22 found

Year:

  1.  7
    Ethical Issues in Genomic Research: Proposing Guiding Principles Co-Produced with Stakeholders.D. Carrieri, L. Jackson, C. Bewshea, B. Prainsack, J. Mansfield, T. Ahmad, N. Hawkins & S. Kelly - 2018 - Clinical Ethics 13 (4):194-198.
    Ethical guidance for genomic research is increasingly sought and perceived to be necessary. Although there are pressing ethical issues in genomic research – concerning for example the recruitment of patients/participants; the process of taking consent; data sharing; and returning results to patients/participants – there is still limited useful guidance available for researchers/clinicians or for the research ethics committees who review such projects. This report outlines the ethical principles and guidance for genomic research co-produced with stakeholders during two workshops which took (...)
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  2.  1
    An Evaluation of Reporting of Consent Declines in Three High Impact Factor Journals.B. H. Figer, S. J. Thaker, M. Boob, N. J. Gogtay & U. M. Thatte - 2018 - Clinical Ethics 13 (4):189-193.
    BackgroundInformed consent confers upon participants the right to decline or accept participation in a study in equal measure. Consent declines can be used as a potential metric to assess the adequacy of the informed consent process. Limited literature is available on the reporting of consent declines in Clinical Research. We evaluated randomized controlled trials published in three high-impact factor journals for consent declines to assess the extent of exertion of autonomy by research participants.MethodsCONSORT flow charts in RCTs published in New (...)
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  3.  1
    General Practitioners’ Ethical Decision-Making: Does Being a Patient Themselves Make a Difference?Katherine Helen Hall, Jessica Michael, Chrystal Jaye & Jessica Young - 2018 - Clinical Ethics 13 (4):199-208.
    There is very little literature on the actual decision-making frameworks used by general practitioners with respect to ethical issues and virtually none on the impact of personal experiences of illness on this. This study aimed to investigate what these frameworks might be and if and how they were altered by doctors’ own illness experience. Twenty general practitioners were recruited, 10 having had a previous serious medical illness and 10 having no such history. They participated in a semi-structured interview, including case (...)
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  4.  2
    Are We Creating Ethical Dilemmas Where There Are None?Amy J. Howells - 2018 - Clinical Ethics 13 (4):220-224.
    This case study focuses on decision-making for minors who are permanently unconscious and dependent on life-sustaining therapies. Cases of this type often cause anguish and angst for health care providers and caregivers and can lead to mistrust, moral distress, and communication problems. After presenting a particular case, an ethical analysis is applied to determine whether there is an apparent course of action or an ethical dilemma. The ethical analysis focuses on the currently accepted guidance principle for surrogate decision-making for minors (...)
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  5.  3
    Ambiguity, Death Determination, and the Dead Donor Rule.Will Lyon - 2018 - Clinical Ethics 13 (4):165-171.
    The dead donor rule states that organ donors must be declared dead before any vital organs are removed. Recently, scholars and physicians have argued for the abandonment of the dead donor rule, based on the rule’s supposed connection with the concept of brain death, which they view as a conceptually unreliable definition of death. In this essay, I distinguish between methods of death determination and the question of whether or not the dead donor rule should be a guiding principle of (...)
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  6.  1
    The Zone of Parental Discretion and the Complexity of Paediatrics: A Response to Alderson.Rosalind McDougall, Lynn Gillam, Merle Spriggs & Clare Delany - 2018 - Clinical Ethics 13 (4):172-174.
    Alderson critiques our recent book on the basis that it overlooks children’s own views about their medical treatment. In this response, we discuss the complexity of the paediatric clinical context and the value of diverse approaches to investigating paediatric ethics. Our book focuses on a specific problem: entrenched disagreements between doctors and parents about a child’s medical treatment in the context of a paediatric hospital. As clinical ethicists, our research question arose from clinicians’ concerns in practice: What should a clinician (...)
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  7. Physicians and Caregivers Do Differ in Ethical Attitudes to Daily Clinical Practice.Patrik Kjærsdam Telléus, Dorte Møller Holdgaard & Birthe Thørring - 2018 - Clinical Ethics 13 (4):209-219.
    It is commonly assumed that there are differences in physicians’ and caregivers’ ethical attitudes towards clinical situations. The assumption is that the difference is driven by different values, views and judgements in specific situations. At Aalborg University Hospital, Denmark, we aimed to investigate these assumptions by conducting a large quantitative study. The study design, based on the Factorial Survey Method, was a carefully constructed survey with 50 questions designed to test which factors influenced the respondents’ ethical reasoning. The factors were (...)
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  8.  2
    Physicians’ Communication Patterns for Motivating Rectal Cancer Patients to Biomarker Research: Empirical Insights and Ethical Issues.Sabine Wöhlke, Julia Perry & Silke Schicktanz - 2018 - Clinical Ethics 13 (4):175-188.
    In clinical research – whether pharmaceutical, genetic or biomarker research – it is important to protect research participants’ autonomy and to ensure or strengthen their control over health-related decisions. Empirical–ethical studies have argued that both the ethical concept and the current legalistic practice of informed consent should be adapted to the complexity of the clinical environment. For this, a better understanding of recruitment, for which also the physician–patient relationship plays an important role, is needed.Our aim is to ethically reflect communication (...)
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  9.  20
    Autonomy, Trust and Ante-Mortem Interventions to Facilitate Organ Donation.Sarah-Jane Brown - 2018 - Clinical Ethics 13 (3):143-150.
    Over the last few years, policies have been introduced in the UK that identify and treat patients as potential organ donors before death. Patients incapacitated due to catastrophic brain injury may now undergo intensive ante-mortem interventions to improve the chances of successfully transplanting their organs into third parties after death. The most significant ethical and legal problem with these policies is that they are not based on the individual’s specific wishes in the circumstances. Policy-makers appear reluctant to inform potential registrants (...)
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  10.  2
    Recognizing Disparities in Health Care for Children with Special Health Care Needs.Christie Crump - 2018 - Clinical Ethics 13 (3):112-119.
    IntroductionThere is a significant disparity in the United States between the health care received by children with special health care needs versus physically healthy children.ObjectiveThe objective of the paper is to show that children with special needs receive less than adequate health care overall. This disparity affects the quality of life for these children and influences their ability to live their lives to their full potential.MethodsResearch was conducted by examining multiple studies with a focus on six major factors that play (...)
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  11.  2
    Error Trawling and Fringe Decision Competence: Ethical Hazards in Monitoring and Address Patient Decision Capacity in Clinical Practice.Thomas Hartvigsson, Christian Munthe & Gun Forsander - 2018 - Clinical Ethics 13 (3):126-136.
    This article addresses how health professionals should monitor and safeguard their patients’ ability to participate in making clinical decisions and making subsequent decisions regarding the implementation of their treatment plan. Patient participation in clinical decision-making is essential, e.g. in self-care, where patients are responsible for most ongoing care. We argue that one common, fact-oriented patient education strategy may in practice easily tend to take a destructive form that we call error trawling. Illustrating with empirical findings from a video study of (...)
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  12.  3
    Value-Impregnated Factual Claims May Undermine Medical Decision-Making.Niels Lynøe, Gert Helgesson & Niklas Juth - 2018 - Clinical Ethics 13 (3):151-158.
    Clinical decisions are expected to be based on factual evidence and official values derived from healthcare law and soft laws such as regulations and guidelines. But sometimes personal values instead influence clinical decisions. One way in which personal values may influence medical decision-making is by their affecting factual claims or assumptions made by healthcare providers. Such influence, which we call ‘value-impregnation,’ may be concealed to all concerned stakeholders. We suggest as a hypothesis that healthcare providers’ decision making is sometimes affected (...)
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  13.  4
    Opinions of Nurses on the Ethical Problems Encountered While Working as a Team in Intensive Care Units.Oya Ögenler, Ahmet Dağ, Havva Doğan, Talip Genç, Hürmüs Kuzgun, Tülay Çelik & Didem Derici Yıldırım - 2018 - Clinical Ethics 13 (3):120-125.
    BackgroundThe intensive care unit entails working as a team in rescuing patients from life-threatening conditions. The care being given by the team could also be done by nurses and other health professionals through the coordinated use of all medical practices.ObjectiveTo determine the opinion of nurses on the ethical problems they experienced while working as a team in the intensive care units of a university hospital.MethodThe descriptive research was conducted on nurses working in intensive care units. A 56-item data collection form (...)
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  14.  5
    Truth-Telling to a Cancer Patient About Poor Prognosis: A Clinical Case Report in Cross-Cultural Communication.Mohammad Razai - 2018 - Clinical Ethics 13 (3):159-164.
    Ethical principles are not mere abstract concepts of academic interest. They have to be applied by care providers in the real world under complex, challenging and often perplexing conditions. This paper discusses, through the case of an ethnic minority patient with metastasis of bowel cancer, the ethical dilemma of truth-telling and withholding information about poor prognosis. It highlights the complexities of applying ethical principles in a different cultural milieu, reflecting on different ethical frameworks and justifications. The paper also discusses some (...)
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  15.  5
    The Ethical Concerns of Seeking Consent From Critically Ill, Mechanically Ventilated Patients for Research – A Matter of Possessing Capacity or Surrogate Insight.Avelino C. Verceles & Waqas Bhatti - 2018 - Clinical Ethics 13 (3):107-111.
    Conducting clinical research on subjects admitted to intensive care units is challenging, as they frequently lack the capacity to provide informed consent due to multiple factors including intensive care unit acquired delirium, coma, the need for sedation, or underlying critical illness. However, the presence of one or more of these characteristics does not automatically designate a potential subject as lacking capacity to provide their own informed consent. We review the ethical issues involved in obtaining informed consent for medical research from (...)
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  16.  5
    Self-Report Measure as a Useful Tool to Identify Prenatal Substance Use and Predict Adverse Birth Outcomes.Yukiko Washio, Neal D. Goldstein, Richard Butler, Stephanie Rogers, David A. Paul, Mishka Terplan & Matthew K. Hoffman - 2018 - Clinical Ethics 13 (3):137-142.
    ObjectivesThe purpose of the current study was to examine whether a self-report measure identifies prenatal substance use and predicts resulting adverse birth outcomes in a large cohort using electronic medical records.MethodsPregnant patients who were admitted between 2014 and 2015 at Christiana Care Health System and delivered singleton birth were included in the analyses. Participant demographic information, pregnancy comorbidities, self-reported substance use, and birth outcomes were retrieved from electronic medical records. Detailed descriptive analyses of prenatal substance use were conducted, and logistic (...)
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  17.  1
    Remuneration in the United States and Mexico: Assessing the Level of Influence on Potential Clinical Research Participants About Their Decision to Participate in a Clinical Trial and the Risk of Fraud.Jose Flores-Figueroa, Ingrid Badillo, Gilberto Botello, Ursus Pacheco, Mercedes Paredes-Paredes & Suzan McGovern - 2018 - Clinical Ethics 13 (2):98-105.
    Monetary compensation given to study subjects in a clinical trial is an effective tool to increase overall study enrolment, nonetheless it may stimulate some participants to commit fraud and lie about their medical history.A survey-study in 684 Hispanic prospective subjects in Mexico and USA was conducted to evaluate if a high monetary compensation would encourage them to lie about their medical history. Almost half of the subjects considered participating in a clinical trial with no compensation. Younger male individuals were more (...)
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  18.  2
    Conscientious Objection: A Morally Insupportable Misuse of Authority.Arianne Shahvisi - 2018 - Clinical Ethics 13 (2):82-87.
    In this paper, I argue that the conscience clause around abortion provision in England, Scotland and Wales is inadequate for two reasons. First, the patient and doctor are differently situated with respect to social power. Doctors occupy a position of significant moral and epistemic authority with respect to their patients, who are vulnerable and relatively disempowered. Doctors are rightly required to disclose their conscientious objection, but given the positioning of the patient and doctor, the act of doing so exploits the (...)
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  19.  3
    Allowing Harm Because We Care: Self-Injury and Harm Minimisation.Patrick J. Sullivan - 2018 - Clinical Ethics 13 (2):88-97.
    Harm minimisation has been proposed as a means of supporting people who self-injure. When adopting this approach, rather than trying to stop self-injury immediately the person is allowed to injure safely whilst developing more appropriate ways of dealing with distress. The approach is controversial as the health care professional actively allows harm to occur. This paper will consider a specific objection to harm minimisation. That is, it is a misguided collaboration between the health care professional and the person who self-injures (...)
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  20.  10
    Love as a Core Value in Veterinary and Medical Practice: Towards a Humanimal Clinical Ethics?Ann Gallagher, Fraje Watson & Noel Fitzpatrick - 2018 - Clinical Ethics 13 (1):1-8.
    This article represents the outcome of a dialogue between a vet and a healthcare ethicist on the theme of ‘love’ in professional life. We focus on four types or varieties of love in relation to the professional care of humans and animals. We discuss the relevance of Fromm’s core elements of love and consider the implications of these for human and animal health care practice. We present and respond to five arguments that might be waged against embracing love as a (...)
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  21.  5
    Life-Sustaining Treatments in End-Stage Chronic Respiratory Failure: A Single-Centre Study.Jose Filipe da Purificacao Monteiro - 2018 - Clinical Ethics 13 (1):26-33.
    PurposeThe acute-on-chronic exacerbations of end-stage respiratory diseases often result in prolonged hospital stays, relating these events to ethical conflicts in the fields of medical futility and distributive justice. This study aimed to understand patients’ preferences for life-sustaining treatments when clinically stable and during regular follow-up visits, and to determine the factors that can influence these preferences.ProcedureThis was a prospective, observational, exploratory study using convenience sampling. Over a three-year period, the study enrolled 106 adult outpatients with end-stage pulmonary disease on long-term (...)
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  22.  7
    Testing Conscientious Objection by the Norm of Medicine.Toni C. Saad & Gregory Jackson - 2018 - Clinical Ethics 13 (1):9-16.
    Debate persists over the place of conscience in medicine. Some argue for the complete exclusion of conscientious objection, while others claim an absolute right of refusal. This paper proposes that claims of conscientious objection can and should be permitted if they concern kinds of actions which fall outside of the normative standard of medicine, which is the pursuit of health. Medical practice which meets this criterion we call medicine qua medicine. If conscientious refusal concerns something consonant with the health-restoring aims (...)
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