Search PubMed⌕ Search

Biomedical subjects

B M Dickens

Publications and source records attributed to B M Dickens.

At least 37 records · Page 2Linked to original sources
PubMed2002

Patient care and the health-impaired practitioner.

The risk of HIV-infected or otherwise impaired practitioners infecting or injuring their patients is very low, but is of proper concern to patients, practitioners and healthcare facilities. Practitioners' general legal and ethical duties to protect patients includes protection against their own liability to present risk of harm. Healthcare facilities have similar duties of care to protect patients, for instance by proper selection and management of personnel, but may also bear indirect or vicarious ('no fault') legal liability for injuries due to the negligence of the personnel they engage. Impaired practitioners should disclose their status to licensing and health facility authorities. They are entitled to non-discriminatory employment opportunities, but may be licensed and approved to practice under conditions that appropriately protect patients. When impaired practitioners practice within such approved conditions, modern courts hold that they have no legal duty to volunteer disclosure of their status to their patients.

Disclosure↗
PubMed2002

Female genital cutting (mutilation/circumcision): ethical and legal dimensions.

The practice better described as female genital cutting (FGC) is of long standing in some communities, and has spread to non-traditional countries by immigration. It is of varying degrees of invasiveness, often including clitoridectomy, but all raise health-related concerns, which can be of considerable physical and/or psychological severity, and compromise gynecological and obstetric care. The practice is not based on a requirement of religious observance, although parents usually seek it for their daughters in good faith. It is directed to the social control of women's sexuality, in association with preservation of virginity and family honor. FGC is becoming increasingly prohibited by law, in countries both of its traditional practice and of immigration. Medical practice prohibits FGC. In compromising women's health and negating their sexuality, FGC is a human rights abuse that physicians have a role in eliminating by education of patients and communities.

Africa↗
PubMed2001

Origins of the desire for euthanasia and assisted suicide in people with HIV-1 or AIDS: a qualitative study.

BACKGROUND: Euthanasia and assisted suicide, and policies to address them are the subjects of contentious debate in many countries. However, the question of why people desire euthanasia or assisted suicide has not been coherently answered. We aimed to answer this question in a specific group of patients. METHODS: We did a qualitative study of 32 people with HIV-1 or AIDS, who were enrolled in the HIV-1 Ontario Observational Database at Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada. We elicited participants' experiences of deliberation about euthanasia or assisted suicide, and the meaning of these experiences with in-depth, face-to-face interviews. We analysed our data with grounded theory methods. FINDINGS: Participants' desire for euthanasia and assisted suicide were affected by two main factors: disintegration, which resulted from symptoms and loss of function; and loss of community, which we defined as progressive diminishment of opportunities to initiate and maintain close personal relationships. These factors resulted in perceived loss of self. Euthanasia and assisted suicide were seen by participants as means of limiting loss of self. INTERPRETATION: These determinants of desire for euthanasia or assisted suicide in people with HIV-1 or AIDS have implications for the debate on these practices, and development of policies to regulate them.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Bioethics for clinicians: 24. Brain death.

Brain death is defined as the complete and irreversible absence of all brain function. It is diagnosed by means of rigorous testing at the bedside. The advent of neurologic or brain death criteria to establish the death of a person was a significant departure from the traditional way of defining death and remains ethically challenging to some. We review the ethical, cultural, religious and legal issues surrounding brain death and outline an approach to establishing a diagnosis of brain death in clinical practice.

Adult↗
PubMed2001

The management of severely malformed newborn infants: the case of conjoined twins.

The birth of 'Siamese' twins in August 2000 whose parents refused to consent to surgery for separation required English courts to decide whether the twins could lawfully be separated despite that refusal when one twin would certainly die as a direct surgical result. The Court of Appeal unanimously upheld the trial judge's decision to authorize surgery, taking account of principles of family law, criminal law and human rights law. Parental duties to the viable twin were found consistent with the justification of allowing, without intending, natural death of the non-viable twin. The right to human dignity of both twins supported the justification of separation surgery. The decision did not elevate physicians' choices over parents', but subjected both to the law. The hospital was found entitled to bring the case to court, but not obliged; it could have declined surgery in conformity with the parents' wishes.

Canada↗
PubMed2001

Assisted reproduction developments in the Islamic world.

A November 2000 workshop organized by the International Islamic Center for Population Studies and Research, Al-Azhar University, Cairo, considered use of assisted reproduction technologies (ART) in the Islamic world. The workshop reinforced a 1997 recommendation that a Standing Committee for Shari'a Medical Ethics be constituted to monitor and assess developments in ART practice. Among issues the workshop addressed were equitable access to services for infertile couples of modest means, and regulation of standards of equipment and personnel that ART centers should satisfy to gain approval to offer services. Acceptable uses of preimplantation genetic diagnosis were proposed, and follicular maturation research in animals, including in vitro maturation and in vitro growth of oocytes, was encouraged, leading to human applications. Embryo implantation following a husband's death, induced postmenopausal pregnancy, uterine transplantation and gene therapy were addressed and human reproductive cloning condemned, but cloning human embryos for stem cell research was considered acceptable.

Animals↗
PubMed2001

The legal status of emergency contraception.

Emergency contraception (EC), an intervention within 72 h of unprotected intercourse, dates back approximately 30 years, to the Yuzpe method. Recent development of a second generation of 'morning after,' better called 'emergency' contraceptives, has raised claims that they are abortifacient. These claims are largely rejected in medical, legal and much religious reasoning. Pregnancy is usually ascribed to the postimplantation period; means to prevent completion of implantation do not terminate pregnancy. An alternative attack on EC has arisen under South American laws that protect human life 'from conception.' The chance of conception from a single act of unprotected intercourse is very low, in view of limited times of fertility during menstrual cycles. The protection of a woman's life is not suspended during pregnancy. Risks to women's interests are more credible than the chance of conception having occurred. The claim to prohibit EC to protect embryonic life from conception is therefore problematic.

Contraceptives, Postcoital↗
PubMed2001

Reproductive health services and the law and ethics of conscientious objection.

Reproductive health services address contraception, sterilization and abortion, and new technologies such as gamete selection and manipulation, in vitro fertilization and surrogate motherhood. Artificial fertility control and medically assisted reproduction are opposed by conservative religions and philosophies, whose adherents may object to participation. Physicians' conscientious objection to non-lifesaving interventions in pregnancy have long been accepted. Nurses' claims are less recognized, allowing nonparticipation in abortions but not refusal of patient preparation and aftercare. Objections of others in health-related activities, such as serving meals to abortion patients and typing abortion referral letters, have been disallowed. Pharmacists may claim refusal rights over fulfilling prescriptions for emergency (post-coital) contraceptives and drugs for medical (i.e. non-surgical) abortion. This paper addresses limits to conscientious objection to participation in reproductive health services, and conditions to which rights of objection may be subject. Individuals have human rights to freedom of religious conscience, but institutions, as artificial legal persons, may not claim this right.

Abortion, Induced↗
PubMed2000

Recognizing adolescents' 'evolving capacities' to exercise choice in reproductive healthcare.

All countries (except Somalia and the USA) have adopted the UN Convention on the Rights of the Child, which usually applies to individuals aged under 18 years. The Convention requires governments to 'respect the responsibilities, rights and duties of parents [or others acting as parents] ellipsis in a manner consistent with the evolving capacities of the child'. Many adolescents gain capacity to make decisions for themselves concerning reproductive and sexual health services, and to decide issues of confidentiality. Immature adolescents must be given usual protections. The Convention sets a legal limit on parental power to deny capable adolescents reproductive and sexual health services. The question whether an adolescent is a 'mature minor' must be decided by health service providers independently of parental judgment. The specific duties of government and health service providers to implement adolescent rights regarding their reproductive and sexual health needs are examined.

Adolescent↗
PubMed2000

Law and ethics in conflict over confidentiality?

Ethical principles that require the preservation of patients' confidential information are reinforced by principles found in several areas of law, such as law on contracts, negligence, defamation and fiduciary duty. However, laws sometimes compel disclosures of medical confidences, and more often may justify or excuse disclosures. Legally contentious issues concern patients' confidences regarding possible unlawful conduct, such as pregnancy termination, and the risk of spread of HIV and other infections. This article reviews the various legal bases of the duty of confidentiality, and legal challenges to the ethical obligation of non-disclosure. It addresses the justifications and limits of exchange of patients' health information among healthcare professionals and trainees, and considers legally recognized limits of confidential duties, and the scope of legitimate disclosure. An underlying theme is how to determine whether physicians are ethically justified in employing the discretion the law sometimes affords them to breach patients' expectations of confidentiality.

Argentina↗
PubMed2000

The scope and limits of conscientious objection.

Principles of religious freedom protect physicians, nurses and others who refuse participation in medical procedures to which they hold conscientious objections. However, they cannot decline participation in procedures to save life or continuing health. Physicians who refuse to perform procedures on religious grounds must refer their patients to non-objecting practitioners. When physicians refuse to accept applicants as patients for procedures to which they object, governmental healthcare administrators must ensure that non-objecting providers are reasonably accessible. Nurses' conscientious objections to participate directly in procedures they find religiously offensive should be accommodated, but nurses cannot object to giving patients indirect aid. Medical and nursing students cannot object to be educated about procedures in which they would not participate, but may object to having to perform them under supervision. Hospitals cannot usually claim an institutional conscientious objection, nor discriminate against potential staff applicants who would not object to participation in particular procedures.

Abortion, Legal↗
PubMed2000

Voluntary and involuntary sterilization: denials and abuses of rights.

Laws that allow competent persons to make free and informed decisions for sterilization serve their entitlements to reproductive choice. Laws that allow others to consent to sterilization of disadvantaged persons who cannot freely consent risk oppression and denial of human rights. Laws that prohibit competent persons' choices for their own sterilization are comparably oppressive and violative of human rights to decide whether and how often to have children. Whether laws approach sterilization as a procedure done for patients, or to patients, is often ambivalent. Details of laws may indicate their liberating and oppressive potential. Programs offering inducements to persons to be sterilized may assist those who are disadvantaged to achieve their goals, but may appear to coerce those who, through poverty or dependency, cannot resist the inducement.

Decision Making↗
PubMed1999

Human rights and abortion laws.

Human rights protections have developed to resist governmental intrusion in private life and choices. Abortion laws have evolved in legal practice to protect not fetuses as such but state interests, particularly in prenatal life. National and international tribunals are increasingly called upon to resolve conflicts between state enforcement of continuation of pregnancy against women's wishes and women's reproductive choices. Legal recognition that human life begins at conception does not resolve conflicts between respect due to women's reproductive self-determination and due to prenatal life. Human rights protect healthcare providers' claims to conscientious objection, but not at the cost of women's lives and enduring health.

Abortion, Induced↗
PubMed1999

Some ethical and legal issues in assisted reproductive technology.

The potential and actual applications of reproductive technologies have been reviewed by many governmental committees, and laws have been enacted in several countries to accommodate, limit and regulate their use. Regulatory systems have nevertheless left some legal and ethical issues unresolved, and have caused other issues to arise. Issues that regulatory systems leave unresolved, or that systems have created, include disposal of embryos that remain after patients' treatments are concluded, and multiple implantation and pregnancy. This may result in risks to maternal, embryonic and neonatal life and health, and the contentious relief that may be achieved by selective reduction of multiple pregnancies. A further concern arises when clinics must (or choose to) publicize their success rates, and they compete for favorable statistics by questionable patient selection criteria and treatment priorities.

Embryo Disposition↗