Principles Of Biomedical Ethics Research Articles

Medical Ethics in Perspective of Islamic Teachings

Summary: Islam as a universal religion, presents a comprehensive and practical system of ethics for the entire humanity in every field of life. Medical ethics is one of the most important components of this extensive ethics system. Islamic medical ethics is the approach of dealing with and handling the healthcare practice and process according to the Islamic moral system and legislative sources (primarily ‘The Quran’ and ‘Hadith’). It is also adopted and promoted by several international organizations. Islamic ethics endorses the basic principles of biomedical ethics, i.e. Beneficence, non-maleficence, confidentiality, justice, truth-telling, autonomy and informed consent, which have been mainly derived from the “Hippocratic Oath”, with some additions and modifications. Moreover, Islamic teachings present some additional moral values over these basic ethical principles. The present manuscript aims to concisely highlight the evolution and history of bio-medical ethics, briefly describe its basic concepts and focus on the influence of teachings, principles and characteristics of Islam on this important aspect of medical practice. In the end, some important relevant topics such as the general responsibilities of the doctor, protection of life, legal status of treatment and status of treatment with prohibited substances, in the light of Islam, are also discussed briefly. Keywords: Medical ethics, Hippocratic Oath, basic principles of ethics, Islamic perspective.

Bioethics-CSR Divide

Bioethics-CSR Divide

Fostering Medical Students’ Commitment to Beneficence in Ethics Education

Fostering Medical Students’ Commitment to Beneficence in Ethics Education

Caring for Pregnant Patients with Cancer: A Framework for Ethical and Patient-Centred Care.

(1) Background: Caring for pregnant cancer patients is clinically and ethically complex. There is no structured ethical guidance for healthcare professionals caring for these patients. (2) Objective: This concept paper proposes a theoretically grounded framework to support ethical and patient-centred care of pregnant cancer patients. (3) Methodological approach: The framework development was based on ethical models applicable to cancer care during pregnancy-namely principle-based approaches (biomedical ethics principles developed by Beauchamp and Childress and the European principles in bioethics and biolaw) and relational, patient-focused approaches (relational ethics, ethics of care and medical maternalism)-and informed by a systematic review of clinical practice guidelines. (4) Results: Five foundational discussion themes, summarising the key ethical considerations that should be taken into account by healthcare professionals while discussing treatment and care options with these patients, were identified. This was further developed into a comprehensive ethics checklist that can be used during clinical appointments and highlights the need for a holistic view to patient treatment, care and counselling while providing ethical, patient-centric care. (5) Conclusion: The proposed framework was further operationalised into an ethics checklist for healthcare professionals that aims to help them anticipate and address ethical concerns that may arise when attending to pregnant cancer patients. Further studies exploring clinicians' attitudes towards cancer treatment in the course of pregnancy and patient experiences when diagnosed with cancer while pregnant and wider stakeholder engagement are needed to inform the development of further ethical, patient-centred guidance.

An introduction to dental ethics Part 4 - The four principles of biomedical ethics. Part 1

An introduction to dental ethics Part 4 - The four principles of biomedical ethics. Part 1

Principlism and contemporary ethical considerations for providers of transgender health care

Background : Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims : We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method : This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results : The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion : We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound.

Health teachers' ethical conflict experiences in the COVID-19 situation: a qualitative content analysis.

In the context of the COVID-19 pandemic, health teachers who are responsible for the health of school staff and students are experiencing many ethical conflicts, and research on this is needed. This study was to investigate and explore the ethical conflicts experienced by health teachers during the COVID-19 pandemic situation. This was a qualitive study using directed content analysis applied to the four principles of biomedical ethics. Study participants were a total of 26 health teachers in Seoul, South Korea. In-depth individual interviews were conducted with 14 health teachers, and focus group interviews were conducted with the other 12 (2 teams with each 6 persons). Data were collected between May-June 2022, and analyzed using a deductive approach among the qualitative content analysis of Elo and Kyngäs. This study satisfied the four aspects of credibility, transferability, dependability, and confirmability presented by Guba and Lincoln (1989) to secure the reliability of qualitative research. The ethical conflicts related to the four principles of biomedical ethics advocated by Beauchamp and Childress (autonomy, non-maleficence, beneficence, and justice), and the ethical conflicts in which overlap with the two principles of autonomy and non-maleficence, and the ethical conflicts related to miscellaneous matters or relationships, which were not included in the four principles, were investigated as the main 6 categories of ethical conflicts experienced by health teachers. Based on this, 10 generic categories and 17 subcategories were derived. This study could be used as primary data for policy development and intervention research. Such engagements can help identify ethical conflicts faced by health teachers in infectious disease crises, thus improving their ability to cope.

Structure and features of psychopathological symptoms in forced migrants and internally displaced persons

Aim: To study the structure and characteristics of psychopathological symptoms in FM who left Ukraine as a result of the full-scale armed aggression of the Russian Federation against Ukraine, and internally displaced persons, in a comparative aspect. Materials and Methods: Examination was performed in compliance with the principles of biomedical ethics, based on informed consent. Research was provided on the basis of the Ternopil Regional Clinical Psychoneurological Hospital. Inclusion criteria were women who were forced to leave the territory of Ukraine as a result of hostilities after February 24, 2022, and who left for temporary residence in the territory of the Republic of Poland (Poland) (FM), and women who were temporarily relocated within Ukraine in connection with connection with hostilities (IDP). Exclusion criteria from the study were presence of language disorders, pronounced cognitive disorders, severe somatic condition. The examination was organized by the method of a semi-structured clinical interview according to the developed by us protocol and was conducted remotely. During the examination, depressive, anxiety-phobic, asthenic and dyssomnic disorders, addictive behavior and symptoms of PTSDwere identified and verified. Statistical and mathematical processing a was carried out using Fisher’s exact test. Results: The data we obtained indicate a significant spread of psychopathological symptoms in FM and IDP. Conclusions: FM and IDP are characterized by a high incidence of psychopathological symptoms. The most frequent were: depressed mood (FM – 67.2%, IDP – 58.5%), feelings of anxiety and fear (FM –52.5%, IDP – 43.6%), obsessive thoughts (FM – 58.9 %, IDP – 49.5%).

Analysis of the psychosocial component continuum of psychological adaptation-disadaptation in patients with a dermatological profile with different levels of vital threat

Purpose: to investigate the state of psychosocial functioning as a component of the continuum of psychological adaptation - maladaptation in patients with a dermatological profile with diseases of various levels of vital threat, to develop, in the future, personalized psychocorrection programs for this category of patients. Contingent and research methods. On the basis of informed consent, in compliance with the principles of biomedical ethics and deontology, we examined 120 dermatological patients who were treated in three branches of the clinic “Dr. Zapolska Clinic” during 2020-2021, namely: 60 patients with non-vital dermatological diseases (seborrheic keratosis L82, condylomas A63.0, angiomas D18.0, pigmentation disorders L80), and 60 patients with dermatological diseases posing a vital threat (melanoma C43, basal cell carcinoma C44, skin carcinoma D04). The results. Both by integral indicators and by separate characteristics of socio-psychological adaptation/maladaptation, we found a general trend of the primary importance of the lack of adaptive resources and the secondary – nosospecificity features of dermatological pathology, in the formation of states of psychological maladaptation, which is manifested both in the clinical and psychological plane, and in the field of psychosocial functioning. These data are also consistent with the results of the study of the quality of life (QoL) of the examinees: the general trend of association between the level of QoL and the presence of signs of psychological maladjustment (PMA) was confirmed both for the integral criteria for the assessment of QoL and for 8 out of 10 evaluation parameters of QoL (levels of physical well-being and work capacity turned out to be nosospecificity, in contrast to all other parameters). The study confirmed our assumptions regarding the absence of a direct relationship between nosospecificity and vitality of a dermatological disease and the state of psychosocial functioning of an individual, especially in the context of adaptability and its resource base. The obtained results regarding the fact that dermatological patients without clinical signs of psychological maladjustment, regardless of the nosological affiliation of the main disease, have a sufficient resource of adaptability and use it in the field of social-psychological interaction, are predictable for us, but such that required scientific justification and proof. The issues of primary/secondary states of the resource base and adaptability at the clinical-psychological and psychosocial levels require further study. We assume that we are talking about the mechanisms of mutual influence of biological predisposition and psychological and psychosocial factors, the mosaic combination of which determines the resource capabilities of the individual regarding the constructive acceptance of the fact of the presence of a dermatological disease and the development of an adequate strategy for its mastery, regardless of the degree of vitality of the disease. Conclusion. The identified regularities should be considered when developing treatment-rehabilitation and psycho-prophylactic measures in patients with dermatological pathology with different levels of vital threat.

ETHICAL CONSIDERATIONS UNDERLYING ACP FOR ACCOMPANIED OLDER ADULTS WITH COGNITIVE IMPAIRMENT

Abstract While clinicians understand the importance of ACP, it is difficult to overcome logistical and ethical challenges in the limited time providers have in primary clinic appointments with older adults with ADRD and other complex co-morbidities. Ethical/moral dilemmas faced by patients, families, and clinicians are reflected in the four principles of biomedical ethics including autonomy, beneficence, nonmaleficence, and justice. While ethical challenges are recognized there is a lack of real-world evidence to guide clinicians or family caregivers in ACP for older adults with ADRD based on the reality of complex patient and family dynamics. Throughout the SHARE trial, facilitated ACP conversations with trained ACP facilitators, older adult patients with cognitive impairment, and their family caregiver were audio recorded and transcribed. The purpose of this presentation is to expand our understanding of best practices for facilitating ACP conversations among persons with ADRD and their family caregivers, guided by medical ethics and the Learning Health Care System Ethics Framework. We draw on the unique dataset of recorded ACP conversations involving older adults with severe cognitive impairment (N=92, average age=88 years), family caregivers, and trained ACP facilitators. We qualitatively coded transcripts for ethical considerations of ACP conversations and conducted the thematic analysis. We will present major themes related to ethical considerations in facilitating ACP conversations among persons with moderate to severe ADRD and their family caregivers. We will provide a discussion framed in balancing patient, family, and provider needs within a Learning Health Care System.

Is there a legal and ethical duty on doctors to inform patients of the likely co-payment costs should they be treated by practitioners who have contracted out of medical scheme rates?

A hypothetical scenario is presented in which a female patient is admitted to a private hospital to undergo a mastectomy and breast reconstruction. The surgeons and anaesthetists conducting the different procedures charge three times the medical aid rates. When the patient asks what the co-payments are likely to be, she is informed by the doctors’ accounts section that they can only provide this information after each procedure. The patient’s medical scheme also advises her that it cannot determine the likely co-payments unless she completes the assessment form sent to her. The form requires her to include the costs reflected against the relevant ICD10 codes. The patient cannot complete the form because the doctors’ accounts sections have not informed her about the proposed procedures and the likely costs of each. This article builds on a previous article discussing doctors’ overarching responsibility to disclose medical treatment costs in advance. The present article outlines the legal requirements in the South African Constitution, the National Health Act and the Health Professions Act, and refers to the Promotion of Access to Information Act and Consumer Protection Act. Similar to the earlier article, this article addresses the ethical requirements of the Health Professions Council of South Africa and the internationally recognised biomedical ethical principles. Furthermore, it also refers to the National Patients Charter, the government’s policy document on health care services.

Algorithm of prognosis of psychological adaptation-maladaptationas the basis of personalized psycho-correction of patients with dermatological diseases with different levels of vital threat

Purpose: to substantiate the algorithm for predicting the state of psychological adaptation - maladaptation of patients with dermatological pathology with different levels of vital threat, on the basis of which to develop personalized psychocorrection programs for this contingent, and to evaluate the effectiveness of their implementation. .
 Contingent and research methods. Based on the principles of biomedical ethics and deontology, we comprehensively examined 120 dermatological patients who were treated in three branches of the clinic "Dr. Zapolska Clinic" during 2020-2022, namely: 60 patients with non-vital dermatological diseases (seborrheic keratosis L82, condylomas A63.0, angiomas D18.0, pigmentation disorders L80), and 60 patients with dermatological diseases posing a vital threat ( melanoma C43, basal cell carcinoma C44, skin carcinoma in situ D04).
 Results. Among patients with dermatological diseases, there are both psychologically adapted and maladapted individuals, regardless of the vitality/non-vitality of the pathological process.
 The process of formation of psychological maladaptation in patients with dermatological diseases with different levels of vital threat does not have nosospecificity, but depends on the initial state of the adaptive resource base of the individual, first of all, its psychosocial and individual-psychological components.
 Summarizing the obtained results made it possible to identify three main blocks of characteristics that cover a wide range of biological, individual-psychological, social-environmental and psychosocial factors, which we defined as factors/markers of psychological adaptation-maladaptation in patients with dermatological diseases with different levels of vital threat: psychoemotional , psychosocial and personal.
 Based on the analysis of determined markers of psychological adaptation-maladaptation using mathematical methods, an algorithm for assessing and predicting psychological maladaptation in this contingent of patients is proposed.
 This algorithm determines the criteria of personification, the structure and scope of developed psychocorrective measures at different degrees of risk of psychological maladaptation in patients with dermatological diseases with different levels of vital threat.
 A three-stage system of psychocorrective interventions (assessment-diagnostic, clinical-therapeutic, and correction-adaptation stages) has been developed, united by the complexity and continuity of correction, psychotherapeutic, and adaptation measures. At the assessment-diagnostic stage, the prognosis of the development and progression of maladaptation is assessed, which ensures the personification of psychocorrective interventions, which are carried out mainly at the clinical-therapeutic stage, the positive effect of which is fixed at the last, corrective-adaptation stage.
 The evaluation of the effectiveness of these measures proved their effectiveness in eliminating psychopathological manifestations (depression and anxiety), improving the quality of life and social functioning, and increasing vitality and resilience.
 Conclusion. Personalized psychocorrection of patients of dermatological practice with different levels of psychological maladaptation may be recommended for the introduction into health care practice.

Principles of Biomedical Ethics

The text presents the principles of biomedical ethics (the principle of respect for autonomy, the principle of beneficence, the principle of non-harm, the principle of justice) and shows how principlism has influenced perceptions of what is right (good) in medical practice – both in everyday medicine, as well as in clinical research – and to what extent bioethics has provided answers to the moral dilemmas of medicine of the 20th and 21st centuries, a medicine supported by advances in science and research. It is shown that although the principlist approach is not perfect, it represents a successful attempt to bring together the great moral theories developed over time and to create, by balancing them in a new formula, a scheme that represents at the same time a guide moral and an analytical key to human behavior and actions in health care.

Clinical trial implementation: a primer for neurosurgeons.

In the current landscape of evidence-based medicine, prospective clinical trials are an important avenue through which to establish the efficacy and safety of biomedical treatments compared with standard-of-care interventions. Depending on their scope and aims, clinical trials can be extremely costly and time intensive, and significant coordination is needed to ensure optimal utilization of healthcare resources, adherence to the principles of biomedical ethics, and appropriate interpretation of study results. This review highlights the core principles for designing and implementing clinical trials within neurosurgery, with the aim to provide clinicians with a framework for implementing both investigator-initiated and industry-sponsored trials.

간호대학생의 생명의료윤리 원칙 인식에 대한 분석

Objectives This study was attempted to identify and systematically understand how nursing students perceive the principles of biomedical ethics.
 Methods Through an open questionnaire, first-year nursing students who took a biomedical ethics lecture for one semester were asked to choose the most important principle among the four principles of biomedical ethics and write the rationale for it. A total of 99 subjects were analyzed using the content analysis method.
 Results Among the four biomedical ethics principles, the importance distribution was shown in the order of prin-ciple of respect for autonomy(45.5%), principle of nonmaleficence(29.3%), principle of beneficence(20.2%), and principle of justice(5.0%), and 14 themes and 42 statements supporting the basis were revealed. There were a total of 15 statements on the principle of respect for autonomy, and 4 themes were included: inherent rights, right to choose, right to know, and right to be respected(45.5%). There were a total of 15 statements on the principle of nonmaleficence, including 4 themes: avoiding harm, minimizing suffering, basic duties, and licensing as a nurse(29.3%). There were a total of 9 statements on the principle of beneficence, and 4 themes were included: the role of medical personnel, use of professional knowledge, active help, and human well-being(20.2%). There were a total of 3 statements on the principle of justice, including 2 themes: establishment of standards and fair-ness(5.0%).
 Conclusions It was confirmed that the students showed an active attitude to solidify their moral values and to cul-tivate a sense of ethics. In the undergraduate curriculum, not teacher-centered lectures, but learner-centered bi-oethics education that reflects students' understanding and feedback should be provided.

Quality Assurance and Safety Culture in a Healthcare Organization

Patient care and quality management have as one of their primary focuses ensuring the safety of their patients. The four principles of biomedical ethics presented by Beauchamp and Childress are one quality management paradigm that emphasizes the importance of the patient. The Institute of Medicine's six improvement goals capture the essence of excellent medical treatment. Care, money, and health are the three pillars upon which the Institute for Healthcare Improvement's Triple Aim rests. The present review was written with the aforementioned contexts in mind, with the intention of highlighting the system's initiatives to address various efforts of enhancing quality and patient safety. We provide a reflective overview of healthcare legislation, policy, and regulation with special attention paid to the ideas of informed consent and informed refusal. This analysis also details the steps taken and regulations enforced by the administration and management to provide care that is focused on the individual patient. Finally, we discuss model policies like the Delivery System Reform Incentive Payment Program, which incorporates quality management frameworks, the Hospital-Acquired Conditions Reduction Program, which promotes patient safety, and the Hospital Readmissions Reduction Program, which aims to reduce hospital readmissions.

Dignity as a Central Issue in Treating Patients with Dementia Associated with COVID-19 Infection.

COVID-19 was initially considered a primary respiratory disorder associated with various short- and long-term complications, affecting many patients and imposing a significant burden. Patients who have dementia are especially vulnerable to the SARS-CoV2 infection, which is associated with an increased risk for neuropsychiatric complications. These patients need a unique approach to managing ethical issues related to the COVID-19 pandemic, including autonomy, veracity, non-maleficence, justice, compassion, and dignity. The latter is one of the most elusive and misunderstood concepts in medical ethics and is extremely important in debates surrounding the proper management of patients with dementia. However, it is often left out of ethical analysis, as most clinicians, when debating issues associated with clinical practice, often evaluate only the "classical" principles of biomedical ethics. In this article, we aim to assess the unique features of dignity in treating this group of patients during the COVID-19 pandemic. We will briefly analyze dignity as a bioethical concept. We will further explore its principal axes, namely compassion, creating a humane and purposeful environment, employing persuasion to meet the person's essential needs, exerting a certain degree of mild restraint to meet the person's critical needs, minimizing harm in terminal care, and justice, through the lens of people who had dementia during the COVID-19 pandemic. Applying this principle in clinical practice requires significant commitment from all healthcare workers. New approaches to the analysis of dignity, such as through the Ring Theory of Personhood, may facilitate its understanding by practitioners and aid its implementation in populations with multiple vulnerabilities, such as dementia patients, during an infectious outbreak that generates significant social and medical changes.

Navigating the Ethical Landmines of ChatGPT: Implications of Intelligent Chatbots in Plastic Surgery Clinical Practice.

ChatGPT is a cutting-edge language model developed by OpenAI with the potential to impact all facets of plastic surgery from research to clinical practice. New applications for ChatGPT are emerging at a rapid pace in both the scientific literature and popular media. It is important for clinicians to understand the capabilities and limitations of these tools before patient-facing implementation. In this article, the authors explore some of the technical details behind ChatGPT: what it is, and what it is not. As with any emerging technology, attention should be given to the ethical and health equity implications of this technology on our plastic surgery patients. The authors explore these concerns within the framework of the foundational principles of biomedical ethics: patient autonomy, nonmaleficence, beneficence, and justice. ChatGPT and similar intelligent conversation agents have incredible promise in the field of plastic surgery but should be used cautiously and sparingly in their current form. To protect patients, it is imperative that societal guidelines for the safe use of this rapidly developing technology are developed.

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Предиктори, дескриптори та складові емоційного вигорання у лікарів-психіатрів під час війни: взаємозв’язки, комплексна і математична моделі розвитку та прогнозу

The aim of the work was to identify predictors, descriptors and components of emotional burnout (EB) in psychiatrists during the war, to understand the interrelationships between them as a basis for building therapeutic approaches to the prevention and elimination of EB manifestations in this contingent. Contingent and research methods. The study sample, which was formed in compliance with the principles of biomedical ethics and based on informed consent, consisted of 120 psychiatrists who worked in the city of Kyiv in the period from February 24, 2022, during 2022. The criterion for stratification of the examined into groups was the presence and severity manifestations of professional maladjustment (PM) in psychiatrists, which reflected the level of their EB. According to the obtained results, the examinees were divided into three groups: the first group, OG1 – 30.8% (37 people) – doctors without signs of PM, and a low level of EB; the second group, OG2 – 47.5% (57 people) – persons with signs of PM, and a moderate level of EB; the third group, OG3 – 21.7% (26 people) – respondents with clinically defined and pronounced PM, and a high level of EB. Clinical-psychopathological, psychometric and psychodiagnostic research methods were used to assess the state of the parameters that make up the components of EB. Statistical analysis of the obtained results was performed using the non-parametric Mann-Whitney test (determination of differences) and the method of Spearman's rank correlations (estimation of correlations). The results. In the genesis of the development and progression of EB in psychiatrists during the war, the personal, psychopathological, psychosocial, professional and emotional-interpersonal indicators of their life activities are involved.