Questions related to Medical Ethics
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The authorship criteria by ICMJE is clearly mentioned. My query is when a surgeon of lab physician is involved only as treating physician or surgeon doing the patient management as per the patient's requirement and within standard operating procedure of the institute; no active intervention or beyond the routinely required intervention is performed by them; or study methodology does not require any change in the routing care from the surgical of paraclinical laboratory department- is it mandatory to include a surgeon or lab physician as investigator? If not done- how does it breach ethical principles or authorship criteria? What does your (country) rule say?
Medical ethics has a long history starting from Hippocratic oath. Then the Geneva convention etc. With the development of technology, and changing in guidelines medical ethics are getting additions and omissions. Is there an updated global bio-medical ethics that could be applied to any part of the world?
The topic for the discussion an example of an emerging ethical challenge. The discussion opened to discuss whether the insurance companies should respond to rising demand for low-cost surgical and diagnostic procedures in hospitals in other countries.
Shared opinions in this discussion group will be used in an article to by referred names.
Couple of papers attached to discussion below
The plagiarism which we are checking with the help of Turnitin software counts the similarity of usual English words even helping verbs and proverbs. If the similarity of specific terminology is counted instead of the entire usual English Sentences?
Every discharge summaries serve as the primary documents communicating a patient's care plan to the post-hospital care team. Majorly, the discharge summary is the only form of communication that facilitates the patient to the next setting of care. In line with this. It has been discovered that out of every 5 patients case folders, in different units of the government's hospitals, only 2 are found with fully completed discharged summaries. This irregularities can affect proper decision making in healthcare system.
What are the basic steps that can be taken to ensure that all doctors are taking discharge summary completion as important as life?
It is glaring that Medical Data collection in healthcare allows health systems to create holistic views of patients, personalize treatments, advance treatment methods, improve communication between doctors and patients, and enhance health outcomes.
Inconsistent medical data have grave effects on proper planning of health care system. How can the problems of inconsistency in medical data be tackled, in various health institutions?
Sometimes we get some articles from developing country authors with 99% plagiarism, without any ethical clearance letter. We reject the articles. But how can we stop this tendency of authors?
Patients' rights as an extension of right to health and more basically right to life, is one of the main concerns of the recent studies in medical ethics. In recent years, great progress has been made in terms of patient rights. In some cases, it is not uncommon for health professionals to begin to think that the rights of the patients have been replaced by their rights and this trend can be seen in many countries. How are the developments in patient rights affecting the rights of physicians and health professionals? What is your opinion about this issue?
We are doing research in our setting and at our standard. Protocol preparation, data collection, data analysis, manuscript preparation and writing, referencing all of these need honesty. But are we honest enough? How to improve it? Is only intention is enough? What about regulatory bodies? Let us think of it!!
Establishment of considerably acceptable Doctor-Patient Relationship is vita. Does it have any potential to prevent negligence or filing of negligence suit?
I have secured several "informed consent" to terminate life-support after more than twenty years in medical practice, but the number of cases does not make the subsequent cases easier for me. I find every case ethically and legally taxing. One of the most common and challenging issue I have to face is an immediate family member asking me "[W]ho will switch off the device?" In our country, there is no law yet governing end-of-life decisions.
If the person is mentally incompetent, under the influence of drugs, or unconscious then doctors should treat them. But what about persons who have taken a drug overdose and are brought in to A & E and refuse treatment, stating they wanted to die? Surely nowadays we have to recognize patient autonomy, and obey their wishes?
- As an entirely independent researcher -- not receiving any research grant from any Organization in the World -- active in several fields in Medicine, including Cardiology, Neurology, Neuro-Ophthalmololgy, Neuro-Endocrinology, Endocrinology, Gastroenterology, Hepatology, Immunology particularly occult sarcoidosis with published research in these and other fields, and, a reviewer of manuscripts from several prominent medical journals, I have found that scientific letter writing has the power to remove scientific clutter from the desk of the avid researcher, remove the dross and the flotsam that necessarily accompany human efforts, demolish long-cherished assumed areas of knowledge, and bring to the forefront "that which really matters".
- I quote straight from my 1996 article in the Journal of Medical Ethics: "Critical letter writing entails the abilities to: maintain rational scepticism; refuse to conform in order to explain data; persist in keeping common-sense centre-stage; exercise logic to evaluate the biological significance of mathematical figures, including statistics; and, the ability to sustain the will to share insights regarding disease mechanisms on an ostensibly lower research platform"--see attachment.
- For almost a decade, the journal "Neurology"--AAN, refused to accept scientific correspondence in response to published articles from scientists who were not members of the AAN and thus did not directly subscribe to the journal. This was clearly written across over the relevant pages of the issues of Neurology.
- Talent is not a monopoly of advanced countries particularly the U.S.A., a land populated by immigrants of all hues and varieties. Neither is it the sole purview of the American Academy of Neurology and it voice -- the journal NEUROLOGY.
- History must record this shameful and woeful editorial journal policy, as well as our responses to it, so that the future does not see such carbuncles of bias and outright prejudice in science.
- Writers of critical Letters-to-the-Editor are a prized commodity -- the wealth of the scientific enterprise, with the ability to read between the lines -- an ability that is gifted only occasionally by Nature -- see attachments of Letters-to-the-Editor. I have published over a hundred of such pearls over the last three decades.
- The science of Medicine is too important to be left to Editors and Reviewers or to the so-called Original Researchers flush with research funds, Institutional support, and knowledge to navigate the complex business of research. The paper claiming that aspirin had anti-platelet activity and prolonged bleeding time was initially rejected -- Desforges JF. NEJM 329, 14, 1038-1039, 1993 -- the very pillar of modern cardiovascular and cerebrovascular therapeutics.
- Nothing in Medicine cannot be improved (Popper KR. Conjectures and Refutations. London: Routledge, 1978, p.47; The Logic of Scientific Discovery; Lancet 342 (8879); 1063-1064,1993). The human quest for perfection will never cease -- the imperfect human seeking the Ultimate, the paradoxical enterprise that keeps our heads high and our spirit higher, to soar where our mind is no longer shackled, the finite existence in tango with the Infinite.
Researchers wants data availability for research and NCDRC / SCDRC are duty bound to issue instructions to all members to mention date of institution and date of disposal in each judgment. But it is not happening in all judgments including NCDRC/SCDRC judgments. This is the Limitation of Research on medical negligence cases that necessary data is not available for study.
Does the national frameworks of laws set the parameters and tone of the ethical stance of the population therein? Do subsets of society break that normative statement with different ethical foundations?
I ask as the IEEE document "Ethically Aligned Design" proposes group by group ethical alignment for AI/Robots, and I can see potential conflict with national and local laws in complying with that design criterion?
I am a retired Physiologist still acting as an independent court surveyor in the field of work physiology and have often to respond to inquiries of insurances, who notoriously refuse to pay retirement salaries to persons who have been performing heavy work over prolonged periods. My judgements of workload are based on your MET list of 2011 and I would like to ask if you kindly could provide me with a reprint of dos Anjos and Ferreira: Cardernos de Saude Publica 16: 785, 2000 to be able refer to the original literature when arguing for a retirement pay due to heavy work.
We are about to start a qualitative research study to demonstrate the effects of role models and the ideology intrinsic to medical education processes on shaping medical students' moral stances as future physcians. In order to reach this aim, "student observers" will continue their usual education processes but they will also collect data by observing people's everyday behaviours at their medical school over a structured data collection sheet. However, for two reasons they consider not obtaining informed consent from people whom they will observe: 1) Asking informed consent would contaminate the data and cause bias in the results. 2) It seems impossible to ask a consent from everybody since they cannot define the size and configuration of the subjects precisely beforehand as the data collection process is usually unpredictable and open to random encounters. I would be glad if you share your opinions and experiences regarding this issue.
As a student of this profession, it is common to find in our work the appearance of ethical dilemmas, but I still do not understand how I could face them, besides being interested in knowing some experiences of people in that profession.
It is a small 2 physician clinic, only details discussed are past acceptance of FP methods,
Do you know of any studies on this subject? I've seen a number of cases in my practice but no doctors, surgeons or anaesthesiologists want to talk about it. I've only found information in work by traumatologists like Dr Robert C. Scaer who himself was traumatised as a child by medical procedures. He associates being held down as a very young child - unable to fight or flee, only to freeze - with torture.
Thanks in advance for any leads to studies on this subject.
The Declaration of Helsinki is a statement of ethical principles for medical research involving human subjects, including research on identifiable human material and data.
As the Helsinki's main target is bio-medical research. Which ethical aspects are demands from health care research by social scientists?
1. Which ethical aspects should be addressed to claim that the study (related to health care research) has settled ethical considerations?
2. How to deal with the situation where an institute doesn't have Institutional Review Board (IRB) for ethical approval?
Recently all over India medical practitioners are facing physical violence by angry mobs who claim to be relatives of patients....I want to know the scenario in other countries....
What comes to mind for me here is the debate on the use of arguably (?) life-saving medical data collected by Nazi doctors in concentration camps.
Thanks to humanitarian organizations that offer "free cares" otherwise impossible in their native countries, lots of children's life are saved.
No discussion that these organizations are great and do excellent work.
But, on the other hand, if they had a choice how many parents would give away their child without being with her or him? Some of these sick children stay in a foreign countries without parents for weeks for months before going back home.
Others die in a foreign hospital far away home without having parents with them.
How "ethical is that"? Who should claim "Children's' Rights" who clearly stipulate that a child has the right to have at least one of his parent when at the hospital?
What about "parents right"? Does a parent not have the right to be with his child when hospitalized?
The availability of smartphones and other electronic gadgets made it so easy for patients to audio/video record any conversations or visits with a doctor, with or without consent. Medical doctors are becoming wary of this reality, more so after an adverse event.
We have been noticing increasing medical and medications malpractice , in the recent years and ethics should be incorporated as part and parcel of the Pharmacy curriculum.
There are many chronic pain patients who visit different therapist seeking treatment desired by them. Though, therapist give valid information related to their condition and try to implement evidence based practice. It seems these patients expectation cant be fulfilled. So, Incorporating Placebo treatment in addition to desired treatment in a graded way in order to bring adherence of patient to therapist protocol might benefit patients. But Is there any restrictions or ethical issues incorporating Placebo Treatments?
Is there any research articles or guidelines regarding Ethical issues and Placebo treatment?
I am finding it very difficult to access information on the academic program that is specific for Nurses who want to gain expertise and knowledge in medical law and ethics which then can be utilized within scope of Nursing Practice.
Both seem literature poor, but the latter particularly so. There is a literature review, handbook for medical professionals and a few articles on clinical ethics in the rural setting. I'm particularly interested in the New Zealand setting, but obviously would love to get recommendations from any setting.
Am currently part of a study on health research ethics, and would love to have materials on ethics and genomics in the african context
Hi, can someone please provide reasons as to why the current system of patenting of pharmaceutical products are ethically sustainable?
I am working with South Australian law but am interested in international law. Who are the carers?. What support do they receive? Have used deontological and utilitarian ethics, where does ethic of care come in? How can the needs of the patient be balanced with the needs of carers, families and communities? Stereotyping of the patients and their needs is a problem.
From ancient times, surgeons have been viewed differently and have been held more accountable for their decisions. This trend is currently more prevalent; where, in the UK, the government has mandated individual surgeon data to be published online. Do you think it takes a different sort of personality to be a good surgeon? Do we and should we rely solely on more evidence-based science in our operative decisions or is individual observation, training and experience of equal importance? I believe the later to be true and this is what current literature reports. I am interested in the valued opinion of international peers. Thanks.
The Israel Medical Cannabis Authority plans to create mixed material sorted by chemical composition (CBD and THC) and impose this material on patients in place of the natural strains. Since this move is based upon a. very incomplete knowledge of the entire chemical composition of the natural strains and b. based on an untested hypothesis that only the measurable THC and CBD are relevant and c. based on considerations external to the welfare of the patients who are satisfied with the natural strains and used to them and d. therefore this constitutes a breach in continuity of care, I believe that imposing such untested matreial on patients constitues human experimentation without consent. Anyone out there with an opinion or literature to cite?
Professional ethics had been an integral part of practice in medicine and dentistry for thousands years ago. The young professionals used to learn professional ethics from their mentors during informal training. The literature reveals that the structured and formal education of dentistry and medicine included only the core subjects in the curriculum because behavioural sciences were not considered as part of dentistry and medicine by that time. Today we find none of the courses have been included in the dental curriculum in different countries of the world. This question focuses to brain storm the group members and to seek their valuable input about the significance of professional ethics in dentistry. It is hoped the discussion will lead the administrators to modify dental curriculum.
Eric Racine, a bioethicist, notes: “Naturalism is a controversial stance [in bioethics] because it is customary to view ethics and bioethics as normative and prescriptive fields and therefore different from empirical sciences, which are descriptive and explicative. The reluctance to acknowledge naturalistic commitments, however, can impede methodological and empirical progress in bioethics” (2008, 98). Addendum to that:
"His [Seedhouse’s] belief that no distinction can be drawn between the ethical and empirical aspect of medicine is both wrong and dangerous Whether or not there is a fundamental metaphysical distinction between facts and values, in clinical practice one can and must distinguish the two dimensions…Failure to do so results in muddled thinking. Hume´s naturalistic fallacy is rife in medicine…[he] encourages the powerful body of opinion, which believes that medical ethics is just a matter of opinion…"(Toon 1995, 47).
I know Strong Naturalism, or bioethics as developed by Potter in 1970 doesn't have a good way to counteract a highly relativized medical ethic. Pragmatic Naturalism offers a slightly better model for medical ethics. But also falls short as it will marginalize weaker societal voices. “Thus, as Bellantoni notes, religious experience must, for pragmatic bioethics be at least discounted, if not fully discredited (2003).” (Tollefsen, Cherry, 2003, 541). Then finally, “[I]n the absence of something authoritative to guide moral choices, the phenomenon of moral assertion and argument becomes rather ominous. If moral assertion and argument are understood as oriented towards some standard by which it is to be measured as successful or deviant, then participants in the practice of moral assertion and argument can understand themselves in a common undertaking, aimed at resolving itself into the correct, or right answer. Where there is no such standard, by contrast, assertion and argument become more and more the mere expression of will, and the attempt to manipulate others into accepting one’s own personal dictates.” (540).
Is obtaining ethical clearance/approval essential/mandatory for case report, report of cases or case series? Must an ethical approval be sought and obtained prior to writing case report or case series?
I will be doing a project this summer with Planned Parenthood looking at barriers to cervical cancer screening among Latinos living in a Philadelphia suburb. Most of the folks in this area are recently migrated Mexicans. I have permission to verbally consent the folks who will be participating in focus groups (rather than a signed informed consent document as some folks may be undocumented and having their signature on a piece of paper may present some risk to them).
Thanks in advance.
I am also planning on conducting one-on-one interviews with participants, and will also be requesting that I be allowed to verbally consent these participants (for the same reasons listed above). I spoke with some of my IRB colleagues who suggested that I touch base with colleagues who do work with Latinos in the U.S. to see what has worked for them regarding informed consent. Do the people who work with Latinos (recent immigrants who may be undocumented and technically illegal) at your various institutions generally use signed informed consent documents with this population, or have you found verbal consent to be acceptable and preferable?
Please include experiences on how to obtain ethical approval and informed consent for research among sexual minorities (LGBTI) in a country where the practices are illegal. Thank you
The purpose of this question is to add examples of lack of integrity, respect, compassion, accountability, and other values towards patients and their families, in which staff physicians, residents, and students have been involved. A selection of these examples will be added to a paper concerning medical professionalism and values-based practice. Would anyone be willing to share their own experiences of such instances, or experiences of colleagues, friends, and/or relatives?
How can we investigate the effects of caffeine on performance of a balance task in children? Are there any considerations, ethical problems or health risks for caffeine usage in children?
I am planning to collect hair samples from patients for measurement of cortisol (up to a pencil thickness in diameter cut as close to the root as possible) but I am not sure how difficult it will be to get a young person to agree to this. Anyone who can comment on their experiences with hair sample collection will be much appreciated.
Trying to examine how Moral/ethical reasoning is used, if at all, when nursing students make prioritizing decisions regarding hand hygiene vs essential care activities. I think functional MRI would be excellent to see what neurological pathways are used during such decisions but I doubt it is in the budget.
As far as I'm concerned, case report doesn't require ethical approval and/or informed consent if researchers can protect the right to anonymity and confidentiality of the patient.
I searched and found that the authors usually don't need any informed consent or/and ethical approval for publishing their article(s) (or they didn't state that information?). Nevertheless, I also found some "outside" ones, they mentioned about informed consent in their article.
This is an example: http://www.jogc.com/abstracts/full/201309_CaseReport_2.pdf (The woman whose story is told in this case report has provided written consent for its publication.).
Do I miss something? Could you please give me a big picture about this?
It is well known as a principle of medical ethics, but there are other contexts as well, since it has to do with principlism and moral decision-making even within pluralistic environments. Nonmaleficence is directly related to beneficence and contributes to the spiritual dimension of health. The question is how many disciplines are really engaged ….
I am about to start a research regarding physician - physician relationship. Was not able to find any research. Most researchs are about physician alienation, workloads, salaries etc.. Those kind are not the ones I am looking for. Will be glad if anyone can notify me if there is any research...
Currently, I have been given the duty to perform an in depth series of interviews/oral histories with an elderly patient with severe Alzheimer's. The purpose of the interviews is to obtain historically significant details of a life/era which will shortly disappear from memory. However, the subjects condition is so severe that they regularly forget what year it is, let alone that they have agreed to a series of interviews. My question, can someone with severe Alzheimer's possess the capacity for 'informed consent'? Any literature/thoughts on the matter are highly appreciated.
The latest revelations about CIA torture methodologies demonstrates that medical doctors took part in what is euphemistically described as Enhanced Interrogation Techniques. How is it that an international doctrine prohibiting medical doctors from involvement in torture has failed in one of the countries that presided over the Nuremberg Trials?
Can we trust any nation that employs doctors in torture to simultaneously apply the principalist ethic Primum non Nocere in its hospitals and medical practice generally?
Should those 'medics' be identified and disbarred for life from medical practice?
Hello friends, I want to design my study on anthracosis, a chronic lung disease characterized by the deposit of coal dust in the lungs and by the formation of black nodules on the bronchioles, resulting in focal emphysema. My patient samples will be taken through bronchoscopy from lung tissue. But I wanted to ask how to provide control groups regarding medical ethics? How can I compare my results if I would not have the control negative group?
In one of my local shops works a young man who shows all clinical signs of anterior pituitary insufficiency. Should I tell him about his condition or would that be considered unethical?
For teaching, lecture, small group teaching, clinical demonstrations and laboratory exercises are used very effectively. Theory exam consisting of essay type questions, various type of MCQs are good tools for assessment. For practical exams, OSPE, OSCE Viva and practical performance are tools used for the purpose.
But for skills like communication, interpersonal skills, leadership qualities, research interest, working as team member etc, no significant emphasis is given and no tool is available to judge such abilities in a graduating student.
Smart drugs are usually referred to cognition-enhancing drugs which improve mental functions such as cognition, memory, intelligence, motivation, attention and/or concentration.
A New South Wales dentist has been charged with carrying out unauthorized surgeries on elderly patients
Given the various kinds of health care problems we face as a result of an aging and growing population, is it possible to address medical rationing concerns without, at some point, necessarily reducing such considerations to economic (i.e. basic supply and demand) questions? That is, given the reality that we live on a finite planet with finite resources, must basic economic considerations always be present when we make decisions that directly affect human life and human well-being within the context of our health care systems?
According to the Freedom of Information Act, American patients can access their health information upon their request. I wonder if there is a global consensus over this issue? Do other countries have a similar legislation?
In my country, doctors can refuse to show the patients their own information. They believe and say that the doctor and not the patient owns the patient's information. Is it legal? Is it ethical?
ps. By "owning the health information" I mean "the right to read, copy, or keep a copy of everything written in the patient's record".
We are collecting human saliva as an outcome measure as part of our study. I would like to know what all the important ethical issues are which may be involved in the study.
Thanks for the replies.
I'm facing two different questions.
(1) Are plants produced by conventional breeders' breeding processes (i.e. cross, select, etc), patentable? This is now before the EBA at the European Patent Office (I believe G-1/98 is wrong), and
(2) Does a method of diagnosis in medicine have to be of a disease condition, and does there have to be a cure available if suffering from the condition is diagnosed? (I believe G-1/04 is wrong). This is now the subject of an opposition.
On both, I have to put my case together in the next week or so. In neither case do I have a financial interest - I just want the law to get back on track.
Can anyone help? Is anyone willing to help? More particularly, are there any non-OB/GYN medics out there who would be willing to talk?
I would ask what is your experience about clinical trials submitted for approval to Research Ethics Committees/IRB regarding open-label extension studies to evaluate the long term safety and efficacy of a new drug. The parent phase 3 trial - randomized and controlled versus placebo - has been concluded. However the results have been not yet elaborated and therefore they are not known with respect to the efficacy before the extension study take place. Data related to safety can be instead indirectly derived.
Do you think that a REC/IRB should approve such extension study (without knowing the results regarding the efficacy of the parent phase 3 blinded trial)?
If yes which arguments could be given to sustain this opinion of RECs/IRBs?
Do you think that an open-label extension trial should be still considered as a valid research or only as a marketing purpose ?
Ethics is an important element in the field of medicine, and it is astonishing to note that is a constant decline over the period of years, it is a must to address this issue to preserve the field from further deterioration.
There is an increased requirement both in ethics and law for the preservation of patients's confidential information. The various theories underpinning ethics-Kantian, Consequentialism, Virtue ethics and Communitarianism uphold the need to maintain confidentiality to a different varying degree. Fidelity to the absolute need to preserve confidentiality is advocated by Kantian. This level of adherence is largely consistent with the Hippocratic Oath; although ancient, the Oath continues to provide an overarching umbrella on national and international codes of practice. The Oath contains succinct but strong statement as regards confidentiality. However, Hippocratic medicine was a one-one consultation without the involvement of other professionals; health insurance and electronic transmission of information. Information disclosure for the overall benefit of the society was almost unknown.
For example, migraine has multiple evidence based prophylactic treatments such as propenalol. Is it ethical to use a placebo arm in a migraine clinical trial?
In a case where a radiologist misses a lung cancer the only information he might have at the time is "patient has cough". Once the cancer is diagnosed and said patient sues the radiologist for negligence, does the patient's expert radiologist have more information when reviewing the original image? If so, surely there is hindsight bias which should deem the evidence unreliable.
How select order of authors in case where one person designs experiment (aim, goals, materials and methods), order chemicals/kits, select statistical tests to perform and prepare manuscript while the other run assays and statistical analysis. Is there a quantitative method/model to show what is the value of selecting kit versus running experiment with this kit?