1. Aim of the guidelines2. Principles of good practice3. Circumcision for medical purposes4. Non-therapeutic circumcision 4.1. The law 4.1.1. Summary: the law 4.2. Consent and refusal 4.2.1. Children’s own consent 4.2.2. Parents’ consent 4.2.3. Summary: consent and refusal 4.3. Best interests 4.3.1. Summary: best interests 4.4. Health issues 4.5. Standards 4.6. Facilities 4.7. Charging patients 4.8. Conscientious objection5. Useful addresses.

Recently, the Israel National Bioethics Council (INBC) issued recommendations permitting egg freezing to prevent both disease- and age-related fertility decline. The INBC report forms the basis of Israel's new policy, being one of the first countries to regulate and authorise egg freezing for what it considers to be non-medical (ie, social) uses. The ethical discussion in the INBC report is reviewed and compared with the scant ethical discourse in the academic literature on egg freezing as a means of preventing age-related (...) loss of fertility. We argue that both the INBC recommendations and the bioethical academic discourse on egg freezing are grounded in liberal ideology, which views technology as primarily enabling. Accordingly, they promote ‘individual autonomy’ as exercised through informed consent. Our study suggests that a relational approach to autonomy may be a more suitable model for considering women's choices about egg freezing. (shrink)

In Western industrialized countries, women report using health services, and certain medications, more often than do men. Often, analyses are based on data that exclude objective measures of morbidity and that come from cross-sectional surveys, which precludes the use of socioeconomic covariates that are endogenous to seeking care. Here, differences in objective cognitive and physical function, as well as differences in reporting on illness, propensity to seek care, and socioeconomic resources are expected to account for differences in care-seeking behaviour among (...) women and men. This model is applied to the question of medication use in Ismailia, Egypt, using two waves of survey data and in-home tests of physical function from 896 adults aged 50 years and older. The results show that women use medications more often than do men, and that differences between women and men in reported morbidity and disability, observed cognitive and physical function, and economic resources account for womens and men’s care-seeking behaviour in later life. (shrink)

There is substantial evidence that methylphenidate (MPH; Ritalin), is being used by healthy university students for non-medical motives such as the improvement of concentration, alertness, and academic performance. The scope and potential consequences of the non-medical use of MPH upon healthcare and society bring about many points of view.

New uses of preimplantation genetic diagnosis to screen embryos prior to transfer raise ethical, legal, and policy issues that deserve close attention. Extensions for medical purposes, such as to identify susceptibility genes, late onset disease, and human leukocyte antigen matching, are usually ethically acceptable. Whether embryo screening for gender, perfect pitch, or other non-medical characteristics are also acceptable depends upon the parental needs served and the harm posed to embryos, children, and society. Speculations about potential future uses of PGD should (...) not prevent otherwise acceptable current uses of PGD. (shrink)

Dem Personbegriff wird als Grundlage zur Bewertung bioethischer Konfliktfälle wie der Frage nach dem moralischen Status menschlicher Embryonen eine Schlüsselfunktion zugewiesen. Zugleich ist seine Verwendungsweise stark umstritten. Ein Konsens ist angesichts der hitzig geführten Debatten nicht in Aussicht. Die Wertepluralität spiegelt sich nicht zuletzt in der uneinheitlichen – und damit unbefriedigenden – deutschen Rechtslage wider. Angesichts der Dringlichkeit, die bioethische Debatte nach dem vorläufigen Scheitern des Personbegriffs intern aufzubrechen, diskutiert der vorliegende Beitrag, in wie fern Argumenttypen, die nicht unmittelbar bei (...) Statusfragen ansetzen – Stichworte sind hier "Gattungssolidarität", "Normschutzinteresse", "kulturelle Normen" und "relationaler Ansatz" – plausiblere und befriedigendere Lösungen erhoffen lassen. (shrink)

In their recently published target article, Bowman-Smart et al. (2023) summarize the ethical issues at play in both the case for and the case against using NIPT to screen for non-medical traits.The...

BackgroundPregnant people have been overlooked or excluded from clinical research, resulting in a lack of scientific knowledge on medication safety and efficacy during pregnancy. Thus far, both the opportunities to generate evidence-based knowledge beyond clinical trials and the role of pregnant people in changing their status quo have not been discussed. Some scholars have argued that for rare disease patients, for whom, just like pregnant people, a poor evidence base exists regarding treatments, solidarity has played an important role in (...) addressing the evidence gap. This paper explores whether and how the enactment of solidarity among pregnant people can be stimulated to help address the poor evidence base on medications used during pregnancy.MethodWe use the concept of solidarity formulated by Prainsack and Buyx and enrich their concept by providing an account for stimulating the enactment of solidarity. Then we apply this account to the case of pregnant people who use medication.ResultsSolidarity means enacted commitment on the part of an individual to assisting others with whom the person recognizes a similarity in a relevant respect. Although solidarity cannot be imposed, we argue that the empowerment of people is a crucial concept in understanding how solidarity can be stimulated. Empowerment in the context of pregnant people means creating awareness about their status quo, explaining how scientific research can help close the knowledge gap, and how pregnant people can themselves contribute. In particular, how pregnant people can contribute to the collection of health data to strengthen the evidence base for medications used during pregnancy.ConclusionsWe conclude that acting in solidarity can help change the status quo for pregnant people. Furthermore, we argue that the empowerment of pregnant people and other relevant stakeholders is a way to stimulate the enactment of solidarity. The process of empowerment starts by raising awareness about the lack of evidence on medications used during prengnacy and by explaining to pregnant people how they can contribute to changing the way knowledge is being generated by, for example, sharing data on the health effects of medications. (shrink)

DALLAS — With a friend videotaping, 27-yearold Christopher Lenzini of Dallas took a hit of Salvia divinorum, regarded as the world’s most potent hallucinogenic herb, and soon began to imagine, he said, that he was in a boat with little green men. Mr. Lenzini quickly collapsed to the floor and dissolved into convulsive laughter.

Porcine-derived medical products represent an effective solution for a wide range of human suffering, yet this may contradict Muslim and Jewish religious prohibitions against consuming pig. The present study evaluated the level to which Muslim and Jewish participants are knowledgeable about the conditions permitting porcine-based treatments and explored their attitudes toward the permissibility of these treatments. A questionnaire that presented fifteen medical uses of porcine-derived products was completed by 809 Muslims and 714 Jews. Neither Muslim nor Jewish participants are knowledgeable (...) about the religious rulings of their religions which permit the use of pig for life saving. Participants of both groups objected to the view that porcine-derived materials should be permitted. The findings imply that the attitude toward porcine-derived materials for medical use is contingent upon the knowledge or lack thereof that individuals have regarding the permissibility of such use. We offer useful recommendations to improve the informed consent process before conducting porcine-based treatments. (shrink)

Professor Robertson sketches an elegant framework for policy evaluation and regulation of the use of preimplantation genetic diagnosis for various medical, medical related, and non-medical purposes. In criticism of his position, I argue that the distinction between policy and ethics upon which his argument relies is highly unstable, and the approach taken to ethical evaluation of particular parental interests leaves open many issues which the policy approach would hope to exclude. In conclusion I argue that while his position ultimately fails, (...) the onus is on his critics to come up with a viable and satisfying alternative. (shrink)

Background: Community-based education (CBE) involves educating the head (cognitive), heart (affective), and the hand (practical) by utilizing tools that enable us to broaden and interrogate our value systems. This article reports on the use of virtue ethics (VE) theory for understanding the principles that create, maintain and sustain a socially accountable community placement programme for undergraduate medical students. Our research questions driving this secondary analysis were; what are the goods which are internal to the successful practice of CBE in medicine, (...) and what are the virtues that are likely to promote and sustain them? -/- Methods: We conducted a secondary theoretically informed thematic analysis of the primary data based on MacIntyre’s virtue ethics theory as the conceptual framework. -/- Results: Virtue ethics is an ethical approach that emphasizes the role of character and virtue in shaping moral behavior; when individuals engage in practices (such as CBE), goods internal to those practices (such as a collaborative attitude) strengthen the practices themselves, but also augment those individuals’ virtues, and that of their community (such as empathy). We identified several goods that are internal to the practice of CBE and accompanying virtues as important for the development, implementation and sustainability of a socially accountable community placement programme. A service-oriented mind-set, a deep understanding of community needs, a transformed mind, and a collaborative approach emerged as goods internal to the practice of a socially accountable CBE. The virtues needed to sustain the identified internal goods included empathy and compassion, connectedness, accountability, engagement [sustained relationship], cooperation, perseverance, and willingness to be an agent of change. -/- Conclusion: This study found that MacIntyre’s virtue ethics theory provided a useful theoretical lens for understanding the principles that create, maintain and sustain CBE practice. (shrink)

In 1866, six Inuits were taken to the United States for the purpose of serving as specimens to American scientists at the Natural History Museum. Shortly after their arrival in New York, four of them had died. One of the survivors returned to the Arctic, while the sixth, Minik, now alone, fought to make possible the return of the remains of his dead companions to their village. Since the latter were being exhibited, as was then often the case (and happens (...) even today in many museums), in order to offer visitors examples of the Inuk people, Minik protested in vain. In 1909 he returned to Greenland when the scientists denied that the remains of his friends still existed. Several years later, still pursuing the issue, he went back to the United States to take up the fight against the bureaucracy for the repatriation of the bodies. He died in the United States in 1918. It was only in 1993 that he won out and that the remains of the four were returned to the Arctic homeland. (shrink)

Even though medics in the present day may think that clinical pathology is derived from normal physiology, I argue here that this is not necessarily the case. Historically, physiology may have been derived from clinical pathology. After deriving physiological knowledge like this, medics can reverse the conceptual priority, to make believe that physiological knowledge is at the foundation of medical practice. This implies that supposedly objective physiological knowledge can be influenced by the evaluative judgements made to define practical concepts of (...) clinical pathology. I argue for this view using the history of the disease heart failure, drawing on an argument made by Georges Canguilhem. (shrink)

The upstream framework presented in public health and medicine considers health problems from a preventive perspective, seeking to understand and address the root causes of poor health. Medical-legal partnerships (MLPs) have demonstrated the value of this upstream framework in the practice of law and engage in upstream lawyering by utilizing systemic advocacy to address root causes of injustices and health inequities. This article explores upstreaming and its use by MLPs in reframing legal practice.

In the past ten years, there has been growing interest in and concern about protecting the privacy of personal medical information. Insofar as medical records increasingly are stored electronically, and electronic information can be shared easily and widely, there have been legislative efforts as well as scholarly analyses calling for greater privacy protections to ensure that patients can feel safe disclosing personal information to their health-care providers. At the same time, the volume of biomedical research conducted in this country continues (...) to grow. The budget of the National Institutes of Health, for example, was $20,298 million in 2001, having more than doubled from a budget of $9,218 million 10 years before. This growing body of research includes increased efforts to use stored medical records as a source of data for health services, epidemiologic, and clinical studies. (shrink)

In the past ten years, there has been growing interest in and concern about protecting the privacy of personal medical information. Insofar as medical records increasingly are stored electronically, and electronic information can be shared easily and widely, there have been legislative efforts as well as scholarly analyses calling for greater privacy protections to ensure that patients can feel safe disclosing personal information to their health-care providers. At the same time, the volume of biomedical research conducted in this country continues (...) to grow. The budget of the National Institutes of Health, for example, was $20,298 million in 2001, having more than doubled from a budget of $9,218 million 10 years before. This growing body of research includes increased efforts to use stored medical records as a source of data for health services, epidemiologic, and clinical studies. (shrink)

The objective of the paper is to implement and validate diagnosis in the medical field via refined neutrosophic fuzzy logic (RNFL). As such, we have proposed a Max-Min composition (MMC) method in RNFL. This method deals with the diagnosis under certain constraints like uncertainty and indeterminacy. Further, we have considered the diagnosis problems to validate the sensitivity analysis of the novel multi attribute decision-making technique. Finally, we gave the graphical representations and compared the obtained results with other existing measures in (...) refined neutrosophic fuzzy sets. (shrink)

With a global commitment to scaling up AIDS care and treatment in resource-poor settings for some of the most HIV-affected countries in Africa, availability of antiretroviral treatment is no longer the principal obstacle to expanding access to treatment. A shortage of trained healthcare personnel to initiate treatment and manage patients represents a more challenging barrier to offering life-saving treatment to all patients in need. Physician-centered treatment policies accentuate this challenge. Despite evidence that task shifting for nurse-centered AIDS patient care is (...) effective and can alleviate severe physician shortages that currently obstruct treatment scale-up, political commitment and policy action to support task shifting models of care has been slow to absent. In this paper we review the evidence in support of task shifting for AIDS treatment in Africa and argue that continued policy inaction amounts to unwarranted healthcare rationing and as such is ethically untenable. (shrink)

An issue in current animal welfare ethics is the use of animals in medical education. At stake is the conflict of pain and suffering of the animals vs. the benefit to the students. The educator's role is to balance these two concepts. If the animals do suffer, this has to be justified by clearly establishing the necessity of their use. Neither this justification nor the methods for making the decision are clear. Addressed in this discussion are the arguments for and (...) against animal use, alternatives, and proposals for the resolution of the controversy. (shrink)

Reflective capacity is integral to core healthcare professional practice competencies. Reflection plays a central role in teacher education as reflecting on teaching behaviours with critical analysis can potentially improve teaching practice. The humanities including narrative and the visual arts can serve as a valuable tool for fostering reflection. We conducted a multinational faculty development workshop aiming to enhance reflective capacity in medical educators by using a combination of abstract paintings and narratives. Twenty-three family physicians or physicians-in-training from 10 countries participated (...) in the workshop. Qualitative assessment of the workshop showed that the combined use of art and narrative was well received and perceived as contributing to the reflective exercise. Participants generally felt that viewing abstract paintings had facilitated a valuable mood transformation and prepared them emotionally for the reflective writing. Our analysis found that the following themes emerged from participants’ responses: narratives from different countries are similar; the use of art helped access feelings; viewing abstract paintings facilitated next steps; writing reflective narratives promoted examination of educational challenges, compassion for self and other, and building an action plan; and sharing of narrative was helpful for fostering active listening and appreciating multiple perspectives. Future research might include comparing outcomes for a group participating in arts–narrative-based workshops with those of a control group using only reflective narrative or in combination with figurative art, and implementing a combination of qualitative and quantitative methods of assessment. (shrink)

With the increased use of technology, the use of medical photography has also increased, especially for secondary purposes. Secondary use only results in a benefit for clinicians and is considered a one-way process. This, in turn, raises several potential ethical issues, despite the numerous benefits of medical photography. The descriptive cross-sectional study was conducted with 82 physicians who took medical photos, in Ankara, Turkey. The mean age of the participants was 44.7 years. Of the participants, 95.1% reported using their personal (...) mobile phones for photographing and 84.1% reported taking medical photos for “use in clinical trainings (clinical seminars, student and patient trainings, etc.)”. Among physicians who took photos for research purposes, 29.3% reported obtaining only verbal consent. In addition, 53.7% of physicians reported storing medical photos on their personal computers. It seems that there is no consensus among physicians regarding taking, storing, and using medical photos, and these results cause ethical problems. (shrink)

Despite medicine's achievements, medical errors and the difficulty of reproducing research prove medicine is far from perfect. This book provides a critical and historical analysis of medical reasoning that recognizes the constant need for certainty despite the enormous variety of disease, illness, symptoms, and behavior in patients. According to Erwin Montgomery, Jr., medicine depends on logic, balancing utility with certainty, and anticipating errors in judgment.

The standard approach to treatment decision making for incapacitated patients often fails to provide treatment consistent with the patient’s preferences and values and places significant stress on surrogate decision makers. These shortcomings provide compelling reason to search for methods to improve current practice. Shared decision making between surrogates and clinicians has important advantages, but it does not provide a way to determine patients’ treatment preferences. Hence, shared decision making leaves families with the stressful challenge of identifying the patient’s preferred treatment (...) option. To address this concern, the present paper proposes to incorporate the use of a “Patient Preference Predictor” (PPP) into the shared decision-making process between surrogates and clinicians. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual’s characteristics and information on what treatment preferences are correlated with these characteristics. Use of a PPP is likely to increase the chances that incapacitated patients are treated consistent with their preferences and values and might reduce the stress and burden on their surrogates. Including a PPP in the shared decision-making process therefore has the potential to realize important ethical goals for making treatment decisions for incapacitated patients. The present paper justifies this approach on conceptual and normative grounds. (shrink)

Inevitably a policy-oriented report on issues as complex and as rapidly changing as the medical and scientific uses of human tissue can achieve neither philosophical purity nor regulatory completeness. The council's strategy has been to begin with robust ethical principles, for which sound philosophical arguments can be given, which will (it is hoped) command widespread support. The council went on to argue for guidelines of sufficient, but not vapid, generality which could be of practical use to the various medical intermediaries, (...) professional and regulatory bodies and research ethics committees which will carry out the tasks of detailed regulation and of making decisions that affect uses of human tissue. The council's hope is that the recommendations of the report can be absorbed into regulatory and professional practice, and where needed into government policy. If they can, the increasing diversity of uses of human tissues need lead neither to overt nor to covert 'commercialisation of the human body', but will also not put unnecessary restrictions on advances in research and medical practice. (shrink)

After noting why the issue of the use of animals in medical education and research needs to be addressed, this article briefly reviews the historical positions on the role of animals in society and describes in more detail the current positions in the wide spectrum of positions regarding the role of animals in society. The spectrum ranges from the extremes of the animal exploitation position to the animal liberation position with several more moderate positions in between these two extremes. Then (...) the philosophical issue of the moral agency of animals is discussed in terms of an explication of the concept of rights and the concept of personhood. Further research is suggested concerning institutional policies regarding medical students who refuse to do physiology dog labs or other assignments which involve the suffering and/or death of animals. (shrink)

The Declaration of Geneva is one of the core documents of medical ethics. A revision process was started by the World Medical Association in 2016. The WMA has also used this occasion to examine how the Declaration of Geneva is used in countries throughout the world by conducting a survey of all WMA constituent members. The findings are highly important and raise urgent questions for the World Medical Association and its National Medical Associations : The Declaration of Geneva is only (...) rarely used as an oath text despite the fact that physicians’ oaths are generally widespread. This is not consistent with the intention and claim of the Declaration of Geneva. The article then discusses three questions. Should there be one single binding oath? Which organization should be responsible for such an oath? Which oath is the most obvious candidate? In a globalized world and despite all cultural diversity, the medical profession should have one core moral basis which is binding for physicians all over the world. The most obvious candidate for an oath incorporating this moral basis is the Declaration of Geneva. (shrink)

Description Logics are nowadays widely accepted as formalisms which provide reasoning facilities which allow us to discover inconsistencies in ontologies in an automatic fashion. Where ontologies are developed in modular fashion, they allow changes in one module to propogated through the system of ontologies automatically in a way which helps to maintain consistency and stability. For this feature to be utilized effectively, however, requires that domain ontologies be represented in a normalized form.

The AMA Council on Ethical and Judicial Affairs (CEJA) has written a position paper on how social medical use challenges medical professionalism. The report offers persuasive ethical and practical guidelines for nonclinical internet use, specifically for social networking.This commentary provides a framework from which to apply these guidelines, but adds that there may be important situations in which physicians are not able to act in accordance. The guidelines call for professional reporting of questionable online portrayals or behaviors, but this commentary (...) argues that this may be not only cumbersome to implement, but may violate aspects of constitutional rights. While online social networking may in many ways be a new application of old challenges, there may be other aspects that require novel approaches to medical professionalism. (shrink)

This paper conducts a comparative analysis of data governance mechanisms concerning the secondary use of health data in Taiwan and the European Union (EU). Both regions have adopted distinctive approaches and regulations for utilizing health data beyond primary care, encompassing areas such as medical research and healthcare system enhancement. Through an examination of these models, this study seeks to elucidate the strategies, frameworks, and legal structures employed by Taiwan and the EU to strike a delicate balance between the imperative of (...) data-driven healthcare innovation and the safeguarding of individual privacy rights. This paper examines and compares several key aspects of the secondary use of health data in Taiwan and the EU. These aspects include data governance frameworks, legal and regulatory frameworks, data access and sharing mechanisms, and privacy and security considerations. This comparative exploration offers invaluable insights into the evolving global landscape of health data governance. It provides a deeper understanding of the strategies implemented by these regions to harness the potential of health data while upholding the ethical and legal considerations surrounding its secondary use. The findings aim to inform best practices for responsible and effective health data utilization, particularly in the context of medical AI applications. (shrink)

As in other countries, the traditional doctor-patient relationship in the Japanese healthcare system has often been characterised as being of a paternalistic nature. However, in recent years there has been a gradual shift towards a more participatory-patient model in Japan. With advances in technology, the possibility to use digital technologies to improve patient interactions is growing and is in line with changing attitudes in the medical profession and society within Japan and elsewhere. The implementation of an online patient engagement platform (...) is being considered by the Myotonic Dystrophy Registry of Japan. The aim of this exploratory study was to understand patients’ views and attitudes to using digital tools in patient registries and engagement with medical research in Japan, prior to implementation of the digital platform. We conducted an exploratory, cross-sectional, self-completed questionnaire with a sample of myotonic dystrophy patients attending an Open Day at Osaka University, Japan. Patients were eligible for inclusion if they were 18 years or older, and were diagnosed with MD. A total of 68 patients and family members attended the Open Day and were invited to participate in the survey. Of those, 59 % submitted a completed questionnaire. The survey showed that the majority of patients felt that they were not receiving the information they wanted from their clinicians, which included recent medical research findings and opportunities to participate in clinical trials, and 88 % of patients indicated they would be willing to engage with digital technologies to receive relevant medical information. Patients also expressed an interest in having control over when and how they received this information, as well as being informed of how their data is used and shared with other researchers. Overall, the findings from this study suggest that there is scope to develop a digital platform to engage with patients so that they can receive information about medical care and research opportunities. While this study group is a small, self-selecting population, who suffer from a particular condition, the results suggest that there are interested populations within Japan that would appreciate enhanced communication and interaction with healthcare teams. (shrink)

Out of 288 Hong Kong cancer patients, 92.3% include themselves in decision-making, 71% prefer joint decision-making: with family, with doctor, with doctor plus family, with family minus doctor, and with doctor minus family. <5% want decision-making by “doctor-alone” and <1% desire decision-making by “family-alone”. Harmony, communication and responsibility are reasons for family participation. Most patients prefer “specialist” for information, followed by “family”, “friends”, and “GP”. Trust in doctors and prospects for controlling/curing disease are important factors in decision-making. Patients want to (...) participate and be listened to rather than make decisions. Doctors should not disclose information to family without patients’ permission, nor withhold information from patient [End Page 109] on family’s request. Only 25% of patients have discussed post-competent treatment with others and 7% have heard of Advance Directive ; 24% refuse to discuss it. After AD has been explained to them, 66% remain reluctant to sign one, preferring to leave oral instructions or appoint family as proxy decision-makers. The family’s decision-making role increases when patients become incompetent. The top reason for signing AD is to receive preferred post-competent treatments, and for not signing it, difficulty with making a prospective decision. The implications of these findings will be discussed. (shrink)

The use of informed consent for surgery or research has been widely studied; however, its use in other areas of clinical practice has received less attention. This study investigates how doctors and nurses understand informed consent in relation to the prescription and administration of medicines in secondary care. It uses a qualitative analysis of semi-structured in-depth interviews with 19 doctors and 6 nurses recruited from various specialties in a teaching hospital. The results indicate a striking gap between official and actual (...) standards of practice. Providing information, assuring adherence and communication about potential treatment harms were raised as key issues instead of the principal goals of informed consent. Rather than simply treating these findings as support for a 'deficit' account of professionalism, the paper concludes that we need a richer and more grounded account of exactly when hospital medication decisions need to be subjected to the highest standards of informed consent. (shrink)

Physicians who care for critically ill people with opioid use disorder frequently face medical, legal, and ethical questions related to the provision of life-saving medical care. We examine a complex medical case that illustrates these challenges in a person with relapsing injection drug use. We focus on a specific question: Is futility an appropriate and useful standard by which to determine provision of life-saving care to such individuals? If so, how should such determinations be made? If not, what alternative decisionmaking (...) framework exists? We determine that although futility has been historically utilized as a justification for withholding care in certain settings, it is not a useful standard to apply in cases involving people who use injection drugs for non-medical purposes. Instead, we are welladvised to explore each patient's situation in a holistic approach that includes the patient, family members, and care providers in the decision-making process. The scope of the problem illustrated demonstrates the urgent need to definitively improve outcomes in people who use injection drugs. Increasing access to high quality medication-assisted treatment and psychiatric care for individuals with opioid use disorder will help our patients achieve a sustained remission and allow us to reach this goal. (shrink)

El prodigioso desarrollo de la ciencia y la tecnología médicas tiene una vertiente negativa que se expresa en la crisis de la atención de salud y de la relación médico-paciente. Los cambios en dicha relación, la mayor especialización y las nuevas posibilidades de tecnologías médicas llevan a reflexionar sobre las consecuencias y los efectos a largo alcance desde el punto de vista ético. Se realizó una revisión bibliográfica utilizando la base de datos EBSCO para determinar cómo repercute el proceso tecnológico (...) en el declinar de la relación médico-paciente en la especialidad de Neurología. Además se revisaron las revistas de Ética y Bioética en su formato impreso de los últimos 10 años. El prodigioso desarrollo de la ciencia y la tecnología médicas tiene una vertiente negativa que se expresa en la crisis de la atención de salud y de la relación médico-paciente. Los cambios en dicha relación, la mayor especialización y las nuevas posibilidades de tecnologías médicas llevan a reflexionar sobre las consecuencias y los efectos a largo alcance desde el punto de vista ético. Se realizó una revisión bibliográfica utilizando la base de datos EBSCO para determinar cómo repercute el proceso tecnológico en el declinar de la relación médico-paciente en la especialidad de Neurología. Además se revisaron las revistas de Ética y Bioética en su formato impreso de los últimos 10 años. (shrink)

Medical-legal partnerships (MLPs) have the potential to address racial health disparities by improving the conditions that constitute the social determinants of health. In order to live up to this potential, these partnerships must intentionally incorporate seven core racial justice principles into their design and implementation. Otherwise, they are likely to replicate the systemic barriers that lead to racialized health disparities.

As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by the (...) patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured. (shrink)

The use of genome-wide association studies in medical research and the increased ability to share data give a new twist to some of the perennial ethical issues associated with genomic research. GWAS create particular challenges because they produce fine, detailed, genotype information at high resolution, and the results of more focused studies can potentially be used to determine genetic variation for a wide range of conditions and traits. The information from a GWA scan is derived from DNA that is a (...) powerful personal identifier, and can provide information not just on the individual, but also on the individual's relatives, related groups, and populations. Furthermore, it creates large amounts of individual-specific digital information that is easy to share across international borders. This paper provides an overview of some of the key ethical issues around GWAS: consent, feedback of results, privacy, and the governance of research. Many of the questions that lie ahead of us in terms of the next generation sequencing methods will have been foreshadowed by GWAS and the debates around ethical and policy issues that these have created. (shrink)