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Bioethical principles and the practice of therapeutic recreation in clinical settings.

The Therapeutic Recreation (TR) profession is obligated to articulate the ethics of its practice and to develop an ethical code to guide its conduct. The principles of bioethics and the rules of moral conduct derived from them are presented as a foundation for examining the ethical dimensions of TR practice in clinical settings. These principles and rules are illustrated in a discussion of two issues that may represent problems of moral choice for the TR specialist: distribution of resources and the clinician's role.

Ethics↗

[Bioethics of dying].

The bioethical problems related to the dying person might be classified in four groups: 1) those of the society the person is involved in, 2) those of physicians and other health professionals, 3) those of the nursing staff in the broadest sense and 4) those connected with the dying person himself. The society must consider the death as a part and natural end of life. One of the most delicate problems related to patient-physician relationship is adequate information concerning the diagnosis and prognosis of the condition. A very complex problem is stopping or not introducing the treatment which cannot influence significantly the quality and length of life. Palliative therapy, although risky, should be introduced if suffering is great. The duty to alleviate suffering is more important than life prolongation. The nursing staff and family should honour the wishes of the dying. Active euthanasia legalization is too risky, especially for nonautonomous persons unable to express their will. In autonomous persons even the possibility of its realization could be the cause of extreme disturbances in patient/physician relationship. Active euthanasia, due to the involvement of public opinion, is already becoming a sociopolitical problem.

Ethics, Medical↗

[Bioethical principles concerning human genetic data].

UNESCO'S Universal declaration on the human genome and human rights (1997) has been accepted by the international scientific community. To apply these laws, it is necessary to get more specific rules about data regulation, human genetic samples and its derived information in biomedic research. Indeed, genetic material recollection, processing, use and storing, has potential risks over human rights' protection and exercise. The author, member of UNESCO'S intergovernmental Bioethics Committee which approved the final draft in June 2003, has taken part in the writing of the final text of an international declaration about human genetic data, whose abbreviate text is described and commented in this communication.

Biological Specimen Banks↗

[The law and "the bioethics of the beginning of life" on the Internet. A new electronic information resource promoted and developed by the Italian National Research Council].

The Institute of Theory and Techniques of the Legal Information (ITTIG) of the Italian National Research Council (CNR) has produced various electronic information systems. Among these, the archive BIG (Bibliography on right to life and interruption of pregnancy, bioethics and genetic engineering). The article presents the archive BIG in its previous version in print and Internet versions, and it describes its main characteristics (original, analytical, objective, scientific). At last, it exposes the rules for data selection and the debate about the right to life in Italy. The archive BIG enables the expert as well as the layman, to exercise an effective control on the enormous material published on this matter.

Academies and Institutes↗

The examination of genetic characteristics since the adoption of the French law on bioethics.

The French bioethics law of July 1994 was due to be revised five years after its enactment. It was not until 6 August 2004, that the revised law was finally adopted. The examination of the genetic characteristics of a person may only be undertaken for medical purposes or for the purposes of scientific research. Consent must therefore be obtained in writing, after fully informing the patient, and may be withdrawn at any time, in either form (orally or in writing). French law nevertheless authorises carrying out such an examination where there is no consent, solely for medical purposes and in the interest of the patient. The issue has arisen of the detection of a serious genetic anomaly during an examination of genetic characteristics. In this respect, certain anomalies may lead to the patient's relatives being tested, in order to suggest suitable treatment. A procedure for informing families has been implemented by the French Biomedicine Agency (details of which will be specified in a decree).

Congenital Abnormalities↗

Infertility and bioethical issues of the new reproductive technologies.

The scientific breakthroughs resulting in the delivery of Louise Brown in 1978 have opened the floodgates for an ongoing bioethical discussion about medically assisted reproduction. The majority in our society has accepted in vitro fertilization as an ethically justifiable procedure for infertile couples. The concern persists, however, that new reproductive technology has started us on the course of a slippery slope with potentially dire consequences for the so-created children, the traditional family, and, indeed, for society as a whole. The moral status of the embryo is the central issue in debates about such reproductive developments as the "spare" embryo, embryo freezing, embryo donation, embryo research and micromanipulation. Conflicts of interests between the adult's desire to become a parent and the welfare of the offspring are at the root of moral objections raised against manipulation of human reproduction. Extracorporal conception with the possibility for various gamete donors has also brought the long-practiced procedure of artificial insemination by donor and the potential consequences for the child into the discussion. Surrogate mothering and surrogate gestational mothering force us to redefine the age old dictum mater certa est and can render the child a helpless pawn in parental, emotional, and legal strife. Over the ages, society has through firmly established values exerted control over reproduction and acceptance of the new member in the community. Sex without reproduction was a severe blow to the highly regarded societal belief in parenting as the epitomy of life goals. Reproduction without sex through various technically feasible collaborative means further jolts fundamental traditional values and mandates their re-evaluation. Ethical belief systems are by nature highly charged and fiercely defended. Thus, in a pluralistic society, a consensus on the question "What ought to be done of all that can be done with new reproductive technologies?" is probably unachievable. Heated controversies between interest groups constitute an additional psychological burden complicating the ethical ambiguities for some infertile couples who have to decide about using noncoital conception. The interdisciplinary group report by the ethics committee of the American Fertility Society published in the "Ethical Considerations of the New Reproductive Technologies" constitutes a wide framework of guidelines for rational consideration. It will, one hopes, help to formulate needed regulations because some segments of our society as well as many scientists and physicians in the field believe that not all that potentially can be done ought to be done.(ABSTRACT TRUNCATED AT 400 WORDS)

Ethics, Medical↗

Bioethical problems in pharmacogenetics and ecogenetics.

Many societal and bioethical problems are raised when our knowledge of genetic variation is translated into public policy. The various dilemmas faced by imperfect knowledge are discussed. The difficulties of issuing regulations in the face of uncertain scientific knowledge are considerable. Potential variation in nutritional requirements due to biochemical variation needs to be faced by nutritional scientists and policy makers. The problems of discrimination against carriers of the currently testable genetic traits are discussed. Screening of workers susceptible to industrial injury for genetic reasons is being started. However, industry may escape its responsibilities for industrial hygiene by concentrating on susceptibility testing--often in the face of poor data. A variety of other issues such as the "false positive" test and genetic identity cards are discussed. Public policy dealing with human genetic variation must be based on accurate genetic data. At that point, careful assessment of the societal impact of the policy needs to be considered before implementation. Problems of coping with human genetic variation are of increasing importance for developed societies but remain a low priority item for developing societies that face current problems of malnutrition and infectious disease.

Ecology↗

[Bioethics and drug experimentation in hospitalized patients].

The authors discuss about clinical experimentation with drugs involving hospitalized subjects in consideration of four principles of Bioethics: Autonomy, Beneficence, Non Maleficence and Justice. This article explores also the problems linked to the application of good clinical practice according to the European and Italian recent rules. Human integrity, respect of patient's dignity, informed consent, correct methods, placebo, Ethics committees represent the essential basis for those researchers that intend conduct clinical trials really "with subject and not on the subject".

Clinical Trials as Topic↗

Two instruments to measure interdisciplinary bioethical decision making.

OBJECTIVE: To develop and test two instruments measuring decision making about level of aggressiveness of intensive care unit (ICU) patient care. Decisions about Aggressiveness of Patient Care (DAC) measures care providers' general perceptions about decision making. Decisions about Aggressiveness of Patient Care for Specific Patients (DAC[SP]) measures perceptions in specific situations. DESIGN: Two-phase psychometric instrument evaluation. SETTING: Phase I, nationally mailed questionnaire. Phase II, northeastern medical center medical ICU. SUBJECTS: Phase I, 22 ICU nurse and physician experts. Phase II, 35 medical ICU staff nurses and eight medical resident physicians. OUTCOME MEASURE: Psychometric properties of instruments. RESULTS: Content validity of both tools was supported by their development from the literature and by the experts. Face validity was supported by the experts, staff nurses, and medical resident physicians. Both instruments had variance in responses, internal consistency reliability (r = 0.53, r = 0.73) and, test-retest reliability (r = 0.73). CONCLUSION: These instruments may enrich our understanding of how care providers make bioethical decisions for ICU patients. Such understanding could assist with development of interventions to increase collaborative interdisciplinary decision making, leading to increased care provider satisfaction and better patient outcomes.

Attitude of Health Personnel↗

[Bioethical problems in the definition of the beginning of life in Judaism].

In accordance with the Jewish view human life begins with the first breath. The consequences following are wide reaching for the bioethical arguing within prenatal medicine and abortion in particular. The Jewish understanding of the beginning of life is based on theological grounds (like the special emphasis on this life or the principle of "actuality before potentiality"). whose consequences are philosophically contestable.

Abortion, Legal↗

Bioethical principles and care-based ethics in medical futility.

The process for solving ethical, legal, and moral dilemmas in the field of medicine is complex and time consuming. Frequently, the constraint of time forces the healthcare professional to make decisions quickly. When working with the cancer population, one faces, additionally, the dilemma of medical futility. Guidelines from the bioethical principles of autonomy, beneficence, nonmalificence, and justice help to address this dilemma. The use of care-based ethics allows healthcare professionals to establish trust, thus enabling patients and their families to be open to change and make realistic decisions. This article contrasts care-based ethical theory with justice-based ethical theory, using a case presentation to illustrate the importance of care-based ethics in making a moral decision to forgo medically futile treatment.

Aged↗

Current events and bioethical concerns in physician-assisted death.

In June 1997, the Supreme Court of the United States found that the Constitution does not guarantee a right to physician-assisted suicide, thereby allowing states the opportunity to variously prohibit or permit such practice. The Court's findings notwithstanding, physician-assisted death remains a topic of intense medical, legal and philosophical discussion. Principled discourse variously supports both an ethical prohibition against assisted death and an ethical obligation to help some patients achieve death. Both theoretical and practical concerns are raised by the practice of physician-assisted death. This essay reviews recent events and developments concerning assisted suicide and euthanasia. The discussion which follows was generated by the members of the Committee on Bioethical Issues of the Medical Society of the State of New York and builds upon a previous Committee report.

Advance Directives↗