Perspective Of Medical Ethics Research Articles

Medical Research on Human Subjects – Historical Landmarks

Medical clinical research, otherwise defined as research on human subjects, represents the standardized method unanimously accepted by the medical, scientific community, as well as by civil society, as the only way that allows the approval of the use in medical practice of a new drug, as well as of a new method of investigation or treatment. We will briefly present the history of medical research, with reference to Hippocrates, Galen, Avicenna, Ambroise Paré, James Lind, Edward Jenner, Pasteur, as well as about the negative examples and errors that manifested themselves in the name of medical research, from the perspective of medical ethics.

Promising for patients or deeply disturbing? The ethical and legal aspects of deepfake therapy

Deepfakes are hyper-realistic but fabricated videos created with the use of artificial intelligence. In the context of psychotherapy, the first studies on using deepfake technology are emerging, with potential applications...

A Feminist Bioethics Conference in Qatar? Critical Viewpoints and an Impulse for Further Discussion

In October 2022, the International Association of Bioethics announced that the 17th World Congress of Bioethics (WCB) 2024 would be held in Doha, Qatar. The International Network on Feminist Approaches to Bioethics (FAB) traditionally holds its World Congress jointly with the WCB. As part of the ongoing debate about the ethics of bioethics conferencing, the FAB provided a detailed statement discussing concerns about choosing Qatar as the site for a feminist bioethics conference. In order to explore possible approaches towards the FABs decision, the German Feminist Perspectives in Medical Ethics and Bioethics working group (FME) dedicated one of its meetings to the topic. In this commentary, we present two aspects that we consider particularly important for this current debate: (1) the participation of LGBTQIA+ people in the conference and (2) the possibility of racist and anti-Muslim bias in the evaluation of Qatar as the site for the WCB 2024. As members of the FME, we aim to contribute to an exchange of various perspectives within the international feminist bioethics community.

Confounders in Predictive Medical Models: The Role of Religion

Aim: The aim of this study was to assess the acceptance among natural science specialists of the current official regulatory recommendations to avoid utilizing artificial intelligence (AI) and machine learning (ML) models that could exacerbate social disparities. Materials and Methods: An anonymous online survey was conducted using the Telegram platform, where participants were asked a single question: "Do you consider the inclusion of religious status in AI and ML models justified from the perspective of medical ethics and science?" Respondents were provided with only two response options: "Yes" or "No." This survey was specifically targeted at international groups, focusing primarily on English and Russian-speaking clinicians and scientific researchers. Results: 134 unique individuals participated in the survey. The results revealed that two-thirds of the respondents (87 individuals) agreed that including Religion status as predictor in the ML and AI models is inappropriate. Conclusion: Two-thirds of healthcare practitioners and scientific researchers participating in this survey agree that categorizing individuals within healthcare settings based on their religion is inappropriate. Constructing healthcare predictive models based on confounders like religion is unlikely to aid in identifying or treating any pathology or disease. However, the high conflict potential of this predictor may deepen societal disparities.

Why does the COVAX facility fail to bridge the 'immunization gap'?

In April 2020, the World Health Organization launched a COVID-19 Vaccines Global Access (COVAX) Facility, a groundbreaking public health policy, to work "for global equitable access to COVID-19 vaccines". Although innovative, it fails to bridge the 'immunization gap' between high-income and low-income countries. The main reasons for this include: (1) failure to provide adequate incentives for self-financing countries to participate; (2) failure to design the vaccine allocation mechanism to reflect to national political considerations along with the perspective of medical ethics; (3) lack independent financing and power to enforce the policies globally. Constraints have limited the effectiveness of COVAX to date but transforming it into an information center to provide information on vaccine supply and demand, disseminate vaccine knowledge, and publish requests for help can accelerate progress.

Ethical Considerations on Some Issues of Medical Artificial Intelligence Applications

Artificial intelligence has been widely applied in the medical field recently, such as medical imaging, pathological diagnosis, mental health, rehabilitation medicine, and home health support have progressed, which also triggered extensive ethical thinking. Under the perspective of medical ethics, this paper explores the controversial status of moral subjects of AI machines, the definition of multiple relationships arising from machine use, value judgments and trust considerations of AI technologies, data accessibility and privacy protection. It further points out the potential injustice, discrimination and risk liability arising from AI, and calls for the establishment of an ethical review and collaborative governance mechanism for AI that is deeply integrated with technology.

Zenofobi ve Medikal Zenofobi’yi Yeniden Düşünmek

With the increasing refugee population in our country, which has faced an intense wave of migration since 2011, xenophobia is increasing day by day. During the delivery of health services, the immorality of xenophobia, which grows usually by hiding behind the increasing average number of patients and unsolvable communication problems, was discussed from the perspective of the medical profession, which has ethical codes and deontology. First of all, the medical and social science literature on xenophobia, the current, historical and psychopathological background of this phenomenon, and its explicit or implicit relationship with medicine were investigated. The xenophobic attitudes and actions of physicians, who are the main actors of health care delivery all around the world, were evaluated from the perspective of medical ethics and history. In this article, the findings of the socioeconomic, political, and psychological foundations of xenophobia, its relationship and context with new racism theories, and the historical existence of medical xenophobia, which is discussed as a current phenomenon in health services, and especially in South Africa, and what it can cause today are tried to be revealed. The fact that xenophobia may arise against a vulnerable subject who is about to lose his self-respect in the society in a place and encounter, with where all kinds of identity and biographical information are of no importance except for medical reasons, not only puts all kinds of ethical contexts of the patient-physician and physician-physician relationship (confidentiality, secrecy, intimacy, mutual respect, professional solidarity, courtesy, etc.) at risk but also it turns the issue into a morality one. Medicine should be practiced by the physician in a neutral space where all kinds of knowledge and identity, except for illness, are ignored.

ANALISIS TANGGUNG JAWAB PIDANA PADA PELAKU TINDAK PIDANA PERCOBAAN ABORSI YANG MELIBATKAN JASA OKNUM DOKTER (STUDI PUTUSAN NO. 1106/PID.SUS/2018/PN.PLG)

Abortion is a problem that has violated ethics, laws and religions of various parties. Based on this, the problems of the thesis included the following aspects: (1) the judges considerations of imposing criminal sanctions on individual doctors, (2) criminal responsibility, (3) the perspective of medical ethics in conducting attempted abortion in the Decision No. 1106/Pid Sus/2018/PN.Plg. and (4) regulating abortion in the future The research method used was juridical normative (legal research). The results of the research showed that in imposing criminal sanctions, the judges considered juridical decisions more than non-juridical ones, criminal responsibility in which individual doctors conducted attempted abortion in the Decision No 1106/Pid Sus/2018/PN Plg had the elements of dualist view which fulfilled subjective and objective clements, regarding the ethical perspective of medical profession towards the crime of committing attempted abortion in the Decision No. 1106 Pid Sus 2018 PN Plg, the individual doctors had violated the code of ethics and doctor's oath, regarding eriminal-abortion laws in the future, it is necessary to reform criminal law with the policy-oriented approach as well as the value-onented approach. Keywords:Criminal Responsibility, Attempted Abortion, Medical Profession Code Of Ethics

Triage of the elderly in the period of the COVID-19 pandemic crisis as a bioethical process

Abstract The paper discusses the problem of triaging the elderly in the period of the COVID-19 pandemic crisis by analyzing the triage process, caused by lack of resources, in Germany, Holland, the Czech Republic, and Slovakia. We apply inductive, deductive, and normative bioethical methods, comment on various recommendations for the indication of intensive care during a crisis, and discuss the utilitarianism of benefit maximization. As it follows from the evaluation of the elderly by the frailty parameter, medically inappropriate treatment, as a result of limited resources, is characterized by clinical and bioethical uncertainty. If the main bioethical objective of general bioethics for the COVID-19 pandemic is, in the case of limited resources, based on the non-utilitarian consequentialism paradigm, from the perspective of medical ethics, we face a borderline situation closely related to the topic of dying and death. Such a situation requires social, ethical, and professional reflection. An algorithm for intensive care indication in the situation of crisis and limited resources in the period of the pandemic requires a definition of criteria that identify an acceptable reason for abandoning the treatment in the context of the autonomy of the elderly and by respecting their human dignity and humanity. A global objective of general bioethics in the situation of the pandemic crisis should be based on the paradigm of social justice.

Assessment of the Quality Management System for Clinical Nutrition in Jiangsu: Survey Study

BackgroundAn electronic system that automatically collects medical information can realize timely monitoring of patient health and improve the effectiveness and accuracy of medical treatment. To our knowledge, the application of artificial intelligence (AI) in medical service quality assessment has been minimally evaluated, especially for clinical nutrition departments in China. From the perspective of medical ethics, patient safety comes before any other factors within health science, and this responsibility belongs to the quality management system (QMS) within medical institutions.ObjectiveThis study aims to evaluate the QMS for clinical nutrition in Jiangsu, monitor its performance in quality assessment and human resource management from a nutrition aspect, and investigate the application and development of AI in medical quality control.MethodsThe participants for this study were the staff of 70 clinical nutrition departments of the tertiary hospitals in Jiangsu Province, China. These departments are all members of the Quality Management System of Clinical Nutrition in Jiangsu (QMSNJ). An online survey was conducted on all 341 employees within all clinical nutrition departments based on the staff information from the surveyed medical institutions. The questionnaire contains five sections, and the data analysis and AI evaluation were focused on human resource information.ResultsA total of 330 questionnaires were collected, with a response rate of 96.77% (330/341). A QMS for clinical nutrition was built for clinical nutrition departments in Jiangsu and achieved its target of human resource improvements, especially among dietitians. The growing number of participating departments (an increase of 42.8% from 2018 to 2020) and the significant growth of dietitians (t93.4=–0.42; P=.02) both show the advancements of the QMSNJ.ConclusionsAs the first innovation of an online platform for quality management in Jiangsu, the Jiangsu Province Clinical Nutrition Management Platform was successfully implemented as a QMS for this study. This multidimensional electronic system can help the QMSNJ and clinical nutrition departments achieve quality assessment from various aspects so as to realize the continuous improvement of clinical nutrition. The use of an online platform and AI technology for quality assessment is worth recommending and promoting in the future.

Euthanasia dalam Perspektif Kaidah Fikih al-Ḍararu Lā Yuzālu bi al-Ḍarar

Eutanasia is an attempt, action and assistance carried out by a doctor intentionally accelerating the death of a person, which he estimates is nearing death with the aim of alleviating or freeing his suffering. This study aims to determine and understand the practice of Eutanasia in the perspective of the principle of fiqh al-ḍarar lā yuzālu bi al-ḍarar. The problems that the authors raise in this study are: First, how to apply Eutanasia in the perspective of medical ethics. Second, how is the concept of the principle of fiqh al-ḍararu lā yuzālu bi al-ḍarar. Third, what is the position of Eutanasia in the perspective of the rules of al-larar lā yuzālu bi al-ḍarar. To get answers to these problems, the authors use descriptive qualitative (non-statistical) research that focuses on the study of texts and texts. And using the method of historical, juridical-ormative and philosophical approaches. The research results found are as follows; First, Eutanasia is contrary to the medical code of ethics, although this practice is applied in several countries through procedures and requirements that must be met. The two harms must be removed but cannot be eliminated by the other harm. Third Eutanasia is divided into two, namely active Eutanasia and passive Eutanasia. Active Eutanasia of scholars agree that the law is haram, whereas passive Eutanasia there are differences in ulama in it.

Editorial: COVID-19 pandemic: urgent need for action in care homes and senior citizens' homes from a medical-ethics perspective.

Editorial: COVID-19 pandemic: urgent need for action in care homes and senior citizens' homes from a medical-ethics perspective.

Compassionate Limit Setting for the High-Risk Non-Adherent Patient Population

In a society that overlooks, stigmatizes, and becomes desensitized to the growing substance use disorder population, medical ethics looks to the future to help patients that are high-risk and non-adherent (HRNA) while in an acute care setting. Medical ethics can create an environment that supports providers in managing patients with behavioral, social, and substance use disorders as well as offering a higher quality of care by providing consistent, safe, and effective care for patients. This initiative provides a safe and therapeutic environment for patients and healthcare teams. This stance of medical ethics outlines the communication management of non-adherent patients and family members to help aid in the continuation of their inpatient medical treatment. All possible avenues will be explored for the best environment to optimally control the situation, and to provide safe and effective medical care for the patient and lessen the risk to staff. Ethics’ goal is to facilitate conflict management discussions between medical providers and the patient. This paper then gives the perspectives of medical ethics conflict management strategies pertaining to a case study based upon the HRNA patient population.

Whose life to save? Scarce resources allocation in the COVID-19 outbreak

After initially emerging in China, the coronavirus (COVID-19) outbreak has advanced rapidly. The World Health Organization (WHO) has recently declared it a pandemic, with Europe becoming its new epicentre. Italy...

Influence of response shift and disposition on patient-reported outcomes may lead to suboptimal medical decisions: a medical ethics perspective

BackgroundPatient-reported outcomes (PROs) are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts (changes in interpretation) and dispositions (stable characteristics).Main textWe identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution.ConclusionIf influences of response shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used.

RELIGIOUS CONSIDERATIONS AS AN INTEGRAL PART IN MEDICAL DECISION-MAKING

As a Muslim, I have a certain belief system that encompasses all of life, including my approach to medical ethics. My belief system is distinctive, as are others. Thus, the approaches of Judaism and Roman Catholicism offer a new perspective on medical ethics. The thesis of this paper is that religious considerations play a large and integral part in medical decision-making. The topics to be discussed include shared values; methodology, along with the related concepts of metaethics and the principle of double effect; and applications of these perspectives in medical ethics, particularly with regard to healthcare decisions involving the end of life. Each area will be explored in this paper in order to give insight into how these religious approaches came to be what they are today and how they present positions in medical ethics which may be at odds with other perspectives not based on any theological doctrines. Specifically, this paper discusses shared values, by referring to human dignity and its concepts, as well as theological principles in health care ethics, and definitions of these principles. In addition, the paper discusses the methodology in Roman Catholicism, in addition to explaining the meaning of natural law. Furthermore, the discussion focuses on metaethics and its theories, as well as a consideration of the principles of double effect (PDE) and its four conditions. Lastly, the discussion considers applications of theologically based medical ethics to the question of forgoing treatment and what are the pillars of ethics with regard to this issue.

The medical ethical aspects of organization of medical rehabilitation

The article considers such aspects of organization of medical rehabilitation care of population as accessibility, quality, social efficiency from perspective of medical ethics. The quality of diagnostic, prevention and treatment of diseases is affected by qualification of medical personnel that is applied both to areas of clinical medicine and health care management. The specialists are to apply common principles and standards of health care. Among them are support of valuable quality of medical care under optimal application of available resources and observance of medical ethics standards. The Republic of Dagestan is anagrarian region where 55% of population resides in rural area and most of health care resources are cumulated in urban area. The indices of health of population residing in rural area are in many parameters worse than in urban population and provision of medical institutions with medical personnel is low. The specialized medical care support including medical rehabilitation, of rural population, is provided without additional managerial decisions and is much more difficult as compared with patients residing in urban area. Hence in conditions of necessity of optimization of resource support of health care system functioning no extensive development of possibilities of medical rehabilitation is possible in rural residents of Dagestan.

Retributivism and the Moral Enhancement of Criminals Through Brain Interventions

AbstractThis chapter will focus on the biomedical moral enhancement of offenders – the idea that we could modify offenders’ brains in order to reduce the likelihood that they would engage in immoral, criminal behaviour. Discussions of the permissibility of using biomedical means to address criminal behaviour typically analyse the issues from the perspective of medical ethics, rather than penal theory. However, recently certain theorists have discussed whether brain interventions could be legitimately used for punitive (as opposed to purely therapeutic) purposes. For instance, Jesper Ryberg argues (although he himself is not a retributivist) that there is nothing to prevent retributivists from endorsing brain interventions as a legitimate form of retributive punishment. Legal academics have not yet paid sufficient attention to whether this proposal would be compatible with international human rights law, nor have retributivist philosophers discussed whether their favoured penal theories have the conceptual resources to explain why brain interventions would not be an appropriate method of punishment. This chapter considers whether there is any indication that these interventions are being used at present for punitive purposes and whether this would violate the European Convention on Human Rights. It examines different versions of retributivism and considers which theory is in the best position to challenge the use of brain interventions as a form of punishment. Finally, it considers whether offering these interventions as an alternative to punishment would violate principles of proportionality.

Their view: difficulties and challenges of patients and physicians in cross-cultural encounters and a medical ethics perspective

BackgroundIn todays’ super-diverse societies, communication and interaction in clinical encounters are increasingly shaped by linguistic, cultural, social and ethnic complexities. It is crucial to better understand the difficulties patients with migration background and healthcare professionals experience in their shared clinical encounters and to explore ethical aspects involved.MethodsWe accompanied 32 migrant patients (16 of Albanian and Turkish origin each) during their medical encounters at two outpatient clinics using an ethnographic approach (participant observation and semi-structured interviews with patients and healthcare professionals). Overall, data of 34 interviews with patients and physicians on how they perceived their encounter and which difficulties they experienced are presented. We contrasted the perspectives on the difficult aspects and explore ethical questions surrounding the involved issues.ResultsPatients and physicians describe similar problem areas, but they have diverging perspectives on them. Two main themes were identified by both patients and physicians: >patients’ behaviour in relation to doctors’ advice< and > relationship issues<.ConclusionsA deeper understanding of the difficulties and challenges that can arise in cross-cultural settings could be provided by bringing together healthcare professionals’ and patients’ perspectives on how a cross- cultural clinical encounter is perceived. Ethical aspects surrounding some of the difficulties could be highlighted and should get more attention in clinical practice and research.

Advance Statements and Ruth Macklin’s Useless Concept of Human Dignity

This paper aims to demonstrate the importance and usefulness of human dignity from the perspective of achieving of Advance Statements as a manifestation of the concerned person able to make gaugeable and valid in particular his intention to exercise the constitutional right to die with dignity and, from that, submits an objection to the thesis of human dignity held by Ruth Macklin. For this purpose, in the first topic, human dignity will be explored under the philosophical approach, from the perspective of medical ethics and its foundation in the Brazilian legal system. The second topic will demonstrate the Advance Statements as an instrument of materialisation of human dignity, specifically for patients in end-of-life stage. This writing will be directed according to the deductive method of qualitative approach, starting from general notions of human dignity, passing through the perspective of medical ethics and the study of Advance Statements, to present, finally, an answer to Ruth Macklin. The results confirmed the effectiveness of human dignity in face of inevitable death of terminally ill patients by formalizing of Advance Statements, proving, thus, the actual usefulness and relevance of human dignity. In the doctor-patient relationship, human dignity involves pain and suffering mitigation, respect for patients and for their autonomy in decision-making about where and they prefer stay in the last days before dying, right information about their illness and risks due to medical and health care interventions, access to therapies and treatments in order to mitigate their distress, offer the possibility to renounce, suspend and withdraw therapeutic techniques, not abandoning patients and respect for their beliefs.