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The New Zealand Report of the cervical cancer inquiry: significance for medical education.

The New Zealand Cervical Cancer Inquiry has elicited considerable interest in Australia as well as in New Zealand. However, relatively little attention has been paid to the future practice of medicine with regard to the relevance of the Inquiry's findings for medical education, although it did recommend the incorporation of ethics teaching into all stages of the medical curriculum, and also urged that attention be paid to communication skills within the curriculum. In this article, I argue that medical ethics teaching should be seen as an essential part of the medical curriculum, with the teaching being integrated closely with the other disciplines that comprise the medical course. To illustrate one possible approach, I have outlined elements of current ethics teaching at the University of Otago. I also have raised what I regard as wider issues for the medical curriculum. These include the need for students to develop a critical facility and an ability to handle conflicting data and attitudes (fostered principally by an understanding of research methods), to appreciate the importance of accountability (fostered in part through group learning activities) and to be aware of the impact of community concerns on the practice of medicine. Another issue which I consider is raised indirectly by the Inquiry concerns the procedures that are used for the selection of students into medical courses.

Attitude of Health Personnel↗

The recruitment of normal healthy volunteers: a review of the literature on the use of financial incentives.

Unresolved issues of ethical, methodological, and legal concerns in the use of normal healthy volunteers persist. Financial incentives in their recruitment offer a unique ethical dilemma because of questions surrounding payment. A review of literature was conducted to obtain research systematically examining volunteer motivation and the role offinancial incentives. The primary selection criterion was motivation and payment to volunteers; seven studies met the criterion for review. Studies that have systematically investigated volunteer motivation have found financial rewards to be an important motivator among normal healthy volunteers in their decision to participate in clinical trials. Also evident is that differences based on demographic characteristics exist in the motivation and rates of volunteerism. Ethical issues surrounding the use of normal healthy volunteers are discussed, with attention to the issue offinancial incentives (e.g., economically vulnerable volunteers, undue inducements). Regulations, guidelines, and recommendations are discussed with regard to volunteers and financial incentives.

Bioethical Issues↗

Studies in the explanation of issues in biomedical ethics: (II). On "on play[ing] god", etc.

A previous essay (Erde, 1988) tracked the influence of the major Western historical paradigm of the great chain of being through various positions taken about abortion. This essay shows the paradigm's influence on our language--especially in animating the use of "god" and phrases like "playing god". This is important given the prevalence of religious values in bioethics debates and the pervasiveness of the language. I hunt unsuccessfully for a meaning that could serve as a moral principle, and I show how these phrases are rooted in the paradigm. I conclude that all that such language can do is offer the pretense that there is a specific absolute ground for forbidding something which could otherwise be morally acceptable. But such language is nearly senseless, and worse still, it is immoral in that it cuts off reflection and debate.

Adult↗

The human use of humanoid beings: chimeras and patent law.

As biotechnology advances, the day may soon come for the creation of a self-aware, human-nonhuman chimera. The USPTO has ruled on whether a patent may issue on such an organism, but Congress must still legislate a dividing line between human and non-human patentable subject matter.

Animals↗

Development of a teaching program in clinical medical ethics at the University of Chicago.

The University of Chicago Pritzker School of Medicine has developed and evaluated an extensive teaching program in clinical ethics coordinated primarily through the Center for Clinical Medical Ethics. The program provides medical students with a foundation in medical ethics during the four years of medical school and augments the clinical ethics knowledge and teaching skills of the housestaff and clinical faculty at the University of Chicago. Together, medical student teaching and clinical faculty development have made clinical ethics an integral part of medical education at the University of Chicago. Through these efforts, the teaching program aims to incorporate clinical ethics considerations into medical decisions and in this way contribute to improving patient care. (A detailed overview of all clinical ethics instruction at the school is provided.)

Bioethical Issues↗

Human subjects--are they protected?

From the time of Hippocrates, physicians have sworn to "abstain from all intentional wrongdoing and harm," (Lifton, 1986). They are guided by ethical principles and theories that are intended to help them in their practice of medicine and scientific research. The purpose of this paper was to define research and human subjects, to review cases of abuse, address benefits and risks of human experimentation, discuss regulations governing experiments on humans, and address ethical principles and theories regarding this type of research. Human experimentation is an important activity of great societal benefit that must be conducted in a manner consistent with basic societal beliefs and values about the rights and worth of an individual (Gray, 1975). Ethical issues in human experimentation defy definite solutions, and the problems involved in human experimentation will almost certainly continue to receive active attention in future years.

Bioethical Issues↗