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PubMed2005

Many worlds, one ethic: design and development of a global research ethics training curriculum.

The demand for basic research ethics training has grown considerably in the past few years. Research and education organizations face the challenge of providing this training with limited resources and training tools available. To meet this need, Family Health International (FHI), a U.S.-based international research organization, recently developed a Research Ethics Training Curriculum (RETC). It was designed as a practical, user-friendly tool that provides basic, up-to-date, standardized training on the ethics of human research. The curriculum can easily be adapted to different audiences and training requirements. The RETC was reviewed by a group of international experts and field tested in five countries. It is available in English, French, and Spanish as a three-ring binder and CD-ROM, as well as on the Web. It may be used as either an interactive self-study program or for group training.

Clinical Trials as Topic↗
PubMed2006

Ethics and pharmaceutical medicine -- the full report of the Ethical Issues Committee of the Faculty of Pharmaceutical Medicine of the Royal Colleges of Physicians of the UK.

The practice of pharmaceutical medicine brings with it ethical challenges and dilemmas often very different from those encountered in the practice of clinical medicine. Having established a framework of guiding ethical principles, this report aims to look in some detail at specific areas of possible ethical concern to pharmaceutical physicians, offering practical advice and guidance on good practice. The report covers issues related to pharmaceutical research, including dissemination of research findings, communication with other health professionals and patients and involvement of pharmaceutical physicians and companies in the provision of patient services. The primacy of the interests of patients and the wider public is emphasised, and the possible impact of new developments in pharmaceutical technology is explored. It is hoped that the report will help those working in pharmaceutical medicine and act as a stimulus for wider discussion and debate.

Biomedical Research↗
PubMed1988

Technical expertise as an ethical form: towards an ethics of distance.

The present article proceeds from the observation that the therapeutic relationship is basically unequal. This inequality essentially concerns the respective situation of the patient and his or her doctor vis-à-vis medical knowledge. A strict professionalism guarantees that this inequality remains factual and without essential value. Yet, if both partners unreflectively allow affectivity excessively to intrude into their relationship, their behaviour may then be inspired by subconscious, rather than rational, motives. In that case, the unverifiable allegations of philanthropy or paternalism may be used to rationalise a kind of 'medical sadism' which attempts to justify the will to humiliate the patient by means of the constraints inherent in medical care. The concept of ethical form is introduced as a non-verbal criterion of ethical reliability. It is mainly a way of training the will through the application of rationally justified rules of behaviour. In this context, it is suggested that an effort to remain constantly within the limits of professionalism represents a method of training for the achievement of some degree of ethical credibility in the therapeutic relationship. In the long term, such abstinence could constitute a sort of catharsis, and thereby help to reveal the non-rational motives in medical behaviour. Contrary to the belief prevailing in modern society, the established limits of medical knowledge are not so broad. The application of these limits would probably be the best method of preventing emotions from interfering undesirably in the therapeutic relationship.

Dehumanization↗
PubMed1994

Ethics in dental research. Publication of research: the ethical dimension.

If science is to achieve its goal, i.e., advancement of human well-being, the results of scientific research must be made available. When such results are presented, that presentation must be 'ethical'; it must conform to recognized standards of honesty, originality, and fairness. Unfortunately, not all such presentations conform to these standards; the public and scientific community alike are becoming ever more concerned about duplication in publication, about illegitimate claims to authorship, and about misleading use of statistics in presentation of experimental results. Certain of these 'unethical' practices can be eliminated or minimized by education, institutional practice, and requirements set by scientific journals. In the end, however, 'ethical publication' will depend on the 'ethical investigator'--an individual who has professed dedication to truth and the well-being of mankind.

Authorship↗
PubMed2000

Comprehensive STD/HIV prevention education targeting US adolescents: review of an ethical dilemma and proposed ethical framework.

Adolescents are increasingly at risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection. The prolonged latency period, sometimes in excess of five years, and the incubation period of up to 10 years before the manifestation of symptoms, may foster adolescents' false sense of invincibility and denial as they often do not see the devastating effects of the disease in their peers until they are older. In turn, their practice of safer sex may be hindered and thereby contribute to the escalation of this public health crisis among sexually active adolescents. Prevention-focused recommendations were made in the USA as a result of this crisis. Recommendations were made to: (1) include STD/HIV education in the curricula of grades kindergarten to 12; (2) increase to at least 75% the proportion of primary care and mental health professionals who provide age-appropriate STD/HIV prevention counselling to adolescents; and (3) expand HIV prevention services to include age-appropriate HIV education curricula for students in grades 4-12 in 95% of schools. Yet, in the USA, the provision of school-based comprehensive STD/HIV education has been difficult to achieve owing to certain limitations and, in some instances, legal action. These limitations include: limited student access; restricted content; and the implementation of sporadic and/or brief educational programmes. Given these recommendations and the fact that adolescents are acquiring STDs and HIV infections at increasing rates, and despite the limitations and legal actions, do health care professionals not have an ethical obligation to provide adolescents with comprehensive STD/HIV prevention education? This ethical dilemma will be discussed using the ethical decision-making principles of 'autonomy' and 'beneficence', and a decision-making model proposed by Thompson and Thompson, and by Chally and Loric.

Adolescent↗
PubMed1991

Ethical issues in health care institutions. Lesson three: Hospital ethics committees.

The hospital ethics committee serves as the topic for this third lesson of a five-part WMU/AHRA magazine course on ethics. Proliferating during the last ten years and fostered by the Karen Ann Quinlan case, hospital ethics committees today function in three areas: education, development of guidelines and policies, and individual case consultation. Using specific examples in the discussion of each function, the authors give a detailed picture of the valuable contribution these committees make to the institutions they serve.

Aged↗
PubMed1984

Are codes of professional ethics ethical?

This essay reviews and situates codes of professional ethics within the general field of ethics and considers the specific characteristics of such codes. In the process, the author argues against the view that one's professional role and code take precedence over other roles or codes. One's personal value system, once clarified and criticized, provides the appropriate basis from which to continuously assess our codes of professional ethics.

Ethics, Professional↗
PubMed1999

Nonselective embryo reduction: ethical guidance for the obstetrician-gynecologist. Number 215, April 1999 (replaces number 94, April 1991). Committee on Ethics.

Although physicians may choose not to participate in nonselective embryo reduction, they should be knowledgeable about this procedure and be prepared to react in a professional and ethical manner to patient requests for information or services or both. The first approach to the problem of multiple gestation should be prevention. Although embryo reduction will be ethically acceptable to many as a response to an unforeseen and unavoidable contingency, in almost all cases it is preferable to terminate a cycle or limit the number of embryos to be transferred in order to prevent a situation in which the patient and physician need to consider an embryo reduction. Counseling for treatment of infertility should include the risks of multiple gestation, and the ethical issues surrounding embryo reduction should be discussed with patients before the initiation of any treatment that could increase the risk of multiembryo pregnancy.

Ethics, Medical↗
PubMed1999

Research ethics committees: a comparative study of assessment of ethical dilemmas.

Research ethics committees (REC) constitute an important instrument for the regulation of biomedical research involving human beings. The purposes of this work were to study the ethical reasoning in RECs and to ascertain whether the composition of RECs has any bearing on the decisions subsequently made by them. We used a postal questionnaire, containing authentic cases of research ethical dilemmas, sent to the ten RECs in Sweden (n = 124) and to comparison groups consisting of 200 randomly selected medical researchers, 200 randomly selected healthcare politicians and 200 randomly selected district nurses. The average response rate was 68%. A difference was found in how REC members assess a project in comparison with researchers, healthcare politicians and district nurses. Differences depended on the type of project assessed. The study indicates that membership in RECs may exert a normative influence on its members. It is proposed that this investigation should be followed up by a study with a qualitative design.

Adult↗
PubMedDate not supplied

[About ethics in psychiatry and psychiatrists facing ethics].

The plug in account of the suffering, notably psychological, in a consultation, puts the problem of the relationship between suffering and ethics. However, the originality of the ethical step is justly not to be confined to the social norm conformism, but being specific to the individual dimension. The psychiatric pathology offers in this area of particularities interesting. The neurotic, as the obsessed, suffering inwardly pathological manifestations that he judges absurd, replies to the medical moral in asking a care. The psychotic, which projects his suffering on the other, does not feel sick, requests no therapeutic assistance. As such he contests the medical order in an immoral position by definition, and the patient represents from then on a social and medical scandal. In front of a such clinical diversity, we can easily underline that approaching the theme of ethics in psychiatry isn't a well-off exercise, and necessitates a precise locating registered in the history of the patient.

Ethics, Medical↗
PubMed2001

[Ethical aspects of man and commerce(Literary overview 2000/2001) Literature report on the new approach of the Archives on ethics toward animals, nature and the environment].

The question how the volume of the annual report could be reduced in the face of a continuous increase in literature has been discussed in the past. But now, we have arrived at a reduction of one-third which could only be achieved through far-reaching neglect of English-language articles and especially of periodicals. The scope of topics, reinforced over the years, has been maintained and should facilitate the orientation of the reader. In the continuing ethics-boom, a change seems to be in the offing. While dealing with the animal-epidemics, the animals themselves were, aside from consumer protection interests, at least of some concern. In the bio-ethics discussion human well-being and dignity have asserted themselves as the almost exclusive issue. At any rate, the various ethics-commissions have been installed solely for representing human interests, and it is conspicuous how the voices speaking in favour and for justice of non-human life are becoming lesser and softer. The report's central goal remains the intent to introduce and comment recent published developments in the man - animal relationship.

Animals↗
PubMed1986

Ethics and medical-ethical decisions.

This article reviews basic ethical language and presents an ethical decision-making model that is designed to assist ethical decisions in critical care medicine.

Critical Care↗
PubMedDate not supplied

Ethics in actual surgery. Ethics and organ transplantation.

Actual organ transplantation evokes more and more ethical questions. There is scarcity of donor organs. The waiting lists of potential recipients for organ transplantation are steadily growing as is the number of dead among the waiting patients. In Belgium the mortality rate of traffic victims during the first thirty days of hospital admission has been reduced by half. Among this group the number of potential cadaveric donor candidates is further reduced following complications of sustained intensive care. Shortage of cadaveric organs prompts some to select candidates for transplantation with exclusion of those considered responsible for their illness. Some centres incline to reconsider the definition of cerebral death by extending this notion to the irreversibly unconscious and therefore socially dead. Organ donation by living donors opens the way to commercialism specially in case of unrelated living donation. Living donors are often insufficiently informed about their risks and the final outcome of these transplantations. The use of implantable artificial organs should be the solution to many ethical problems. But some experience with the Jarvik heart as a temporary implant increases so far the shortage of donor heart supply and the number of patients on the waiting lists as well. It also excludes patients who became unsuitable for transplantation after complication of the Jarvik implantation. Xenotransplantation is largely under investigation. However, it is out of question that primates, which are threatened already with extinction should act as organ suppliers for mankind. Xenograft organs should be found in animals for food consumption, sufficient in number and more easily accepted as organ donors on ethical ground.

Accidents, Traffic↗
PubMed1997

Ethical issues in umbilical cord blood banking. Working Group on Ethical Issues in Umbilical Cord Blood Banking.

OBJECTIVE: Banking umbilical cord blood (UCB) to be used as a source of stem cells for transplantation is associated with a set of ethical issues. An examination of these issues is needed to inform public policy and to raise the awareness of prospective parents, clinicians, and investigators. PARTICIPANTS: Individuals with expertise in anthropology, blood banking, bone marrow transplantation, ethics, law, obstetrics, pediatrics, and the social sciences were invited to join the Working Group on Ethical Issues in Umbilical Cord Blood Banking. EVIDENCE: Members were assigned topics to present to the Working Group. Following independent reviews, background materials were sent to the Working Group. CONSENSUS PROCESS: Individual presentations of topics at a 2-day meeting were followed by extensive group discussions in which consensus emerged. A writing committee then drafted a document that was circulated to the entire Working Group. After 3 rounds of comments over several months, all but 1 member of the Working Group agreed with the presentation of our conclusions. CONCLUSIONS: (1) Umbilical cord blood technology is promising although it has several investigational aspects; (2) during this investigational phase, secure linkage should be maintained of stored UCB to the identity of the donor; (3) UCB banking for autologous use is associated with even greater uncertainty than banking for allogeneic use; (4) marketing practices for UCB banking in the private sector need close attention; (5) more data are needed to ensure that recruitment for banking and use of UCB are equitable; and (6) the process of obtaining informed consent for collection of UCB should begin before labor and delivery.

Biomedical Research↗
PubMed1998

Ethical and quasi-ethical issues in medical editing and publishing.

The peer review system is a complex, delicately balanced, and dynamic system by which most new medical information is made known. The participants in the process - authors, reviewers, and editors - all have responsibilities to shoulder and rights that need to be protected. An ethical structure has evolved over time to accomplish these two goals. This paper discusses six of these ethical or quasi-ethical issues. Authorship is currently a contentious matter, in part because authors see it as a credit, whereas editors view it as responsibility. Conflict of interest, usually financial, which seems to be increasing with the growing commercialization of medicine, can undermine the credibility and integrity of publication. Confidentiality is an essential component of peer review to protect an author's creative work from exploitation or misappropriation and to protect reviewers from retribution. Redundant publication, publishing or attempting to publish essentially the same work more than once, is regarded seriously because it wastes a journal's resources, confuses later literature reviews, and depreciates the value of authorship. Advertising is a necessary fact of life for most medical journals, but safeguards must be in place to prevent its influencing editorial decisions. When fraud or plagiarism is alleged about something a journal has published, the journal is not equipped to undertake the kind of investigation needed, and should refer the matter to the institution that sponsored the research.

Advertising↗
PubMed1999

Ancient Chinese medical ethics and the four principles of biomedical ethics.

The four principles approach to biomedical ethics (4PBE) has, since the 1970s, been increasingly developed as a universal bioethics method. Despite its wide acceptance and popularity, the 4PBE has received many challenges to its cross-cultural plausibility. This paper first specifies the principles and characteristics of ancient Chinese medical ethics (ACME), then makes a comparison between ACME and the 4PBE with a view to testing out the 4PBE's cross-cultural plausibility when applied to one particular but very extensive and prominent cultural context. The result shows that the concepts of respect for autonomy, non-maleficence, beneficence and justice are clearly identifiable in ACME. Yet, being influenced by certain socio-cultural factors, those applying the 4PBE in Chinese society may tend to adopt a "beneficence-oriented", rather than an "autonomy-oriented" approach, which, in general, is dissimilar to the practice of contemporary Western bioethics, where "autonomy often triumphs".

Adult Children↗