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Dear Colleagues,
A quick survey is underway to gather feedback from scholarly authors on their current research on COVID-19. This google form should take no longer than 3 minutes to complete. In appreciation of your time, we will donate $2 for each completed questionnaire for vaccination in low-income countries. And also, respondents will be rewarded with the option to enter a competition to win a $500 Amazon gift card (value in USD).
It would be great if you complete this 3-minute survey on your views. The survey will be open until 20th February, 2022 at 23:45 BST.
Click on the link below:
or copy and paste the following into your browser:
With thanks for your time and consideration.
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The best survey are those from reference organization like:
WHO
CDC
OIE
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Greetings
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?
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Dear Sir,
At first I am a retired surgeon. Then, to perioperative outcome a surgeon and lab are dealt, in therapy and research and both could be investigators.
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Some authors use their published article as reference in their new work without any scientific reason . They do this only for increasing of their citation.
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Hi, under terms and conditions based on research ethics can look in a good range
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While doing peripheral nerve block,do you inject dexamethasone intravenously or within the catheter, this is an ethical issue!
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Studies shows that both have almost similar efficiency. But on addition of dexamethasone in peripheral nerve block prolongation of motor block is observed....
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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?
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And how is it new medical situation only to man closest manifestation new historical situations in which was found humanity - ethics is a methodologically and objectively relatively short time, from the initial stage, new medical ethics transformed into integrative orientation science.
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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
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There exist towns, which are centers of dental medicine tourism, but you will see a high percentage of toothless people, due to rising prices for the locals.
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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?
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These rules of plagiarism are more than enough. Otherwise, we couldn't write anything new.
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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?
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It isn't the prescribers, it is the discharge planners who fail to send the appropriate information to the appropriate follow up agency.
I often have to call the in-patient hospital and ask someone to tell me what meds were ordered, if a LAI was given/when/dose, copy of labs, etc. It is really sad. All I seem to get is papers with "how to quit smoking", "what to do if suicidal", etc. instead of information, that I need.
We need a universal EHR so we can tap into labs, medications, consults from specialists, test results, etc. Nothing is integrated and it is sad. Also, REASON for admission.
When I work out-patient ER Psych, I write a fast letter letting the ER and Psych provider know my concerns, copy of my brief assessment, and petition/cert.
I hope your research has an impact.
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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?
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The question becomes the degree to which national economies are affected by disease burdens when the nature of that burden is unclear because of different standards of reportage. Similarly, if you mean data on supply--for instance ventilators or certain medications--if unreliable the limits of those records will result in a lack of resources at treatment sites. The effect on the economy in the first will involve the cost of unanticipated disease incidence or the expansion of diseases (for example in epidemic cases) that might have been anticipated, with better records, and thus better prepared for. Similarly, if it's about supply of equipments or pharmaceuticals the shortages that result from inconsistent records will mean either higher costs for emergency purchase or higher mortality/morbidity in the absence of necessary equipment or pharmaceuticals. If the numbers are sufficient--for instance provision of vaccines, or undercounting of those with critical conditions requiring extensive medication, the effect may be broadly economic as well as clnical.
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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?
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Yes.
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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?
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Bottom line in the case of competent patients and competent physicians:
1. It is the patient’s body/mild/soul; and
2. the physician’s duty to care, treat, and educate the patient to the extent the patient is willing and will allow such contacts.
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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!!
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Yaa! Thanks Sir.
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I am trying to organize a research question based on Gorgi's descriptive phenomenology.Has any one used this method in Medical Ethics or Healthcare sciences in general?
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The following papers may further help:
  • Ebrahimi, Z., Wilhelmson, K., Moore, C. D. and Jakobsson, A. (2012) Frail elders' experiences with and perceptions of health, Qualitative health research, 22, 11, pp. 1513-1523.
  • Lee, P. A., Greenfield, G. and Pappas, Y. (2018) Patients' perception of using telehealth for type 2 diabetes management: a phenomenological study, BMC health services research, 18, 1, pp. 549-558.
  • Mayoh, J., Todres, L. and Bond, C. S. (2011) Exploring the online health information seeking experiences of older adults, Indo-Pacific Journal of Phenomenology, 11, 2, pp. 1-13.
  • Rodriguez, A. and Smith, J. (2018) Phenomenology as a healthcare research method, Evidence-based nursing, 21, 4, pp. 96-98.
  • Whiting, L. (2001) Analysis of phenomenological data : personal reflections on Giorgi's method, Nurse Researcher, 9, 2, pp. 60-74.
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Establishment of considerably acceptable Doctor-Patient Relationship is vita. Does it have any potential to prevent negligence or filing of negligence suit?
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The focus of doctor-patient relationship is comprehensive and sometimes hailed as being humanistic and the spiritual dimension in medicine.It is a very important area most physicians especially in the developing world dont pay attention to.
Too often our patients become cases and no longer people, a collection of symptoms, rather human beings with real life stories and real feelings.
having said this,
A few models exist;
The Activity-Passivity model
The Mutual participation model
The reverse-guidance
Others
These models are not rigid, it depends on the scenario, though it is reverse-guidance is never recommended for doctors.
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Please explain the rationale for your view.
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There is no one answer to this question. Specific uses must be considered, since a scientific find that cures a horrible disease does not carry the same moral weight as things like testing makeup brands on animals. Further, the moral weights given to animal rights vs. scientific discovery differ by moral universe. In the ethics of more biocentric religions, such as Buddhism, one often finds moral dismay regarding the uses of animals in science, like one sees in the work of the current Dalai Lama. The rights of animals not to suffer outweigh considerations of human benefit. Within religious universes that tend more toward anthropocentric outlooks, such as with ethics stemming from the Abrahamic religions, harming animals in science for human benefit remains more tolerated and pursued. Of course, things are not neat and tidy regarding this, since one still may find a Buddhist who supports experimentation on animals and a Christian who does not. You might check out Tom Regan's classic work, <Animal Sacrifices: Religious Perspectives on the Use of Animals in Science>, and the work that he, Jeff Masson, Lisa Kemmerer, and others have done since. You might also look into the essays found in <A Communion of Subjects>.
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Why or why not?
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Killing for mercy is difficult to differentiate from murder; for killing is synonymous with taking life or homicidal. The difference could be if there is an authentic intention to take the life of a fellow who suffers and for mercy it ends this suffering.
On the other hand, in murder, an intention to harm is inferred, to deliberately kill with a perverse intention; where whoever is killed is not suffering and could suffer at the time of the murder.
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What are the best papers, in your mind, regarding justification of the use of empirical research in medical ethics? And the best papers decribing the methodological variety?
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Maybe this could help you :
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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.
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Generally, turning off life support leads to death which most legal system consider a crime and unethical especially where there is no advance directive or it is done without the consent of the patient, same could be done safely with a court order though
as in the case of Nancy Cruzan and Quin Ann.
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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?
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There is a fine line between making a conscious, clear-thinking decision to suicide and having an illness interfere w/one's ability to think & make good choices.  How do we determine which group the suicidal patient falls into?  And in making the determination, are we playing God?
There is one school of thought that believes since we put down (euthanize) sick or injured animals to relieve their untreatable pain, we should allow the same choice to people.  At the same time, there is the opposing school of thought that believes there is a difference between euthanizing a companion animal and a human being.  Who is right?  And if someone is right, then it stands to reason the other is wrong.
I've evaluated people who have come into the emergency room after a suicide attempt.  There seems to be an equal number who tell me the attempt has changed their minds, they don't really want to die, those who continue their suicidal ideation, & those who say they don't want to die but see no other way of making the pain stop.  Additionally, there are those whose behavior can be said to be a slow form of suicide--alcoholics, addicts, self-mutilation, and many others.  Then there are those who are determined to suicide and no matter the intervention, will eventually succeed as they eliminate all of the ways that did not work.
The question of treating people with suicidal ideation must be answered on several different levels.  There is the physical treatment of reversing whatever they have done in the attempt.  The mental treatment, which may involve medication to treat a mood disorder.  And the spiritual dimension, which is where the provider must be clear within themselves about what they believe with the recognition that the client may not hold the same beliefs.  And there is the idea that people have the right to be wrong.  
Do we treat people with suicidal thoughts?  I think that we must even while we recognize their right to be wrong and  we perceive the person with unconditional positive regard. 
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  • 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.
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Dear Dennis:
Thank you for your response.
I am an old hat at research publication after learning the ropes over 3 decades. The matter you provided was very thoughtful.
The issue I raised was a little different. What do you do if the Editor or the reviewer is heavily biased or prejudiced, based on their interpretation of the science involved? 
Vinod
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Which journals of radiology and nuclear medicine  allow free submission of articles.
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It is a good idea to check the list of “Radiology, Nuclear medicine, and Imaging” journals in the SCImago Journal & Country Rank (SJR) website (the link is attached) powered by Scopus® database.
Open access journals are indicated by an “open padlock” image next to the journal’s name. Most of these open access journals require submission and/or article processing charge(s). This fact, however, is not universal since there are two models of open access journals, i.e. (1) the journal-pays model (publishing costs are borne by the journal owner); (2) the author-pays model (publishing costs are paid by the author or his/her organization). You may check if the open access journal follows the author-pays model in the “instruction for authors” section on the journal’s webpage.
On the other hand, majority of closed access journals do not require any fee paid by the author, and the publishing costs are borne by the readers. In this platform, you have usually the option to pay the costs and free up your article if you would like to make your article most likely to be used and cited. It is also the chance that your article becomes open access based on the Editor’s choice in some closed access journals.
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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.
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Timely disposal and backlog can be used as a performance indicators for Consumer Courts
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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?
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It is always astonishing to discover how much has been written about so little.
Cf. from another discussion on Autonomous Vehicles:  "Academics and the press have referred to this type of mathematical solution to ethical decision-making as the ‘moral algorithm’.”. 
No, it is not a ‘moral algorithm’ at all, and I am rather troubled that such terminology should be used, or have begun to gain any currency or respect in the professional ICT community.  If such a mathematical solution is anything new, it is an ‘expert systems algorithm’ (and actually such algorithms are not new at all – for example, recall the Alvey Programme which first gave UK Government support to IKBS, AI and Expert Systems developments way back in the 1980s).
AI does not have morals.  To discuss Autonomous Vehicle development in terms of humans writing (self-learning) code to program a ‘moral algorithm’ is an absurdity.  That is the whole point of the existential challenge facing humanity with the coming of the Machine Species.  Asimov’s ‘3 Laws’ are already a quaint literary/fictional anachronism (as he himself subsequently acknowledged; and as most AI specialists simply do not see the need for).
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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. 
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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.
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A very interesting question Mustafa. First question i have as an organisational ethnographer  is about the gatekeepers in this participant observation project. If you are running the project with your own students, it might be very hard for you and your student researchers to be covert about the research. Organisational settings are not very amenable to be covert,  especially when you have a chart or notebook and take notes in unexpected settings.   Secondly, keeping it purely an observation based research without having triangulation interviews with your research subjects about different dimensions the observational patterns  would undermine the credibility  of research- your answers to your research question will be incomplete without informal and formal conversations with your research subjects. After all, the idea of participant observation is to understand how any domain of life is constituted and reconstituted by actions, perceptions, and attitudes of research subjects. Relying only on observations to capture these dimensions is not only very difficult (e.g.,, is it possible to capture attitudes and perception just by observation) but also  might lead to biases such as research imposing his/her own frames on the meaning of research subjects' actions. There are however some recent pieces on the merits of covert research, see below. This maybe useful for you too. 
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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.
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there are many theories of ethics...find one which suit your understanding and capabilities then you can apply it in your social works....
I am a muslim so that we have our own code of ethics. however it does not mean we  reject other theories...
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It is a small 2 physician clinic, only details discussed are past acceptance of FP methods,
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It  is an evaluation of the care provided at the facility and will be used to improve the care offered. Clearance has been taken from the individual facility since the data is from a single facility. 
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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.
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Thanks Orla, for this information.
The subject of medically induced trauma is indeed difficult. No one wants to touch it. Yet, my professional and personal experiences convince me that trauma or DESNOS can result from people's reactions to 'ordinary medical procedures' as well. Apparently, patients of orthopaedic surgeries are particularly at risk because they must often be forcibly immobilised. The patient experiences it from the inside - often without words or a forum to express their suffering. I've found an article about medical errors and how one doctor and his patient dealt with it (see below).
'Medically induced trauma and compassion: Reflections from the sharp end of care' F. van Pelt https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943694/
In the aftermath, the doctor and his patient each created a support structure. His supports professionals in the situation he found himself in (see http://qualitysafety.bmj.com/content/qhc/17/4/249.full.pdf); hers supports patients (see http://www.mitss.org/aboutus_faq.html). 
Contact for the doctor:
F van Pelt, Department of
Anesthesiology, Perioperative
and Pain Medicine, Brigham and
Women’s Hospital, 75 Francis
Street, Boston, MA 02115, USA;
If anyone has other information on this area please let me know.
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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? 
For example, 
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? 
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Marceline has basically answered your second question. To answer your first there are many codes and guidelines that cover social science health research. If you follow these you should have no problem with either a competent REC/IRB and in gaining approval. That will also help with subsequent publication of your work.
Any of the major professional associations offer suitable codes or guidelines. Try also:
Although the professional associations do not always directly address health or biomedical issues, you will find that they generally apply to research done in any field.
You might also find my book useful. Follow the checklist and there are links to the various codes:
Ethical Decision Making in Social Research
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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....
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In the last few months, Russia has slightly increased the number of aggressive behaviour of patients against doctors and medical staff. In particular, over the past three months there have been 1 fatal for the doctor and about 5 that are associated with causing sustainable damage to health. This is due to the large number of holidays, bringing many out of balance. Unfortunately, many patients do not have the will to occupy themselves with something sensible and positive from the point of view of socially useful work on weekends and public holidays.
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What do you do if a patient comes into your office for a surgical procedure then ask you before you begin you should be tested for HIV or hepatitis B?
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I will just suggest a possible avenue of thought (emphatically not an answer) from the perspective of rights-based moral theories (there could be radically different answers from the perspective of other moral theories; and of course, there is no unique, "known to be true" rights-based theory either):
It depends on what you believe about employer/employee moral (not legal) rights and duties.  Do you believe that employers have the moral right to impose drug, smoking, HIV tests etc. on their employees?  In that case, your patient (i.e., your employer) has the same moral rights.  The fact that most legal systems do not encode such patients' rights might just be the shortcoming of those legal systems.
I would not worry much about the trust issue unless you have a deeply-founded relationship with the patient (delivered 3 generations of the family, etc. :) ). Trust (as opposed to "acting as if you trust") is supervenient on a genuine relationship.  I am 60 years old, and I have spent less time with my doctor(s) than I have with some barbers in Turkey.  And I know more about the personality of the latter than I do about my doctor(s).  I don't take offense when a physician shows that she does not trust me, by charging before providing service.  I understand that she does not know me enough to make that kind of judgment.
Good luck
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I need to know the newest theory on the making of customary international law
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I have the article Non-refoulement as Custom and Jus Cogens? Putting the Prohibition to the Test - Springer.. if you don't have it yet, please send me your email
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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.
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No (although there is not a consensus among scientists or lawyers).
First, unethical research should, to the best of our ability, be banned.
Second, persons who do unethical research have an agenda (eg, Nazi doctors like Mengele, Rüdin, others used data to bolster their a priori assumptions re: race and the superiority of "Aryans"--they were not interested in proving or not proving the null hypothesis).
Third, how generalizeable is data on tortured incarcerated persecuted hopeless concentration camp prisoners to the general population? It is not.
So unethical research by biased "researchers" on a persecuted subgroup is wrong and confounded by selection bias.
Lewis A Opler, MD, PhD
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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?
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Obviously, in life and death situations it would be unethical not to treat the child, irrespectively of whether the parents can be consulted. The less urgent the child needs care, however, the more problematic it is to treat the child without first consulting the parents. 
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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.
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A written account is a doctors report of his visit or his consult. Because it is written by the doctor the report might not be completely objective. An audio/video record seems to be more objective, but by using just cerain parts of the conversation to formulate a complaint or in a law suit the truth might be twisted. Both the record or the written account can be used by the patient. The written account can be used by the doctor in defense of a criminal charge or complaint.
In the Netherlands it is prohibited to record a conversation without consent. Laws may differ in other countries, but some kind of privacy protection (not only for patients) is established in many countries.
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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.
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I am impressed with the quality of many of the responses. And I agree fully that ethics are important and should be taught. But I am also concerned about the deteriorating quality with which pharmacokinetics has been taught over the last 40 years. Pharmacists are no longer as capable as they iused to be with regard to carefully individualized drug therapy. So - called "basic pharmacokinetics" simply repeats the obsolete practice of using linear regression on the logs of the serum concentrations.This is a total waste of time, in my view. We need to teach useful clinical PK based not on NONMEM etc., for exaample, but rather on the clearly more capable methods of nonparametric modeling and maaximally precise multiple model dosage design. And this is just as easily taught as Sawchuk Zaske. Then there is the interacting multiple model approach to acutely ill and unstable patients in the ICU. The ITAG5 workshop in Lyon this April is devoted to this, with a combination of MD's and pharmactsts. Go to www.lapk.org and click around. This is what can be done by both MD's and Pharm D's together. This, I would respectfully suggest, is what can be done NOW in pharmacy education. I am attaching one paper giving an overview of this.
Very best regards to all,
Roger Jelliffe
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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?
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Murugavel,
Most of the ethics literature on placebos focuses on their use in research. This is probably because their use in clinical practice appears contrary to the accepted medical ethics principles of veracity, autonomy, and informed consent. But the fact that placebos can have a beneficent effect, makes their use in practice an interesting and meaningful ethical question. Most of the limited literature on this question then seems to say "yes" or "maybe" with some severe restrictions, like, as in its research use, letting pts. know the possibility of a placebo being used. Here are a couple articles that tackle the problem:
Lichtenberg, Heresco-Levy, and Nitzan, "The Ethics of the Placebo in Clinical Practice." The Journal of Medical Ethics, 2004, 30, 551-554.
Miller and Colloca, "The Legitimacy of Placebo Treatments in Clinical Practice: Evidence and Ethics." The American Journal of Bioethics, 2009, 9(12).
In addition, this may be of limited or only theoretical relevance to you, but the American Medical Association has published a statement on this question:
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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.
Any suggestions?
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You might like to have a look at an old chapter 'Doctors' handmaidens: the legal contribution' from January 1992 in book: Health, Health Regulation and the Law, Publisher: Dartmouth Publishing Co., Aldershot, Editors: McVeigh S & Wheeler S, pp.141-168. The text is here on ResearchGate. The legal details are outdated, but the issues seem current.
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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.
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Thanking you madam I am also facing the same situation.Still we have to cross the traffic.It may be difficult task but another way try to resolve it as per your own talent. No one can challenge if  you having good evidence and better information.You have to be solid and very bold in your study is very important. Even i have faced in my ethical clearance meeting related to 99m TC ECD SPECT for infants.
Love and thanking you once again.
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Hi,
Am currently part of a study on health research ethics, and would love to have materials on ethics and genomics in the african context
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Hello,
May I suggest you to read the following articles?
The H3Africa policy framework: negotiating fairness in genomics http://dx.doi.org/10.1016/j.tig.2014.11.004
and
Ethical issues in the export, storage and reuse of
human biological samples in biomedical research:
perspectives of key stakeholders in Ghana and
Kenya
Happy reading!
Odile
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Hi, can someone please provide reasons as to why the current system of patenting of pharmaceutical products are ethically sustainable?
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In my view, 'sustainable' refers to a process that can be carried out indefinitely, that is, there is an unlimited supply of raw materials and energy to supply the process. So the phrase 'ethically sustainable' is interesting because ethics doesn't usually deal with such quantities. It refers more to the social judgements that guide the behaviour of individuals and societies. So, are you asking whether societies are simply prepared to allow the present system of pharmaceutical patenting to continue? I  would imagine that the system has been created by governments on the advice of the pharmaceutical companies, so I would be very surprised if they were to turn round and suddenly admit that their systems were unethical and needed changing.
But governments are in a bind, too, because it can cost the best part of a $1billion to  research, develop, test, refine, retest and finally qualify some drug for human use. Who's going to pay for this unless the company has an effective patent? Should the taxpayer simply underwrite ALL pharmaceutical developments past a certain stage in return for a much more limited patent system? It's not an easy issue!
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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. 
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Depending on the quality of the care a person receives, he or she may transform from being 'involuntary' to being 'voluntary'. It doesn't always happen, but many times it does, so it is always worth trying to try one's best to do whatever evidence has shown to be most effective for the majority.
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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.
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A good surgeon is simply a good physician, like any good internist, cardiologist, nephrologist, psychiatrist and so on........The core character traits are the same regardless of the discipline one chooses to practice. Stating the obvious, each discipline will have their own respective manual skills demanded by their respective discipline. In my law practice surgeons or "cutting doctors" have the highest number of malpractice cases, which will beg the question "is it the different character traits" that brings about the increase number? To be candid about, as an internist I continue to be awed by  good surgeons.
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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?
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You would need to specify more on the proposed legislation to say for sure, but medical marihuana is doubtful in itself in clinical setting, as there is very little evidence of efficacy for any condition. I presume the move is an attempt at shifting the public from herbalist formulation to something of pharmaceutical quality. The only thing I can say here is that any intervention should be judged on available evidence of safety and efficacy. So far cannabis-derived products are mostly based on pre-scientific faith in "the natural" remedies. I don't think this is acceptable as it is not acceptable with other medical interventions. As commenters above said if we are talking of research protocol it needs to be judged on it's merits.
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If anyone could refer any insightful articles on this topic it would be greatly appreciated!
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Hi - late answer, I know, but in case you are still interested in this issue, there was a recent case that might be of interest to you in the UK called F v F (MMR Vaccine).   I wrote on this and have uploaded a publication on it (also if you google it you'll find a link to the BBC coverage of the case and an overview of the general issues in law).
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I'm looking for some reviews, experiences,... about the ethical issues of resuscitation. Who can help me out?
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The ERC 2015 Guidelines for Resuscitation  have a chapter devoted to ethics: "The Ethics of Resuscitation and End-of-Life Decisions". It will be published on October 2015 in the Journal Resuscitation
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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.
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Dear Dr. Miftachul,
Thank you very much for your kind response to the question. The paper highlights ethics of social media. On the other hand question asks importance of professional ethics employed by dentists and dental practice. I think you will give your valued opinion in this dimension too.
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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).
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If I understand the question - I would say, methodological naturalism (understood as exclusion of the supernatural from consideration) has done very little to relativize bioethics.  One might think that, by abandoning talk of God in bioethical work, one cannot ground universal, objective moral claims.  But secular ethics has developed a plethora of resources in an attempt do just that. Consider, for example, Rawlsian demands for publically-accessible reasons justifying (basic) laws, which exclude supernatural claims that some will reject.  Rawlsians hardly end up being relativists at the normative level (whatever their metaethical commitments) - they ground universal moral claims using the entirely natural procedure of reflective equilibrium.  And principalism, which for better or worse is dominant in practical bioethics, is also entirely naturalistic while eschewing relativism.  Secular bioethics is very interested indeed in justifying objective moral claims without appeal to God.
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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?
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most journals do not ask for ethical approval however patient consent is definitely required. 
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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?
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Great issue. I have had several colleagues researching in areas such as drug use or teenagers living on the street  where verbal consent is used.  My colleagues claim that the paper consent is more appropriate as anything  written is regarded with suspicion. In addition, the consent is a 'rolling process' in the sense that should the person disclose something that the researcher feels may be compromising, then the consent is renewed , allowing the interviewee to revoke such disclosure . This is particularly important if they name someone else involved in an illegal activity. 
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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
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The key is to outreach the population. In Guatemala, we're building an experience to increase coverage in MSM. Is important to mention that in Guatemala isn't an unfreandly legal system for LGBTI, however stigma is a major concern in our context.
The close work with a community based organization, and promotion through social network as Facebook, Twitter; and "gay apps" such as Grindr and Manhunt; are an important strategy to contact MSM. 
Also, Mpowerment model 
Here are some publications that may help you:
Goldenberg T, McDougal JS, Sullivan SP, Stekler DJ, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR mHealth uHealth [Internet].
Young SD, Szekeres G, Coates T. The Relationship between Online Social Networking and Sexual Risk Behaviors among Men Who Have Sex with Men (MSM). PLoS One. 2013;8(5):15–8.
Usher D, Frye V, Shinnick J, Greene E, Baez E, Benitez J, et al. Recruitment by a Geospatial Networking Application for Research and Practice: The New York City Experience. JAIDS J Acquir Immune Defic Syndr [Internet]. 2014;67(5).
Suthar AB, Ford N, Bachanas PJ, Wong VJ, Rajan JS, Saltzman AK, et al. Towards Universal Voluntary HIV Testing and Counselling: A Systematic Review and Meta-Analysis of Community-Based Approaches. PLoS Med. 2013;10(8).
Kegeles SM, Hays RB, Coates TJ. The Mpowerment project: A community-level HIV prevention intervention for young gay men. Am J Public Health. 1996;86(8 I):1129–36.
Kahn JG, Kegeles SM, Hays R, Beltzer N. Cost-Effectiveness of the Mpowerment Project, a Community-Level Intervention for Young Gay Men. JAIDS J Acquir Immune Defic Syndr [Internet]. 2001;27(5)
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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?
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Dear Carlos, if you want medical practitioner transgressions specifically of varying severity, then here in New Zealand the Health and Disability Commissioner (the body that deals with complaints) shares it's decisions and the reasoning behind them openly online. There might be something of interest there. Best of Luck! Emma
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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?   
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Dear Saeed: what is the purpose of the study? Children are a vulnerable population in research, and ethics principles state that carrying a research in children should consider: 1) the aim of the research should be to address a children's problem, and to give answers that could improve their health. 2) if the research can be done in adult population, should it be that way, in first place. 3) no risk or minimal risk  to the research subjects is the golden standard. Being a member of a Bioethics Committee at a Pediatrics' setting I would like to know these answers first, in order to consider the protocol.
Cheers. Susie.
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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.
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Thanks Taciane, we have had positive experiences as well with our first few study recruits. Apologies I did not see your comment earlier. Kind regards, Mazen
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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. 
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i have a  article about this matter . in this case may be help you. plz go to my profile.  pooriya vali, he is one of the personal creat sport moral.
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Dear everybody, 
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?
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You should acquire informed consent by those involved in the study, even if you believe that the anonymity and confidentiality of the patients is being ensured. Research on anonymised data sets have shown that by combining the anonymised data with other open information sources, then deanonymisation is often possible. This risk may be especially large if you talk about a rare disease. It is therefore better to be on the safe side and acquire informed consent by the patients, which they most often will accept doing.
Here is one example of a paper on deanonymising anonymised users:
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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 ….
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Dear colleagues,
Thank you for your concern! We are aware that a supposed universal moral consensus does not always translate into universal moral praxis. Relatively new disciplines have been developed on the basis of this guiding concept, for ex. food safety, work safety, environmental protection, biostatistics (especially predictive modeling), behavioral research, quality management, pharmacovigilance, social economy, etc…. Even modern philosophy recognizes that “primum non nocere” concept supports human dignity. Obviously, nonmaleficence is more relevant in medicine because of short-term measurable consequences.
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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...
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No sé si esta es la perspectiva que le puede interesar, mi libro
 " Médico y paciente". El lado humano de la medicina". Ed Duxelm, 2006
Pertenece al campo de la fiosofía y ética de antigua como sustrato o fundamento de la medicina Antigua Hipocrática ya que  contiene las dimensiones  antropológicas y éticas  de cuidado, socorro protección servicio y respeto imprescindible en la adecuada relación médico-paciente.
Se pone de relieve  que el éxito terapéutico depende en buena parte de la capacidad de comunicación  y colaboración  entre el enfermo y el médico.
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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.
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Hi Nicholas,
Informed Consent is absolutely necessary in research involving humans unless the institutional review board finds allows the otherwise on basis of very careful decision. The only reason for not taking informed consent before an intervention or a research is an emergency. In case of patients with serious cognitive disabilities where they might not be able to give consent, a consent from the 'custodian' (a person or an institution) is necessary. Additionally, assent is necessary is children below 18 years who have developed acceptable cognitive abilities.
In your case, I find no reason why the patient may not be able to understand and give consent. Further, the patient has the freedom to opt out of the study whenever he feels like. The consent is never a 'binding agreement'. If your patient, therefore, feels that he does not want to continue, he is free to leave (regardless of his consent or dementia).
I am attaching links of some literature that will be useful to you.
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I'm drafting a proposal on perception and behavior of Peri-operative nurses towards Surgical Conscience..
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Dear Danjuma Aliyu,
Some papers:
The paradox of conscientious objection and the anemic concept of 'conscience': downplaying the role of moral integrity in health care. Giubilini A.                     Kennedy Inst Ethics J. 2014 Jun;24(2):159-85.
Nurse can't ignore her conscience. Milne K. Nurs N Z. 2013 Oct;19(9):3.
Reducing surgical nurses' aseptic practice-related stress.
Aholaakko TK. J Clin Nurs. 2011 Dec;20(23-24):3339-50.
Conscientious objection and induced abortion in Europe.
Heino A, Gissler M, Apter D, Fiala C. Eur J Contracept Reprod Health Care. 2013 Aug;18(4):231-3.
Conscientious objection and the nurse: a right or a privilege?
McHale JV. Br J Nurs. 2009 Nov 12-25;18(20):1262-3.
Surgical Conscience: Still Pertinent
Nancy J. Girard;  Aorn 2007 Volume 86, Issue 1, Pages 13–14   
Compassion and responsibility in surgical care. Torjuul K, Elstad I, Sørlie V. Nurs Ethics. 2007 Jul;14(4):522-34.
Nursing is different than medicine: ethical difficulties in the process of care in surgical unitsKirsti Torjuul MSc RNT and
Venke Sorlie; Journal of Advanced Nursing
Volume 56, Issue 4, pages 404–413, November 2006
Surgical Conscience: A guiding light in the modern OR          http://ortoday.com/surgical-conscience-a-guiding-light-in-the-modern-or/
Surgical conscience, intuitive skills are essential for perioperative nurses
Carol J. Applegeet
Kenya Nurs J. 1986 Dec;14(2):23-8.
Surgical conscience and the true believer: ethical problems for the operating theatre nurse.
Rohe J.
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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? 
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The big conundrum with the Nuremberg Doctrine is that it banned the use of data obtained in Nazi concentration camp experiments entirely.  It is well known that the majority of so called scientific research in the camps was of no scientific value whatsoever and was the product of fantasist race theory but some was of obvious use.
The US and Soviet space programmes relied heavily not only on Nazi rocket engineers but on some of the medical experiments carried out on unwilling prisoners. The rationale behind the Nuremberg Doctrine was that to use this data would in someway justify the appalling brutality that was used to obtain it.
Returning to torture and the involvement of medics there is no justification for torture at all and no exception to the international law that the US and the Allies imposed on the World in 1945.  Torture is not even efficient and many people give information under torture that is false simply to make the pain stop.  Many tortured actually do not know anything anyway.  
In the GDR sleep deprivation was the most common form of what is euphemistically described as EIT.  The victim was sat in a chair facing an interrogator and kept awake for many hours under constant interrogation.  The interrogators changed shifts but the interrogation continued until the victim gave the information the Stasi wanted.  Incidentally it did not need to be true, only what they wanted to hear which was usually the denouncing of others.
No one was able to resist for long and this technique can't be beaten by training.  The problem with it is that many victims were so disorientated and confused by the lack of sleep that their answers were useless in terms of information of real value.  Any psychiatrist or clinical psychologist could have told the torturers that.
The psychiatrists, psychologists and other medics involved in torture or EIT or whatever other euphemism is used for brutality are not only condoning it but facilitating it.  Those doctors are themselves torturers and there is no convenient excuse for it.  
The Nazi doctors at Auschwitz and other facilities in the 3rd Reich believed what they were doing was for the good of humanity too.  The KGB and the MfS believed that they were protecting socialism for the good of mankind.  Its always easy to find an excuse but impossible to justify one.
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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?
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Recruitment of volunteers may be very ethical but a control group thus formed may be quite inadequate in the framework of a particular study. I still believe that one should, first of all,  think about characteristics which must be equal in the groups to be compared.. As to the ethics, the first question is whether the new  knowlege you hope to obtain is worth invasive tests at all.
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Medical Errors.
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Evidence of disobedience to Lex Artis rules, and the duty to take care over the medical procedures, shows up as the main cause of iatrogenic disease, and medical errors. Mainly regarding to the informed consent of the patient over the procedure recommended by physician. It´s obvious that a high quality medical act demand high quality means to provide medical services in the better patterns possible.  The great need for health care by patients, and the less numbers of physicians able to take specific action to engage treatment is one of the main causes of medical errors, also we fell that the inobservance of the recommended technical procedures on specific cases may increase the level of occurrences of medical errors and iatrogenic diseases. A good reference for this matter is the study publish by Dr. Barbara Starfield on Journal of American Medical Association about Iatrogenic Diseases.  It´s also important to take a look above physicians behavior on duty, that might be guide through ethics e technical references.  
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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?
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As a person with a professional medical education and degree, I would think that unless there are some extraordinary circumstances you have not mentioned, you have a moral obligation to advise this young man to see a practicing physician.  I do not know how serious a condition anterior pituitary insufficiency is, but if the consequences of not being properly diagnosed and treated are serious then your moral obligation to counsel the young man, give him the information needed to be correctly diagnosed, and to suggest an appropriate medical group, hospital, or health center seems very clear.  If you sense that the young man is averse to medical treatment, then you ought to carry out your obligation with delicacy.
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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.   
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Thanks for prompt reply. 
No doubt, formative and summative  evaluation is very effective and gives good results. But patient counselling is one aspect to be assessed. What about other skills like  research abilities,leadership qualities, punctuality, confidence, motivation,self-reliance etc. How can we evaluate them in formative evaluation.  
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Smart drugs are usually referred to cognition-enhancing drugs which improve mental functions such as cognition, memory, intelligence, motivation, attention and/or concentration.
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Dear Dick,
I do agree that making what can be momentous decisions for students' future program opportunities on what are probably statistically insignificant GPA differences, is neither wise nor fair.  Thank you for your clarification.  I now have a better understanding of the point you were making. I still maintain that fair academic competition has a place in the educational process, but the decision making you describe, based on insignificant GPA differences, is not really competition at all, and certainly not beneficial to students or to the society at large.
Having lived in Europe for 12 years, I saw something similar to what you mention in the German system of public education, although I also understand that changes have been made more recently to modify the "testing as destiny" model which has deep historical roots, to some degree, in all Germanic educational systems.  
Albert Einstein, of course a German himself,  was, early in his career, denied a university position in theoretical physics, and was relegated to the Swiss patent office based on less than stellar performance in several courses at the Zurich Technical University, as well as due to unenthusiastic recommendation letters from several professors there. Not until well after a series of brilliant papers (including special theory of relativity) in 1905, did his scientific career begin to blossom.
Best, David
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A New South Wales dentist has been charged with carrying out unauthorized surgeries on elderly patients
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His medical license should be cancelled along with fine as penalty.
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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?
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Pat
John Rawls' Theory of Justice is a masterpiece of liberal theory regarding distribution and there are literally hundreds of articles about his theory. Start there!  Relative to bioethics Beauchamp and Childdress' Bioethics is a great text for getting you up to speed on this big issue. A more conservative approach can be found in Englehardt's Foundations  of Bioethics.  These three will give you a great sense of how large the problem is .
Most hospital emergency rooms deal with this on a triage basis and tend toward taking care of seriously ill patients on a "first come first served basis"  This is basically a lottery approach to distribution but looks really bad if you do not adequately fund the ER or if your patient population is so large and so ill that the concept of "minimally  decent" becomes totally unworkable.  
Try to narrow your focus to a question like "how do you define minimally decent funding for an ER" in a poor part of a city.  You will find that defining "minimally decent" is brutally difficult. 
Try taking a look at a technological approach to distribution. In this arena you eliminate the human providers and replace them with data gatherers  connected to IBM's Watson.  Watson can diagnose better than most docs and he can monitor ongoing care better than most nurses and he can manage millions of patients at one time.   It feels a little inhumane but inhumane care is better than no care and subsequent death. This might meet our budget requirements.
Good luck
Brendan
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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".
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Increasingly, hospitals give patients electronic access to parts of the electronic medical record, i.e. the physician's conclusions at the end of a visit, new test results etc. In addition,  patients  can request access to all the evaluation and treatment information that pertains to them. They are also the ones that can pass this information on to others, something that the physician or the hospital cannot do (with some legally defined exceptions). All this is part of the notion that there is an ethical obligation to empower the patients and to respect their right to control what happens to them . Thus, the ethical issue may be one of patient empowerment rather than "ownership".
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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.
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hi Kesava! From a bioethical approach I'll be interesting in knowing what the study is for, who are the research subjects, if you are going to gain some scientific information that can be of use for the research subjects, whether you'll be keeping the samples and if so for what purpose, if you are going to work with identified,  anonimous,  anonimized or double coded samples. All this information should be in the protocol and in the informed consent.
Cheers. Susie.
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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?
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The current legal status of these issues at the European Patent Office is as follows.
(1) Are plants produced by conventional breeders' breeding processes (i.e. cross, select, etc), patentable?
According to Art. 53(b) of the European Patent Convention, plant or animal varieties or essentially biological processes for the production of plants or animals are excluded from patentability. In the past, there has been questions on what exactly is means by "essentially biological processes". This resulted in two referrals to the Enlarged Board of Appeal of the European Patent Office (G 2/07 and G 1/08) which then made the following statements.
1. A non-microbiological process for the production of plants which contains or consists of the steps of sexually crossing the whole genomes of plants and of subsequently selecting plants is in principle excluded from patentability as being "essentially biological" within the meaning of Art. 53(b) EPC.
2. Such a process does not escape the exclusion of Art. 53(b) EPC merely because it contains, as a further step or as part of any of the steps of crossing and selection, a step of a technical nature which serves to enable or assist the performance of the steps of sexually crossing the whole genomes of plants or of subsequently selecting plants.
3. If, however, such a process contains within the steps of sexually crossing and selecting an additional step of a technical nature, which step by itself introduces a trait into the genome or modifies a trait in the genome of the plant produced, so that the introduction or modification of that trait is not the result of the mixing of the genes of the plants chosen for sexual crossing, then the process is not excluded from patentability under Art. 53(b) EPC.
4. In the context of examining whether such a process is excluded from patentability as being "essentially biological" within the meaning of Art. 53(b) EPC, it is not relevant whether a step of a technical nature is a new or known measure, whether it is trivial or a fundamental alteration of a known process, whether it does or could occur in nature or whether the essence of the invention lies in it.
Following this case law, one cannot patent plants that are produced by conventoinal breeders' breeding processes. However, one can protect such plants using the breeder's right.
Unfortunately, this is not the end of my answer, since meanwhile new questions have been referred to the Enlarged Board of Appeal in G 2/12 and G 2/13. These questions are the following.
G 2/12:
1. Can the exclusion of essentially biological processes for the production of plants in Art. 53(b) EPC have a negative effect on the allowability of a product claim directed to plants or plant material such as a fruit?
2. In particular, is a claim directed to plants or plant material other than a plant variety allowable even if the only method available at the filing date for generating the claimed subject-matter is an essentially biological process for the production of plants disclosed in the patent application?
3. Is it of relevance in the context of questions 1 and 2 that the protection conferred by the product claim encompasses the generation of the claimed product by means of an essentially biological process for the production of plants excluded as such under Art. 53(b) EPC?
G 2/13:
1. Can the exclusion of essentially biological processes for the production of plants in Art. 53(b) EPC have a negative effect on the allowability of a product claim directed to plants or plant material such as plant parts?
2. In particular:
(a) Is a product-by-process claim directed to plants or plant material other than a plant variety allowable if its process features define an essentially biological process for the production of plants?
(b) Is a claim directed to plants or plant material other than a plant variety allowable even if the only method available at the filing date for generating the claimed subject-matter is an essentially biological process for the production of plants disclosed in the patent application?
3. Is it of relevance in the context of questions 1 and 2 that the protection conferred by the product claim encompasses the generation of the claimed product by means of an essentially biological process for the production of plants excluded as such under Art. 53(b) EPC?
Hence, your question can currently not be answered completely. We will have to wait and see as to what the Enlarged Board of Appeal will decide in these matters.
(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?
The answer to this question is simpler. For patentability, methods of diagnosis are similar regardless the technical field. Hence, it does not matter whether the method of diagnosis is in the medical field or not. Even if it is in the medical field, the diagnosis does not necessarily have to deal with a disease condition, as long as something is diagnosed. Also, a cure does not have to be available. For example, a method for diagnosing whether a certain individual suffers from ebola may be patentable, even though currently no cure exists.
There is case law on methods of diagnosis however, since Art. 53(c) EPC states that methods for treatment of the human body by surgery or therapy and diagnostic methods practised on the human body or animal body are excluded from patentability. With respect to diagnostic methods under Art. 53(c) EPC the Enlarged Board of Appeal listed the following requirements in G 1/04.
1. In order that the subject-matter of a claim relating to a diagnostic method practised on the human or animal body falls under the prohibition of Art. 52(4) EPC [now Art. 53(c)], the claim is to include the features relating to:
(i) the diagnosis for curative purposes stricto sensu representing the deductive medical or veterinary decision phase as a purely intellectual exercise,
(ii) the preceding steps which are constitutive for making that diagnosis, and
(iii) the specific interactions with the human or animal body which occur when carrying those out among these preceding steps which are of a technical nature.
2. Whether or not a method is a diagnostic method within the meaning of Art. 52(4) EPC may neither depend on the participation of a medical or veterinary practitioner, by being present or by bearing the responsibility, nor on the fact that all method steps can also, or only, be practised by medical or technical support staff, the patient himself or herself or an automated system. Moreover, no distinction is to be made in this context between essential method steps having diagnostic character and non-essential method steps lacking it.
3. In a diagnostic method under Art. 52(4) EPC, the method steps of a technical nature belonging to the preceding steps which are constitutive for making the diagnosis for curative purposes stricto sensu must satisfy the criterion "practised on the human or animal body".
4. Art. 52(4) EPC does not require a specific type and intensity of interaction with the human or animal body; a preceding step of a technical nature thus satisfies the criterion "practised on the human or animal body" if its performance implies any interaction with the human or animal body, necessitating the presence of the latter.
I hope this information is helpful to you.
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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 ?
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Is it appropriate to have a placebo control in a open label study? Its very obvious that participants receiving placebo are already aware of that hence the study design cannot control the placebo effect.    
With regard to above explanation I doubt about the REC approval of parent phase 3 trial itself hence I feel that further extension studies should not be approved by REC without confirming and critically evaluating the results of parent phase 3 trial.
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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. 
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There is definitely a decline in ethics in the field of Medicine and in the society as a whole. We read the chapter on ethics and its almost restricted only to the books. The factors would be the greed to become rich. money always becomes a priority nowadays than moral values. Being ethical, following strict moral values doesn't make you rich and sometimes doesn't allow you to progress in the profession too. So, its like you are forced to be become unethical in the present generation which is so competitive. There can be times where you are forced to be unethical since the top management is.
However, those who don't follow ethics maybe rich and be successful but the conscience will haunt them forever. “There are two types of people in this world, good and bad. The good sleep better, but the bad seem to enjoy the waking hours much more.” ― Woody Allen. Ultimately peace of mind is very important for a person than loads of money. “There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.”
― Elie Wiesel
I hope we all start to think from our heart than from our brain and be ethical and provide quality service in the field of medicine and be a good person and not cheat your conscience.
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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.
 
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Apart from the challenges to maintain confidentiality in health information, there are other challenges. One big challenge is the difficulty in integrating medical records of different service providers to maintain continuity of patient records. Furthermore, within health care services, a lot of the time , electronic record maintenance can lead to problems such as duplication of records and inefficient management of databases such that it becomes difficult to have clean data at finger tips necessary for health care provision. Maintenance of Unique Medical Record Number (UMRN) or similar for each patient record is crucial but may often be overlooked. Retention of records and proper storage of hardcopy of medical records is another common problem faced by many health care institutions. It really depends on the institution, health system and the country as there are many variations.
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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?
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Placebos are often used in randomized double blind cancer "add-on" trials designed for drug approvals, where the investigational  arm gets standard of care plus the new agent, and the control arm gets standard of care plus placebo.  
Sometimes patients perceive the term "placebo' to mean "no treatment" when in fact the use of placebos does not preclude standard of care.  In cancer, at least in the US, it is not considered ethical to not treat a patient if a standard of care treatment exists.  But there are situations where "no treatment" actually is standard of care, for example, following adjuvant treatment in early breast cancer.  In this case, it would be ethical to do a trial comparing "no treatment" (i.e. standard of care) to an intervention that might lower the risk of recurrence--for example extending hormonal treatment beyond 5 years vs. placebo.  
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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.
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Ideally a medical expert witness would have only the information available to the treating physician at the time of consultation. However, in reality the outcome is always known when a malpractice case is launched, and experts for both sides know the outcome. An ethical witness should restrict consideration to those facts that either were known or should have been known to the treating physician at the time of the consultation when rendering an opinion about the reasonableness of a certain action or inaction. However, hindsight bias can of course be instrumental, and often is influential. It is the job of defense counsel to try to put this into perspective for the decisionmaker. However, in a jury system of jurisprudence, almost all expert testimony is admitted, and the lay jury is expected to be able to interpret testimony and determine fact from bias. In the U.S. no special qualifications exist for medical experts in many jurisdictions, for example a technician or nurse can testify against a physician as an expert and vice versa, a specialist can testify for/against a generalist. The judge will make the determination as to expertise on a case by case basis. Expert witnesses in most jurisdictions do not even need to prove that they have had the training or experience (for example a medical degree or specialty training) that they claim to use in arriving at an opinion. Nor do they need to defend their sometimes astronomical fees. Again it is up to opposing counsel to expose any misinformation, and for the jury to judge. It's a poorly regulated system.
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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?
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