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)
Ranging from miniaturized biological robots to organoids, multi-cellular engineered living systems (M-CELS) pose complex ethical and societal challenges. Some of these challenges, such as how to best distribute risks and benefits, are likely to arise in the development of any new technology. Other challenges arise specifically because of the particular characteristics of M-CELS. For example, as an engineered living system becomes increasingly complex, it may provoke societal debate about its moral considerability, perhaps necessitating protection from harm or recognition of positive (...) moral and legal rights, particularly if derived from cells of human origin. The use of emergence-based principles in M-CELS development may also create unique challenges, making the technology difficult to fully control or predict in the laboratory as well as in applied medical or environmental settings. In response to these challenges, we argue that the M-CELS community has an obligation to systematically address the ethical and societal aspects of research and to seek input from and accountability to a broad range of stakeholders and publics. As a newly developing field, M-CELS has a significant opportunity to integrate ethically responsible norms and standards into its research and development practices from the start. With the aim of seizing this opportunity, we identify two general kinds of salient ethical issues arising from M-CELS research, and then present a set of commitments to and strategies for addressing these issues. If adopted, these commitments and strategies would help define M-CELS as not only an innovative field, but also as a model for responsible research and engineering. (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)
We examined a largely ignored but imperative dimension of safety literature by testing the impact of ethical leadership style on organizational safety performance. We also tested dual mediating paths of safety culture and safety consciousness in the relationship between ethical leadership style and organizational safety consciousness. Data were collected from a large public sector telecom company in Pakistan. Confirmatory factor analysis was used to assess the reliability and validity of the study scales and model fit. Preacher and Hayes’s macro of (...) mediation was employed to test the direct and indirect paths proposed in the study. The findings suggest that ethical leadership has a positive impact on organizational safety performance. Partial mediating roles of safety culture and safety consciousness were also found between the dependent and independent variables. Theoretical and practical implications are discussed. (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)
Deliberative democracy is often celebrated and endorsed because of its promise to include, empower, and emancipate otherwise oppressed and excluded social groups through securing their voice and granting them impact in reasoned public deliberation. This article explores the ability of Habermas’ theory of deliberative democracy to accommodate the demands of historically excluded social groups in democratic plural societies. It argues that the inclusive, transformative, and empowering potential of Habermas’ theory of deliberative democracy falters when confronted with particular types of historical (...) injustices. It falters because it pays little attention to the historical dimension of injustices and the demands to which it gives rise. The historical dimension of longstanding injustices, it is argued, gives rise to a set of distinctive demands, such as collective memory of exclusion, acknowledgement of historical injustices, taking responsibility, and offering apology and reparations for causing these injustices, which go beyond the type of democratic inclusion that is often offered by deliberative democracy. Yet, the solution is not to abandon the model of deliberative democracy. Quite the contrary, it remains a valuable basis for forward-looking political decision making. The article concludes that in order to achieve inclusive, empowering and transformative deliberation in consolidated democracies that have experienced historical injustices, the politics of reconciliation is indispensable. (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.
Proper utilization of antenatal and postnatal care services plays an important role in reducing the maternal mortality ratio and infant mortality rate. This paper assesses the utilization of health care services during pregnancy, delivery and post-delivery among rural women in Uttar Pradesh and examines its determinants. Data from a baseline survey of UP Community Mobilization project was utilized. A cross-sectional sample of currently married women who delivered a baby 15 months prior to the survey was included. Information was collected from (...) 2208 women spread over five districts of UP. Information on socio-demography characteristics, utilization of antenatal care, delivery and postnatal care services was collected. To examine the determinants of utilization of maternal health services, the variables included were three ANC visits, institutional delivery and PNC within 42 days of delivery. Separate multilevel random intercept logistic regressions were used to account for clustering at a block and gram panchayat level after adjusting for covariates. Eighty-three percent of women had any ANC. Of them, 61% reported three or more ANC visits. Although 68% of women delivered in a health facility, 29% stayed for at least 48 h. Any PNC within 42 days after delivery was reported by 26% of women. In the adjusted analysis, women with increasing number of contacts with the health worker during the antenatal period, women exposed to mass-media and non-marginalized women were more likely to have at least three ANC visits during pregnancy. Non-marginalized women and women with at least three ANC visits were more likely than their counterparts to deliver in an institution. Contacts with health worker during pregnancy, marginalization, at least three ANC visits and institutional delivery were the strong determinants for utilization of PNC services. Self-help group membership had no association with the utilization of maternal health services. Utilization of maternal health services was low. Contact with the health worker and marginalization emerged as important factors for utilization of services. Although not associated with the utilization, SHGs can be used for delivering health care messages within and beyond the group. (shrink)
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 (...) place in the UK between November 2016 and May 2017. The stakeholders involved in these workshops included: healthcare professionals, genomic research teams, academics, patients, biobank managers, and representatives from the Health Research Authority, NHS Research Ethics Committees, patient support groups, pharmaceutical industry, and health policy think tanks. The co-produced principles and guidance are specifical... (shrink)
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)
A democratic ethics of biological technology must engage the public. This is not easy to do in a way that satisfies the demands of democratic ethics, or meets the pace of rapidly changing, complex technology. This paper describes a solution proposed by the University of British Columbia’s Norms Evolving in Response to Dilemmas interdisciplinary research group. The solution, the NERD web survey, has three distinct advantages over other methods: it is Deep—the survey provides deep data, particularly when compared to alternatives (...) such as polls and focus groups; Cheap—our survey is cost effective, which is important for a truly democratic tool; and Improvable—the NERD survey is a work in progress, improvable by design. (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)