Biomedical subjects
Ian H Kerridge
Publications and source records attributed to Ian H Kerridge.
A narrative account of the impact of positive thinking on discussions about death and dying.
GOALS OF WORK: The purpose of this study was to explore the experience of autologous stem cell transplant recipients (ASCT) and those who care for them. MATERIALS AND METHODS: This was a qualitative prospective, longitudinal study. Ten patients who were about to have ASCT and nine carers were recruited to the study. Interviews were to be conducted at regular intervals six times over 2 years. The narratives of two widowed carers were analysed using Grounded Theory and read for themes on positive thinking and death. MAIN RESULTS: Positive thinking has a range of meanings, and its use can have a range of consequences. It can either be a useful coping strategy or can interfere with important conversations and planning about the end of life, and subsequently add to the distress of a grieving partner. CONCLUSIONS: It is important for patients, their partners and their health professionals to be able to discuss potential adverse consequences of illness, including death, without being hindered by the obligation to be positive or optimistic.
An empirical study of tissue banking in Australia: navigating regulatory and ethical challenges.
Collections of tumour samples can be an invaluable resource for medical research. There are, however, numerous ethical and legal challenges associated with tumour banking. While there has been extensive discussion of these issues in the legal and ethical literature, there are few available empirical data in relation to the activities of tumour banks in Australia, their practices around ethically charged issues, and their success in implementing complex regulatory guidelines. The aim of this study was to gain more information about the activities of tumour banks in New South Wales, Australia, with a particular focus on their management of, and attitudes towards, ethical and regulatory issues. A survey of 27 tumour collection and research facilities was conducted using a 55-item questionnaire. There is significant heterogeneity of research methodologies as well as of methods for gaining consent and ensuring donor privacy, and there is general concern among the research community about ethical and regulatory issues related to tumour banking. Heterogeneity of practice and uncertainty about ethical and regulatory requirements is problematic in its potential to hinder research and its potential to generate the space for unethical practice, whether intentional or unintentional. There is a pressing need to address these issues so that tumour banks can be used in the most ethical and efficient way possible.
Increasing diversity at the cost of decreasing equity? Issues raised by the establishment of Australia's first religiously affiliated medical school.
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Medical specialists and pharmaceutical industry-sponsored research: a survey of the Australian experience.
OBJECTIVES: To characterise research relationships between medical specialists and the pharmaceutical industry in Australia. DESIGN AND SETTING: Questionnaire survey of medical specialists listed in the Medical Directory of Australia and believed to be in active practice, conducted in 2002 and 2003. MAIN OUTCOME MEASURES: Details of medical specialists' involvement in pharmaceutical industry-sponsored research, and reports of potentially undesirable research outcomes. RESULTS: Of 2120 specialists approached, 823 (39%) responded. Participation in pharmaceutical industry-sponsored research was more commonly reported by those in salaried practice (49%) than those in private practice (33%); P < 0.001. 216 reported that industry had made initial contact, compared with 117 who had initiated contact with industry. 14.0% of respondents reported premature termination of industry-sponsored trials, which they considered appropriate when in response to concerns about adverse drug effects. 12.3% of respondents reported that industry staff had written first drafts of reports, which they viewed as an acceptable practice for "internal" documents only. Of greatest concern to respondents were instances of delayed publication or non-publication of key negative findings (reported by 6.7% and 5.1% of respondents, respectively), and concealment of results (2.2%). Overall, 71 respondents (8.6%) had experienced at least one event that could represent breaches of research integrity. CONCLUSIONS: These data indicate a high level of engagement in research between the pharmaceutical industry and medical specialists, including those in private practice. Examples of possibly serious research misconduct were reported by 8.6% of respondents, equivalent to 21% of those with an active research relationship with industry.
Ethical and legal issues at the interface of complementary and conventional medicine.
Doctors should: Honestly answer patients' direct questions about CAM and elicit information about their use of it. Establish patients' understanding of the conventional and complementary therapies, both those available to them, and those that they may already be using. Establish why the patient uses CAM, and their goals for both complementary and conventional therapies. Reflect on whether information about CAM would be material for that patient at that time, taking into account the patient's burden of illness, his or her expressed preferences and the risks and benefits of both conventional and complementary therapy. Take steps to become adequately informed about available CAM that has consistently been shown to be safe and effective; has consistently been shown to be ineffective and/or harmful; or is consistently enquired about by patients. Become familiar with qualified and competent CAM practitioners (medical and non-medical) to whom referrals can be made when necessary. Continue a relationship with the patient, while continuing to monitor the patient conventionally and staying open to further discussions about CAM.
Loved one's body in the anatomy laboratory.
An Australian medical student recognized parts of her father's body during classes in an anatomy laboratory and suffered considerable trauma as a consequence. While the risk of a further case may be small, the potential for trauma could be minimized by adopting appropriate policy and procedures. Institutions that receive donations of bodies may benefit from considering suggestions for minimizing that risk and for responding appropriately should it ever occur. The article draws on the investigation into this case to offer some suggestions for minimizing the chance of recognition of bodies or body parts by students and academic or professional staff and for managing those circumstances should they ever occur. The suggestions extend to minimizing the risk of recognition of deceased persons or their body parts through photographic records, video material, and case studies presented in a number of different formats.
The challenge of cultural and ethical pluralism to medical practice.
* "Culture" can be understood as the way in which people make sense of the world by deploying shared meanings, attitudes, assumptions and values. * Doctors will frequently encounter patients whose lives are guided by ethical systems and values that are different from their own. * Individuals may differ in their beliefs about decision-making, regardless of their cultural background. * Doctors should be willing to examine and test their own moral systems and cultural assumptions and be open to alternative traditions and beliefs. * Engaging with other cultures does not imply that all cultural norms should be accepted uncritically, as there may not always be room for compromise. * Failure to engage with issues of culture can erode the trust on which the doctor-patient relationship depends. * Tensions can only be resolved through rigorous attention to a person's story.
Ethical issues concerning the relationships between medical practitioners and the pharmaceutical industry.
Medical practitioners and the pharmaceutical industry serve interests that sometimes overlap and sometimes conflict. There is strong evidence that associations between industry and doctors influence the behaviour of the latter in relation to both clinical decision making and the conduct of research. In view of the risk of compromising relationships with patients and the integrity of the research process, doctors must exercise care in their dealings with industry. The basic principles underlying the conduct of doctors with respect to pharmaceutical companies should be openness and transparency. Clearly articulated procedures should be developed to deal with specific issues such as travel subsidies, receipt of gifts, sponsorship of conferences and continuing education activities, and dualities of interest arising in clinical and research settings.
Mixing metaphors in umbilical cord blood transplantation.
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Religious perspectives on withdrawal of treatment from patients with multiple organ failure.
Religious or spiritual values often influence health care decision-making by patients and their families, particularly in times of crisis. Though religious values might seem to be irrelevant where continuing treatment is judged to be "futile", such clinical assessments should instead serve to open a dialogue about values and beliefs. The six major religious traditions in Australia have some similar values and principles about death and provision of care for the dying, but differ in their processes of ethical reasoning, cosmologies, and key moral concepts. Engaging with religious traditions on the common ground of basic values (such as human dignity, care, the sacredness of human life, non-violence, compassion, and selflessness) promotes negotiation of the manner in which care is provided, even where conflicts exist.