Principles Of Biomedical Ethics Research Articles

Analisis Etika Biomedis Terhadap Pasien Transgender dalam Mengakses Layanan Kesehatan di Yogyakarta

This research focuses on transgender patients discrimination in Yogyakarta in accessing healthcare services. There are two questions on this research: what is the obstacle faced by the transgender-patients in accessing healthcare services? How is the analysis of biomedical ethics seeing this issue? Theresults on this research are despite the facttheywere notbeing discriminated inthehospital, they did not getthe health insurance by the governmentbecause of the administrative issuewhichcan not accommodatetheir genderchoice. Therefore, this researchseeks to understand the barriers of transgender patients in accessing healthcareservices through the perspective of biomedical ethics ofTom L. Beauchamp and James Childress. The researcher concludes that thegeneral ruleon social benefitsappliedin society isstill limitedonlyto the specificgenders. Itis not in accordance with the two principles in biomedical ethics:the principle of justice states that the transgender who is physically harmedhasright to getsocial benefitsto remedy the effect of thedisadvantagesdue to theirnatural property and to have more equal chance of life;and the principle of autonomy states that an autonomous decision of the transgender people to choose their gender is related to the individual rightsalthough they have different view with others andas long as their action do not leave the disadvantage toothers,it must be respected as a moral obligation.

Implementation of a medical ethics course in undergraduate dental education and assessment of knowledge and attitudes

ABSTRACTObjectives:A medical ethics course was launched in 2012 in a French University Dental School. We compared knowledge and attitudes, before and after implementation of that course. The aim of this study was to compare students who received an ethics course (third year) to those who did not have such training, however, most of them did have some clinical traineeship.Materials and Methods:An anonymous questionnaire was sent to the second-, third-, and sixth-year students. It comprised questions with Likert item format answers and clinical vignettes with open responses. The results were analyzed by two approaches: a statistical analysis (chi-square or Fischer exact tests) and a content analysis using a predefined grid.Results:A total of 299 respondents replied (75% students) the questionnaire. The analysis showed a statistically significant association between knowledge of the law and information procedures (P < 0.0001), access to medical files (P = 0.004), and recording consent (P = 0.049). It was also significant between knowledge of the law and the principles of biomedical ethics (P < 0.0001 for autonomy and beneficence). The third-year students could state the principles of medical ethics with their percentage always greater than the sixth-year students. After the third year, the students’ attitudes switched from a social to a medical emphasis, and their point of view regarding patient’s autonomy evolved. Patient’s refusal of care raised potential conflicts between autonomy, professional judgment, information, and consent.Conclusion:Ethics teaching could offer a way to turn positive attitudes into real competencies and should be considered at an early stage.

The benefit of foresight? An ethical evaluation of predictive testing for psychosis in clinical practice.

Risk prediction for psychosis has advanced to the stage at which it could feasibly become a clinical reality. Neuroimaging biomarkers play a central role in many risk prediction models. Using such models to predict the likelihood of transition to psychosis in individuals known to be at high risk has the potential to meaningfully improve outcomes, principally through facilitating early intervention. However, this compelling benefit must be evaluated in light of the broader ethical ramifications of this prospective development in clinical practice. This paper advances ethical discussion in the field in two ways: firstly, through in-depth consideration of the distinctive implications of the clinical application of predictive tools; and, secondly, by evaluating the manner in which newer predictive models incorporating neuroimaging alter the ethical landscape. We outline the current state of the science of predictive testing for psychosis, with a particular focus on emerging neuroimaging biomarkers. We then proceed to ethical analysis employing the four principles of biomedical ethics as a conceptual framework. We conclude with a call for scientific advancement to proceed in tandem with ethical consideration, informed by empirical study of the views of high risk individuals and their families. This collaborative approach will help ensure that predictive testing progresses in an ethically acceptable manner that minimizes potential adverse effects and maximizes meaningful benefits for those at high risk of psychosis.

Empirical Investigation of Ethical Challenges Related to the Use of Biological Therapies.

The aim of this study was to investigate the ethical dilemma of prioritising financial resources to expensive biological therapies. For this purpose, the four principles of biomedical ethics formulated by ethicists Tom Beauchamp and James Childress were used as a theoretical framework. Based on arguments of justice, Beauchamp and Childress advocate for a health care system organised in line with the Danish system. Notably, our study was carried out in a Danish setting.

MODERN APPROACHES TO THE TREATMENT OF PATIENTS WITH A PRIMARY EPISODE OF BIPOLAR AFFECTIVE DISORDER

A comprehensive system of treatment and rehabilitation measures for the initial episode of bipolar affective disorder is proposed, which is implemented in three interrelated stages: a psychodiagnostic stage, which provides a comprehensive clinical and psychodiagnostic analysis to determine the clinical option; the stage of complex therapy, which involves the combination of psychopharmacology with normotymics, antidepressants, atypical neuroleptics with psychoeducation, compliance therapy, family therapy, work with comorbid mental and narcological pathology; and the stage of psychosocial rehabilitation and prevention, which includes supportive psychopharmacological therapy and psychosocial therapy and rehabilitation activities. We conducted a clinical psychodiagnostic examination of 88 patients with a primary episode of Bipolar Affective Disorder (PE BAD) who were treated at the Ternopil Regional Psychoneurological Hospital during the period 2011-2016 in compliance with the principles of biomedical ethics. The following groups were formed from them: 1) 34 patients with depressed variant of PE BAD, who received treatment according to the proposed scheme; 2) 33 patients with depressive variant of PE BAD who received treatment according to the traditional scheme; 3) 11 patients with a manic variant of PE BAD who received treatment according to the proposed scheme; 4) 10 patients with a manic variant of PE BAD who received treatment according to the traditional scheme. The results were compared in pairs in each of the clinical groups according to the clinical version of PE BAD. The evaluation was performed before the start of treatment and 6 months after the start of treatment in three main areas: dynamics of mental state (complete clinical remission, significant improvement of mental state, improvement of mental state, slight improvement of mental state); dynamics of changes in psycho-emotional state based on the results of evaluation using standardized psychodiagnostic tools (M. Hamilton Depression and Anxiety Scales, The Zung self-Rating Depression Scale, Bipolar Diagnostic Scale); the dynamics of quality of life indicators according to the Scale of Quality of Life Mezzich et al. in the adaptation of N.O. Maruta. The comparative analysis showed a higher effectiveness of the proposed therapy compared to the traditional relative clinical effect, normalization of the affective sphere and improvement of the quality of life of patients.

Incentives for Smoking Cessation During Pregnancy: An Ethical Framework.

IntroductionSmoking during pregnancy increases the risk of morbidity and mortality of the mother and child. The inability of the unborn child to protect itself, raises the social and academic responsibility to protect the child from the harmful effects of smoking. Interventions including rewards (incentives) for lifestyle changes are an upcoming trend and can encourage women to quit smoking. However, these incentives can, as we will argue, also have negative consequences, for example the restriction of personal autonomy and encouragement of smoking to become eligible for participation. To prevent these negative consequences, we developed an ethical framework that enables to assess and address unwanted consequences of incentive-based interventions whereby moral permissibility can be evaluated.Aims and MethodsThe possible adverse consequences of incentives were identified through an extensive literature search. Subsequently, we developed ethical criteria to identify these consequences based on the biomedical ethical principles of Beauchamp and Childress.ResultsOur framework consists of 12 criteria. These criteria concern (1) effectiveness, (2) support of a healthy lifestyle, (3) motivational for the target population, (4) stimulating unhealthy behavior, (5) negative attitudes, (6) personal autonomy, (7) intrinsic motivation, (8) privacy, (9) fairness, (10) allocation of incentives, (11) cost-effectiveness, and (12) health inequity. Based on these criteria, the moral permissibility of potential interventions can be evaluated.ConclusionsIncentives for smoking cessation are a response to the responsibility to protect the unborn child. But these interventions might have possible adverse effects. This ethical framework aims to identify and address ethical pitfalls in order to avoid these adverse effects.ImplicationsAlthough various interventions to promote smoking cessation during pregnancy exist, many women still smoke during pregnancy. Interventions using incentives for smoking cessation during pregnancy are a promising and upcoming trend but can have unwanted consequences. This ethical framework helps to identify and address ethical pitfalls in order to avoid these adverse effects.It can be a practical tool in the development and evaluation of these interventions and in evaluating the moral permissibility of interventions using incentives for smoking cessation during pregnancy.

Empathy as an ethical principle for environmental health

PurposeEnvironmental health ethics is a relatively young field of study, drawing on experience from medical ethics, public health ethics, and the ethics of radiological protection. Fundamental to all of these in one way or another are the four “principles of biomedical ethics”, originally proposed by Beauchamp and Childress (1979) as a guide for decision making in clinical practice. Suggestions have been made of various other principles which should be added to address the specifics of the individual disciplines under consideration. Here we are exploring empathy as a principle complementing those hitherto applied in environmental health practice. Results and conclusionsEmpathy can be defined as the “capability (or disposition) to immerse oneself in and to reflect upon the experiences, perspectives and contexts of others”. It is often understood as a skill that one either has or has not, but research has shown it can be taught and therefore can be required as an attitude of those working in health care, education, design, and even politics. We suggest to consider it a procedural principle on a par with inclusiveness, accountability, and transparency. It should drive the assessment of any environmental situation and the health problems accruing from it.

Ethics for Laboratory Medicine.

Laboratory medicine, like other areas of medicine, is obliged to adhere to high ethical standards. There are particular ethical issues that are unique to laboratory medicine and other areas in which ethical issues uniquely impact laboratory practice. Despite this, there is variability in ethics education within the profession. This review provides a foundation for the study of ethics within laboratory medicine. The Belmont Report identifies 3 core principles in biomedical ethics: respect for persons (including autonomy), beneficence (and its corollary nonmalfeasance), and justice. These core principles must be adhered to in laboratory medicine. Informed consent is vital to maintain patient autonomy. However, balancing patient autonomy with the desire for beneficence can sometimes be difficult when patients refuse testing or treatment. The use of leftover or banked samples is fundamental to the ability to do research, create reference intervals, and develop new tests, but it creates problems with consent. Advances in genetic testing have created unique ethical issues regarding privacy, incidental findings, and informed consent. As in other professions, the emergence of highly contagious and deadly infectious diseases poses a difficult ethical dilemma of helping patients while protecting healthcare workers. Although many clinical laboratorians do not see or treat patients, they must be held accountable to the highest ethical and professional behavior. Recognition and understanding of ethical issues are essential to ethical practice of laboratory medicine.

Consent for Conducting Evaluations to Determine Death by Neurologic Criteria: a Legally Permissible and Ethically Required Approach to Addressing Current Controversies

Ethical and legal questions persist in the bioethics and clinical communities surrounding the determination of death by neurologic criteria (DNC). Among challenges to the determination of DNC are questions about the physician’s role in the process. Once the exam is performed, if the patient meets criteria, the patient-physician relationship terminates. Whether informed consent is required to perform the exam, however, is a subject of ongoing controversy. Recent court cases also consider whether informed consent should occur prior to the determination of DNC. Those who argue against consent suggest that physicians have an obligation to determine death and the examination for DNC is required to make this determination. Those who support obtaining informed consent prior to the examination argue that informed consent is required prior to any examination, treatment, or test, following principles of biomedical ethics. This paper reflects on the existing debate about whether consent is necessary, ultimately concluding that is legally permissible and ethically required.

'You wouldn't do that to an animal, would you?' Ethical issues in managing pain in patients with substance dependence.

In this article, we present a secondary analysis of a descriptive phenomenological study that we conducted in the United Kingdom exploring nurses' experiences of working with patients with substance dependence and pain. Our aim was to focus upon the ethical issues that emerged in the empirical data and so we used the Four Principles of Biomedical Ethics plus attention to scope to guide and inform our analysis. We present six key themes: trust, paternalism, coercion, failure to respect autonomy, advocacy and withholding. We discuss how these themes intersect with the four principles plus scope to illuminate practice and the ethical issues that emerge when managing this patient population's pain. We recommend that clinicians adopt a collaborative approach to managing pain for patients with substance dependence that they remain aware of the power differentials inherent within the clinical setting and ensure that communication and teamwork remain at the forefront of decisions. Clinicians need access to ethical guidance to inform their practice decisions and clinical ethics support services could provide one solution.

Application of the integrated approach to the ethics of radiological protection

The main objective of this study is to continue an open dialogue between representatives of the nuclear industry and the interested public concerned about the ethics of decision-making in nuclear energy. The authors consider these problems from the perspective of integral philosophy differentiating levels of consciousness. The study consists of two parts. The first one described in this paperis aimed to analyse ethical platforms of radiological protection and the principles of biomedical ethics using the level approach. The summary table of ethical correlates of radiation safety and principles of bioethics is presented.

Semantic algorithms of bioethics

In the article the authors study moral and legal algorithms of bioethics as universal methods of solution of topical problems in the health care system which reflect a wish of citizens to live and act healthily. Specificity of bioethical ideology in the modern health care system consists in the demand to follow the algorithms of preserving life in general, protection of a man and protection of his health from different negative circumstances and deliberate or occasional technological influence. In order to bring to light the ideals and principles of biomedical ethics the authors pay special attention to natural (biological) origin of a man. It is stated that co-evolutional imperative of bioethics is to push scientists-medicals and clinicians to overcoming of social, economic and political conflicts. The article is presented in English that is topical in the context of growing popularity of the Russian higher education among foreign students, as well as the lack of educational literature in foreign languages. The material of the article can be used in designing work programs, lecture and practical courses of «Bioethics».

Natural Products in Neurodegenerative Diseases: A Great Promise but an Ethical Challenge.

Neurodegenerative diseases (NDs) represent one of the most important public health problems and concerns, as they are a growing cause of mortality and morbidity worldwide, particularly in the elderly. Despite remarkable breakthroughs in our understanding of NDs, there has been little success in developing effective therapies. The use of natural products may offer great potential opportunities in the prevention and therapy of NDs; however, many clinical concerns have arisen regarding their use, mainly focusing on the lack of scientific support or evidence for their efficacy and patient safety. These clinical uncertainties raise critical questions from a bioethical and legal point of view, as considerations relating to patient decisional autonomy, patient safety, and beneficial or non-beneficial care may need to be addressed. This paper does not intend to advocate for or against the use of natural products, but to analyze the ethical framework of their use, with particular attention paid to the principles of biomedical ethics. In conclusion, the notable message that emerges is that natural products may represent a great promise for the treatment of many NDs, even if many unknown issues regarding the efficacy and safety of many natural products still remain.

The Theory of Common Morality of Bernard Gert

Tom L. Beauchamp and James F. Childress have been increasingly using a moral theory known as “Theory of Common Morality” as a philosophical basis for their four principle approach to biomedical ethics, currently known as principlism. In the latest edition (2013) of their Principles of Biomedical Ethics, they acknowledge the contribution of some previous theorists of common morality. Bernard Gert, a critic of principlism, is one of them. The aim of this paper is to provide a critical analysis of Gert’s Theory of Common Morality, as developed in his book Common Morality. Deciding What to Do (2004). According to Gert, common morality is a moral system that everyone uses implicitly when making decisions and judgments. This system consists, basically, of moral rules, moral ideals and a two-step procedure used intuitively by every person to decide whether a given violation of a rule or ideal is legitimate. There are ten moral rules, which can be collapsed into two basic ones, Do not cause harm (Do not kill; Do not cause pain; Do not disable; Do not deprive of freedom; Do not deprive of pleasure), and Do not violate the trust (Do not deceive; Keep your promises; Do not cheat; Obey the law; Do your duty). Moral rules apply to moral agents, which are constituted by all humans able to fully understand the moral rules, as well as predict the consequences of their eventual violation. It is our understanding that, despite the highly intuitive appeal of Gert’s approach, as well as of Beauchamp and Childress’s, the Theory of Common Morality has some fundamental flaws which are discussed in the article.

Striving to Do No Harm and Yet Respect Patient Autonomy: Plastic Surgeons' Perspectives of the Consultation for Breast Reconstruction with Women Who Have Early-Stage Breast Cancer.

Rates of contralateral prophylactic mastectomy (CPM) have doubled over the last decade among women considered low risk for developing contralateral breast cancer. Despite the strong association between CPM and breast reconstruction, little is known about the clinical encounter between patients and plastic surgeons. A qualitative study was performed to understand how plastic surgeons describe their roles in the treatment decision-making process through their consultations with women who have unilateral early-stage breast cancer. Semi-structured interviews with Ontario plastic surgeons were conducted. An inductive and interpretive thematic approach was initially used to analyze the data. The four principles of biomedical ethics then served as the conceptual lens to interpret the findings. The participants in this study were 18 plastic surgeons, and data saturation was reached. Four themes were identified: maintaining non-maleficence, supporting patient autonomy, delivering (un)equal health care, and providing care to enhance well-being. The ongoing push-pull between competing ethical principles was the overarching theme, specifically, striving to balance parallel responsibilities to do no harm while also respecting patients' rights to make their own healthcare decisions. In this patient-centric climate, it is important to acknowledge that patients may value outcomes such as achieving greater peace of mind above other clinical factors and are willing to incur additional risks to achieve these goals. Shared decision-making will help to reveal the rationale underlying each individual's treatment choice, which in turn will allow physicians to appropriately weigh patient requests with the best available medical evidence when counseling women on decision-making for breast cancer care.

The dialectic approach to biomedical ethics as a foundation of its implementation in actual social cultural conditions

The most consecutive statement of biomedical ethics principles within educational process and the correct analysis of its problems in the context of rapid development and expansion of a scope of medical technologies are possible only on the basis of synthesis of philosophical, culturological, historical and theological knowledge. Otherwise, biomedical ethics could be substituted for deontology which utilitarian value is indisputable, but which has no sufficient universality in relation to various historical periods and sociocultural conditions. It becomes especially obvious during a globalization era when the states with various experience of cultural-historical development and level of economic potential are forced to create large regional associations for the benefit of the sustainable development. However the synthetic concept can exist only based on serious humanitarian preparation which it isn't necessary to for medical community even of developed countries within the existing educational standards. Dialectic approach, being «cleared» of the known ideological excesses, could become the compact, available and at the same time universal tool for forming of complete view of students on biomedical ethics, the analysis of its problems and implementation of its principles in dynamically changing conditions of modern society. Russian Federation naturally applying for a leader role of various regional political structures, in particular - in extremely diverse and therefore very difficult Asia-Pacific region, could offer foreign colleagues the general agenda in the field of biomedical ethics based on dialectic approach. Fields of Eastern Economic Forum which is annually held on the base of Far Eastern Federal University in Vladivostok could become the platform for the presentation of this agenda.

Rehabilitation Ethics Codes in English-Speaking Countries: A Narrative Review

Introduction: Rehabilitation of people with disability has ethical dimensions. Therefore, the aim of this study was to review the codes of ethics for rehabilitation in English-speaking countries through a narrative review. Materials and Methods: In this study, the ethical codes in Australia, Canada, the Unite States, and the United Kingdom were searched electronically through the google search engine, because the language was understandable for researchers. Accordingly, the codes of ethics for rehabilitation (including Orthotics and Prosthetics, occupational therapy, and physiotherapy) were extracted and studied by two researchers independently. Results: A set of professional responsibilities for the rehabilitation services were categorized according to four principles of biomedical ethics and presented as ethical codes for rehabilitation services. Conclusion: As the first step in developing a reliable framework for professional ethics, professional ethics codes for rehabilitation in Australia, Canada, the United States, and the United Kingdom were reviewed through a narrative review, in order to provide the basis for professional ethics in rehabilitation services based on Iranian Islamic teachings.

Prioritizing Benefits: A Content Analysis of the Ethics in Dementia Technology Policies.

As the global prevalence of dementia rises, care costs impose a large burden on healthcare systems. Technology solutions in dementia care have the potential to ease this burden. While policies exist to guide and govern the use of dementia care technologies, little is known about how ethical considerations are incorporated into these documents. The goal of this study was to examine ethics-related content in dementia care technology policies. We used a two-step data mining approach to collect a sample of dementia technology policies. Policy documents were analyzed using emergent content analysis. Following the coding of the sample, thematic categories were organized using the principles of biomedical ethics as a framework. A total of 23 policy documents from four Alzheimer associations in four countries were included in our analysis. General ethics considerations and themes related to beneficence were mentioned in 96% of the documents. Thematic categories related to justice were present in 74% of the sample, themes related to non-maleficence appeared in 52% of documents, and themes related to autonomy appeared in 43% of the sample. While ethical considerations are present in existing policies for dementia care technology, these considerations revolve primarily around the benefit of the technologies. Further efforts are needed to provide formal guidance that incorporates both benefits and potential harms.

Transformation of the Doctor-Patient Relationship: Big Data, Accountable Care, and Predictive Health Analytics.

The medical profession is steeped in traditions that guide its practice. These traditions were developed to preserve the well-being of patients. Transformations in science, technology, and society, while maintaining a self-governance structure that drives the goal of care provision, have remained hallmarks of the profession. The purpose of this paper is to examine ethical challenges in health care as it relates to Big Data, Accountable Care Organizations, and Health Care Predictive Analytics using the principles of biomedical ethics laid out by Beauchamp and Childress (autonomy, beneficence, non-maleficence, and justice). Among these are the use of Electronic Health Records within stipulations of the Health Insurance Portability and Accountability Act. Clinicians are well-positioned to impact health policy development to address ethical issues associated with the use of Big Data, Accountable Care, and Health Care Predictive Analytics as we work to transform the doctor-patient relationship towards improving population health outcomes and creating a healthier society.

Formulating the Code of Professional Responsibilities in Providing Rehabilitation Services based on a Narrative Review Study

Introduction: Rehabilitation is one of the most important components of health, and includes a set of services to empower people with disability. The first step in providing a secure framework for professional ethics, is identifying the needs and rights of persons with disabilities based on the evidence and scientific documentation, and also the use of experiences from developed countries. Therefore, the aim of this study was to examine the available evidence of professional ethics through a narrative systematic review study designed to provide the basis for professional ethics in Iranian rehabilitation services. Materials and Methods: This was a narrative systematic evidence-based review study. All Persian and English articles published in the past 10 years with the main focus of ethical issues related to the provision of rehabilitation services in physiotherapy, occupational therapy, and orthotics and prosthetics were considered. A structured search of the peer-reviewed literature catalogued in major electronic databases (Scopus, PubMed, and Web of Science) was conducted using the following words and their derivatives (Rehabilitation, Human right, Patient right, Professionalism, Justice, Autonomy, Responsibility, Ethics, Bioethics) Results: The initial search by two reviewers yielded 1260 papers. Following review of title and abstract, 98 articles were considered relevant. 67 articles had full text. Full text review reduced this number to 24. To categorize the articles, four principles of biomedical ethics in principlism method. Conclusion: A set of professional responsibilities for the rehabilitation services were categorized in four principles of respect for autonomy, beneficence, non-maleficence, and justice, and also 10 titles outlined in the charter of physicians.