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PubMed2004

Medical research ethics in Thailand: what should be the most appropriate approach? An analysis based on Western ethical principles.

An approach to the ethical consideration of medical research in Thailand is presented in terms of Western principles. It is argued that at the present time the principle of therapeutic beneficence is to be considered a priority over respect for autonomy, expressed as informed consent. This approach is especially recommended for therapeutic research in an inpatient hospital setting in Thailand. Only when valid and effective informed consent processes have been developed should respect for autonomy be given more weight in research ethics considerations. The discussion is presented within the context of recent developments in the field of bioethics and in light of some recent findings in informed consent research both in and outside of Thailand.

Ethics, Research↗
PubMed1991

Medical ethics reflected in codes of ethics: the Hippocratic Oath and the 1980 AMA code compared.

The Hippocratic Oath and 1980 Code of Ethics of the American Medical Association (AMA) are compared to evaluate the nature of the relationship between students and teachers of medicine and the ethical injunctions that guide practice and make up the essence of the Hippocratic Oath. Such injunctions include the need to take care that harm is not done, to maintain confidentiality, and to avoid acts leading to death. The AMA code is analyzed from the perspective of its injunctions to give competent and compassionate care, to follow the law, to be responsible for guarding patients against incompetent physicians, and to assure that patient care is based on principles of compassion and skill. The centrality of trust in the relationship between patient and doctor as a crucial value in defining a profession is emphasized.

American Medical Association↗
PubMed1990

Ethics and AIDS: a summary of the law and a critical analysis of the individual physician's ethical duty to treat.

Persons afflicted with acquired immune deficiency syndrome (AIDS) or its preceding medical conditions face a potential problem with assured access to basic threshold medical care. Subject to certain limitations, there is no guarantee that a physician will fulfill the health care needs of any population of patients. Individuals with AIDS, thus, have a considerable interest in the development of a duty on behalf of physicians to provide treatment. This Note first highlights the limits of the legal duty to treat. It then examines the theoretical impetus propelling an ethical duty to treat. The Note concludes that the grounds for imposing an ethical duty on physicians are too weak to support that result, but the creation of an AIDS-specific legal duty is a viable alternative.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The neurologist as ethics consultant and as a member of the institutional ethics committee. The neuroethicist.

Because of the increasing number of neuroethical dilemmas in medicine, neurologists are becoming more involved with the activities of institutional ethics committees and also serving as ethics consultants. This article discusses the role and functions of a "neuroethicist" and gives common clinical examples that illustrate how a neurologist can be of value in these neuroethical dilemmas in the clinical setting.

Ethics, Medical↗
PubMed1993

[Embryo research: ethics of technology and technique of ethics].

A short survey is given of the aims and methods used in embryo research. Ethical aspects of research and possible applications lead to the conclusion that questions are raised that concern society as a whole. In the last decade the awareness in this respect has increased. Methodology of broad ethical judgement and decision making however is still in a stage of development. It is suggested to strive for: 1) clarification of fundamental views on values in (human) life, 2) answering the question: who decides about what, and 3) determination of decision making procedures.

Animal Husbandry↗
PubMed1995

Ethics of emergency department triage: SAEM position statement. SAEM Ethics Committee (Society for Academic Emergency Medicine).

Emergency department overcrowding, the growth of managed care, and the high cost of emergency care are creating pressures to triage patients away from U.S. EDs. Paradoxically, this pressure to limit patient access to EDs has increased in spite of federal laws that restrict patient triage and transfer. The latter regulations view EDs as the safety net for the U.S. health care system. The SAEM Ethics Committee evaluated the ethical implications of policies that triage patients out of the ED prior to complete evaluation and treatment. The committee used these implications to develop practical guidelines, which are reported.

Beneficence↗
PubMed1990

Ethics and human values committee survey: (AMI Denver Hospitals: Saint Luke's, Presbyterian Denver, Presbyterian Aurora: Summer 1989). A study of physician attitudes and perceptions of a hospital ethics committee.

By studying physician perceptions of the Hospital Ethics Committee (HEC), the committee can determine (1) what areas the committee should concentrate on, and (2) how it is perceived by the physician community. The topics covered by the study included whether or not a HEC is needed in any hospital system, as well as the specific need within AMI Denver hospitals. In addition, the physician participants discussed what departments should be represented on the HEC and what topics it should study and discuss. By discussing the perceived effectiveness and the ideal function of HECs the physicians were able to provide the committee with many concrete suggestions to improve its effectiveness and visibility within the hospital community. Most of the advice is captured in one physician's words: "Be Visible and Credible."

Attitude of Health Personnel↗
PubMed1999

Paradigms and personhood: a deepening of the dilemmas in ethics and medical ethics.

There are many calls for a definition of personhood, but also many logical and Wittgensteinian reasons to think fulfilling this is unimportant or impossible. I argue that we can consider many contexts as language-games and consider the person as the key player in each. We can then examine the attributes, presuppositions and implications of personhood in those contexts. I use law and therapeutic psychology as two examples of such contexts or language-games. Each correlates with one of the classic "theories" of ethics-deontology and consequentialism. But each is a large enough cluster to consider them as paradigms in a sense related to Thomas Kuhn's notion in The Structure of Scientific Revolutions. Showing the presuppositions about and "takes" on personhood together with the connections involved in the paradigms deepens the dilemmas we already know to be present.

Bioethical Issues↗
PubMed2000

Collaborative ethics: a standing renal dialysis ethics committee.

We describe a unique, award-winning, multidisciplinary, standing committee focused on ethical issues associated with chronic dialysis. The committee was formed as a collaboration between the National Kidney Foundation of Kansas and Western MO affiliate and the Midwest Bioethics Center, Kansas City, MO in June 1995 to serve the local nephrology community. The committee is comprised of experienced nephrologists, dialysis nurses, and social workers, as well as clergy, medical ethicists, and patient representatives. Committee membership has remained relatively stable over the 4 years of its existence, creating a collaborative spirit among members, which is noteworthy because members are otherwise competing with each other for patients. The committee provides education in a variety of forms, from case consultations to organized seminars. We believe this committee is valuable to the care of patients on dialysis in our local community and that similar committees can be created in other affiliates. We can envision a national network of such committees that together could work on issues in ways that serve both the local and national level.

Community Health Services↗
PubMed2005

What is the role of the research ethics committee? Paternalism, inducements, and harm in research ethics.

In a recent paper Edwards, Kirchin, and Huxtable have argued that research ethics committees (RECs) are often wrongfully paternalistic in their approach to medical research. They argue that it should be left to competent potential research subjects to make judgments about the acceptability of harms and benefits relating to research, and that this is not a legitimate role for any REC. They allow an exception to their overall antipaternalism, however, in that they think RECs should have the power to prohibit the use of financial inducements to recruit research subjects into trials. In this paper it is argued that these claims are unjustified and implausible. A sketch is provided of an alternative model of the role of the REC as an expert body making judgments about the acceptability of research proposals through a consensual weighing of different moral considerations.

Attitude to Health↗
PubMed1983

Professing ethically. On the place of ethics in defining medicine.

Medicine, despite technological advances and societal changes, remains essentially what it has always been, a profession rather than a trade, with its own ends, means, and intrinsic norms of conduct. Being a professional is an ethical matter, entailing devotion to a way of life, in the service of others and of some higher good. The medical profession is devoted to the naturally given end of health and assists the immanent powers of self-healing. It serves the needs as it treats the infirmities of the sick, sensitive to their vulnerability, shame, and exposure and mindful of the meaning of the delicate tension between bodily wholeness and necessary decay. These special characteristics imply specific and inherently medical obligations, both of omission and commission, as well as an appropriately reverential stance of the physician before his chosen profession.

Ethics, Medical↗
PubMed2001

Ethical dilemmas in neonatology: recommendations of the Ethics Working Group of the CESP (Confederation of European Specialists in Paediatrics).

Neonatal intensive care has greatly improved the survival chances of a very sick infant. At the same time, it has also given rise to serious ethical problems. In all circumstances, however, parents and paediatricians and other healthcare team workers should continuously evaluate together what is in the best interest of the infant and react accordingly. It is also clear that the principle "the best interests of the infant" can be interpreted in different ways; therefore no simple guideline is possible.

Critical Care↗
PubMed2004

ACOG committee opinion: ethical considerations in research involving women. Number 290, November 2003: Committee on Ethics.

In this Committee Opinion, the American College of Obstetricians and Gynecologists Committee on Ethics affirms both the need for women to serve as research participants and the obligation for researchers, institutional review boards, and others reviewing clinical research to evaluate the potential effect of proposed research on women of childbearing potential, pregnant women, and the developing fetus.

Biomedical Research↗
PubMed2002

Ethics; 'in consideration of the love he bears.' Apprenticeship in the nineteenth century, and the development of professional ethics in dentistry. Part 1. The practical reality.

This paper takes a look at the ancient institution of apprenticeship. In doing so it regards the conventions of the scheme as having had a positive influence on the morality, legal identity, and professional allegiance of dentists during the ethical development of their profession in the nineteenth century. Two important effects can be detected from the records available. One is general, since the moral ground of apprenticeship derived from, and spread throughout, society, and the other is particular to the development of dentistry as a profession, as those who were apprenticed to dentists acquired a natural loyalty to their dentist Masters in person, and to their craft.

Clinical Clerkship↗
PubMed2001

Ethics seminars: beyond authorship requirements-ethical considerations in writing letters of recommendation.

Letters of recommendation may serve a number of vital functions related to the evaluation, selection, and promotion of candidates. The lure of academic celebrity or the desire of an individual candidate for a flattering letter must not threaten the veracity of the content. Letters of recommendation should be appropriately authored to meet the needs of the institution or individual requesting the letter, while keeping authenticity paramount. Length and content should be complete but not overly verbose. Relevant elements suggested by standardized formats should typically be included, such as nature of contact with the applicant, commitment to emergency medicine, work ethic, ability to develop a differential and treatment plan, personality, interpersonal interactions, and an overall comparative ranking. The seven cardinal elements of an exemplary letter of recommendation are that it should be: 1) authentic (based on adequate first-hand knowledge of the candidate's skills); 2) honest (accurate; avoiding exaggeration or hyperbole); 3) explicit (avoidance of veiled omissions); 4) balanced (taking care to incorporate both strengths and weaknesses); 5) confidential (avoiding unnecessary or unanticipated disclosure); 6) of appropriate detail and length (content relevant to the institutional or individual requests); and 7) technically clear (avoidance of unnecessary abbreviations and jargon). The implied duty to future students, colleagues, researchers, and patients who might come in contact with the applicant should motivate authors to write honest, explicit, appropriate, and complete letters.

Authorship↗
PubMed2000

[The ethics of appropriateness and the appropriateness of ethics. Comments on a current topic of which we know little and which we discuss even less].

Doctors and patients "alone on a desert island or in health market?". Antinomy is strongly paradoxical and provocative to invite us to think on two extreme lines of thinking modalities about fragile, variable, and changed relationship between doctors and patients in the light of the new health business administration. Probably, the balance point exists and may be found only introducing three main elements into the complex problem: patient in the middle, health care accuracy, ethical behavior, not only of the single doctor but also of the overall health system.

Delivery of Health Care↗