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"A Practice-Based Bioethic" is a regular column in Advanced Practice Nursing Quarterly. A practice-based approach is derived from, and therefore is intended to be appropriate to, the situation of a patient, the purpose of the health care setting, and the role of the nurse. It is based on a shared state of awareness, the foundation on which ethical interactions between nurse and patient occur.
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A questionnaire was sent to the 590 members of the European Society of Intensive Care Medicine to define both the current practices and the opinions of these specialists on various ethical issues. The answers from 242 (41%) European members were collected and analysed. The first part of the questionnaire was designed to define the criteria for admission to Intensive Care throughout Europe. Admissions to the ICU were generally or commonly limited by the number of available beds according to 57% of the respondents and sometimes or almost never according to 41% (100/242). Bed availability in the ICU was especially limited in Spain, Portugal, Italy and the United Kingdom. Despite limited bed availability, two thirds of the respondents did admit patients who were thought to have little or no hope of survival other than for a few weeks. When asked about what ought to be done in these circumstances, the number of respondents who supported the admission of such terminal patients to ICU was halved. These data illustrate the heterogeneity of admission practices in Europe and stress the need for all ICUs to define a policy for admission. The second part was designed to assess the information given to patients in the ICU. Only 24 (10%) of the respondents stated that they always delivered complete information to their patients and only 31 (13%) thought they should do so. When an iatrogenic incident occurred, only 39 (16%) claimed to relate exactly what had happened, to the patient or their relatives but 121 (50%) thought they should. Informed consent was usually required for surgery or gastroscopy and the administration of a new medication.
Research regulation is a timely topic for discussions in bioethics and public health policy. This response to articles in the previous special issue of the Monash Bioethics Review emphasises the importance of having both internal and external controls on human experimentation. Unless both elements are incorporated into research ethics governance frameworks, they will ultimately fail to achieve what should be their primary goal: human subject protection.
This case involves invasive research on captive wild populations of birds to study aggressive animal behavior. The case and associated commentaries raise and examine fundamental issues, whether and under what conditions, such research is ethically justified when the research has no expected, direct application to the human species; the moral status of animals and how one balances concern for the animal's interests against the value of gains in scientific knowledge. They also emphasize the issue of the importance of a thorough literature search to ensure appropriate research design and experimental design to minimize animal suffering. It raises the issue of circumstances in which such research should be modified or terminated.
For both moral and practical reasons, the veterinary profession must begin to nurture a serious veterinary ethics of human-companion animal interaction. Among the central concerns of such a discipline will be the moral value of the veterinary patient: the moral significance of human-animal companionship; the proper response of the practitioner to conflicts of interests between the patient, its owner, and himself; and the proper role of the practitioner in the client's decisions. Approaches that urge moral equality of man and animal or encourage the veterinarian to control the client's decision undervalue the moral status of the animal owner in the human-companion animal bond.
An Institute of Medical Ethics working party supports the view that explicit permission should normally be sought in the case of testing for HIV antibody. It discusses this in relation to anonymised HIV testing for epidemiological purposes, concluding that this is to be welcomed, given certain safeguards. It next argues that pregnant women may have a greater and more immediate need than others to know their HIV status. It concludes that this need does not justify testing them without their permission, but can be met by voluntary diagnostic testing on an 'opting-out' basis, supported by adequate briefing.