Problems In Medical Ethics Research Articles

СОВРЕМЕННЫЕ ПРОБЛЕМЫ МЕДИЦИНСКОЙ ЭТИКИ И ДЕОНТОЛОГИИ

Due to the rapid development of medicine in various industries, new ethical and deontological problems arise that need to be discussed. Reproductive technologies, genome editing, telemedicine and many other areas are still the subject of public controversy. Medical workers should be able to competently carry out their activities in accordance with ethical and deontological norms. The article discusses the key problems of modern medical ethics and deontology based on the analysis of scientific publications.

Chapitre 1. Considérations bioéthiques sur le corps multiple : Point de vue des philosophes européens et russes

The article attempts to critically apprehend the profound problems of medical ethics, posed by the Dutch philosopher Annemarie Mol in her book “The Body Multiple: Ontology in Medical Practice” [4]. The logical and mathematical concept of transitivity and intransitivity, chosen by the philosopher, makes us approach the traditional problems of bioethics from a new angle: through the models of physician-patient relationship, the status of a person vs. human being, organ transplantation, as well as the conflict between the individual and the collective in epidemic conditions. The key points on which the philosopher relies are the concepts of intransitivity of the patient and his organs, the status of the human body, the relationship between the whole body and its parts, as well as the concept of inclusion as a relationship of integration of a multiple body. Trying to analyze these concepts, the author of the article refers to the works of Russian and French philosophers, and also addresses modern problems of bioethics through the prism of the questions posed by A. Mol from an unusual angle.

A modern approach to developing care for a premature baby

Around the world every year, about 15 million children are born prematurely. On average, 1 in 10 babies are born prematurely. In Russia, more than 110,000 children are born prematurely every year, which is about 5.7 % of all newborns per year [1]. The most important role in nursing, treatment and provision of high-tech medical care, solving moral and ethical problems is assigned to the neonatologist and nurses at all stages of nursing premature babies. The neonatology service currently uses developmental care for premature babies

Биологическое и социальное — два ракурса идентичности человека в контексте медицинской этики

At present, the most important problems of medical ethics related to the issues of fair access to medicine and health care as the main human benefits are of particular importance. In this regard, the study of biological and social foundations seems to be especially relevant, allowing us to consider a person not only as a user of medical services, but also as a sense-m aking center, influenced by the value-driven norms and societal ideas. The aim of the study is to consider the following two aspects of conceptualizing a person in medical ethics: his/her biological and social status. Dialectical method, system analysis, cultural and phenomenological approaches constitute the article’s methodological basis. Based on the discussion undertaken in modern scientific literature, these allow us to come to an understanding of a person in the system of medical ethics. It is noted that consideration of a person in the context of issues of medical ethics goes, first of all, in two main directions: first, the role of a person is revitalized in the process of choosing treatment methods and understanding the degree of risk associated with the treatment and prevention of his person as a biological being; the second is the immersion of a person, engaged in decision-m aking, into the system of values and traditions of society. It is shown that the second aspect is connected with the understanding of a citizen as a social being. Comprehension of a person should be undertaken through the study of his moral, spiritual, emotional, physical and biological foundations of being; at the same time, biological and social approaches should not act separately, but in unity, and lead to a holistic concept of man.

Ethical Problems about Epidemic Prevention and Control for Covid-19 Pandemic Situation

The COVID-19 outbreak in Wuhan in December 2019 is a public health emergency, which is characterized by unexpected, complex, clustering and staged characteristics. COVID-19 has had a significant impact on China’s economic and social development, caused a huge burden on people’s lives and health, and triggered a series of social and medical ethical problems. The main ethical problems include the restriction of personal freedom, social discrimination, clinical ethics, drug research ethics and so on. The government and society should pay attention to the ethical problems about epidemic prevention and control for COVID-19 pandemic situation. They should understand the causes and processes of these contradictions, and take scientific and effective measures to reduce the overall burden of prevention and control for COVID-19.

Medical pedagogy and its role in the professional activity of a doctor

This article is devoted to medical pedagogy. The methodological basis of the research was formed by the following approaches: anthropological, axiological, competence-based, synergetic, personal, activity-based, humanistic, and subjective. Scientists today began to seriously think about the problems of medical ethics. A long-known fact was realized in a new way: a doctor has to take on a huge responsibility every day, determining what is Good and what is Evil for his patient, in each case, identifying the boundaries of possible medical intervention. Corresponding, essentially philosophical, questions should be included in the course of medical pedagogy.

Great Expectations: Induced pluripotent stem cell technologies in neurodevelopmental impairments

Somatic cells such as skin fibroblasts, umbilical cord blood, peripheral blood, urinary epithelial cells, etc., are transformed into induced pluripotent stem cells (iPSCs) by reprogramming technology, a milestone in the stem-cell research field. IPSCs are similar to embryonic stem cells (ESCs), exhibiting the potential to differentiate into various somatic cells. Still, the former avoid problems of immune rejection and medical ethics in the study of ESCs and clinical trials.Neurodevelopmental disorders are chronic developmental brain dysfunctions that affect cognition, exercise, social adaptability, behavior, etc. Due to various inherited or acquired causes, they seriously affect the physical and psychological health of infants and children. These include generalized stunting / mental disability (GDD/ID), Epilepsy, autism spectrum disease (ASD), and attention deficit hyperactivity disorder (ADHD). Most neurodevelopmental disorders are challenging to cure. Establishing a neurodevelopmental disorder system model is essential for researching and treating neurodevelopmental disorders. At this stage, the scarcity of samples is a bigger problem for studying neurological diseases based on the donor, ethics, etc.Some iPSCs are reprogrammed from somatic cells that carry disease-causing mutations. They differentiate into nerve cells by induction, which has the original characteristics of diseases. Disease-specific iPSCs are used to study the mechanism and pathogenesis of neurodevelopmental disorders. The process provided samples and the impetus for developing drugs and developing treatment plans for neurodevelopmental disorders. Here, this article mainly introduced the development of iPSCs, the currently established iPSCs disease models, and artificial organoids related to neurodevelopmental impairments. This technology will promote our understanding of neurodevelopmental impairments and bring great expectations to children with neurological disorders.

Medical ethical problems of organ donation after circulatory death

Medical ethical problems of organ donation after circulatory death

Clinical and pathomorphological parameters of brain death: from the origins of the concept to its use in organ transplantation

The criteria for brain death (BD), the parameters of their clinical and pathomorphological determination and use in organ harvesting for transplantation are being clarified in different countries to date.Objective: analysis of the formation and clinical and pathological characteristics of brain death.The review provides retrospective analysis of the formation and improvement of the medical concept of BD: the concepts of “death of the whole brain” (including the brain stem) and “death of the brain stem”. Based on our own data, the main pathomorphological forms of BD are described (total necrosis of the brain, subtotal necrosis of the brain stem and cerebellum), their development mechanisms, and diagnostic pathological parameters. It has been established that the main criterion for the development of human biological death, which determines irreversible cardiac arrest and the impossibility of restoring spontaneous respiration, are irreversible destructive changes in the nuclei of the pons and medulla oblongata, which make up the cardio-respiratory center that regulates heart rate, vascular tone and blood pressure, and generating rhythm and breathing patterns. The modern standards of clinical diagnosis of BD and their real application in different countries during organ transplantation, as well as the prerequisites for the revival of the concept of "circulatory death" in the era of organ transplantation are highlighted.Conclusions. The applied three standards of human death have insufficiently studied medical aspects and unresolved ethical problems.

Das provokative Essay: Justifizierung ethisch-moralischer Maßstäbe der Gesellschaft im bio- und medizinethischen Kontext? Zur Frage des normativen Einflusses juristischer Grundsatzurteile im Rahmen der ethischen Bewertung weitreichender medizin- und bioethischer Problemstellungen

Bio- and life sciences raise ethical-moral problems due to technological advances and far-reaching decisions at the beginning and the end of life. For example, ethical considerations are important not only with regard to pre-natal genetics, stem-cell research and gene therapy, but also in the fields of neonatology, when problems occur after birth, and when discussing medically assisted suicide at the end of life. Against the background of social developments, in particular in the context of postmodernism, and the high level of complexity of bioethical and medical ethical problems, it seems that social conventions and ethical-moral standards diffuses more and more. In consideration of observed eroding social and ethical agreements and only sporadic political debates, the thesis is discussed that finally in the question and decision of far-reaching medical and bioethical problems, some basic legal decisions often take a key role. Fundamental aspects of Niklas Luhmann’s Theory of Autopoietic Legal Systems, Philosophy of Law and Sociology of Law are involved in the discussion.

The problems of medical ethics and deontology in the XXI century

The problems of medical ethics and deontology in the XXI century

Foundations for Molecular and Enzymatic Functional Surgery

This paper presents an approach of molecular and enzymatic surgery for treatment of human diseases, including opportunity for use of systemic biology methods in planning of surgical interventions, possible biological components of a “molecular scalpel”, and problems of standardization, medical ethics and clinical trials of the new pharma-surgical toolbox. In conclusions is proposed to consider of molecular and enzymatic surgery methods as realization of the principles of “functional surgery” and also further development of fast track surgery with attaining the modern concept of a personalized approach to surgical treatment of the patient.

Actual aspects of medical ethics in training of the pediatrician

Nowadays the problems of medical ethics are gaining the special significance as a result of changes in social and economic relations, healthcare modernization due to appearance of new effective methods for instrumental and laboratory examinations, treatment approaches, development of market relations in medicine. The aim of the presented paper is to cover the actual aspects of medical ethics in pediatrics. The paper reviews the ethical aspects of the work of a in detail. Differentiated approach in choosing pediatrician interns, which is based not only on academic progress, but also on professional and moral qualities of the medical university alumni and continuity in their upbringing starting form the first years of the medical school until the end of post-graduate education, seems rationale. It is during the student years when the cognitive and moral values of a forthcoming specialist are formed, which may be a criterion of a suitability of working with children. The roles of the competition, including the modular approach to knowledge evaluation, professional competencies and rating system are stressed. Considering the modern requirements to a young professional, the accent is made on the role of the leading tutor in a forthcoming specialist formation. The requirements to a higher education teacher and the importance of the moral atmosphere in hospitals and faculties for forming the ethical features of a forthcoming pediatrician and improving his/her professional level according to the medical progress are outlined. Thus, teaching pediatrics has a lot of particularities, including teaching the basics of medical ethics, having an extremely important role in professional education of pediatricians for proper forming of the young professional according to contemporary life requirements.

Women’s attitude in Poland and Belarus toward the issue of induced abortion

Introduction. In most countries, abortion is allowed to save woman’s physical and mental health. In Poland, women have no right to abortion on demand; the procedure is illegal and punishable by imprisonment up to 3 years. In the neighbouring country of Belarus, induced abortion on demand is legal through the 12th week of pregnancy, while for social reasons and on demand, through the 22nd week of pregnancy, in governmental hospitals only. Abortion deserves the name of one of the most serious contemporary ethical dilemmas and constitutes one of the most difficult problems in medical ethics. Performing abortion continues to be opposed by many individuals and communities. Aim. The study of the attitude of women in Poland toward the problem of induced abortion and the comparison of their attitude with that of women in Belarus. Material and methods. The method used to conduct this study was a diagnostic survey using a questionnaire designed for the purpose of this work. The study was conducted among women in Poland and Belarus. The group surveyed was comprised primarily of young women of reproductive age, with the desire to conceive, have families or plan to have families. Two hundred surveys, properly filled out, 100 from Poland and 100 from Belarus, qualified for the analysis. Results. The comparative analysis of the responses of the women surveyed in Poland and Belarus demonstrated that in both countries attitudes toward the problem of induced abortion and women’s opinions on the use of induced abortion are still divided. Conclusions. Women of Belarus are more supportive of abortion and they consider it less shocking and more common than women from Poland.

Complex Medical Ethical Problems

Jana Wandrowski et al. published an informative article on physicians’ knowledge and awareness of medical ethics. On the basis of our experience in patient care as well as continuing medical education in medical ethics, we think that some additional comments are warranted. Better ethics in clinical practice requires more training in medical ethics. Even though one might intuitively agree that this hypothesis expressed by the authors is correct, the presented empirical data are too weak to support such a far-reaching statement. Others have rightly pointed out that the method used by the authors, of questions with predefined responses on a scale, does not do justice to the complexity of medical ethical problems (1). The superficial case description given in the questionnaire can test merely knowledge of the terminology of medical ethics, but does not promote deeper understanding of ethical positions. In contrast to the authors’ assertions, non-insertion of a percutaneous endoscopic gastrostomy (PEG) tube does not automatically equate to passive assistance in dying since patients can also be fed intravenously. The term “passive assistance in dying” is actually outdated. The article lacks a clear definition for the term “medical ethical knowledge”. The authors’ tacit understanding is led by the topic and focuses exclusively on autonomy. The subject of medical ethics entails more than just autonomy. Physicians’ ethical positions partly change as their professional experience grows. This finding is made clear in the study. Since we recognized this fact at an earlier stage, we initiated a special seminar course that is available to physicians (2). We agree with the authors in that an increased need for training exists at all levels of medical education in questions and problems in the area of medical ethics and law. The subject matter should be taught with the target audience in mind so that they can be applied in clinical practice.

Book Review

Charles Foster's book is an indication of a growing interest amongst English lawyers in the concept of human dignity. To be sure, philosophers have long been debating this concept and, in some countries (Germany being the obvious example), lawyers have developed a considerable jurisprudence of human dignity. But, why should medical lawyers and bioethicists take an interest in this elusive notion? For Foster, the answer is clear: ‘dignity is the key that … unlocks all problems in medical ethics and bioethics’ (p. 1). Quite simply, human dignity ‘is the bioethical Theory of Everything’ (p. 1). No doubt, readers who view human dignity as a source of confusion and obfuscation, not to mention a cover for conservative credos, will regard Foster's claim as risible; even for readers who think that human dignity might have some contribution to make, the claim will seem extravagant. However, before we take the measure of this highly provocative claim, we should set it in the context of a book-length discussion that is both useful and succinct.

The problem of ‘thick in status, thin in content’ in Beauchamp and Childress' principlism

For many, Thomas Beauchamp and James Childress have elaborated moral reasoning by using the four principles whereby all substantive problems of medical ethics (and of ethics more generally) can be...

의료윤리학의 학문적 위상과 학제적 연구의 범위에 대한 일고*

Medical ethics, which is expanding in scope, now includes public health ethics, bioethics, and biomedical or health care ethics. Though it started as a form of professional ethics, medical ethics is one of the most important fields of practical ethics, a branch of philosophy. According to Rawls, much of moral theory is independent from the other parts of philosophy. That is, the study of moral concepts and their relation to our moral sensibility has its own distinctive problems and subject matter, requiring unique forms of study. But what is the relation between ethics and medical ethics? In this article we argue that moral theory and medical ethics are necessarily interconnected and that they support each other. Professional duties are influenced by health care systems and policies, and public health ethics is influenced by ethical and political theory. Therefore, we argue that problems in medical ethics should be addressed from a meta-viewpoint that takes other disciplines into consideration.

Natality. A theological approach to an anthropological basic concept in the context of bioethics

In the controversy about the introduction of new biotechnological and medical technologies, their judicial regulation and political control, not only so-called moral values are discussed but ultimately also religious credos. By the example of natality it will be shown what theology can contribute to the clarification of basic categories of anthropology, which are crucial for medical ethics. The term “natality” (“Geburtlichkeit”) derives from the philosopher Hannah Arendt. In terms of the human finiteness, attention is usually turned to the mortality of the human being. Yet what does it mean for human existence that we are born? What role does this factor play with regard to concrete problems in medical ethics, and which perspectives can theology contribute in terms of their solution?

Euthanasie bij dementie: een reële optie?

Nursing home physicians are bound to be confronted more often with patients that have an advance directive concerning a request for euthanasia in the case of dementia. Despite the fact that in the Netherlands euthanasia in dementia, under certain conditions, is justified when a written request is present, these requests are rarely carried out.This article provides insight into the medical ethical problems that physicians may encounter when treating a patient with dementia in the posession of a written request for euthanasia. Dilemma's with respect to the patient's (in)competence, personal identity and unbearable suffering, are adressed successively. It appears that insight into the way that physicians in daily practice deal with these dilemma's is limited. More research into the issues around advance directives in dementia is recommended.