complicated the lives of medical professionals and intruded directly on the delivery of medical care’ (p. 63). The final two chapters deal with the issue of medical care in prisons during the Troubles. The first of these is largely based on the allegations of prisoners and gives an insight into the effects of the Troubles on both prisoners and prison doctors during the period. The final chapter deals with the topic of ‘Prison Protests’, in particular, focusing on the ‘Dirty Protest’ and the strain it placed on medical services. This chapter was well balanced, and gave adequate focus to the experiences of prison medical staff, the stories of whom are often neglected in broader histories of the Troubles. Doctors working in prisons were targets for assassination on the outside, and the type of work they experienced resulted in consequences for their mental health, with one senior doctor, ‘Dr P’, who nursed most of the hunger strikers, representing a victim of this and committing suicide, arguably as a result of the pressures of his job (pp. 105-6). This book is a significant contribution to the history of Northern Ireland, examining the history of the Troubles from the perspective of those delivering and receiving medical care. The oral history accounts which form the basis of the book will represent a valuable historical resource for future generations of historians.

Ethische Aspekte in der Therapie am Lebensende

Therapy decisions in the care of critically ill and dying patients in intensive care and emergency medicine must reflect probably conflicting issues of medical indications, ethics and law. This is of particular relevance when treatment preferences of patients are not known or are in contrast to those of the carers. Difficulties regarding prognostication or with determining the beginning of an irreversible dying process may also lead to treatment situations that need ethical reflection. It is recommended to tackle medico-ethical issues by discussion of the meaning of relevant terms and medico-ethical principles, analyzing the professional self-image in intensive care and emergency medicine, consideration of options of palliative medicine and by use of an ethics case consultation.

THE NEW MILITARY MEDICAL ETHICS: LEGACIES OF THE GULF WARS AND THE WAR ON TERROR

United States military medical ethics evolved during its involvement in two recent wars, Gulf War I (1990-1991) and the War on Terror (2001-). Norms of conduct for military clinicians with regard to the treatment of prisoners of war and the administration of non-therapeutic bioactive agents to soldiers were set aside because of the sense of being in a 'new kind of war'. Concurrently, the use of radioactive metal in weaponry and the ability to measure the health consequences of trade embargos on vulnerable civilians occasioned new concerns about the health effects of war on soldiers, their offspring, and civilians living on battlefields. Civilian medical societies and medical ethicists fitfully engaged the evolving nature of the medical ethics issues and policy changes during these wars. Medical codes of professionalism have not been substantively updated and procedures for accountability for new kinds of abuses of medical ethics are not established. Looking to the future, medicine and medical ethics have not articulated a vision for an ongoing military-civilian dialogue to ensure that standards of medical ethics do not evolve simply in accord with military exigency.

Patents, Priority Disputes and the Value of Credit: Towards a History (and Pre-History) of Intellectual Property in Medicine

In recent years, intellectual property in medicine has generated much debate, becoming one of the most significant issues in modern day medical ethics and linking in with wider discussions about the commercialisation of medicine and the commodification of the human body. Recent high-profile cases in the USA have centred on gene patenting, that having been enthusiastically practised by universities and biotechnology companies, is now having its legality questioned. The unexpected March 2010 ruling of a federal court against Myriad Genetics, which invalidated the company's patents on the BRCA1 and BRCA2 genes, has highlighted the complexities that now govern the ethical and legal tenure of asserting property rights over biological material.

Blood work

Holly Tucker, a medical historian at Vanderbilt, has written a history of the ill-fated first animal and human blood transfusions during the early phase of the scientific revolution of the late 17th century in England and France. The narrative has an intimate style that includes precise descriptions of people and events as well as reconstructions of conversations that were never documented. The main thrust of the tragic story is that transfusions were ultimately forbidden for centuries in France because of medical politics, personality clashes, and scientific and religious dogma. The final chapters recounting events in Paris from 1667 to 1668 are particularly riveting; in the end, the primary patient being treated was murdered by a physician who was opposed on religious and conceptual grounds to the very idea of blood transfusions. The tale mainly deals with the career of the iconoclastic French physician Jean-Baptiste Denis. Denis was an outsider, from a provincial school in Montpelier rather than the Paris School of Medicine. Denis, with the support of a wealthy patron, challenged the medical establishment of Paris. Despite some initial successes, he was eventually prevented from continuing experimentation with blood transfusion in humans in France. Until the discovery of blood groups in 1901 by Landsteiner, successful transfusions were a rare event in medicine. When, more than a century after Denis’s work, the English obstetrician James Blundell employed transfusion to save a few of his hemorrhaging postpartum patients, his work did not really have a dramatic effect on the practice of medicine. For Blundell, the inability to predict which patients would have fatal hemolytic reactions was exacerbated by technical difficulties involved in direct donor to patient infusions, rendering transfusion a heroic measure rather than standard practice. Along with the primary story of Denis and transfusion, Tucker sets the historical scene, describing the politics of Louis XIV’s court, the French Academy, and scientific competition between England and France as well as greater religious and scientific events of the period. Medical politics, the danger of pioneering clinical research, and, indirectly, the issue of medical ethics are all topics explored in this book. Finally, Tucker relates the horrific tale of how Denis’s opponents — particularly Dr. Henri-Martin de la Martiniere — were prepared to murder his patient to prove their point that transfusion was anathema and dangerous. As a physician, I might have emphasized the point that the medical theories of the time led Denis and his English competitors, such as Richard Lower, astray. They hoped that transfusion could treat psychiatric illness, believing that a patient with choleric disposition or florid insanity could be rendered calmer and more rational by the infusion of blood from a docile lamb. That theory was, as we now know, hopelessly incorrect. Indeed, prior to Blundell’s work, we have no historical records of blood transfusion being employed for its current clear-cut indications: treatment of exsanguinating hemorrhage and/or life-threatening anemia. Denis’s opponents were members of the medical establishment who feared that transfusion from animals would turn humans into chimeras or subhuman creatures. This was as much a religious as scientific debate, and the two were largely conflated at that time. One physician argued that someone willing to fill his veins with another’s blood would possibly be prone to cannibalism as a next step. One might consider that current disagreements about stem cell therapies are similar in nature, as some find it impossible to separate considerations of religious belief and scientific approach. In the end, transfusions were attempted for the “wrong” reasons, at least by our current standards of knowledge, imperfect as they are. Denis’ transfusions were doomed to failure both clinically and politically. The failure in France temporarily squelched research in England as well. Further, that the patient was murdered by a physician is appalling, adding to the bad karma surrounding this unhappy story. Bleeding and purging remained a staple of medical practice for centuries despite the fact that they were mostly useless, except perhaps for phlebotomy in cases of congestive heart failure. We are confronted with a similar dilemma about transfusion in the 21st century. Most current transfusion practices developed prior to the advent of randomized trials, and they are increasingly being viewed as not all that efficacious and definitely not as beneficial to patients as we had thought (1). For example, correcting non–life-threatening anemia by red cell transfusion is sometimes a very bad idea indeed. The next decades will determine whether future physicians will view some of the first century of successful transfusion practices as misguided. Hopefully, our attempts to treat anemia with red cell transfusion in the 20th century will not be viewed as harshly as Denis and Lower’s attempts to treat insanity by blood transfusions from unsuspecting herbivores. This story does have lessons for the modern era, but they are shrouded in ambiguity and irony.

Argument for the Non-Permissibility of Abortion through Potentiality

Abortion is a serious issue in the medical ethics and its proponents and opponents have raised many arguments in its favor or against it. One of the arguments raised against abortion is the reasoning through potentiality. Some philosophers of ethics take the fertilization as the beginning moment of being a person and deem abortion wrong. Although some other scholars do not believe that a human seed becomes a human being at the moment of fertilization, yet they consider abortion as morally wrong from the very moment of fertilization at first sight. This paper argues for the ethical non-permissibility of abortion via the idea of potentiality, though assuming that an embryo is not regarded as a person since the moment of fertilization. In addition to the exposition of this argument some related criticisms have been mentioned and analyzed.

The Heart-Brain Connection

The article discusses what individuals can do, such as exercising and not smoking, to delay dementia. According to a report by a panel of scientists convened by the U.S. National Institutes of Health (NIH) to examine how Alzheimer's disease could be prevented, there is no scientific evidence that anything exists that could reduce the risk of developing Alzheimer's. Topics include an overview of the response to the panel's conclusion by memory and cognition researchers, the biology of dementia, and the difficulties in acquiring better data on the cause and effect of dementia and Alzheimer's, such as issues of medical ethics in randomized controlled trials involving human subjects.

Nurse-focused ethical solutions to problems in organ transplantation

Technological developments in recent years have brought about a rapid increase in the number and variety of organ transplants, leading to problems in finding enough organs to meet the need. Organ transplantation has also become a particularly significant issue in medical ethics, especially regarding the question of how and from whom organs are procured. Many methods have been tried in order to solve these problems and discussed from an ethical perspective. This study investigates the Spanish, Belgian and Iranian approaches to solving the organ procurement problem. The Spanish model, which is based on persuading patients and their relatives, is ethically less problematic and is also an improved version of the model applied in Turkey. This study argues that an ideal solution can be found without disregarding ethical rules. In particular, nurses can contribute by helping to run the system more efficiently. The principal aim of this article is to demonstrate the contribution of nurses to solving the current organ procurement problem in Turkey and offer some reflections on what can be done to improve the efficiency of the system.