Practice Of Bioethics Research Articles

Understanding, being, and doing of bioethics; a state-level cross-sectional study of knowledge, attitude, and practice among healthcare professionals.

The field of bioethics examines the moral and ethical dilemmas that arise in the biological sciences, healthcare, and medical practices. There has been a rise in medical negligence cases, complaints against healthcare workers, and public dissatisfaction with healthcare professionals, according to reports from the Indian Medical Council and other healthcare associations. We intend to assess the level of knowledge, attitude, and practice of bioethics among the registered healthcare professionals (HCPs) of Maharashtra, India. A State-level online survey was conducted among the registered HCPs (n = 2143) casing all five regions of the Maharashtra state using a pre-tested self-administered questionnaire. The responses were expressed as mean, and proportions with their standard deviation and 95% CI respectively. Binary logistic regression and a multivariate logistic model were used to determine factors associated with knowledge, attitude, and practice of bioethics. Of the 2143 registered HCPs in Maharashtra included in this study, most of them (65.2%) had adequate knowledge of bioethics. Adequate knowledge was associated with lower age, profession (nurses and dentists), employment in the private sector, HCPS at Marathwada and Pune, and higher educational attainment. About 3 in 5 HCPs (59.4%) had a favorable attitude towards the ethical practice of bioethics, and was associated with profession, place of work, region of practice, and work experience. The distribution of unethical bioethics practices among 10 items was proportionally high, and only 34.4% reported good/fair practice. The common unethical practices in the state were allowing patients to be examined by interns, and not informing them about professional misconduct to the regulatory bodies. Most HCPs had adequate knowledge of bioethics, which is encouraging and would favor the laying foundation for forming a good bioethics framework. Only 3/5 HCPs demonstrated a favorable attitude, and the observed unethical practice is alarmingly common. A serious consideration to evaluate the compliance level of bioethics practice periodically and measures to educate, sensitize, and train bioethics among HCPs in Maharashtra is warranted.

At the confluence of ethics, laws and society: global working theory merging bio-ethics

The pressing global challenges facing humanity highlight the urgency of reconciling medicine, society and ecology. By shedding light on the role of theories of translation and justification, the intention here is to show the potential usefulness of an in situ bioethics that reconciles practices in medicine and ecology. Science and policy should be reassembled in hybrid working theories developed, adopted and reframed by/for Society. Yet, a major challenge emerges from translating ethics, sciences, and economics claims, both within expert and lay milieus. This paper proposes foundational pillars for operationalizing the Potterian view of global bioethics. Van Rensselaer Potter challenged the perspective that compartmentalizes values, knowledge and laws, proposing ways to bridge them by linking appreciative, descriptive, and normative knowledge. The missing link, however, is a coherent governance process that coordinates the thinking, ordering, and enacting in the world. Based on an extensive revision of the Potterian legacy and action-research case studies, this article applies the Global theoretical view in the complex in situ practice of bioethics. Little known outside the world of academic bioethics, Potter’s primarily scientific curriculum helps translate and operationalize the socio-political reflections of notable contemporary philosophers of science and critical social theoreticians such as Karl Popper, Thomas Kuhn, John Rawls, Bruno Latour and Jürgen Habermas. In this era of mass communication, government education programs, and large-scale research funding, I propose a conceptual framework for operating a Community-based Global Bio-Ethics, echoing the 60th anniversary of Habermas’ call for The Structural Transformation of the Public Sphere (1962).

Mental health and psychiatry: Distinctions, links, and ethical/bioethical perspectives

Introduction. Mental health and psychiatry have been terms of intense and complex use for almost a century, and they may have reached a critical level of ambiguous and imprecise synonymy that makes their definition and validation difficult. Objective. To examine these concepts in depth, establishing precise distinctions, ontological connections, and instrumental scope reinforced by well-defined ideas in ethics and bioethics. Method. Narrative review of pertinent literature, consultation with diverse scientific, medical, historical, philosophical, and literary sources, with appropriate analysis of ethical and bioethical practices. Results. A broad, comprehensive definition is elaborated of mental health as a field with sociocultural, political, and demographic implications, and of psychiatry as a medical specialty. In addition to making clear distinctions and describing the specific impact of both fields on diverse populations, various levels of conceptual linkages, sociopolitical action, and ethical content are highlighted, as well as in processes of administration, education, and research. Discussion and conclusion. There are factors that reinforce or weaken the scope of mental health and psychiatry, including their ethical and bioethical dimensions. Their effectiveness requires a reaffirmation of objectives and the reinforcement of individual and institutional initiatives, as well as the search for authentic connections and a social projection that is objective, comprehensive, and just.

A semantic exploration: Nurse ethicist, medical ethicist, or clinical ethicist: Do distinctions matter?

Since the 1960s, it has been recognized that "medical ethics," the area of inquiry about the obligations of practitioners of medicine, is inadequate for capturing and addressing the complexities associated with modern medicine, human health, and wellbeing. Subsequently, a new specialty emerged which involved scholars and professionals from a variety of disciplines who had an interest in healthcare ethics. The name adopted is variously biomedical ethics or bioethics. The practice of bioethics in clinical settings is clinical ethics and its primary aim is to resolve patient care issues and conflicts. Nurses are among these clinical ethicists. They are drawn to the study and practice of bioethics and its applications as way to address the problems encountered in practice. A significant number are among the ranks of clinical ethicists. However, in the role of bio- or clinical ethicist, some retained the title of their original profession, calling themselves nurse ethicists, and some did not. In this article, we explore under which conditions it is permissible or preferable that one retains one's prior profession's nomenclature as a prefix to "ethicist," under which conditions it is not, and why. We emphasize the need for transparency of purpose related to titles and their possible influence on individual and social good.

A Critique of Principlism

A Critique of Principlism

Человек должен принадлежать самому себе (интервью с П. Д. Тищенко)

The interview discusses a number of critical issues related to those social and technological transformations that are radically changing the way people think about their place within the state and amongst other people, and that have created the need for such a line of thought and action as bioethics. The discussion begins with the problem of just access to medical care, which turns out to be tied to the position that the individual occupied during the Soviet era, when in fact his physical body belonged to the State, when his subjectivity also belonged to the State, and his values and interests were represented by the doctor. The moral formula for the patient's actions was medical paternalism, represented by the doctrine of medical deontology. The task of the present time is the formation of autonomy of personality, the ability to realize oneself, where subjectivity is formed as a response to the demands imposed by various biomedical and bioethical practices. The core of this subjectivity is encapsulated in the concept of autonomy, and the rule of free and informed consent is its practical implementation. These questions are rooted in the problem of dignity, which, in turn, is deeply connected to the familiar model of the “other,” in which the doctor, when prescribing treatment, prescribes it not to this particular person, but to a generalized person. The task of philosophical criticism is discussed, which consists in diagnosing the zones of the most glaring discrepancy between our knowledge, skills, moral and legal norms, and philosophical understandings of the new reality. This diagnosis influences the formation of philosophical anthropology of B.G. Yudin, which interprets the borders of the human in human being’ consciousness as “zones of phase transitions”. The idea of transition from a dialogue to a conversation is discussed. Unlike dialogue, conversation is originally multipolar, intermittent and nonlinear, and problemocentric. Ultimately, this leads to the question of the meaningfulness of life in general, which, according to Aristotle, is the highest form of human existence.

Human-centred design, disability and bioethics

Human-centred design methodologies provide a means to align bioethical advocacy with the needs and desires of disabled people. As a method, human-centred design seeks to locate points of friction in...

4.Q. Workshop: Intersex human rights and wellbeing - Part II: From ethics to healthcare approaches and policies

Abstract Intersex newborns, children and adolescents frequently are subjected to not clinically necessary surgeries and other non-consensual treatments. According to the UN Factsheet Intersex, “Intersex people are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies”. Since the 1950s, Western medicine developed a clinical model of early surgeries and other treatments performed on intersex newborns, children and adolescents. In October 2005, an expert meeting elaborated on the Consensus of Chicago, establishing clinical recommendations for intersex healthcare and introducing a new nomenclature: Disorders of Sex Development, a document criticised from activist and academic perspectives. Human rights bodies, intersex activists and allies demand the cessation of not clinically necessary genital surgeries and other treatments performed on intersex children, recommending the postponement of these interventions until the intersex person can give informed consent. Furthermore, they highlight the relevance of providing access to clinical information and medical records, continued healthcare and psychosocial support, if needed. In the clinical field, different approaches for intersex healthcare are currently being discussed, including the elaboration of clinical recommendations. The discussion in the field of intersex studies includes the review of human rights and bioethical principles, clinical and research practices, as well as lived experiences, social circumstances and healthcare needs of intersex people. This workshop is the second part of the workshop series “Intersex human rights and wellbeing”. Part I “From frameworks to ethics and lived experiences” presented theoretical frameworks, ethical aspects in intersex studies and lived experiences of intersex people. Part II “From ethics to healthcare approaches and policies” aims at opening up a shared reflection on clinical practices, health policies and legal frameworks related to intersex health and healthcare needs. The presentations include a review of the right of intersex children to autonomy and informed consent in the Belgian clinical practice and legislation (Presenter: Dr. Pieter Cannoot, Belgium), the presentation of a qualitative research project on the perspectives of intersex people, parents, medical doctors and psychologists regarding intersex healthcare (Presenter: Dr. Ute Lampalzer, Germany), a reflection on the experience of a multidisciplinary team specialised in intersex healthcare in Switzerland (Presenter: Cynthia Kraus, Switzerland), the review of cross-cultural differences in psychosocial intersex healthcare in Germany and Israel (Presenter: Dr. Meoded Danon, Germany), as well as the proposal of an agency-based model of health in intersex healthcare (Presenter: Daniela Crocetti, Italy). Key messages The questioning of not clinically necessary surgeries and other non-consensual treatments performed on intersex children motivates a discussion on new clinical approaches in intersex healthcare. Activists, practitioners and researchers call for clinical recommendations and policies that focus on human rights, informed consent, decisional autonomy, agency and multidisciplinary collaboration.

A questionnaire based institutional assessment of ‘knowledge’, ‘attitude’ and ‘practice’ about bio-ethics in clinical research among postgraduate residents

Background: Research ethics govern the standards of conduct for scientific researchers. Post graduate residents are one of the key stakeholders in clinical research. Therefore, the present study is designed to assess the Knowledge, Attitude and Practice about bio-ethics in clinical research among post-graduate residents.Methods: A self-administered pretested questionnaire was given to 40 students selected on the basis of convenience sampling. The questionnaire consists of questions related to knowledge and attitude toward principles and practice of bioethics in clinical research, informed consent, and role of the ethics committee in the institution. Descriptive statistics was used to analyse the results.Results: 70% of the students have formally taken Hippocratic Oath. Knowledge, attitude, and practice regarding Institutional Ethics Committee, and informed consent were more among final year students when compared to their juniors. Source of knowledge of bioethics were multiple. Department lectures were not a preferred mode of learning.Conclusions: There is an urgent need to include practical education of ethics to bridge the gap in the knowledge, attitude, and practices regarding ethics in clinical practice and research.

Bioethics in Africa: A contextually enlightened analysis of three cases.

Across sub-Saharan Africa, bioethics is an emerging field of scholarly inquiry, informed by contextual features distinct to the region. A cultural mix comprised of Euro-American influences, indigenous traditions, Christian faiths and Muslim communities, a bioethics for the sub-Saharan region must be responsive to this milieu. This paper asks, what values and methods can best promote the practice of bioethics in Africa? We set forth a strategy that leans one way or another in response to contextual features of a particular setting. Since our aim is to be responsive to context, we begin with a series of cases and develop values and methods in response to each case as we work through its ethical analysis. Section I introduces a case involving setting priorities for public funding of services that produce large benefits for a small group of people, using the example of dialysis in Ghana. Section II presents a situation involving determining the permissibility of a double standard of quality for healthcare devices in rich and poor nations, using the example of explanting pacemakers from deceased people in wealthy nations for use by people in low- and middle-income nations. Section III describes a scenario where international groups clash with religious and spiritual healers over the chaining of people with severe mental illness at prayer camps and healing centers in Ghana. Section IV articulates a three-pronged strategy for engaging in bioethics brought to light by the case analyses and defends it against objections. Throughout the paper, we tag certain views 'African' and others 'Western' to indicate ethical beliefs commonly found in these regions and less commonly found elsewhere. We do not mean to imply that all Africans hold a certain ethical stance or that all Westerners do; nor do we mean to suggest that people outside these regions do not hold the views in question.

Development and validation of an instrument to measure physician awareness of bioethics and medical law in Oman

BackgroundA different ethos with respect to the perception of medical ethics prevails in societies in transition such as those in the Arabian Peninsula, which makes it difficult to apply international principles of bioethics in medical practice. This study aimed to develop and psychometrically test an instrument that measures physicians’ awareness of bioethics and medical law and their attitudes towards the practice of medical ethics. Additionally, it examined physician correlates influencing the awareness of bioethics.MethodsFollowing a rigorous review of relevant literature by a panel of experts, a 13-item instrument, the Omani physicians’ bioethics and medical law awareness (OBMLA) questionnaire was developed with the aim of assessing physicians’ awareness of bioethics and medical law. The study tool’s construct validity and internal consistency reliability were examined by exploratory factor analysis (EFA) and Cronbach’s alpha. In a cross-sectional study, the questionnaire was distributed among a random sample of 200 physicians at a tertiary hospital in Muscat, Oman. Participant characteristics that may influence awareness of bioethics and medical law were explored.ResultsThe EFA of the OBMLA questionnaire resulted in three well-loading factors: (1) Physicians’ bioethics practice subscale (2) incentive related bioethics subscale and (3) medical law awareness subscale. Internal consistency reliability ranged between Cronbach’s α: 0.73–0.8. Of the total 200 participants, 52% reported that teaching medical ethics during medical school was inadequate. The overall mean (standard deviation, SD) of the bioethics awareness score and Omani medical law awareness were 27.6 (3.5) and 10.1 (2.1) respectively. The majority of physicians (73%) reported that they frequently encountered ethical dilemmas in their practice and 24.5% endorsed the view that unethical decisions tended to occur in their practice.ConclusionThe study provides an insight into the practice of bioethics, and the awareness of bioethics and medical law among physicians in a teaching hospital in Oman. The OBMLA questionnaire appears to be a valid and reliable tool to assess a physician’s awareness of bioethics and medical law. In this preliminary study, it appears that participants have suboptimal scores on the indices which measure practice and awareness of bioethics and medical law.

Philosophy and Practice of Bioethics Across and Between Cultures

Philosophy and Practice of Bioethics Across and Between Cultures

Introduction: Defining Cases in Pediatric Bioethics.

The history and practice of pediatric bioethics, like medicine itself, is inherently case based. Just as anatomy, pathophysiology, and pharmacology are applied in making clinical decisions for pediatric patients, ethical theory, principles, standards, and frameworks must also be applied to each clinical encounter. Sometimes, this occurs without much thought or controversy, whereas other cases may be marked by the lack of a clear path or a conflict over the right and good decision. But in the clinical setting, unlike the classroom, decisions must be made. Since its inception, specific cases have captured the attention of ethics scholars and helped define pediatric bioethics, challenging existing practice, beliefs, or standards, requiring critical reflection and debate, and sometimes leading to the creation of new theories, understandings, and approaches. In the last 50 years, advances in medical technology, social changes altering the relationship between patients and their health care providers, the rise of the Internet, changes in attitudes about the moral worth of all children, and many other factors have changed the nature of medical decision-making for children and their families. The bioethics movement has expanded dramatically with these changes and has both influenced and been influenced by these changes in societal … Address correspondence to Aaron Wightman, MD, MA. E-mail: aaron.wightman@seattlechildrens.org

Can bioethics be an honest way of making a living? A reflection on normativity, governance and expertise

The authority of bioethics as a field of inquiry and of bioethicists as scholars with a distinctive expertise is being questioned on various fronts. Sarah Franklin’s 2019 Nature commentary ‘Ethical...

Using a game for undergraduate global health students in the United States to practice applying ethical research principles

Global health programmes have become quite popular within universities in the United States. But despite the growth in undergraduate programming in global health, the training of American undergraduates to ensure they engage ethically when conducting research in a low- or middle-income country has not followed. I teach a course in global bioethics and developed the board game described in this article as a means of engaging students in active, peer-to-peer learning about ethical challenges, questions and concerns during the research planning process, while students are working abroad in unfamiliar contexts or upon return to their home university once their data collection is completed. The game is intended for students to apply what they learned regarding global bioethical practice.

Do We – and Should We – Have a Canadian Bioethics?

Do we have a genuinely Canadian bioethics – and not only a practice of bioethics in Canada? This question, and this paper, are about the connection between bioethics and the actual healthcare, research, and public health experiences of Canadians. In addressing it, I am inspired by the philosophy of pragmatism that stresses the importance of everyday experience as a starting point for ethics, and of human flourishing as a goal for ethics. Through this lens, an ideal Canadian bioethics is one that is rooted in the lived experiences of Canadians; it reflects the ideal of flourishing projected by Canadian individuals, including their views on their political communities. However, it is unclear if a full-fledged Canadian bioethics has taken shape given increasingly uniform scholarship worldwide that sets expectations about the kinds of moral problems worth investigating and the kinds of solutions to be adopted. In the spirit of thinking about this question, I discuss aspects of Canadian society that could shape the development of a Canadian bioethics: (a) the existence of competing Canadian political narratives, (b) the distinctiveness of Canadian healthcare systems and healthcare experiences, (c) the commitment of Canadians to certain values and aspirations, (d) the institutional and procedural aspects of the Canadian public sphere, (e) the challenges of increasingly uniform scholarship across geographic and national contexts, and (f) the practical obstacles to developing a Canadian bioethics. These challenges that Canadian bioethics faces are likely relevant internationally for all contexts in which socially shaped moral problems are discussed and solutions envisioned.

Urban bioethics – The architect of a healthy city

Urban bioethics pays attention to the design of healthy relationships through the involvement of citizens. The main characteristics of urban bioethics: inclusion, integrity, transdisciplinarity. Involvement is a relentless engaging scriptwriter that is deployed by urban bioethics to explore the everyday application of its principles. Integrity discloses integrative mechanisms for bringing communities together in order to create a development strategy for the city and society in general. Transdisciplinarity explains the mechanism of transcendental space, bringing together a variety of languages, professions, cultures, and etcetera. In this article, we go into examples of bioethical practices that promote the development and implementation of intercultural strategies on an Integrated Bioethics Platform, which can be found in the city both - online and offline. We also make suggestions on the leading types of behavior that are indoctrinated by this platform: networking; involvement through art; awareness of public space and one’s place/one’s self; educational practices.

Awareness of Millennial Undergraduate Students of a Private University in the Philippines on Bioethical Practices and Issues

This descriptive research assessed the level of awareness of millennial undergraduate students of a private university in the Philippines on bioethical practices such as abortion, surrogacy, euthanasia, eugenics, organ donation/ transplant, and in-vitro fertilization that give rise to bioethical issues. The author utilized a validated self-made instrument to gauge the respondents’ knowledge, understanding, and awareness of these bioethical practices and issues. The findings show that all the student-respondents have a high level of knowledge that bioethical practices, such as abortion, surrogacy, eugenics, organ donation, and in-vitro fertilization do exist in modern society. They also reveal that Psychology, Education, and Nursing student-respondents have a very high level of understanding of the meaning of these bioethical practices. The results further reveal that Education students are the most highly aware of how the advancements in science lead to the emergence of new bioethical issues. The implications reflect the views of the millennial undergraduate students on the bioethical issues brought about by the advancements in medical science. The millennial cohorts are the driving force shaping the future; hence, there is still a need to reinforce and develop the understanding of bioethics as respect for life which can help them make ethical choices in the dilemmas that they may face in life.

Bioética, persona y familia: una bioética que humaniza

En las últimas décadas, se ha percibido el influjo de posturas, y se ha evidenciado corrientes reduccionistas que han vaciado de contenido a la Bioética y afectado su ejercicio. Es a través de la exigencia de la valoración ontológica de la persona que se llega a constituir el fundamento necesario para una adecuada práctica de la Bioética, en una imperiosa necesidad de rescatar y reponer las bases éticas originarias de la persona de las cuales debe partir la toma de decisiones bioéticas que repercuten y redundan en el ser humano, la familia, las generaciones futuras y el ambiente.

Whose harm? Which metaphysic?

Douglas Diekema has argued that it is not the best interest standard, but the harm principle that serves as the moral basis for ethicists, clinicians, and the courts to trigger state intervention to limit parental authority in the clinic. Diekema claims the harm principle is especially effective in justifying state intervention in cases of religiously motivated medical neglect in pediatrics involving Jehovah's Witnesses and Christian Scientists. I argue that Diekema has not articulated a harm principle that is capable of justifying state intervention in these cases. Where disagreements over appropriate care are tethered to metaphysical disagreements (as they are for Jehovah's Witnesses and Christian Scientists), it is moral-metaphysical standards, rather than merely moral standards, that are needed to provide substantive guidance. I provide a discussion of Diekema's harm principle to the broader end of highlighting an inconsistency between the theory and practice of secular bioethics when overriding religiously based medical decisions. In a secular state, ethicists, clinicians, and the courts are purportedly neutral with respect to moral-metaphysical positions, especially regarding those claims considered to be religious. However, the practice of overriding religiously based parental requests requires doffing the mantle of neutrality. In the search for a meaningful standard by which to override religiously based parental requests in pediatrics, bioethicists cannot avoid some minimal metaphysical commitments. To resolve this inconsistency, bioethicists must either begin permitting religiously based requests, even at the cost of children's lives, or admit that at least some moral-metaphysical disputes can be rationally adjudicated.