Principles Of Biomedical Ethics Research Articles

Difficult Conversations.

Difficult Conversations.

Conscientious Objection to Emergency Contraception

Conscientious Objection to Emergency Contraception

Humanizing the Physician-Patient Relationship

Humanizing the Physician-Patient Relationship

Older Adults' Perspectives of Smart Technologies to Support Aging at Home: Insights from Five World Café Forums.

Globally, there is an urgent need for solutions that can support our aging populations to live well and reduce the associated economic, social and health burdens. Implementing smart technologies within homes and communities may assist people to live well and ‘age in place’. To date, there has been little consultation with older Australians addressing either the perceived benefits, or the potential social and ethical challenges associated with smart technology use. To address this, we conducted five World Cafés in two Australian states, aiming to capture citizen knowledge about the possibilities and challenges of smart technologies. The participants (n = 84) were aged 55 years and over, English-speaking, and living independently. Grounding our analysis in values-based social science and biomedical ethical principles, we identified the themes reflecting the participants’ understanding, resistance, and acceptance of smart technologies, and the ethical principles, including beneficence, non-maleficence, autonomy, privacy, confidentiality, and justice. Similar to other studies, many of the participants demonstrated cautious and conditional acceptance of smart technologies, while identifying concerns about social isolation, breaches of privacy and confidentiality, surveillance, and stigmatization. Attention to understanding and incorporating the values of older citizens will be important for the acceptance and effectiveness of smart technologies for supporting independent and full lives for older citizens.

Conflicting Aims and Values in the Application of Smart Sensors in Geriatric Rehabilitation: Ethical Analysis.

BackgroundSmart sensors have been developed as diagnostic tools for rehabilitation to cover an increasing number of geriatric patients. They promise to enable an objective assessment of complex movement patterns.ObjectiveThis research aimed to identify and analyze the conflicting ethical values associated with smart sensors in geriatric rehabilitation and provide ethical guidance on the best use of smart sensors to all stakeholders, including technology developers, health professionals, patients, and health authorities.MethodsOn the basis of a systematic literature search of the scientific databases PubMed and ScienceDirect, we conducted a qualitative document analysis to identify evidence-based practical implications of ethical relevance. We included 33 articles in the analysis. The practical implications were extracted inductively. Finally, we carried out an ethical analysis based on the 4 principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice. The results are reported in categories based on these 4 principles.ResultsWe identified 8 conflicting aims for using smart sensors. Gains in autonomy come at the cost of patient privacy. Smart sensors at home increase the independence of patients but may reduce social interactions. Independent measurements performed by patients may result in lower diagnostic accuracy. Although smart sensors could provide cost-effective and high-quality diagnostics for most patients, minorities could end up with suboptimal treatment owing to their underrepresentation in training data and studies. This could lead to algorithmic biases that would not be recognized by medical professionals when treating patients.ConclusionsThe application of smart sensors has the potential to improve the rehabilitation of geriatric patients in several ways. It is important that patients do not have to choose between autonomy and privacy and are well informed about the insights that can be gained from the data. Smart sensors should support and not replace interactions with medical professionals. Patients and medical professionals should be educated about the correct application and the limitations of smart sensors. Smart sensors should include an adequate representation of minorities in their training data and should be covered by health insurance to guarantee fair access.

Liver transplantation from active COVID-19 donors: Is it ethically justifiable?

The debate on the opportunity to use organs from donors testing positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) in recipients with naïve resolved or active COVID‐19 is ongoing. We aim to present the ethical analyses underlying the decision to perform liver transplantation (LT) in selected patients with resolved or active COVID‐19 in Italy. We used Jonsen, Siegler, and Winslade's Four‐Boxes casuistic method, addressing the four topics considered as constitutive of the essential structure of single clinical cases for their ethical analysis (medical indications, patient preferences, quality of life, and contextual features) to enable decision‐making on a case‐by‐case basis. Based on these topics, we elucidate the meaning and balance among the principles of biomedical ethics. Clinical ethics judgment based on the relation between the risk of acquiring SARS‐CoV‐2 along with its potentially negative effects and the expected benefits of transplant lead to consider LT as clinically appropriate. Shared decision‐making allows the integration of clinical options with the patient's subjective preferences and considerations, enabling a valid informed consent specifically tailored to the patients’ individual circumstances. The inclusion of carefully selected SARS‐CoV‐2 positive donors represents an opportunity to offer lifesaving LT to patients who might otherwise have limited opportunities to receive one. COVID‐19 positive donor livers are fairly allocated among equals, and respect for fundamental rights of the individual and the broader community in a context of healthcare rationing is guaranteed.The ethical analysis of the decision to perform LT in selected patients shows that the decision is ethically justifiable.

Профессиональные компетенции врача: этико-деонтологические аспекты

The article formulates a number of ethical and deontological aspects of the training and work of a doctor. It has been revealed that there is a need for medical students and practicing doctors to form some important professional competencies, based on spiritual and moral culture, personal maturity, conscientiousness, mercy, as well as the ability to avoid and overcome conflict situations using the basic principles of biomedical ethics. Group discussion and solution of controversial ethical and deontological cases using the method of analysis of the presented situation prepares a medical student for communication, treatment, diagnostic and educational and preventive work with a patient who is faced with a difficult choice and must make an important decision.

Environmentally sustainable development and use of artificial intelligence in health care.

Artificial intelligence (AI) can transform health care by delivering medical services to underserved areas, while also filling gaps in health care provider availability. However, AI may also lead to patient harm due to fatal glitches in robotic surgery, bias in diagnosis, or dangerous recommendations. Despite concerns ethicists have identified in the use of AI in health care, the most significant consideration ought not be vulnerabilities in the software, but the environmental impact of AI. Health care emits a significant amount of carbon in many countries. As AI becomes an essential part of health care, ethical reflection must include the potential to negatively impact the environment. As such, this article will first overview the carbon emissions in health care. It will, second, offer five reasons why carbon calculations are insufficient to address sustainability in health care. Third, the article will derive normative concepts from the goals of medicine, the principles of biomedical ethics, and green bioethics—the very locus in which AI in health care sits—to propose health, justice, and resource conservation as criteria for sustainable AI in health care. In the fourth and final part of the article, examples of sustainable and unsustainable development and use of AI in health care will be evaluated through the three‐fold lens of health, justice, and resource conservation. With various ethical approaches to AI in health care, the imperative for environmental sustainability must be underscored, lest carbon emissions continue to increase, harming people and planet alike.

Principles and Duties: A Critique of Common Morality Theory.

Tom Beauchamp and James Childress's revolutionary textbook, Principles of Biomedical Ethics, shaped the field of bioethics in America and around the world. Midway through the Principle's eight editions, however, the authors jettisoned their attempt to justify the four principles of bioethics -autonomy, beneficence, nonmaleficence, justice-in terms of ethical theory, replacing it with the idea that these principles are part of a common morality shared by all rational persons committed to morality, at all times, and in all places. Other commentators contend that their theory has never been empirically confirmed and is unfalsifiable, since counterexamples can be deemed irrational, or as held by those living lives not committed to morality. The thesis of this paper is that common morality theory is the artifact of a category mistake-conflating common areas regulated by moral norms with common norms regulating moral conduct-that accords mid-twentieth century American liberal morality the status of transcultural, transtemporal, eternal moral truths. Such a conception offers bioethicists no tools for analyzing moral change-moral progress, regress, reform, evolution, devolution, or revolution-no theoretical basis for deconstructing structural classicism, racism, and sexism, or for facilitating international cooperation on ethical issues in the context of culturally based moral differences.

소비자 대상 직접 유전자검사의 윤리적 우려를 종사자 교육으로 전환하기*,**

Direct-to-consumer genetic testing was legalized in Korea 2015. According to the 2020 amendment to the Bioethics and Safety Act, employees of genetic testing institutions must receive relevant training as prescribed by law, and the training should include education concerning the ethical issues raised by genetic testing. This study reviews the ethical issues associated with direct-to-consumer genetic testing from the perspectives of virtue ethics and Beauchamp and Childress’s four principles of biomedical ethics (autonomy, beneficence, non-maleficence, and justice). Additionally, this article suggests contents and methodologies for the ethics component of employee education in genetic testing. Raising awareness of the ethical issues associated with direct-to-consumer genetic testing through effective employee education is expected to reduce the occurrence of ethical problems and thereby protect consumers.

The Case for Ethical Efficiency: A System That Has Run Out of Time.

The American health care system increasingly conflates physician "productivity" with true clinical efficiency. In reality, inordinate time pressure on physicians compromises quality of care, decreases patient satisfaction, increases clinician burnout, and costs the health care system a great deal in the long term even if it is financially expedient in the short term. Inadequate time to deliver care thereby conflicts with the core principles of biomedical ethics, including autonomy, beneficence, nonmaleficence, and justice. We propose that the health care system adjust its focus to recognize the nonmonetary value of physician time while still realizing the need to deploy resources as effectively as possible, a concept we describe as "ethical efficiency."

An Islamic Bioethics Framework to Justify the At-risk Adolescents' Regulations on Access to Key Reproductive Health Services.

Adolescent sexuality is one of the most important reproductive health issues that confronts healthcare professionals with moral dilemmas and legal issues. In this study, we aim to justify the at-risk adolescents' regulations on access to key reproductive health services (KRHSs) based on principles of Islamic biomedical ethics and jurisprudence. Despite the illegitimacy and prohibition of sexuality for both girls and boys in Islamic communities, in this study, using 5 principles or universal rules of purpose; certainty, no-harm; necessity; and custom, we argue that first, applying these principles in the context of theno-harm principle can provide the best interests of at-risk adolescents; second, it is permissible to provide KRHSs to these adolescents with their own assent, as long as necessary, only with the intention of preventing or reducing harm. In this framework, while preventing harm, it tries to provide the best interests of at-risk adolescent. Thus, the principle of no-harm requires that the government, by designating the responsibility to healthcare professionals, protects at-risk adolescents from harm, and obliges these professionals to choose and implement the option that best suits adolescents' interests.

Ethics and Law.

Ethics and Law.

Biomedical Ethics for Jehovah’s Witnesses and Patient Blood Management

Jehovah’s Witnesses refuse blood transfusions according to religious beliefs, and for this reason, most hospitals and doctors have refused their treatment. There are more than 100,000 religious people in Korea, but there are few bloodless centers that can receive their treatment. So, the number of Jehovah’s Witnesses patients visiting bloodless centers in Soonchunhyang University Bucheon Hospital has been increasing every year. Despite this situation, no legal or medical countermeasure has yet been proposed against them. Therefore, I would like to take a bioethical approach based on “principles of biomedical ethics” and introduce “patient blood management” which is currently spreading in advanced medical countries.

Decision-making in paediatric palliative care interpreting

The interpreting profession has long used metaphors or rule statements to describe and teach the ways in which practitioners make decisions (Dean & Pollard, 2011, 2018). Interpreting students are also often taught that the context of an encounter will dictate their decision-making by way of statements such as “it depends”. Such pedagogical statements can make talk between a practitioner and a medical professional about the responsibilities of an interpreter during medical encounters difficult. This study is based on the work of Dean and Pollard (2011, 2018) on value-based decision-making and is guided by the four principles of biomedical ethics (respect for autonomy, non-maleficence, beneficence and justice). It has sought to provide evidence of the existence, applicability and usability of these frameworks through a single case study of a real-life appointment in which a parent of a palliative care outpatient and a medical professional communicated during a consultation, aided by a medical interpreter.

Ethical and Methodological Challenges in Research With Hard-to-Reach Groups: Examples From Research on Family Caregivers for Migrant Older Adults Living With Dementia.

Family caregivers of migrants with dementia constitute a population group that is hard to reach for research participation due to factors such as shame about the disease and past experiences of discrimination. In this article, research-ethical challenges associated with participant recruitment and qualitative data collection among relatives of migrants with dementia are discussed. Over a period of 8 years, 3 studies were conducted to investigate the experiences of family caregivers for persons with dementia of Turkish descent in Germany. Across these studies, a total of 32 family caregivers were interviewed. In this article, based on the “Principles of Biomedical Ethics” according to Beauchamp and Childress (2009), research-ethical conflicts associated with sampling methods and the presence of third parties during qualitative interviews are discussed. The potential risks emanating from sampling strategies and the presence of third parties during interviews regarding the voluntary nature of study participation are examined. Additionally, this article formulates recommendations for ensuring truly voluntary participation and protecting both the participants (family caregivers) and relatives with dementia from harm. These practical recommendations aim to help future researchers to avoid ethical pitfalls and represent a roadmap for making necessary methodological decisions.

Гигиеническая оценка режима использования мобильных электронных устройств студентами-медиками

The hygienic assessment of the mode of using mobile electronic devices (ED) was carried out to develop preventive activities aimed at education of medical students. A total of 518 medical students were surveyed. The survey was created in Google Forms. The obtained data were processed with Statistica 13 PL. The study was conducted in accordance with the principles of biomedical ethics and did not expose the participants to any danger. Data on a habitual mode of using mobile electronic devices by medical students during their traditional educational process were obtained through the survey: half of them never did eye gymnastics, over 75.0% reported holding their mobile ED very close to the eyes, 75.0% of those surveyed used mobile ED in the lack of light. While assessing the mode of ED use by medical students, it was established that the visual organ sustained the largest burden. Preventive activities are necessary to avoid negative consequences and produce useful skills of using ED during education of future doctors at a university.

Ethical Implications of Biohacking as Activism: Democratized Health Care, Danger, or What?

Biohacking refers to optimizing one’s body through modifying biology. In the 20th century, do-it-yourself (DIY) biology emerged as a type of biohacking involving biotechnology. Current high- healthcare costs promote DIY -biology insulin and EpiPens as ways to challenge norms in healthcare, thus serving as forms of activism. Biohacked insulin is part of the #WeAreNotWaiting movement to support improved treatment of Type 1 diabetes, whereas biohacked EpiPens allow people to make lifesaving autoinjectors at low costs. Social media acts as a catalyst and aids in the spread of insulin and EpiPen biohacking as activism. In 1979, Principles of Biomedical Ethics by Beauchamp and Childress proposed four principles that continue to guide decision-making in clinical medicine: beneficence, nonmaleficence, autonomy, and justice. This paper applies these principles to explore whether the benefits of performing DIY biology outweigh the potential health risks. Examining biohacking with a biomedical ethics frame, as outlined by Beauchamp and Childress, reveals that biohacking acts as a response to current issues but cannot serve as a solution in its current form. However, biohacking can grant patients more power in their relationship with the healthcare system, therefore lessening the dominance of formal institutions. Out of the four principles, autonomy applies most differently when regarding biohacking than traditional medicine. Accordingly, a model of ethics for biohacking, such as of Beauchamp and Childress’ with the autonomy altered to acknowledge the additional implications of biohacking, should be developed in the future.

Protecting Autonomy of Rohingya Women in Sexual and Reproductive Health Interventions

Protecting Autonomy of Rohingya Women in Sexual and Reproductive Health Interventions

Common Morality Principles in Biomedical Ethics: Responses to Critics.

After briefly sketching common-morality principlism, as presented in Principles of Biomedical Ethics, this paper responds to two recent sets of challenges to this framework. The first challenge claims that medical ethics is autonomous and unique and thus not a form of, or justified or guided by, a common morality or by any external morality or moral theory. The second challenge denies that there is a common morality and insists that futile efforts to develop common-morality approaches to bioethics limit diversity and prevent needed moral change. This paper argues that these two critiques fundamentally fail because they significantly misunderstand their target and because their proposed alternatives have major deficiencies and encounter insurmountable problems.