Main Ethical Issues Research Articles

Drug Development

Drug Development

Camera as sign: on the ethics of unconcealment in documentary film and video

When we look at a documentary, what do we see? Probably not the apparatus that gives us images to view. If we did, then perhaps questions about the ethics of documentary cinema would be easily answered. The goal of this article is to broaden the moralistic purview of image ethics debates with a semiotic phenomenology of the visual mode of address of documentary. I describe how “doubling” and “redoubling” the visual mode of address undermines the authority of documentary and helps to overcome debates about two main ethical issues – participant consent and the audience's right to information. Unconcealing the viewpoint of documentary also broadens media ethics debates by bringing attention to the implied viewer, asking of it to reflect on the consequences of the communicative act of looking. Examples of widely available documentary film and video are discussed.

Genetic Testing for Minors: Comparison between Italian and British Guidelines.

Genetic testing in children raises many important ethical, legal, and social issues. One of the main concerns is the ethically inappropriate genetic testing of minors. Various European countries established professional guidelines which reflect the different countries perspectives regarding the main ethical issues involved. In this paper, we analyze the Italian and the British guidelines by highlighting differences and similarities. We discuss presymptomatic, predictive, and carrier testing because we consider them to be the more ethically problematic types of genetic testing in minors. In our opinion, national guidelines should take into account the different needs in clinical practice. At the same time, in the case of genetic testing the national and supranational protection of minors could be strengthened by approving guidelines based on a common framework of principles and values. We suggest that the Oviedo Convention could represent an example of such a common framework or, at least, it could lead to articulate it.

The ethics of attaching research conditions to access to new health technologies

Decisions on which new health technologies to provide are controversial because of the scarcity of healthcare resources, the competing demands of payers, providers and patients and the uncertainty of the...

How Nurses and physicians face ethical dilemmas — the Croatian experience

The aim of this study was to assess nurses' and physicians' ethical dilemmas in clinical practice. Nurses and physicians of the Clinical Hospital Centre Rijeka were surveyed (N=364). A questionnaire was used to identify recent ethical dilemma, primary ethical issue in the situation, satisfaction with the resolution, perceived usefulness of help, and usage of clinical ethics consultations in practice. Recent ethical dilemmas include professional conduct for nurses (8%), and near-the-end-of-life decisions for physicians (27%). The main ethical issue is limiting life-sustaining therapy (nurses 15%, physicians 24%) and euthanasia and physician-assisted suicide (nurses 16%, physicians 9%). The types of help available are similar for nurses and physicians: obtaining complete information about the patient (37% vs. 50%) and clarifying ethical issues (31% vs. 39%). Nurses and physicians experience similar ethical dilemmas in clinical practice. The usage of clinical ethics consultations is low. It is recommended that the individual and team consultations should be introduced in Croatian clinical ethics consultations services.

Methodological and ethical aspects of evaluation research in bereavement

Bereavement services, in common with all health, social care and counselling programmes and interventions, are increasingly required to demonstrate their clinical and cost effectiveness. This paper describes the main ethical and practical issues raised for one service (a hospice-based bereavement support service), and how they were overcome. It offers advice to other organisations and researchers on important aspects of the process, including the need to ensure good relationships with staff and professional supervision and support for the researcher. It also challenges the common view that participation in research may be harmful for bereaved people. Participants in this survey welcomed the chance to talk about their feelings, and to make a contribution to furthering understanding of the bereavement experience.

Commentary: Systems, rules and the costs of being ethical - a response to D. Chalmers and to S. Whitney and C. Schneider

Commentary: Systems, rules and the costs of being ethical - a response to D. Chalmers and to S. Whitney and C. Schneider

Integrating biobanks: addressing the practical and ethical issues to deliver a valuable tool for cancer research

Cancer is caused by complex interactions between genes, environment and lifestyles. Biobanks of well-annotated human tissues are an important resource for studying the underlying mechanisms of cancer. Although such biobanks exist, their integration to form larger biobanks is now required to provide the diversity of samples that are needed to study the complexity and heterogeneity of cancer. Clear guidelines and policies are also required to address the challenges of integrating individual institutional or national biobanks and build public trust. This Science and Society article highlights some of the main practical and ethical issues that are undergoing discussion in the integration of tissue biobanks for cancer.

Writing About Clients: An Overview of Ethical and Professional Issues in Clinical Case Reports

This introductory article establishes a context for subsequent articles and commentaries regarding the main ethical and professional issues involved in preparing and publishing clinical case reports. An overview is provided of the 4 articles in the special section along with the 2 commentaries that review and critique these articles.

Ethical considerations in the use of complementary and alternative medicine for children with autism

<h3>Background</h3> Evidence suggests that the use of complementary or alternative medicine (CAM) is widespread, particularly for children with autistic spectrum disorders. A wide range of treatments exist encompassing those provided by regulated medical practitioners within the NHS such as homeopathy to those that are unregulated or potentially hazardous. Paediatricians may be involved in discussions about CAM with families and this may raise ethical issues. <h3>Objective</h3> To explore some of the main ethical issues raised by the use of CAM in patients with autistic spectrum disorders using a case report as the starting point for discussion. <h3>Results</h3> I will briefly summarise some of the controversies in the use of CAM for autism, including the case of a 5-year-old boy who died following chelation therapy. I will discuss two major ethical themes that arise: 1) The role of parents in making healthcare decisions about their non-autonomous children. I will argue that parental autonomy may be constrained due to incomplete understanding of the scientific issues or incomplete/inaccurate information about the proposed treatment. Paediatricians have a key role in helping families to interpret information about CAM. 2) Protecting the best interests of the child: Any individual CAM treatment may come with both benefits and harms attached for the child and family. Conflicts may arise between an individual physician9s weighing of these benefits and harms and the opinions of the family. I will explore ways in which doctors can use ethical principles including beneficence and non-maleficence to help determine the best course of action for the child. <h3>Conclusions</h3> The use of CAM in children with autism raises complex ethical issues. Paediatricians should actively attempt to engage families in discussions about CAM and should strive to maintain a good relationship with families even in the face of disagreement about the proposed therapy. However, this should be balanced with a need to consider the best interests of the child including crucially the ethical obligation to protect children from harm.

An Ethical and Policy Analysis of Elective Transplantation for Metabolic Conditions Diagnosed by Newborn Screening

Liver transplantation (LT) is a therapeutic option for some metabolic conditions; however, unlike other causes of liver failure, some of these conditions can be treated with dietary means. For those conditions, LT has been described as “elective.”1 Both maple syrup urine disease (MSUD) and methylmalonic acidemia (MMA) are 2 such metabolic conditions. The main ethical issue is a justice concern: whether to list children and adults with MSUD and MMA for an “elective” LT when other patients with non-metabolic liver failure die because there is an inadequate supply of deceased donor liver grafts.

Ethical Principles and Health Care Reform

Ethical Principles and Health Care Reform

Scientists’ Perspectives on the Ethical Issues of Stem Cell Research

This paper describes findings from an ethics education project funded by the Canadian Stem Cell Network (SCN). The project is part of a larger research initiative entitled "The Stem Cell Research Environment: Drawing the Evidence and Experience Together". The ethics education study began with a series of focus groups with SCN researchers and trainees as part of a "needs assessment" effort. The purpose of these discussions was to identify the main ethical issues associated with stem cell (SC) research from the perspective of the stem cell community. This paper will focus on five prominent themes that emerged from the focus group data including: (1) the source of stem cells; (2) the power of stem cells; (3) working within a charged research environment; (4) the regulatory context; and (5) ethics training for scientists. Additional discussions are planned with others involved in Canadian stem cell research (e.g., research ethics board members, policy makers) to supplement initial findings. These assessment results combined with existing bioethics literature will ultimately inform a web-based ethics education module for the SCN. We believe that our efforts are important for those analyzing the ethical, legal, and social issues (ELSI) in this area because our in depth understanding of stem cell researcher perspectives will enable us to develop more relevant and effective education material, which in turn should help SC researchers address the important ethical challenges in their area.

The ethics of conducting research with mental health service users

There is a growing emphasis on conducting research that represents the voices of mental health service users in relation to their experiences of and desires for health care. However, this type of research may sometimes be complicated, as mental health users are frequently identified as a vulnerable research participant population. The aims of this article are to firstly highlight some of the main ethical issues that researchers encounter when carrying out research with people who use the mental health services and secondly to identify strategies that can be used to address these issues. The authors draw on their personal experiences of conducting this type of research. While of general relevance, this article is particularly designed to provide guidance to researchers conducting qualitative studies.

Ethics and Evidence in Psychiatric Practice

Many psychiatrists have endorsed the idea of evidence-based psychiatry, the application of the principles of evidence-based medicine (EBM) to psychiatric practice. Proponents of an evidence-based approach to psychiatry hope that if practice is driven by "hard" scientific data, there will be greater potential to help patients. In other words, advocates of evidence-based psychiatry aim to bolster psychiatry's ethical standing through scientific evidence. Can EBM provide this ethical substantiation to psychiatry? This article provides an overview of some of the main ethical issues within psychiatry and examines three interrelated questions: (1) to which ethical values is EBM committed? (2) which ethical theory is reflected in these values? and (3) can these values and theories resolve existing ethical issues in psychiatry? EBM strives for the "greatest good for the greatest number," where good is defined as improved health. This utilitarian orientation cannot, however, address critical areas of moral importance for psychiatry, such as how its practitioners differentiate normal from abnormal, how they determine which forms of suffering should be alleviated through psychiatric means, and when involuntary intervention is ethically justified. The ethical principles implicit in EBM are too limited to serve as an ethical basis for psychiatry.

A practical guide to attaining research ethics approval in the UK

This article examines the permissions and approvals required for nurses and other health professionals to conduct research in the NHS in the U.K. today. A fictitious example of a research study conducted by a nurse who did not obtain NHS research ethics committee (REC) approval is provided. The current position regarding the REC approval process, including the role of ethics in research governance, is explored. The differences between research, audit and service evaluation are explained. Finally, the main ethical issues to be addressed in an application for REC approval are summarised.

Cinemeducation: A pilot student project using movies to help students learn medical professionalism

Background: Using movies has been accepted worldwide as a tool to help students learn medical professionalism. In the second year, a group of medical students conducted the “Cinemeducation” project to promote professionalism in the “Medical Ethics and Critical Thinking” course.Method: Five movies with professionalism issues were screened with 20–30 students attending each session. After the show, participants then were asked to reflect on what they had learned in terms of professionalism. Two students led group discussion emphasizing questioning and argumentation for 60 min. Additional learning issues emerging from each session were also explored in more depth and arranged into a report.Results: In the Cinemeducation Project, medical students have learned five main ethical issues in each film, which were the doctor–patient relationship, informed consent and clinical trials in patients, management of genetic disorders, patient management, and brain death and organ transplantation. In addition to issues of professionalism, they also developed critical thinking and moral reasoning skills.Conclusion: Using a case-based scenario in movies has proven to be an effective and entertaining method of facilitating students with learning on professionalism.

Cassandra or False Prophet of Doom: AI Robots and War

The US military currently deploys more than 4,000 ground robots in Iraq. Most are for bomb disposal but some are armed. In addition to the robots, semi-autonomous unmanned air vehicles come equipped with hellfire missiles. For now, all these systems employ a human-in-the-loop for the application of lethal force. But this is set to change. In the near- to mid-term future, the military might allow autonomous unmanned systems to make their own lethality decisions. This article probes the published US military plans and raises questions about the application of AI to discriminate between innocents and combatants in modern warfare. It points to the main ethical issues in terms of the laws of war and discusses the responsibilities of AI researchers embarking on military projects.

Placebo in psychological research conceptual, ethical and methodological issues

The use of placebos has a broad tradition in the medical and pharmacological sciences as a way to evaluate the effectiveness of procedures and medicines. The transposition of this concept to Psychology is pervaded of conceptual, methodological and ethical problems, some of which are also applied to other scientific areas. Considering the lack of national references on the use placebo in Psychology, the present essay aimed to: (a) make a brief revision of studies that focused on the use of placebos in scientific research; (b) discuss some conceptual problems pertinent to the use of placebos in psychological research; (c) present some of the main methodological problems and ethical issues related to the use of placebos and present some recommendations proposed to overcome them. Some implications of the use the concept of placebo in Psychology are discussed, as well as the need to investigate its mechanisms or usual factors and the combination of these mechanisms with those considered characteristic of a particular form of treatment.

The Ethics of International Research with Abandoned Children

The aim of human subjects research is to create generalizable knowledge that benefits future patients. Consequently, it risks sacrificing the interests of research participants for the greater good of society. Ethics guidelines exist to minimize this risk. Over the last decade, international biomedical research in the context of substantial healthcare inequalities has focused discussion on four ethical issues: (i) standards of care; (ii) informed consent; (iii) ancillary care obligations; and (iv) posttrial benefits (see table, right). It is appropriate to consider these issues relative to the Bucharest Early Intervention Project (BEIP) study (1), a randomized trial of the effects of moving institutionalized young children to foster care. Table Four main ethical issues in international research