This paper examines the historical rise of both cardiopulmonary resuscitation and the do-not-resuscitate order and the wisdom of their continuing status in U.S. hospital practice and policy. The practice of universal presumed consent to CPR and the resulting DNR policy are the products of a particular time and were responses to particular problems. In order to keep the excesses of technology in check, the DNR policies emerged as a response to the in-hospital universal presumed consent to CPR. We live with (...) this historical concretion, which seems to perpetuate a false culture that the patient's wishes must be followed. The authors are critical of the current U.S. climate, where CPR and DNR are viewed as two among a panoply of patient choices, and point to UK practice as an alternative. They conclude that physicians in the United States should radically rethink approaches to CPR and DNR. (shrink)
The Médecins Sans Frontières ethics review board has been solicited in an unprecedented way to provide advice and review research protocols in an ‘emergency’ mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, ranging from epidemiological research, to behavioural research, infectivity studies and clinical trials with investigational products at early development stages. This article examines the MSF ERB’s experience addressing issues related to both the process of review and substantive ethical issues (...) in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms. Having noticed different standards across ethics committees, we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the ‘optimal’ ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process. (shrink)
Médecins Sans Frontières is one of the world’s leading humanitarian medical organizations. The increased emphasis in MSF on research led to the creation of an ethics review board in 2001. The ERB has encouraged innovation in the review of proposals and the interaction between the ERB and the organization. This has led to some of the advances in ethics governance described in this paper.
Two sample populations, one refugee and one resident, were studied. The frequencies of consanguineous marriages came out to be 49·8% and 55·4%, respectively, for the refugees and the residents. Caste endogamy was dominant both in the residents and the refugees. The mean coefficient of inbreeding was calculated to be 0·0303 for the refugee population and 0·0332 for the resident population samples. First cousin marriage was the dominant type of marriage in both samples; fathers daughter (FBD) marriage was more frequent among (...) the refugees while mothers daughter (MBD) marriage was more frequent among the residents. Education has no decreasing effect on the incidence of consanguineous marriages. A significant difference in the pattern of marriages in the refugees is observed after the Saur Revolution of 1979. (shrink)
The purpose of this work is to elaborate an empirically grounded mathematical model of the magnitude of consequences component of “moral intensity” (Jones, Academy of Management Review 16 (2),366, 1991) that can be used to evaluate different ethical situations. The model is built using the analytical hierarchy process (AHP) (Saaty, The Analytic Hierarchy Process , 1980) and empirical data from the legal profession. One contribution of our work is that it illustrates how AHP can be applied in the field of (...) ethics. Following a review of the literature, we discuss the development of the model. We then illustrate how the model can be used to rank-order three well-known ethical reasoning cases in terms of the magnitude of consequences. The work concludes with implications for theory, practice, and future research. Specifically we discuss how this work extends the previous work by Collins ( Journal of Business Ethics 8 , 1, 1989) regarding the nature of harm variable. We also discuss the contribution this work makes in the development of ethical scenarios used to test hypotheses in the field of business ethics. Finally, we discuss how the model can be used for after-action review, contribute to organizational learning, train employees in ethical reasoning, and aid in the design and development of decision support systems that support ethical reasoning. (shrink)
The purpose of this work is to elaborate an empirically grounded mathematical model of the magnitude of consequences component of "moral intensity", 366, 1991) that can be used to evaluate different ethical situations. The model is built using the analytical hierarchy process and empirical data from the legal profession. One contribution of our work is that it illustrates how AHP can be applied in the field of ethics. Following a review of the literature, we discuss the development of the model. (...) We then illustrate how the model can be used to rank-order three well-known ethical reasoning cases in terms of the magnitude of consequences. The work concludes with implications for theory, practice, and future research. Specifically we discuss how this work extends the previous work by Collins regarding the nature harm variable. We also discuss the contribution this work makes in the development of ethical scenarios used to test hypotheses in the field of business ethics. Finally, we discuss how the model can be used for after-action review, contribute to organizational learning, train employees in ethical reasoning, and aid in the design and development of decision support systems that support ethical reasoning. (shrink)
Recruiting nurses from other countries is a long-standing practice. In recent years many countries in the developed world have more frequently recruited nurses from the developing world, causing an imbalance in the health services in often already impoverished countries. Despite guidelines and promises by developed countries that the practice should cease, it has largely failed to do so. A consortium of authors from countries that have experienced significant nurse poaching consider the ethical aspects behind this continuing practice.
Introduction Future HIV vaccine efficacy trials with adolescents will need to ensure that participants comprehend study concepts in order to confer true informed assent. A Hepatitis B vaccine trial with adolescents offers valuable opportunity to test youth understanding of vaccine trial requirements in general. Methods Youth reviewed a simplified assent form with study investigators and then completed a comprehension questionnaire. Once enrolled, all youth were tested for HIV and confirmed to be HIV-negative. Results 123 youth completed the questionnaire (mean age=15 (...) years; 63% male; 70% Hispanic). Overall, only 69 (56%) youth answered all six questions correctly. Conclusions Youth enrolled in a Hepatitis B vaccine trial demonstrated variable comprehension of the study design and various methodological concepts, such as treatment group masking. (shrink)
Using patients as teaching tools raise many ethical issues like informed consent, privacy, confidentiality and beneficence. The current study highlights issues on respecting patient’s choice and acquiring informed consent with its spirit rather than as mere formality. The study was conducted in out-patient department of The Kidney Center Postgraduate Training Institute Karachi Pakistan in May 2008 to July 2008. All patients who had come for the first time to see the author were included in the study. The said study explored (...) the willingness of patients to allow medical students to be present during history taking and physical examination by the consultant. There were 18 male and 03 female patients. Age ranging from 22 to 73 years with mean age of 53.5 ± 13.7 years. There were total of 21 patient–students encounters out of which two encounters were with male students only and two with female students only. So in 17 Patient–students encounters, students of both genders were present. All patients permitted history taking in the presence of medical students except one who had a history of extramarital sexual contact and signs and symptoms suggestive of sexually transmitted disease. Of the male patients 50% (9/18) did not allow intimate examination before medical students. Out of these nine patients who refused, four consented earlier but when enquired again about their true willingness, they expressed their preference not to have medical students in the room while undergoing digital rectal and external genital examinations. Physicians need to develop sensitivity to acquire informed consent in its true essence rather than just as a formality by exploring actual willingness of the patient. One should refrain from being judgmental on the basis of gender, looks, religion or norms. (shrink)
We explore aspects of what it means to be a ‘moderate’ Muslim in Britain. Based on interviews with 21 Muslim intellectuals or those active in public or community debates , we examine what these Muslims think about multiculturalism. While there is a variety of views, the respondents are promulticulturalism as long as it includes faith as a dimension of ‘difference’, something they believe has only belatedly, tentatively and slowly happened in Britain. Most of the other aspects of the multicultural ideal (...) and criticisms of contemporary British practice, such as the distinction between mutual respect and tolerance, the importance of non-separateness and dialogue, the need for transformative change on the part of the minorities as well as the majority, seem to be similar to the views held by non-Muslim British multiculturalists. Yet some believe that the Qur’an, Islam and Muslim history are powerful sources of multi-culturalism and represent a form superior to any that has been developed elsewhere or is on offer in the contemporary West. This view was held by those who are experts in using and engaging with contemporary Western discourses rather than those who are authorities in interpreting Islamic texts, and so they, like most others in the group could be said to be a relatively new kind of Muslim public figure. (shrink)
This paper seeks to examine the constitutional and legal implications of Islam in Malaysia with a focus on fundamental liberties and particular reference to freedom of religion; conversion of non-Muslim minors to Islam; Hudud law, `Islamic dress,' offenses against precepts of Islam; and, women, Heads of State and Islam. These areas are chosen as a result of cases in civil courts contesting fundamental liberties, and debate in the public domain. The problems which have surfaced revolve around the following concerns: subjecting (...) non-Muslims to Islamic law or principles; subjecting Muslims and non-Muslims to an Islamic fiqh principle contrary to humanistic principles; the problems of a dual legal system with attempts to demarcate jurisdiction but at the cost of fundamental liberties; and, the relevance of the ``Islamic state" vs. ``secular state" issue in rights adjudication. The courts appear to be in a conundrum when dealing with these cases, and this suggests a conflict in the application of Islamic and civil laws. These issues are not new; they have persisted for a long time. Recently court decisions have aroused a public perception that the problem is one of Islam versus the non-Muslim. This tends to be perceived in ethnic terms as well, specifically as a contest between the Malays, who are mostly Muslims, and other races. The author calls for increased secularization in Malaysia as a way to resolve these issues. (shrink)