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PubMed2002

A double standard in bioethical reasoning for disclosure of advanced cancer diagnoses in Japan.

This article examines the Japanese double standard in bioethical reasoning with respect to disclosure of advanced cancer diagnoses. This article is devoted to the analysis of communication styles preferred among the Japanese across different hypothetical situations involving cancer as one's own illness as opposed to cancer as a family member's illness. Generally, the Japanese prefer the use of a direct communication style, involving disclosure of the true diagnosis for their own cancer. When cancer is a family member's illness, however, many Japanese perceive the use of an indirect communication style, involving no disclosure or ambiguous disclosure to the patient more ethical than direct communication of the diagnosis. This article explores how and why the Japanese use this double standard when making judgments about the morality of disclosing an advanced cancer diagnosis to the patient. Policy and educational implications for reconciling such a double standard in bioethical reasoning for cancer disclosure are discussed as conclusions.

Bioethics↗
PubMedDate not supplied

[Bioethics].

Bioethics is a new field of knowledge and a current of thought that has been largely developing in Brazil, especially since the Nineties. In this article, we try to contextualize its inception by justifying the need to create such a neologism, since ethics was somewhat forgotten, in relation to the technique, being restricted to professional ethics. We are nowadays faced with a wide scope of works in this area that help guide our action as citizens who want quality of life and to preserve life on the planet. Bioethics, however, is concerned about the way of being: thought-judgment-action, in relation to human beings among them and towards nature.

Bioethics↗
PubMed2004

[Plato's philosophy and the bioethical debate on the end of life: intersections in public health].

This article discusses bioethical aspects of medical futility, focusing on some of its intersections in public health. Starting from a demarcation of finitude in the core of the philosophical and bioethical debate on the end of life, we confront the contemporary criticism regarding medical futility with the ideas of Plato (427-347 B.C.), a philosopher who proposed significant considerations on numerous features of the medicine of his time. We thus explore novel theoretic references to guide the disputes related to this essential problem, the implications of which are decisive to health and life.

Bioethical Issues↗
PubMed2004

[The bioethics of protection and the state's role: moral problems in unequal access to drinking water].

The aim of this study is to examine unequal access to drinking water as a public health problem in terms of normative and analytical tools in the bioethics of protection. Therefore, we analyze both the moral implications of unequal treatment of primary needs, such as situations of vulnerability and threat to population groups, and the public sector's responsibility in supplying safe water. In addition, solutions are proposed for the protection of public health and the promotion of legitimate personal development projects. The bioethics of protection reaffirms the state's role in maintaining the drinking water supply and recommends avoiding a policy of privatization of this public good, meanwhile justifying public policies to correct situations of social injustice.

Bioethical Issues↗
PubMed1997

[The exercise of nursing in its bioethical dimension].

In the present study we approached Bioethics, an area that has been targeted for discussion and reflection within the scope of biological and health sciences, in order to rethink human conduct towards moral values in the current context of great technological and scientific development. We started a discussion about the exercise of nursing in its bioethical dimension, analyzing how such exercise has been occurring at the level of the ethics of principles, which is based on beneficence, autonomy and justice. In this respect, in their relations with patients, the members of the nursing team have adopted a posture based on beneficence linked to the subordination of their practice to the medical act. On the other hand, close contact with patients enables the nursing team to form ties that confer a certain power, which can be used to lead patients to exercise the ir autonomy.

Bioethics↗
PubMed1999

Ethnicity, bioethics, and prenatal diagnosis: the amniocentesis decisions of Mexican-origin women and their partners.

Bioethical standards and counseling techniques that regulate prenatal diagnosis in the United States were developed at a time when the principal constituency for fetal testing was a self-selected group of White, well-informed, middle-class women. The routine use of alpha-fetoprotein (AFP) testing, which has become widespread since the mid-1980s, introduced new constituencies to prenatal diagnosis. These new constituencies include ethnic minority women, who, with the exception of women from certain Asian groups, refuse amniocentesis at significantly higher rates than others. This study examines the considerations taken into account by a group of Mexican-origin women who had screened positive for AFP and were deciding whether to undergo amniocentesis. We reviewed 379 charts and interviewed 147 women and 120 partners to test a number of factors that might explain why some women accept amniocentesis and some refuse. A woman's attitudes toward doctors, medicine, and prenatal care and her assessment of the risk and uncertainty associated with the procedure were found to be most significant. Case summaries demonstrate the indeterminacy of the decision-making process. We concluded that established bioethical principles and counseling techniques need to be more sensitive to the way ethnic minority clients make their amniocentesis choices.

Adolescent↗
PubMed2000

[Bioethics in genetic diagnosis and therapy].

Human genetics, or medical genetics have been rarely taught in most of the medical schools in Japan, as there are only several medical schools with genetics departments among 80 medical schools in Japan. Bioethics has just been becoming an important issue in the medical community in Japan. People hate to be told of hereditary diseases, possibly due to the traditional concept of hereditary diseases as punishment for the evil acts of the ancestors. Recent rapid progress in genetic diagnosis and therapy, however, requires the medical community in Japan to consider the bioethical aspects related to human genetics. We need proper guidelines, and the efforts have been made by the government as well as by the Society for Familial Tumor to propose practical guidelines for human genetics. They may considerably be different from those in the Western countries.

Bioethics↗
PubMedDate not supplied

[Cerebral death and bioethics].

INTRODUCTION: Brain death has been a topic of great interest for clinicians throughout the history of Neurosciences. There are so many different ideas about this topic that it has been necessary to constantly define further the criteria and medical decisions applicable in this field. Also about this matter there are a set of cultural, philosophical and religious aspects as well as autonomous principles in the people involved in such an event. Questions and dilemmas are still present in the individuality of every case and especially in terms of management of information and circumstances that define brain death. DEVELOPMENT: This essay tries to analyze the medical and historical issues around death and its relation to the context of brain death as such. There are also a series of reflections supported by the current bioethical thoughts that are identified with a cultural framework that is crucial to acknowledge the way in which the doctor, the family and society approach an event such as brain death. In spite of all the development of diagnostic technology and the extremes of the futility and extreme cruelty of treatments; there are still open questions that require to be looked into with objective criteria and scientific rigor. CONCLUSION: We should not put aside bioethical principles that are inherent to human quality and dignity that touch the sensitivity of those who give out the information and those who receive it within this process of interaction between the medical staff and the family.

Bioethics↗
PubMed2000

[UNESCO's bioethical norms to avoid eugenic practices].

The author, member of the UNESCO Bioethics Committee, participated in the preparation of the Universal Declaration about Human Genome and Human Rights, in 1997. The aim of this work is to analyze the initial articles of such Declaration, defining the bioethical principles that defend human dignity, freedom and rights, against the madness of the present biotechnological revolution. The development of genetics for the benefit of mankind will be guaranteed if these principles are honored. Genetic discrimination, reductionism and determinism, are identified by the author as perversions that, if used by biotechnologists, can lead to the rebirth of eugenism and racism, that were condemned by the Code of Nuremberg, in 1947. Investigators must assume their responsibility, respecting the principles of human dignity, the real freedom of research and solidarity among people. This attitude will avoid the use of genetics for purposes other than the welfare of mankind.

Bioethics↗
PubMedDate not supplied

[Reflexions on some dilemmas in bioethics for the millennium].

With the end of the millennium, several proposals or propositions have been made about politics, culture, and economics for the world society. Science cannot be isolated from this well-recognized globalization process. Information through the Internet allows the spread of scientific data and knowledge among professional and no professional users to be exchanged and non shared, with the possibility of storing that information in a very fast manner. However, there are important differences in the availability and quality the information, especially in developing countries. On the other hand, it is clear that advances in technology in recent years are higher and faster than development in humanistic and philosophical areas. This situation points to the necessity of using some basic bioethical principles to deal with very important dilemmas such as euthanasia, assisted suicide, and new bioethical dilemmas such as technified death, restriction of economic resources in health care institutions, cloning and genetic manipulation, among others.

Attitude to Death↗
PubMed2000

Teaching through clinical cases: a good method to study bioethics. Experience at the Lleida Faculty of Medicine.

This paper summarises our experience in the teaching of bioethics during the final course in medicine at the Universitat de Lleida. Teaching has been based on the discussion of real clinical cases, the ethical implications of which have been extracted and presented by the professor, and analysed under his supervision. We present here the objectives, the programme and the course and evaluation methodology used, as well as the results of an inquiry carried out among the 55 students attending the course. The acceptance level was 92% and the attendance 95%. We believe the methodology used to be successful, since it makes possible the introduction of theoretical aspects of bioethics in order to solve actual cases, as well as encourage wide discussion. At the same time it emphasises that the students discover the values involved.

Attitude of Health Personnel↗
PubMedDate not supplied

[Civil bioethics in pluralistics societies].

The author examines how Bioethics should be approached in a pluralist society. She argues that through the gradual discovery of shared ethical values and principles for judging which practices are humanizing and which or not, ever-more dense civil Bioethics helps bring out--in contrast to relativism and subjectivism--an ethical intersubjectiveness, the fundaments of which should be addressed by moral philosophy if it hopes to fulfill one of its main tasks.

Bioethics↗
PubMed2000

[Bioethical interpretation of intensive care] .

The bioethical interpretation concerns both those receiving intensive care (IC) and the nature of the treatment itself. The principle of autonomy expressed in the doctor-patient relationship is achieved through the use of informed consent and may also be used in the unique context of patients in IC. Organ-function replacement treatment raises the ethical question of the definition and management of the limit to treatment. The appropriateness of IC can be defined by clinical and ethical criteria and aims to avoid inappropriately excessive treatment. In order to improve the decision-making process involving bioethical questions, the authors outline a number of working approaches: the use of informed consent even in IC, the possible role of Advanced Directives in IC, epidemiological studies, operator training.

Bioethics↗
PubMedDate not supplied

[Bioethical considerations in the approach to patients with amyotrophic lateral sclerosis].

INTRODUCTION: The traditional doctor-patient relation has become a great bioethical challenge due to the advances in science in recent years. This is particularly true when patients suffer diseases such as amyotrophic lateral sclerosis (ALS), a neurodegenerative disease with a relentless course and in spite of modern treatment 50% of the patients die within three years of first having symptoms of the disease. It therefore causes great psychological and social impact. OBJECTIVE: To analyze the great bioethical challenge which arises when diagnosing and treating a patient with ALS. DEVELOPMENT: In this paper we analyze the doctor-patient relationship, the principles of doing no harm and of being beneficial, and more modern concepts such as informed consent, biomedical investigations and euthanasia, as well as the importance of palliative medicine and rehabilitation to alleviate suffering and improve quality of life. Biomedical investigations should conform to the relevant national and international rules. We discuss the right of patients to be given truthful information. CONCLUSIONS: We recommend better training of doctors in all aspects of attention to these patients, with emphasis on the diagnosis and importance of rehabilitation, palliative medicine and the management of psychological aspects. Biomedical investigations should fulfil current regulations. We recommend discretion, complete or partial, with regard to information given to the patients and their relatives so as not to cause despair.

Amyotrophic Lateral Sclerosis↗
PubMedDate not supplied

[The bioethics challenge of equity: its significance in public health].

This paper presents the bioethical discourse as a stimulus to dialogue between beliefs, ideologies, rationalities, and persons. Among its dominant themes, it may be distinguished between those related to communities and those related to individuals. Although equity belongs into the former, it finds expression in individual life as solidarity and empathy. It is possible to formulate guidelines for research in social science and epidemiology distinguishing between values, principles and behavior rules, which find expression in the notion that bioethical reflection must anticipate challenges and dangers and not simply respond to technoscientific developments.

Bioethics↗
PubMedDate not supplied

[In the absence of a bioethics debate. Comments on the Decision of the Constitutional Division of the Supreme Court of Justice of Costa Rica on the prohibition against in vitro fertilization].

The ruling by Costa Rica's Constitutional Court on the prohibition of in vitro fertilisation is a consequence of the negligible development of Bioethics, the lack of public debate on the issue and the absence of adequate regulation. Prohibition of such a vital medical technique represents an abuse of power by the courts, and thus curtails other fundamental rights, research, progress and bioethics' debate.

Bioethics↗
PubMed2001

[Human cloning from the perspective of The Council of Europe bioethical standards].

Allegations negating the role of law in the resolving the controversial problem of human cloning are unjustified. Human rights, implying the magnitude and value of human person and deeply rooted inherent dignity of the human being, constitute the very foundation of every legal order. Every lawyer, as well as every specialist in medicine or biology must be aware of his own human dignity and the ethical consequences. Among the standards of the Council of Europe in the context of human cloning there must be mentioned the Additional Protocol of January 12, 1998 on the Prohibition of Cloning Human Beings. It is the integral element of the normative system of the mother convention, the European Bioethical Convention of April 4, 1997. It has the distinguished place - within this system as far as its substantial provisions exclude the possibilities of limitations and derogation. The system of the Convention and the Protocol must be viewed in the light of a broader normative environment, including the integral system of the European Convention on Human Rights and the set of recommended bioethical standards. The absolute prohibition embodied in the Protocol is limited to all the methods leading to the creation of genetically identical human beings. The protocol does not directly regulate cloning of human tissues and cells, including embryonic stem cells. However, some conclusions may be taken from the Convention and from the recommended standards. It is the assumption of the Convention and the Protocol that the guarantees embodied there must be apprehended as practical and effective ones, justifiable and not excluding the use of proper sanctions by the State. It is an unacceptable view that scientists are excluded from the sphere of the functioning of the above-mentioned prohibition. The real sense of this prohibition is to stop the unlimited liberty and arbitrary practice of such scientists. The freedom of scientific research is not absolute, and must be guided by the respect for human dignity and human rights, as by well as protective guarantees embodied in the Convention and recommended standards.

Bioethics↗