With the rise of the “humanitarian drone” in recent years, drones have become one of the most controversial public interest technologies that have gained increasing media attention. It is worth noting that, although there is a perception in the aid sector that drones hold the promise to reinvent the health supply logistics, to date, routine drone delivery is still relatively new and largely unproven. This paper presents a recent field study conducted in 2019, where drones were deployed in (...) Malawi to help address the last mile challenge in medical supply delivery, and where a noticeable mentality of “killing two birds with one stone” around the attempt of using drones in resource-poor settings is observed. The objective of the paper is to shed light, through a real-world case study and from the ethical perspective, on the impacts of implementing such a systemic change in the existing health supply chain systems. As conclusion, a call for more reflexive approaches for the critical examination, as well as more structured guidance for the responsible evaluation, of medical cargo drones is raised. (shrink)

Since 2016, drones have been deployed in various development projects in sub-Saharan Africa, where trials, tests, and studies have been rolled out in countries, including Tanzania, Uganda, Rwanda, Malawi, Ghana, and the Democratic Republic of the Congo. The use cases of drones vary, ranging from imagery collection to transportation of vaccines, lab samples, blood products, and other medical supplies. A wide range of stakeholders is involved, including governments, international organizations, educational institutions, as well as industry. Based on a field (...) study conducted in 2019, this article investigates how drones are used for medical supply delivery in Malawi-a country where the community is underserved for healthcare and related infrastructure underdeveloped, while airspace is largely open and regulations generally relaxed. The objective of presenting this case study is to contribute to the evidence regarding the rapid deployment of medical cargo drones across the African continent, and to spark critical reflections over the utility, suitability, and impacts of incorporating drones in the existing health supply chain systems in resource-poor settings. The discussion revolves around two aspects: 1) the emergent “African Drone Rise”-is it ok “as it is Africa”? and 2) the normative role of technology in the aid sector-is it “a solution looking for a problem”? In conclusion, a call for more structured guidance for the systematic examination and evaluation of the medical cargo drone case is raised. (shrink)

The use of drones (or unmanned aerial vehicles, UVAs) in humanitarian action has emerged rapidly in the last decade and continues to expand. These so-called ‘humanitarian drones’ represent the first wave of robotics applied in the humanitarian and development contexts, providing critical information through mapping of crisis-affected areas and timely delivery of aid supplies to populations in need. Alongside these emergent uses of drones in the aid sector, debates have arisen about potential risks and challenges, presenting diverse perspectives on the (...) ethical, legal, and social implications of humanitarian drones. Guided by the methodology introduced by Arksey and O’Malley, this scoping review offers an assessment of the ethical considerations discussed in the academic and gray literature based on a screening of 1,188 articles, from which we selected and analyzed 47 articles. In particular, we used a hybrid approach of qualitative content analysis, along with quantitative landscape mapping, to inductively develop a typology of ethical considerations associated with humanitarian drones. The results yielded 11 key areas of concern: (1) minimizing harm, (2) maximizing welfare, (3) substantive justice, (4) procedural justice, (5) respect for individuals, (6) respect for communities, (7) regulatory gaps, (8) regulatory dysfunction, (9) perceptions of humanitarian aid and organizations, (10) relations between humanitarian organizations and industry, and (11) the identity of humanitarian aid providers and organizations. Our findings illuminate topics that have been the focus of extensive attention (such as minimizing risks of harm and protecting privacy), traces the evolution of this discussion over time (i.e., an initial focus on mapping drones and the distinction of humanitarian from military use, toward the ethics of cargo drones carrying healthcare supplies and samples), and points to areas that have received less consideration (e.g., whether sustainability and shared benefits will be compromised if private companies’ interest in humanitarian drones wanes once new markets open up). The review can thus help to situate and guide further analysis of drone use in humanitarian settings. (shrink)

Domino's Pizza is testing “Domicopter” drones to deliver pizzas, which will compete with Taco Bell's “Tacocopter” drones. Not to be outdone, Amazon is working on an army of delivery drones that will cut out the postal service. In Denmark, farmers use drones to inspect fields for the appearance of harmful weeds, which reduces herbicide use as the drones directly apply pesticides only where it is needed. Environmentalists send drones into glacial caves or into deep waters, gathering data that would be (...) too dangerous or expensive for human scientists to procure. Federal Express dreams of pilotless aerial and terrestrial drones that will transport goods more cheaply, reliably, and safely than vehicles operated by humans. Human rights activists deploy drones over conflict zones, intelligently searching for and documenting abuses for both rhetorical and legal purposes. Aid agencies send unmanned drones to villages deep in jungles or behind enemy lines, maneuvering hazardous terrain to bring food and supplies to endangered populations. Medical researchers are experimenting with injecting drone blood cells into humans that can mimic good cholesterol carriers or identify and neutralize cancerous cells. Parents in Vermont are using flying drones to accompany children to school, giving a whole new meaning to helicopter parenting. And Pilobolus, a New York dance company, has choreographed a dance in which drones and humans engage each other in the most human of acts: the creation of art. (shrink)

The current humanitarian use of drones is focused on two applications: disaster mapping and medical supply delivery. In response to the growing interest in drone deployment in the aid sector, we sought to develop a resource to support value sensitivity in humanitarian drone activities. Following a bottom-up approach encompassing a comprehensive literature review, two empirical studies, a review of guidance documents, and consultations with experts, this work illuminates the nature and scope of ethical challenges encountered by humanitarian (...) organizations embarking upon innovation programmes. The Framework for the Ethics Assessment of Humanitarian Drones (FEAHD) identifies five values and five key questions related to ethical considerations along the decision chain of humanitarian drone activities. It fills a gap between high-level, principle-based guidance related to humanitarian innovation, and detailed operation-oriented checklists for projects involving the use of drones. In this way, the FEAHD contributes to support value sensitivity in the humanitarian use of drones. (shrink)

The current humanitarian use of drones is focused on two applications: disaster mapping and medical supply delivery. In response to the growing interest in drone deployment in the aid sector, we sought to develop a resource to support value sensitivity in humanitarian drone activities. Following a bottom-up approach encompassing a comprehensive literature review, two empirical studies, a review of guidance documents, and consultations with experts, this work illuminates the nature and scope of ethical challenges encountered by humanitarian (...) organizations embarking upon innovation programmes. The Framework for the Ethics Assessment of Humanitarian Drones (FEAHD) identifies five values and five key questions related to ethical considerations along the decision chain of humanitarian drone activities. It fills a gap between high-level, principle-based guidance related to humanitarian innovation, and detailed operation-oriented checklists for projects involving the use of drones. In this way, the FEAHD contributes to support value sensitivity in the humanitarian use of drones. (shrink)

RESUMEN La formación de profesionales competentes y comprometidos con el ideal de justicia social y solidaridad humana es un reto para las universidades médicas en Cuba. El protagonismo estudiantil en este contexto contribuye a formar jóvenes autodeterminados, críticos, reflexivos, que se hagan cargo de su desarrollo profesional y participen de forma creadora en la transformación de la sociedad. Se realizó una investigación cualitativa en la Universidad de Ciencias Médicas de Camagüey, con el objetivo de valorar la visión que tienen (...) los líderes estudiantiles sobre el protagonismo estudiantil, los factores que lo limitan y acciones para perfeccionarlo. Se utilizaron las técnicas entrevista estructurada, entrevista grupal y observación participante a una muestra de once dirigentes estudiantiles. Se logró identificar que los dirigentes estudiantiles tienen una visión acertada sobre el protagonismo estudiantil y señalan factores que limitan el protagonismo, asociados a los propios estudiantes, los profesores, las autoridades universitarias y la institución. ABSTARCT The formation of competent and committed professionals with the ideal of social justice and human solidarity is a challenge for the medical universities in Cuba. The student-leading role in this context helps to form self-determined, critical, reflective young people, who take charge of his professional development and take part of creative form in the transformation of the society. A qualitative investigation was carried out in the University of Medical Sciences, with the objective to value the vision that the student leaders have on the student-leading role, the factors that limit it and actions to perfect it. There used the techniques structured interview, group interview and taking part observation to a sample of eleven student leaders. It was identified that the student leaders have an appropriate vision on the student-leading role and indicated factors that limit the leading role, associated with the proper students, the teachers, the university authorities and the institution. (shrink)

Fundamental questions in value sensitive design include whether and how high-tech products/artefacts could embody values and ethical ideals, and how plural and incommensurable values of ethical and social importance could be chosen rationally and objectively at a collective level. By using a humanitarian cargo drone study as a starting point, this paper tackles the challenges that VSD’s lack of commitment to a specific ethical theory generates in practical applications. Besides, it highlights how mainstream ethical approaches usually related to (...) VSD are incapable of solving main ethical dilemmas raised by technological design for well-being in democratic settings. Accordingly, it is argued that VSD’s ethical-democratic import would substantially be enhanced by the espousal of a procedural ethics stance and the deliberative approach to value and welfare entailed by Amartya Sen’s capability approach. Differently from rival ethical–political theories, its normative and meta-ethical foundations better handle human diversity, value-goal pluralism, conflicting vested interests as well as the epistemic-moral disagreements typical of contemporary complex democracies. Particularly, Sen’s capability approach procedural-deliberative tenets result in an “objective-impartial” choice procedure selecting a “hierarchy” of plural incommensurable values and rational goals thus, suitable to validate an applied science such as welfare-oriented technological design in concrete social environments. Conclusions suggest that refining VSD with a capability-based procedural approach to ethics fosters the concern for democracy and social justice while preserving vital scientific-technical standards. Major advantages are at an applied level to delivering ethically and socially justified, but yet highly functional technologies and high-tech products/artefacts. (shrink)

In a long and many-sided career, William Hasledine Pepys contributed significantly to the advancement of the chemical and physical sciences during the first half of the nineteenth century. As an original investigator he determined, in collaboration with William Allen, the composition of carbon dioxide, and the density of ammonia, and elucidated the chemical phenomena of respiration in man, animals, and plants. The success of these researches was largely due to the use of ingenious apparatus of his own invention and design. (...) In the field of experimental physics, he investigated several aspects of the recently discovered Voltaic electricity: his 'Voltaic coil', consisting of only two plates, but of very large dimensions, was particularly suited for investigating electromagnetic phenomena and was so used in Davy's researches. Pepys was one of the co-founders of the Mineralogical and Geological Societies, and was elected a Fellow of the Royal Society in 1808. As a prominent member of both the Royal and London Institutions, he held honorary office as Manager and Vice-President, contributing materially to the direction of the affairs of these bodies. Pepys was a friend of Humphry Davy and was acquainted with nearly all the leading scientists and medical men of the day. At the same time, he superintended a notable manufacture of surgical instruments in the City, and promoted by his active directorship the affairs of two public companies, both pioneers in their technological fields, namely the Imperial Continental Gas Association, which was active in introducing the new gas illumination to cities and towns across Europe, and the General Steam Navigation Company, which first maintained a regular passenger and cargo service to Continental ports by the exclusive use of steam-propelled vessels. Pepys' advice in scientific and technical matters was widely sought and freely given; he retained his mental powers to the end of his long life, fulfilling his professional commitments until a few days before his death. (shrink)

Surveillance is a core function of all public health systems. Responses to the COVID-19 pandemic have deployed traditional public health surveillance responses, such as contact tracing and quarantine, and extended these responses with the use of varied technologies, such as the use of smartphone location data, data networks, ankle bracelets, drones, and big data analysis. Applying Foucault’s (1979) notion of the panopticon, with its twin focus on surveillance and self-regulation, as the preeminent form of social control in modern societies, we (...) examine the increasing levels of surveillance enacted during this pandemic and how people have participated in, and extended, this surveillance, self-regulation, and social control through the use of digital media. Consideration is given to how such surveillance may serve public health needs and/or political interests and whether the rapid deployment of these extensive surveillance mechanisms risks normalizing these measures so that they become more acceptable and then entrenched post-COVID-19. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Explode and Die!A Fat Woman’s Perspective on Prenatal Care and the Fat Panic EpidemicJennifer HansenClassifying obesity as a disease provides more ammunition for the “war on obesity.” I gather that this is supposed to be a good thing. The problem is that obesity isn’t a germ or a crime; it’s a word applied to a particular kind of body—and thus to the person inhabiting it.From a fat person’s perspective, (...) the “war on obesity” is a war on fat people. It’s a license to bully, shame, and ostracize fat people and deny us employment, medical care, and even ordinary family life because we don’t look right. Fat people, proclaimed by medical authority to be the enemy and identifiable on sight as outsiders, are made into targets for all kinds of free–floating anger. For example, I am apparently sucking away people’s tax dollars via my fat, and it’s also my fault that men expecting to fantasize about every woman they see on the street encounter my distasteful fatness instead. But no matter how many times we get told that we are wrong just for existing, we go on existing, in public even. How dare we? The answer, obviously, is to keep at us. If we would just admit that we have no right to exist, then we would all either vanish or become socially acceptably thin, and then the whole world would be unicorns and butterflies and everyone would be rich and nobody would get old. Or something like that. If obesity is a disease, then phrenology is a science.Of course, we get a lot of well–meaning flak along with the bullying; after all, concentrating on weight loss can only be good for us, because fat people are always about to explode and die. This assumption has definitely affected my relationship with the only medical practice I can reach that’s in my network. During the 20–plus years since I became visibly obese, I have gotten used to the constant drone of “You’re fat, you’re fat, you’re about to explode and die, we don’t care about what you actually came in for because it’s vitally important that we bug you yet again about your pants size,” but some things can still shock me. For example, during all three of my pregnancies, I never had a result that was even borderline for gestational diabetes (GD). And yet, some time after my last baby was born, someone wrote “HISTORY OF GESTATIONAL DIABETES” in my file. I first heard about it during my annual checkup, when the doctor referred to it when talking about my increased risk of Type 2 diabetes due to age (unavoidable), my first–ever non–whitecoat–syndrome borderline blood pressure (BP) reading (taken with a standard cuff, gee how could it possibly have been inaccurate), and GD (gosh, I felt so safe and supported at this fine reality–based practice). And of course my weight.Whoever wrote that felt free to make things up because I’m fat. To repeat, somebody with access to my file at my only source for affordable health care felt free to write things in it that were completely contradicted by the facts just a few sheets below. There’s no need to fact–check your assumptions when you can tell by looking at her that she’s F–A–T, and everybody knows what they are. They’ll explode and die, every last one of them. Better medicate them now before they inevitably break down!Speaking of which, there’s a particular OB at the practice who I’ll call Doctor Eeyore. At every appointment, Doctor Eeyore would take measurements, stare, and say, “Hmm … tch.” If I asked him to tell me what he had found, he would say, “Too big,” or, “Too small,” or indicate some other inadequacy in his glum, word–miserly way. He only bothered to produce complete sentences when he enthusiastically told me that I would die if I didn’t give birth with an IV in place to administer the life–saving drugs for my inevitable cardiac event... (shrink)

Personal data protection is an ethical issue. In this study we analyzed how research ethics committees (RECs) and data protection officers (DPOs) handle personal data protection issues in research protocols. We conducted a mixed-methods study. We included heads (or delegated representatives) of RECs and DPOs from universities and public research institutes in Croatia. The participants provided information about data protection issues in research and their mutual collaboration on those issues through structured interviews that contained closed and open-ended questions. Qualitative description (...) was used to analyze open-ended questions. The results showed that 55% of the REC representatives were not aware who was DPO in their institution. Among RECs, 65% never contacted the DPO. There were 61% of RECs who reported that they received no training from the organization on personal data protection. When asked about barriers to personal data protection in their institutions, 26% of REC members highlighted the lack of a clear protocol for assessing personal data protection issues, while 30% of DPOs mentioned lack of knowledge among researchers about personal data. In conclusion, we found that when it came to protecting personal data in research protocols, RECs and DPOs hardly ever worked together. When developing future personal data protection policies for academic and scientific research institutions, it is essential that RECs and DPOs should collaborate and both continue to expand/update their knowledge on personal data protection procedures. (shrink)

We write in response to the original article by Rennie and Rudland published in the April 2003 edition of this journal.1 Current and former Dundee Medical School students are concerned at the media misinterpretation of the study and the consequences that this branding of “dishonesty” will have on Dundee Medical School’s reputation and also on individuals embarking on their ….

This code of practice for health professionals was prepared by a multi-professional group and reflects good clinical practice in encouraging dialogue about individuals' wishes concerning their future treatment. It has a broad practical approach, considers a range of advance statements, advises of dangers and benefits of making treatment decisions in advance and combines annotated code of practice with a quick pull out guide for easy reference.

Summary Principles Timely support for patients and people close to them, and effective, sensitive communication are essential. Decisions must be based on the individual patient's circumstances and reviewed regularly. Sensitive advance discussion should always be encouraged, but not forced. Information about CPR and the chances of a successful outcome needs to be realistic. Practical matters Information about CPR policies should be displayed for patients and staff. Leaflets should be available for patients and people close to them explaining about CPR, how (...) decisions are made and their involvement in decisions. Decisions about attempting CPR must be communicated effectively to relevant health professionals. In emergencies If no advance decision has been made or is known, CPR should be attempted unless: the patient has refused CPR; the patient is clearly in the terminal phase of illness; or the burdens of the treatment outweigh the benefits. Advance decision making Competent patients should be involved in discussions about attempting CPR unless they indicate that they do not want to be. Where patients lack competence to participate, people close to them can be helpful in reflecting their views. Legal issues Patients' rights under the Human Rights Act must be taken into account in decision making. Neither patients nor relatives can demand treatment which the health care team judges to be inappropriate, but all efforts will be made to accommodate wishes and preferences. In England, Wales and Northern Ireland relatives and people close to the patient are not entitled in law to take health care decisions for the patient. In Scotland, adults may appoint a health care proxy to give consent to medical treatment. Health professionals need to be aware of the law in relation to decision making for children and young people.IntroductionWhy policies are neededCardiopulmonary resuscitation can be attempted on any person whose cardiac or respiratory functions cease. Failure of these functions is part of dying and thus …. (shrink)

This article presents an analysis of contractual relations in sport from the standpoint of the Croatian legislative system. Due to the complexity of the subject matter, the author considers only a small fragment of it - the significance and the role of sport in Croatian society and the law of contracts „as a cornerstone on which „sports law“ has been built and which is of primary importance in most areas where there is an interface between sport and the law, irrespective (...) of whether the sport is being played at an elite level or at a more humble one“. Bearing in mind the limited extent of this article, the autor tries to provide some clarifications and some guidance on how to deal with the designation and the determination of the applicable law for contracts in the sporting context. Considering that there are different legal regimes which may come into play with regard to the designation of the law applicable to contracts in the sporting context, the author first presents the determination of the applicable law according to the Rome I Regulation and then according to the Croatian Arbitration Act, Swiss Private International Law Act and the CAS Code of Sports-related Arbitration, as the most common in sports practice. Then, the author deals with contracts concluded with minor athletes and the determination of the law applicable to some preliminary questions. Finally, the author presents her perception of the problems encountered and some suggestions for the improvement of the existing legal framework. (shrink)

In the ethics of algorithms, a specifically epistemological analysis is rarely undertaken in order to gain a critique (or a defense) of the handling of or trust in medical black box algorithms (BBAs). This article aims to begin to fill this research gap. Specifically, the thesis is examined according to which such algorithms are regarded as epistemic authorities (EAs) and that the results of a medical algorithm must completely replace other convictions that patients have (preemptionism). If this were (...) true, it would be a reason to distrust medical BBAs. First, the author describes what EAs are and why BBAs can be considered EAs. Then, preemptionism will be outlined and criticized as an answer to the question of how to deal with an EA. The discussion leads to some requirements for dealing with a BBA as an EA. (shrink)

This paper focuses on the _ethics of how_ to approach the introduction of MAiD as an organizational ethics challenge, a focus that diverges from the traditional focus in healthcare ethics on the _ethics of why_ MAiD is right or wrong. It describes a method co-designed and implemented by ethics and medical leadership at a tertiary hospital to develop a values-based, grassroots response to the decriminalization of assisted dying in Canada. This organizational ethics engagement method embodied core tenants that drew (...) inspiration from a variety of sources, including poetic ones. These tenants are: make the problem bigger; focus on values; cultivate open moral spaces; and trust emergence. The paper describes how these tenants were put into practice in order to create a rigorous and sustainable MAiD program that delivers high-quality care to patients and families while honoring the moral diversity of the hospital workforce. One of the goals in sharing this method is to provide a roadmap for healthcare organizations in Canada and other jurisdictions around the world that are facing the challenge of responding to patient requests for MAiD following the decriminalization of this care option. (shrink)

Obstetric ultrasound is the well-recognized prenatal test used to visualize and determine the condition of a pregnant woman and her fetus. Apart from the clinical application, some businesses have started promoting the use of fetal ultrasound machines for nonmedical reasons. Non-medical fetal ultrasound (also known as ‘keepsake’ ultrasound) is defined as using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication. Notwithstanding the guidelines and warnings regarding ultrasound safety issued by (...) governments and professional bodies, the absence of scientifically proven physical harm to fetuses from this procedure seems to provide these businesses with grounds for rapid expansion. However, this argument is too simplistic because current epidemiological evidence is not synchronous with advancing ultrasound technology. As non-medical fetal ultrasound has aroused very significant public attention, a thorough ethical analysis of this topic is essential. Using a multifaceted approach, we analyse the ethical perspective of non-medical fetal ultrasound in terms of the expectant mother, the fetus and health professionals. After applying four major theories of ethics and principles (the precautionary principle; theories of consequentialism and impartiality; duty-based theory; and rights-based theories), we conclude that obstetric ultrasound practice is ethically justifiable only if the indication for its use is based on medical evidence. Non-medical fetal ultrasound can be considered ethically unjustifiable. Nevertheless, the ethical analysis of this issue is time dependent owing to rapid advancements in ultrasound technology and the safety issue. The role of health professionals in ensuring that obstetric ultrasound is an ethically justifiable practice is also discussed. (shrink)

Roughly 40% of the sizeable medical research and literature on recently approved drugs is “ghost managed” by the pharmaceutical industry and its agents. Research is performed and articles are written by companies and their agents, though apparently independent academics serve as authors on the publications. Similarly, the industry hires academic scientists, termed key opinion leaders, to serve as its speakers and to deliver its continuing medical education courses. In the ghost management of knowledge, and its dissemination through key (...) opinion leaders, we see the pharmaceutical industry attempting to hide or disguise the interests behind its research and education. (shrink)

Teaching and learning of medical ethics and law are at the heart of medical education because they are integral to all clinical encounters and public health interventions, and a foundation in medical ethics and law is essential for students to become virtuous doctors. The first model curriculum for medical ethics and law within medical education in the UK, published in 1998, has recently been reviewed and updated. Now called a core content of learning, it emphasizes (...) that teaching and learning of medical ethics and law should be attuned to the students' needs appropriate both to their particular stage of training and to relevant specialty-specific ethical issues; is a shared obligation of all teachers throughout the course; and should be integrated vertically and horizontally throughout the whole medical curriculum. The General Medical Council and the British Medical Association have confirmed that the revised core content of learning is consistent with their guidance on undergraduate education. (shrink)

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.

When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics (...) consultation. In this paper, we aim to contribute to the sensitization of the problem of systematic reasoning biases by showing how exemplary individual and group biases can affect the quality of decision-making on an individual and group level. We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-making. (shrink)

Background:Despite their negative consequences, evidence shows that futile medical treatments are still being provided, particularly to terminally ill patients. Uncovering the reasons behind providing such treatments in different religious and sociocultural contexts can create a better understanding of medical futility and help manage it effectively.Research objectives:This study was undertaken to explore Iranian nurses’ and physicians’ perceptions of the reasons behind providing futile medical treatments.Research design:This was a qualitative exploratory study. Study data were gathered through conducting in-depth semi-structured (...) personal interviews and analyzed using the conventional content analysis method.Participants and research context:Twenty-one nurses and nine medical specialists were recruited purposively from four teaching hospitals affiliated to Tehran University of Medical Sciences.Ethical considerations:This study was approved by the Nursing and Midwifery Research Center and the Research Ethics Committee of Tehran University of Medical Sciences. All participants gave informed consent for the research and that their anonymity was preserved.Findings:The main theme of the study was “having an obligation to provide medical treatments despite knowing their futility.” This theme consisted of three main categories including patients’ and family members’ request for continuing life-sustaining treatments, healthcare professionals’ personal motives, and organizational atmosphere and structure.Discussion and conclusion:Different personal and organizational factors contribute to providing futile medical treatments. Promoting the structure and the function of hospital ethics committees, establishing and developing home care facilities, increasing the number of palliative care centers and hospices, and educating healthcare professionals, patients, and family members about the services and the benefits of such centers can facilitate making wise decisions about continuing or discontinuing treatments which have been labeled as futile. (shrink)

The U.S. federal government provides two tracks for eligible patients to obtain access outside clinical trials to investigational interventions currently under study for potential clinical benefits: the Food and Drug Administration’s expanded access pathway and the pathway created by the more recent Right to Try Act. In this issue of the Hastings Center Report, with a critical focus on patients, industry, and the research enterprise, Kelly Folkers and colleagues frame the inherent challenges that these pathways are meant to solve and (...) have also inadvertently created. But an additional key focus is how the relevant situations should be managed at the bedside and how the system risks both inefficient and inequitable access to options at the institutional level. Although either pathway could be helpful to patients, the challenges of having the pathways coexist are greater than the sum of their parts. Individual clinicians represent the front line of the regulatory and eligibility challenges of expanded access and right to try, making clinical education a critical component of a comprehensive approach to using them well. But it is medical institutions that must take the lead on supporting access to investigational options in the most equitable and effective manner possible. (shrink)

Vesico-vaginal fistula (VVF) was a common ailment among American women in the 19th century. Prior to that time, no successful surgery had been developed for the cure of this condition until Dr J Marion Sims perfected a successful surgical technique in 1849. Dr Sims used female slaves as research subjects over a four-year period of experimentation (1845-1849). This paper discusses the controversy surrounding his use of powerless women and whether his actions were acceptable during that historical period.

A physician and spokesman for the French Ideologues, Pierre-JeanGeorges Cabanis (1757-1808) stands at the crossroads of several influential developments in modern culture--Enlightenment optimism about human perfectibility, the clinical method in medicine, and the formation and adaptation of liberal social ideals in the French Revolution. This first major study of Cabanis in English traces the influences of these developments on his thought and career. Originally published in 1980. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously (...) out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

The current model of technology assessment treats ethics itself as just another problem‐solving technology. Ethics should resist this model to play a more critical role in technology assessment by better understanding the complex relationship between society, medicine, and technology—and by recasting how problems are defined.

It probably should not be surprising, in this time of soaring medical costs and proliferating technology, that an intense debate has arisen over the concept of medical futility. Should doctors be doing all the things they are doing? In particular, should they be attempting treatments that have little likelihood of achieving the goals of medicine? What are the goals of medicine? Can we agree when medical treatment fails to achieve such goals? What should the physician do and (...) not do under such circumstances? Exploring these issues has forced us to revisit the doctor-patient relationship and the relationship of the medical profession to society in a most fundamental way. Medical futility has both a quantitative and qualitative component. I maintain that medical futility is the unacceptable likelihood of achieving an effect that the patient has the capacity to appreciate as a benefit. Both emphasized terms are important. A patient is neither a collection of organs nor merely an individual with desires. Rather, a patient (from the word to suffer ) is a person who seeks the healing (meaning to make whole ) powers of the physician. The relationship between the two is central to the healing process and the goals of medicine. Medicine today has the capacity to achieve a multitude of effects, raising and lowering blood pressure, speeding, slowing, and even removing and replacing the heart, to name but a minuscule few. But none of these effects is a benefit unless the patient has at the very least the capacity to appreciate it. Sadly, in the futility debate wherein some critics have failed or refused to define medical futility an important area of medicine has in large part been neglected, not only in treatment decisions at the bedside, but in public discussions—comfort care—the physician’s obligation to alleviate suffering, enhance well being and support the dignity of the patient in the last few days of life. (shrink)

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible (...) sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive—together with the physician—at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary. (shrink)

Empathy is a thing constantly asked for and stressed as a central skill and character trait of the good physician and nurse. To be a good doctor or a good nurse one needs to be empathic—one needs to be able to feel and understand the needs and wishes of patients in order to help them in the best possible way, in a medical, as well as in an ethical sense. The problem with most studies of empathy in medicine is (...) that empathy is poorly defined and tends to overlap with other related things, such as emotional contagion, sympathy, or a caring personality in general. It is far from clear how empathy fits into the general picture of medical ethics and the framework of norms that are most often stressed there, such as respect for autonomy and beneficience. How are we to look upon the role and importance of empathy in medical ethics? Is empathy an affective and/or cognitive phenomenon only, or does it carry moral significance in itself as a skill and/or virtue? How does empathy attain moral importance for medicine? In this paper I will attempt to show that a comparison with the Aristotelian concept of phronesis makes it easier to see what empathy is and how it fits into the general picture of medical ethics. I will argue that empathy is a basic condition and source of moral knowledge by being the feeling component of phronesis, and, by the same power, it is also a motivation for acting in a good way. (shrink)

A recent update to the Geneva Declaration’s ‘Physician Pledge’ involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of COVID-19, pockets exist in every country with different viral expressions. In the Chareidi religious community, for example, rates of COVID-19 transmission and dissemination are above average compared with other communities within the same countries. While viral spread in densely populated communities is common during pandemics, several reasons have been suggested (...) to explain the blatant flouting of public health regulations. It is easy to fault the Chareidi population for their proliferation of COVID-19, partly due to their avoidance of social media and internet aversion. However, the question remains: who is to blame for their community crisis? The ethical argument suggests that from a public health perspective, the physician needs to reach out and share medical knowledge with the community. The public’s best interests are critical in a pandemic and should supersede any considerations of cultural differences. By all indications, therefore, the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, non-maleficence, utilitarian ethics as well as social, procedural and distributive justice. This includes the ethical duty to reduce health disparities and convey the message that individual responsibility for health has repercussions within the context of broader social accountability. Creative channels are clearly demanded for this ethical challenge, including measured medical paternalism with appropriate cultural sensitivity in physician community outreach. (shrink)

A powerful movement is afoot to create a national computerized system of health records. Advocates claim it could save the health delivery system billions of dollars and improve the quality of health services. According to Lawrence Gostin, a leading commentator on privacy and health records, this new infrastructure is “already under way and [has] an aura of inevitability.” When it is in place, almost any information that is viewed as relevant to a decision in the health care delivery system would (...) be available to a large and yet undetermined number of individuals. The transformation of the collection and communication of health information from texts housed by health care providers and facilities to data electronically transmitted through networks of linked computers has significant implications for confidentiality and for data collection in scientific research. The best evidence clearly indicates that most people in the United States consider confidentiality for health information important and worry that the increased computerization of health records will result in inappropriate disclosure. (shrink)

Background In neonatal intensive care, a child's death is often preceded by a medical decision. Nurses, social workers and pastors, however, are often excluded from ethical case deliberation. If multiprofessional ethical case deliberations do take place, participants may not always know how to perform to the fullest. Setting A level-IIID neonatal intensive care unit of a paediatric teaching hospital in the Netherlands. Methods Structured multiprofessional medical ethical decision-making (MEDM) was implemented to help overcome problems experienced. Important features were: (...) all professionals who are directly involved with the patient contribute to MEDM; a five-step procedure is used: exploration, agreement on the ethical dilemma/investigation of solutions, analysis of solutions, decision-making, planning actions; meetings are chaired by an impartial ethicist. A 15-item questionnaire to survey staff perceptions on this intervention just before and 8 months after implementation was developed. Results Before and after response rates were 91/105 (87%) and 85/113 (75%). Factor analysis on the questionnaire suggested a four-factor structure: participants' role; structure of MEDM; content of ethical deliberation; and documentation of decisions/conclusions. Effect sizes were 1.67 (p<0.001), 0.69 (p<0.001) and 0.40 (p<0.01) for the first three factors respectively, but only 0.07 (p=0.65) for the fourth factor. Nurses' perceptions of improvement did not significantly exceed those of physicians. Conclusion Professionals involved in ethical case deliberation perceived that the process of decision-making had improved; they were more positive about the structure of meetings, their own role and, to some extent, the content of ethical deliberation. Documentation of decisions/conclusions requires further improvement. (shrink)

Medical practice should evolve alongside medical ethics. As our understanding of the ethical implications of physician-patient interactions becomes more nuanced, physicians should integrate those lessons into practice. As early as the 1930s, epidemiological studies began to identify that the rates of medical procedures varied significantly along geographic and socioeconomic lines. Dr. J. Alison Glover recognized that tonsillectomy rates in school children in certain school districts in England and Wales were in some cases eight times the rates of (...) children in other districts, with the only significant predictive factors being the current chief medical officer in the area and the socioeconomic well-being of the child's parents. Unfortunately, Dr. Glover's work revealed that the increase in tonsillectomies did not improve the health of adolescent patients and appeared to be performed “as a routine prophylactic ritual for no particular reason and with no particular result.”. (shrink)