Debate In Medical Ethics Research Articles

Refurbishing a Rusty Cystoscope into the Retrospectroscope Award

Objectives The AUA Earl Nation Retrospectroscope Award is presented annually for the best presentation and paper at the annual History Forum. The award, bestowed by voting members of the AUA History Committee, includes a personalized and refurbished Brown-Buerger cystoscope and an AUA honorarium. The history of this prestigious award itself, however, is not widely known. Our objective was to identify the persons, vision, and processes required to establish the award and continue its tradition as a highlight of the annual meeting of the AUA. Methods We reviewed contemporaneous documents including AUA Board of Directors’ Meeting items, AUA archives, History Committee minutes, and notes by the AUA museum curators. Original newspaper archives were obtained as cited from digital resources. Secondary publications regarding the founding of the AUA History Club, the History of Urology Forum, its creators, and the award itself were obtained from the AUA Archives or from on-line resources as indicated. Results The annual History Forum at the American Urologic Association national meeting has been held annually since 1975, modelled after the smaller history meetings moderated by Earl Nation and Frank Bicknell since 1965. The development of an award for the top history paper was proposed at the 2005 meeting and formally approved by the AUA Board of Directors in 2006. During this time the AUA Museum had collected numerous ACMI Brown-Buerger cystoscopes from urologists who were switching to fiberoptic instruments. The Retrospectroscope Award, later named after 1977 AUA President Earl Nation, thus came into existence whereby the winning History Forum presenter would be given one of the donated cystoscopes and a small honorarium. The first Retrospectoscope winner was Shamim Baker for her 2005 paper on the Tuskegee experiment. The prize has been awarded annually for the past 19 years, eventually coming under AUA sponsorship in 2014. Conclusions The History of Urology Club at the AUA began in 1965 but an award for the best presentation has only been awarded since 2006. The AUA website lists prior award winners. The History of Urology Forum has significantly increased in popularity from the original 5 presentations in 1965 to 21 podium presentations in 2022 with 14 posters, a keynote “Bicknell Oration”, and a Medical Ethics Debate. As competition for the AUA Earl Nation Retrospectroscope Award has increased, contenders must submit a completed manuscript in addition to their presentation.

On the Ethics of Withholding and Withdrawing Unwarranted Diagnoses.

The number of diagnoses and the number of persons having diagnoses have increased substantially, and studies indicate that diagnoses are given or upheld even if they are unwarranted, that is, that they do not satisfy professionally accepted diagnostic criteria. In this article, the authors investigate the ethics of withholding and withdrawing unwarranted diagnoses. First, they investigate ethical aspects that make it difficult to withhold and to withdraw such diagnoses. Second, they scrutinize whether there are psychological factors, both in persons/patients and healthcare professionals, making it difficult to withdraw and withhold unwarranted diagnoses. Lastly, they use recent elements of the withholding-versus-withdrawing treatment debate in medical ethics to investigate whether there are any differences between withholding and withdrawing treatment and withdrawing and withholding unwarranted diagnoses. The authors conclude that it is crucial to acknowledge and address all these issues to reduce and avoid unwarranted diagnoses.

Varsity Medical Ethics Debate 2019: is authoritarian government the route to good health outcomes?

Authoritarian governments are characterised by political systems with concentrated and centralised power. Healthcare is a critical component of any state. Given the powers of an authoritarian regime, we consider the...

Scientometric Analysis of The Research on The Abortion: 2015-2019

Nowadays the researchers have found the Finale the soundless virus of unsafe abortion is an imperative public-health and human-rights authoritative. Furthermore, noticeable global-health issues related to abortion constitute an important debate in medical ethics. Each year, approximately 19–20 million abortions are completed by personalities lacking the necessary bits of help or in situations lower lowest medical ethics or both. As a result, we found that the greatest productive author in standings of the total number of articles, the highest mean of total citation per articles 10.02 registered in the year 2015 against 1684 number of the citation with five citable years, Foster DG is the most remarkable writer according to M-index which is the median number of cited publications. While the author only started to create in 2015, the top two journals with highly (4143 and 4110 cited a Fertil Steril, and Hum Reprod) related to abortion services research.

You shall bury him: burial, suicide and the development of Catholic law and theology

Whether physician-assisted dying should be legalised is a major debate in medical ethics and much has been written on it from both secular and religious perspectives. Less, however, has been...

Advance Directives and the Descendant Argument.

By issuing an advance treatment directive, an autonomous person can formally express what kinds of treatment she wishes and does not wish to receive in case she becomes ill or injured and unable to autonomously decide about her treatment. While many jurisdictions and medical associations endorse them, advance treatment directives have also been criticized. According to an important criticism, when a person irreversibly loses her autonomy what she formerly autonomously desired ceases to be of (central) importance in deciding about her treatment. The medical ethical debate regarding different possible ways of solving the problem on which the criticism is based has grown exceedingly intricate. Instead of assessing the developments made in the debate so far, I present a thought experiment-built around a suicide case-which suggests that the problem is not as intractable as it has generally been deemed to be.

Varsity Medical Ethics Debate 2015: should nootropic drugs be available under prescription on the NHS?

The 2015 Varsity Medical Ethics debate convened upon the motion: “This house believes nootropic drugs should be available under prescription”. This annual debate between students from the Universities of Oxford and Cambridge, now in its seventh year, provided the starting point for arguments on the subject. The present article brings together and extends many of the arguments put forward during the debate. We explore the current usage of nootropic drugs, their safety and whether it would be beneficial to individuals and society as a whole for them to be available under prescription. The Varsity Medical Debate was first held in 2008 with the aim of allowing students to engage in discussion about ethics and policy within healthcare. The event is held annually and it is hoped that this will allow future leaders to voice a perspective on the arguments behind topics that will feature heavily in future healthcare and science policy. This year the Oxford University Medical Society at the Oxford Union hosted the debate.

Remember, Avert, Prevent: Franz Ludwig Berthold Kihn--A Typology of "Euthanasia"

The current debate on assisted suicide provides the occasion for calling to mind the role of Berthold Kihn as a psychiatrist under National Socialism. With a historical presentation of a typology of euthanasia, the Academic Psychiatry of Erlangen together with the Medical Ethics would like to sensitize discussions on assisted suicide by drawing attention to the start and end of Kihn's scientific career. Relevant archive material, primary and secondary literature were analyzed and evaluated. As Assistant and Senior Physician at the Psychiatric and Neurological Hospital of the University of Erlangen, Kihn lectured on "the elimination of the inferiors". As Director of the Psychiatric and Neurological Hospital of Jena University, Kihn selected psychiatric patients to be murdered under the "T4 action". Kihn participated in drafting a "Euthanasia Law". Despite his involvement in the murder of mentally ill, Kihn returned to Erlangen as a "Soviet Zone refugee", where a Denazification Court considered him a "hanger-on". Kihn was reintegrated in the academic faculty of the Friedrich-Alexander-University and headed a private clinic. On 21.01.1963, the State's Attorney Nuremberg-Fuerth dropped the criminal procedure against Kihn--officially due to a lack of proof of punishable guilt. An appropriate medical historical contextualization can represent an important condition for an adequate medical ethical debate on physician-assisted suicide and the involvement of psychiatrists. FINAL COMMENT: The analysis of Kihn's patterns of thought and argumentation can help sensitize those involved in debates on physician-assisted suicide and highlights the critical role of psychiatry as a discipline in this context.

The 2014 Varsity Medical Ethics Debate: should we allow genetic information to be patented?

The 2014 Varsity Medical Ethics debate convened upon the motion: “This house believes that genetic information should not be commoditised”. This annual debate between students from the Universities of Oxford and Cambridge, now in its sixth year, provided the starting point for arguments on the subject. The present article brings together and extends many of the arguments put forward during the debate. We explore the circumstances under which genetic material should be considered patentable, the possible effects of this on the research and development of novel therapeutics, and the need for clear guidelines within this rapidly developing field.The Varsity Medical Debate was first held in 2008 with the aim of allowing students to engage in discussion about ethics and policy within healthcare. Two Oxford medical students, Mahiben Maruthappu and Sanjay Budheo founded the event. The event is held annually and it is hoped that this will allow future leaders to voice a perspective on the arguments behind topics that will feature heavily in future healthcare and science policy. This year the Oxford University Medical Society at the Oxford Union hosted the debate

Bridging the Gap Between Continuous Sedation Until Death and Physician-Assisted Death

The distinction between continuous sedation until death (CSD) and physician-assisted death (PAD) has become a topic of medical ethical debate. We conducted 6 focus groups to examine how nursing home clinicians perceive this distinction. For some, the difference is clear whereas others consider CSD a form of euthanasia. Another group situates CSD between pain relief and ending life. Arguments for these perspectives refer to the following themes: intention, dosage of sedative drugs, unconsciousness, and the pace of the dying process. Generally, CSD is considered emotionally easier to deal with since it entails a gradual dying process. Nursing home clinicians have diverging perceptions of the relation between CSD and PAD; some consider CSD to be more than a purely palliative measure, that is, also as a means to hasten death.

Continuous sedation until death in nursing homes in Flanders, Belgium: palliative sedation or slow euthanasia?

Background Continuous Sedation until Death (CSD), the removal of consciousness of an incurably ill patient until death, has become a controversial topic of medical-ethical debate. Some describe CSD as ‘palliative sedation’ (PS); a treatment with the aim of relieving suffering, not shortening the patient’s life. Others claim that CSD is frequently misused to perform ‘slow euthanasia’ (SE); the administration of sedation with the intention to hasten death gradually. Given the increasing …

Continuous sedation until death in nursing homes in flanders, belgium: Palliative sedation or slow euthanasia?

Background Continuous Sedation until Death (CSD), the removal of consciousness of an incurably ill patient until death, has become a controversial topic of medical-ethical debate. Some describe CSD as ‘palliative sedation’ (PS); a treatment with the aim of relieving suffering, not shortening the patient’s life. Others claim that CSD is frequently misused to perform ‘slow euthanasia’ (SE); the administration of sedation with the intention to hasten death gradually. Given the increasing …

Medical ethics debate: access to NHS resources

The first London Intercollegiate Student Medical Ethics Debate took place at the Wellcome Trust on 28 March. Teams of three to four students from the London schools debated a range of ethical dilemmas in a knock-out ethics tournament. Teams were randomly allocated to argue for or against the motions. The winning team came from St George’s, University of London and we invited them and the other finalists, from King’s College London, to provide arguments for and against one of the scenarios used in the competition. Juan (a non-UK resident) arrives in the UK. He is not eligible to stay in this country. He has some contacts in London and earns money through drug dealing. He has persistent back pain and finally attends a London A&E. He is diagnosed with renal failure and, although not in immediate danger, he is in …

Ending Life, Morality, and Meaning

Opponents of voluntary euthanasia and physician-assisted suicide often maintain that the procedures ought not to be accepted because ending an innocent human life would both be morally wrong in itself and have unfortunate consequences. A gravely suffering patient can grant that ending his life would involve such harm but still insist that he would have reason to continue living only if there were something to him in his abstaining from ending his life. Though relatively rarely, the notion of meaning of life has figured in recent medical ethical debate on voluntary euthanasia and physician-assisted suicide. And in current philosophical discussion on meaning of life outside the medical ethical debate on voluntary euthanasia and physician-assisted suicide several authors have argued that being moral and having a meaningful existence are connected to each other. In this article, I assess whether his intentionally refraining from causing the harm related to voluntary euthanasia and physician-assisted suicide would involve something to such a patient in the sense that it would promote the meaningfulness of his life.

Personal autonomy in the management of candidal prosthetic joint infection

Abstract The principle of patient autonomy dominates the contemporary debate in medical ethics. Twenty-five years ago, most major medical decisions were left exclusively in the hands of physicians. Such decisions were usually made with beneficent intent but without open discussion, much less the full participation of the patient. Our case involves a patient’s decision to treat an infection with Candida species, the most common fungi affecting humans in a broad spectrum of opportunistic infections, including bones and joints. Only four recent cases of delayed reimplantation arthroplasty for candidal prosthetic joint infection have been reported, and there are no reports, besides ours, of successful non-surgical resolution of candidal prosthetic joint arthritis. We report this case as a patient’s choice with an excellent outcome.

Changing parameters for abortion in Iran

Issues related to abortion constitute an important debate in medical ethics. In Iran and other Islamic states, abortion is discussed from an Islamic perspective, but the legalisation of abortion varies in different Islamic countries. For years, Iran did not legalise induced abortion but permitted it under certain conditions. The Iranian parliament ratified the Therapeutic Abortion Act on June 21, 2005. The new law, which allows abortion under a wider set of guidelines, will promote women’s reproductive health Abortion is an emotive subject. For decades, it has raised a variety of issues, some of them arising out of different religious beliefs. The philosophical concept of personhood, the question of when life begins, and the rights of the foetus and the mother have often been debated.

Editorial: Popular concerns about medical research projects in sub‐Saharan Africa – a critical voice in debates about medical research ethics

Popular concerns about blood-stealing, trade in body parts, surreptitious birth control and the deliberate spreading of disease are common across sub-Saharan Africa, and there are indications that they are becoming more common in pace with the process of deprivation that economic and political destructuring has, over the last quarter century, set in motion across most of the continent (Comaroff & Comaroff 2000). Such stories are commonly referred to as ‘rumours’ – by those who observe and dismiss them, but also by those who, usually with due scepticism, pass them on to others. With its connotation of hearsay and gossip, the term is often used in contrast to ‘truth’, much like the equally problematic distinction of ‘belief’ and ‘knowledge’. It is our aim in this paper to move beyond the dismissal of these stories as ‘mere’ rumour, based on erroneous belief or traditional superstition, and to appreciate them as modern commentaries on social relations that involve, and extend far beyond, scientific medical research. If we nevertheless use the words ‘rumour’, ‘story’ and ‘concern’ synonymously, we follow the historian Luise White’s understanding that rumours, such as vampire stories in 20th-century Africa, ‘are neither true nor false, in the sense that they do not have to be proven beyond their being talked about; but as they are told, they contain different empirical elements that carry different weights: stories are told with truths, commentaries, and statements of ignorance’ (White 2000). By telling these stories, relating them to empirical facts in a given locality and at a particular moment, and intertwining them with other seemingly unrelated tales, people make new connections and reveal hitherto unseen links, weaving wide, often global connections into local patterns of relatedness (Geissler 2005). When, below, we speak of ‘rumour’ we are not expressing our scepticism; rather, we are reflecting the scepticism of those who tell these stories: their ambiguity towards formations of knowledge and power that reach deep into their everyday lives, and which are set in a world order that provokes their doubts. Medical research and the ‘trial communities’ it constitutes by linking scientists and subjects, institutions and funders, media and publics, is one of the networks of global connections that has been particularly prolific in the generation of rumours (P.W. Geissler and C. Molyneux, in press). The sort of rumours mentioned above, particularly those about blood, are often directly related to medical research and health interventions. During 15 years of involvement in medical research in Africa we have repeatedly encountered such rumours. From friends and colleagues we have heard many more reports of such rumours, sometimes impeding recruitment to research, affecting adherence to interventions and even threatening the continuation of whole research projects while more commonly providing a background noise without direct impact (Geissler 2005; Molyneux et al. 2005a; Pool & Geissler 2005; Fairhead et al. 2006; for a rare note in a medical paper, see Nchito et al. 2003; for the potential detrimental impact of public debates see most recently Singh & Mills 2005). Most of these rumours follow a relatively limited number of themes, while also showing regional and locally specific variation. On a more general level they merge into related genres such as urban legends and oral traditions (Burke 1998; Ellis & Ter Haar 2001), Tropical Medicine and International Health doi:10.1111/j.1365-3156.2006.01682.x

Forty-First Annual Meeting, The Society of Thoracic Surgeons

Forty-First Annual Meeting, The Society of Thoracic Surgeons

The use of the placebo effect in clinical medicine--ethical blunder or ethical imperative?

The current debate in medical ethics on placebos focuses mainly on their use in health research. Whereas this is certainly an important topic the discussion tends to overlook another longstanding but nevertheless highly relevant question, namely if and how the placebo effect should be employed in clinical practice. This paper describes the way the placebo effect is perceived in modern medicine and offers some historical reflections on how these perceptions have developed; discusses elements of a definition of the placebo effect; and suggests some conditions under which making use of the therapeutic potential of the placebo effect can be ethically acceptable, if not warranted.

Jehovah's Witnesses' refusal of blood: obedience to scripture and religious conscience.

Jehovah's Witnesses are students of the Bible. They refuse transfusions out of obedience to the scriptural directive to abstain and keep from blood. Dr Muramoto disagrees with the Witnesses' religious...