Modern Medical Ethics Research Articles

English

Introduction: Informed consent is the back bone of patients’ autonomy. Theadvancement in medical technology has further increased its importance. In the developingcountries including Pakistan, general physicians play a vital role in providing health careto the patients but unfortunately majority of them are unaware about the ethical aspects oftheir medical practice. Methodology: Objectives: 1. To determine the level of awarenessabout informed consent among general practitioners. 2. To assess the association betweenvarious socio-demographic factors to the awareness about informed consent. Study Design:Community based cross sectional study. Settings: General medical practitioners of districtHyderabad were the study population. Period Of Study: Two months. Material & Methods:One hundred & forty subjects were selected for the study through purposive non-probabilitysampling. A pretested self-administered questionnaire was the tool for the data collection. Thedata was analyzed by using SPSS version 16.The variables of interest were gender of generalpractitioners, their age, level of qualifications, residence & occasions when informed consentwas taken. The association between various socio-demographic variables was determined byapplying Chi-square test at ≤0.05 level of significance. Results: One hundred & forty generalmedical practitioners of varying ages from 32-60 years participated in the study. The meanage of the general physician was 39 ± 1.8 years. The awareness about informed consent wasfound among 128(91.4%) subjects but unfortunately only 45.7%of them actually practiced it.The results regarding awareness as well as practice of informed consent among males andfemales were however not significant (p=0.520). The young general practitioners i.e age 31-40years were less practicing informed consent as compared to older general practitioners i.e.age 51-60 years and onwards (p= 0.04).The physicians practicing in urban areas were morecognizant about informed consent (p=0.05).Informed consent from patients was obtainedbefore giving local anesthesia (80%), blood transfusion (24.3%)&before examination of femalepatients (46.4%). Conclusions: Informed consent taking is not a routine process adopted bygeneral medical practitioners so there is a strong need for general practitioners to change theirattitude and acknowledge the patient’s autonomy by taking informed consent, which is thebasis of modern medical ethics.

Self-criticism of physicians, patient participation and risk competence.

Self-criticism of physicians and patient participation are the pillars of modern medical ethics and medical programmes. Patients expect risk minimisation from physicians, mostly without realising how much they could actively do themselves in this respect. But what about the willingness of German people to take risks, how high is it really at present? Direct empirical data are not available, but results from general empirical research show that people’s willingness to take risks is probably rather low. Post-heroic societies of welfare states are less likely to take risks than supposedly heroic ones. Therefore, the question whether it is responsible for medical experts to transfer even more responsibility to non-medical laypeople becomes increasingly important in a social context.

Modern medical research ethics - bioethics

Modern medical research ethics - bioethics

The principle of autonomy in Brazil: one needs to discuss it ...

The principle of patient autonomy is a cornerstone of bioethics. According to this concept, patients should be given the power to make decisions related to their treatment. It is an important component of modern medical ethics, which has received much interest in current literature. However, the rate of participation of patients and their willingness to participate are variable according to the cultural, social and family environments in which they are inserted. The aim of this paper is to promote a brief descriptive review on autonomy, the preferences of patients and the use of informed consent as an instrument for the exercise of autonomy in literature, and to stress the lack of debate, as well as the pressing need for discussion of these current issues nationwide.

Modern Medical Ethics and the Legacy of Hippocrates

The most enduring guideline for medical ethics in the history of medicine is the Hippocratic Oath. Four of the six core values currently recognized in medical ethics (beneficence, non-maleficence, justice, and confidentiality), are in accordance with ideas codified in the Hippocratic Oath or in the Hippocrates work, in general. With the passing of the years, however, new ethics created by the society added new values, such as autonomy and respect, to values proposed by Hippocrates. On the other hand, certain social ethics, predominating in various countries, are in marked contrast to Hippocratic principles. The most significant of them are the issues of aid in suicide and of abortion. Regardless the rules of conduct prevailing in a given society, the primary task of a physician is to provide competent medical care, with compassion and respect for human dignity and rights, a principle in accordance with the Hippocratic motto “ eπ ’ ωφeλeίη καμνόντων ” ( for the benefit of patient s).

Teaching medical ethics to meet the realities of a changing health care system.

The changing context of medical practice--bureaucratic, political, or economic--demands that doctors have the knowledge and skills to face these new realities. Such changes impose obstacles on doctors delivering ethical care to vulnerable patient populations. Modern medical ethics education requires a focus upon the knowledge and skills necessary to close the gap between the theory and practice of ethical care. Physicians and doctors-in-training must learn to be morally sensitive to ethical dilemmas on the wards, learn how to make professionally grounded decisions with their patients and other medical providers, and develop the leadership, dedication, and courage to fulfill ethical values in the face of disincentives and bureaucratic challenges. A new core focus of medical ethics education must turn to learning how to put ethics into practice by teaching physicians to realistically negotiate the new institutional maze of 21st-century medicine.

Ethik und ärztliches Ethos im Medizinstudium und im Gesundheitswesen

In German speaking areas, in the scientific establishment which is occupied with medical ethics in the narrower and wider senses, a vehement discussion has developed as to whether or not medical practitioners must ultimately advocate that which is understood to be modern medical ethics. Against the background of this discussion, this article takes up a position on these questions, not only theoretically, but also with reference to the fields of practice of medical studies, hospitals, and the health system. The article presents the proposals of the Institute for Ethics and Law in Medicine (University of Vienna) for the evaluation and further development of the theme of ethics within the framework of the Medical Curriculum of Vienna (MCW). Among other things, this requires an integrated model of levels of ethical competence.

In the lifeboat

In 1841, the sailing ship the William Brown , which was carrying 65 Scottish and Irish emigrants who were searching for a new life in the United States, hit an iceberg and sank. The ship had just two lifeboats, and only half the passengers managed to get a place on board. These survivors were to face another danger, however. The next night, the passengers of one lifeboat, worried that their vessel was in danger of being submerged, quietly pushed 16 of their number overboard. This chilling story has become a paradigm case for “lifeboat ethics,” which tackles the question of whom medicine should save when resources are scarce. But, Thieves of Virtue: When Bioethics Stole Medicine by Tom Koch, questions the assumptions that underlie lifeboat ethics, and, indeed, much of modern medical ethics. …

Evidence-Based Persuasion

The primacy in modern medical ethics of the principle of respect for autonomy has led to the widespread assumption that it is unethical to change someone's beliefs, because doing so would constitute coercion or paternalism. In this Viewpoint we suggest that persuasion is not necessarily paternalistic and is an essential component of modern medical practice. There are at least 3 different types of persuasion. The first is the removal of biases; the second is recommending a particular course of action and providing evidence and reasons in favor of it; and the third is the potential creation of new biases, which could cross the line into unethical manipulation. The first of these is always mandatory, the second is usually permissible but sometimes inappropriate, and the third is normally impermissible but sometimes acceptable in rare cases.

Classical American Philosophy and Modern Medical Ethics: The Case of Richard Cabot

In this essay we argue that Richard Cabot (1868–1939) developed a unique approach to medical practice and medical ethics that has been largely overlooked in the history of medicine and philosophy. His impact was significant both in terms of transforming medicine and in encouraging philosophy, particularly ethical theory, to shape the delivery of healthcare. Cabot’s approach was defined by the principle of fallibilism, a unique understanding of virtue ethics, and the ethics of care, all of which he inherited from the classical American philosophers who were his teachers and friends in the second half of the nineteenth century (principally Ralph Waldo Emerson, C.S. Peirce, William James, and Josiah Royce). Cabot translated this philosophical legacy into medical practice at Mass General and Harvard Medical School, insisting that his students understand case medicine as fostering virtuous clinical practice. His support of the Clinicopathological Conferences and his creation of the first department of social work were extensions of this basic sentiment. Cabot’s was a holistic practice that treated patients as genuine individuals, a practice that remains in scarce supply in today’s medical field. Returning to Cabot and the classical American tradition stands to revive virtue ethics and the ethics of care in medical practice and education.

Understanding autonomy within philosophical tradition and modern medical ethics

Understanding autonomy within philosophical tradition and modern medical ethics

Management analysis and experience sharing of modern medical ethics

To explore and discuss the challenge and solutions of medical ethics management in case of rapid development of medical research.Analyzed changes of the model,contents,and methods in modern medical research.Identified the significance of ethics review in medical research.Introduced some practices at Peking Union Medical College Hospital (PUMCH) in recent years.Ethical review is one of the key elements for quality of medical research. Management should be improved and strengthen for the protections of research subjects effectively in the case of rapid development of life science. Key words: Medical ethics; Hospital administration; Translational research

베이비 박스의 도덕성 논쟁

There was dispute on ‘baby box’ in the second half of 2011. In 2009, clergyman, Lee Jong-rak made a baby box on church wall. Actually, 26 new born babies were abandoned in the ‘baby box’. The babies who had disability were thrown out from the unmarried mothers with letters. If there was no baby box,the babies could die by hypothermia in the cold weather. But Ministry of health and welfare, and Gwanak Ward Office are requesting to remove baby box because it is illegal for non-authorized facility to look after baby. Baby box was installed to prevent from abandonment of baby in cold weather and risk. But it is on dispute between ‘protection of infant’ and ‘encouragement of abandonment’. Like dispute surrounding abortion or contraception, baby box is a complicated problem and it is not easy to conclude. It is a difficult subject that anybody cannot judge awkwardly. This is because the subject is related to human life. This thesis tried to evaluate this problem from ethical view. First, contradictory views are reviewed - the views are if baby box is for encouragement of abandonment, or if it is for protection of infant. Second, this problem is investigated from positions of Deontology and Teleology which are representative views of ethics. And this paper applies principles of modern medical ethics from the dispute to evaluate the problem. Finally, this subject is treated with from positions of personal ethic and social ethic.

Ethical reflections on the thoughts and lives of Kurosawa's doctors

The year 2010 marked the centenary of the birth of Akira Kurosawa (1910–1998), whose works have been reassessed favourably in the last couple of years in Japan. During his lifetime,...

The Hippocratic oath: A comparative analysis of the ancient text′s relevance to American and Indian modern medicine

Hippocrates (460-375 B.C.), an ancient Greek physician considered the "Father of Medicine," constructed the groundwork for the principles of ethics in medicine over 2,500 years ago in his establishment of the Hippocratic Oath. One of the oldest binding documents in history, the text has remained the ethical template for physicians to this day. The changing cultural and social environment of modern society, accompanied by the advancement in scientific knowledge and therapeutic tools, has surfaced the need to reframe ethical perspective in modern medicine. Progress in aspects such as organ transplantation, stem cell technology, and genetic engineering has welcomed a new set of ethical dilemmas. These dilemmas have become intimately intertwined with the impact of commercialization, as seen by the interplay between legislation, health care, and pharmaceutical businesses. This paper seeks to dissect the principles of the original Hippocratic Oath and analyze the template in relation to the ethical dilemmas presented by contemporary medicine. Examination will provide a deeper understanding of the paradigm shift in modern medical ethics. Both the value of the Oath and the level of awareness of modern ethical dilemmas through the lens of American and Indian medical graduates will be assessed.

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.

Commentary: Autonomy revisited - a response to H. Haker

Keywords: AsianBioethics,autonomy,individualism,interdependence.IntroductionThe (appropriately) provocative title of this group ofpapers – ‘Should Ideology be Allowed to Trump Pa-tient Wellbeing?’ – immediately raises associationswith recent gross abuses of medicine: for example,the use of psychiatric institutions in the USSR un-der Stalin to detain political dissidents; or the com-plicity of the medical profession in Apartheid SouthAfrica in the torture and murder of the humanrights campaigner, Steve Biko (and many others);or, perhaps most obviously, the powerfully influen-tial eugenic philosophy in both Europe and the USAearly last century, which led to the atrocities of theNaziera in Germany.However,thistitlealsoinvitescritiqueofaratherdif-ferent ideology in medicine – that of the new medicalethics that has influenced medical practice, at leastin the West, since the 1960s. It suggests that ourclaimtobeactingethicallymayinfactbepoorlycon-cealedimpositionofaninappropriateideology,whichistothedetrimentofpatients.(Thisseemslikeakindof commentary on what T.S. Eliot, in Murder in theCathedral,describesas‘thegreatesttreason’–‘Todotherightdeedforthewrongreason.’[1])Invited to make this kind of critique of modernmedical ethics, Haker has singled out respect forthe autonomy of patients as the chief culprit [2].This may not be the only example of an ideologicalbias in modern medical ethics (another might bethe favouring of ‘rescue medicine’ over long-termcare, with its attendant denial of both morbidityand mortality), but I do agree that we need to lookvery carefully at both the interpretation and thepractical applications of the concept of autonomy.Thus, my response to Haker will not be negativelycritical of her main conclusions [2]. Instead, I willamplify two aspects her argument. First, I shallsuggest that we can understand the concept ofautonomy in a way that aligns it with concerns forjustice and with concepts of the good society; andsecondly, in the light of the fact that I now work inAsia, I shall explore the question of plurality invalues in relation to the debate about ‘AsianBioethics’.AutonomyandIndividualismAfrequentconfusioninusesofthetermautonomyisto conflate it with the idea of self-sufficiency or inde-pendence.Ashorthandwayofdescribingthiserroristhat autos (self) has engulfed nomos (law). A correctunderstandingofmoralautonomy,Iwouldargue,de-scribes a regulated life in the company of others, nottherandomnessandpotentialchaosofactingasonechooses at any given moment. This error is com-pounded by supposing that we can act in total isola-tion from others, rather than recognizing the funda-mental relatedness and dependency of humanexistence. I have tried in an earlier publication tostresstheinterrelatednessofhumanlife:To be a creature is to be born of others, to know our-selves through them, to depend on them and createdependency, to know the pain of losing them and fi-nallytobetheinstanceofthatpaintoothers.[3]If we leave this kind of nai¨ve individualism unques-tioned, we quickly erode the basis of morality itself,becausethissurelydependsonreciprocalrightsandobligations between ourselves and others (as Hakernotesinherpaper[2]).Toexpandonthispoint,IturntoOnoraO’Neill’sGif-fordLectures, AutonomyandTrustinBioethics.O’Ne-illoffersanexpositionofKant’sapproachtomoralityintermsofprincipledautonomy.Shewrites:[Kant]doesnotseeautonomyassomethingthatsomeindividualshavetoagreaterandotherstoalesserde-gree, and he does not equate it with any distinctiveformofpersonalindependenceorself-expression,letalone with acting on some rather than other sorts ofpreferences.Kantianautonomyismanifestedinalifeinwhich duties are met, inwhich there is respect for

GenEthics and religion

GenEthics and religion

Offline: History lessons

Doctors must not be complicit in torture. This principle is an important foundation of modern medical ethics. It draws one thick red line between absolutely unacceptable professional practice and a whole series of greyer moral predicaments. But is the question of how doctors ought to respond to a political regime displaying extreme violence quite so clearly answered? In Alone in Berlin, a novel about the resistance of ordinary individuals to fascism in 1940s Berlin, Hans Fallada presents two physicians for readers to examine. Both are collaborationists and both work in the brutal Nazi prison system. One doctor neglects his patients, leaving them to die in agony from perfectly treatable conditions. When challenged by the prison chaplain—himself guilty of collaboration, but someone who secretly tries to mitigate the worst excesses of the system—this doctor replies that since most prisoners will die by the executioner's blade, “what do a couple of months matter?” The chaplain condemns him: “I call on you to renounce your profession!” A second prison doctor, Dr Brandt, is different. His task is to ensure that those about to be executed are fit and well. Yet he is the only person (after the short-lived chaplain) who shows any humanity towards the prisoners. He offers words of encouragement, he gives easing medications, and he provides the chance for a prisoner to pass a hidden note to a loved one. A prisoner, alone and close to death, judges Dr Brandt: “a good man”. By today's standards, we may disagree. But if a physician is the only source of compassion in a regime utterly devoid of compassion, is a wholly critical verdict the right one? One might be left doubtful after reading Fallada's recently translated 1947 masterpiece.

Retrospective views of psychiatric inpatients

An individual’s right to self-determination in treatment decisions is a central principle of modern medical ethics and law, disregarded only when there is mental incapacity. When doctors, particularly psychiatrists, override the treatment wishes of individuals, they risk conflicting with this principle.