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Biomedical subjects

Peter A Clark

Publications and source records attributed to Peter A Clark.

At least 19 recordsLinked to original sources
PubMed2006

Mother-to-child transmission of HIV in Botswana: an ethical perspective on mandatory testing.

Mother-to-child transmission (MTCT) of HIV represents a particularly dramatic aspect of the HIV epidemic with an estimated 600,000 newborns infected yearly, 90% of them living in sub-Saharan Africa. Since the beginning of the HIV epidemic, an estimated 5.1 million children worldwide have been infected with HIV. MTCT is responsible for 90% of these infections. Two-thirds of the MTCT are believed to occur during pregnancy and delivery, and about one-third through breastfeeding. As the number of women of child bearing age infected with HIV rises, so does the number of infected children. It is apparent that voluntary testing in Botswana has made some valuable inroads in decreasing perinatal HIV transmission, but the statistics showing the increased rate of HIV infection among women 15-24 years of age are not very promising. After reviewing all the pertinent scientific data it is clear that mandatory HIV testing of all pregnant women in conjunction with the implementation of a full package of interventions would save thousands of lives -- mothers, newborns and others who could be infected as a result of these women not being aware of their HIV status. If the protection and preservation of human life is a priority in Botswana, then it is time to allow for mandatory HIV testing of all pregnant women, before it is too late for those who are the most vulnerable. To do less would be medically inappropriate and ethically irresponsible.

Africa South of the Sahara↗
PubMed2006

Medical ethics at Guantanamo Bay and Abu Ghraib: the problem of dual loyalty.

Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation or signs of torture. Military medical personnel are placed in a position of a "dual loyalty" conflict. They have to balance the medical needs of their patients, who happen to be detainees, with their military duty to their employer. The United States military medical system failed to protect detainee's human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism.

Beneficence↗
PubMed2005

Face transplantation: a medical perspective.

In May 2004, researchers at the University of Louisville Medical Center in Kentucky submitted a 30-page detailed document to the University's Institutional Review Board (IRB) that outlines their plan for the first face transplant. Despite the fact that both the Royal College of Surgeons in England in 2003 and France's Comite Consultatif National d'Ethique in 2004 issued reports saying that the risks of this surgery far outweigh the benefits to justify it at the present time, the IRB at the University of Louisville is presently studying the proposal. These medical professionals believe they have the microsurgical skills and the anatomical knowledge needed to perform this surgery as well as the pharmaceutical recipe needed to suppress the immune system while ensuring tolerable levels of toxicity in the patient. However, with the number of serious unknowns about this surgery, the risk of further injury and even death to the recipients, and the viable option of reconstructive surgery, face transplantation, a the present time, is not a just use of medical resources, in the best interest of the patient, or an effective way to accomplish the goals of medicine.

Ethics Committees, Research↗
PubMed2005

Face transplantation: Part II-an ethical perspective.

In May 2004, researchers at the University of Louisville Medical Center in Kentucky submitted a 30-page detailed document to the University's Institutional Review Board (IRB) that outlines their plan for the first face transplant. Despite the fact that both the Royal College of Surgeons in England in 2003 and France's Comite Consultatif National d'Ethique in 2004 issued reports saying that the risks of this surgery far outweigh the benefits tojustify it at the present time, the IRB at the University of Louisville is presently studying the proposal. Even though the microsurgical skills and anatomical knowledge is well established, face transplantation is more than a matter of technical achievement. The psychological impact on recipients and donor families as well as the long-term risks of a lifetime of immunosuppressant drugs must also be considered. More time is needed to perfect this surgery so that the rejection rate can be lowered and the patient's immune system can be taught to permanently tolerate the transplanted face. An ethical analysis will show that more time is needed to perfect this surgery so that the rejection rate can be lowered and the patient's immune system can be taught to permanently tolerate the transplanted face. To permit this surgery now, when there are so many unknown, life-threatening dangers would be medically irresponsible and ethically objectionable.

Face↗
PubMed2004

Medication errors in family practice, in hospitals and after discharge from the hospital: an ethical analysis.

Thousands of medical errors are occurring daily in physician's offices, in hospitals, and even upon discharge from the hospital, leading to unnecessary injury and death and costing billions of dollars. We have a systems approach that has been proven to be tried and true in aviation, nuclear energy and many other industrial settings. Being honest when medical mistakes occur, reporting them to national clearing house, objectively searching for root causes, avoiding the fixing of arbitrary blame, and then, where possible, implementing safeguards to minimize the occurrence of future mistakes, is the best way to enhance patient safety. But until the medical establishment takes medical errors and patient safety more seriously, and until the general public rises up in protest, it is up to the state and federal governments to take the lead in protecting the lives of innocent Americans by creating a public policy.

Aftercare↗
PubMed2003

Medical marijuana: should minors have the same rights as adults?

After reviewing the pertinent scientific data, it is clear that there is more than sufficient medical and ethical evidence to warrant the Bush Administration to authorize the Drug Enforcement Agency to reclassify marijuana as a Schedule II drug so that it can be used for medical purposes. Failure to give an effective therapy to seriously ill patients, either adults or children, violates the core principles of both medicine and ethics. Medically, to deny physicians the right to prescribe to their patients a therapy that relieves pain and suffering violates the physician-patient relationship. Ethically, failure to offer an available therapy that has proven to be effective violates the basic ethical principle of nonmaleficence, which prohibits the infliction of harm, injury, or death and is related to the maxim primum non nocere ('above all, or first, do no harm'), which is widely used to describe the duties of a physician. Therefore, in the patient's best interest, patients and parents/surrogates, have the right to request medical marijuana under certain circumstances and physicians have the duty to disclose medical marijuana as an option and prescribe it when appropriate. The right to an effective medical therapy, whose benefits clearly outweigh the burdens, must be available to all patients including children. To deny children the use of medical marijuana when appropriate is a grave injustice which violates the basic foundational beliefs of both medicine and

Child↗
PubMed2003

Fighting AIDS in Sub-Saharan Africa: is a public- private partnership a viable paradigm?

UNLABELLED: In their most recent study, the United Nations AIDS Program estimates that about 22 million people around the world have died from AIDS, and about 40 million more are currently infected with the HIV virus. About 83% of AIDS deaths and 71% of HIV infections have occurred in war-ravaged, poverty-stricken Sub-Saharan Africa. This pandemic is ripping apart the social and economic fabric of this part of the world. The only remedy for this crisis is both prevention and cure. Only through massive education can early and sustained prevention efforts prevent future infections. And only by giving those infected with HIV effective treatments will people be prevented from dying of AIDS in the future. Without a bold, concerted action, not only will millions die in Africa, but the entire world will suffer. To allow sub-Saharan Africa to become socially and economically devastated will have a major impact on the economies of every country of the world. The African Comprehensive HIV/AIDS Partnership (ACHAP) is one answer to the problem. ACHAP, is a joint initiative between the government of Botswana, the Bill and Melinda Gates Foundation and the Merck Company Foundation. This public-private partnership has provided a new sense of optimism for fighting this devastating pandemic. ACHAP offers all interested parties a multifaceted paradigm that addresses not only the need for ARV medications, but also the other social and medical facets of the HIV/AIDS problem facing sub-Saharan Africa. If a coordinated effort can be launched in the other sub-Saharan African nations, using ACHAP as a paradigm, then there is the possibility that the fight against AIDS could be won. CONCLUSIONS: Clinical ethics is of necessity a two-way street, one in which ethical paradigms influence practitioners and researchers whose expertise, in turn, necessarily educates the non-clinical ethicist.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Medical futility in pediatrics: is it time for a public policy?

For the past decade, there has been a debate raging within the medical, ethical, and legal communities focusing on the issue of medical futility. What has fueled the fires of this multi-faceted debate is the patient rights movement and the perception that the right to self-determination extends not only to the refusal of medical treatments but to demands for overtreatment. The medical specialities of Pediatrics and Neonatology further complicate this issue because despite the dramatic technological advances in these areas, diagnostic and prognostic certainty for many medical conditions remains illusive. As a result, surrogates have to decide whether children with various congenital anomalies, diseases, and genetic defects should be treated aggressively if at all. This uncertainty has led to conflicts between physicians and families about whether certain medical treatments are futile and thus not in the best interest of the child. From a legal and ethical perspective, one way to resolve these conflicts would be a specific process-based public policy approach to futility determinations on a case-by-case basis. The medical futility policy proposed as a public policy protects the patient's right to self-determination; the physician's right of professional integrity; society's concern for the just allocation of scarce medical resources; and is securely rooted in the ethical tradition of promoting and defending human dignity.

Beneficence↗
PubMed2002

AIDS research in developing countries: do the ends justify the means?

Concrete ethical standards for human research are clearly stipulated in both international and national codes of ethics, and are meant to protect human subjects, especially the most vulnerable. A recent clinical study conducted from 1994 to 1997 by Dr. Thomas C, Quinn, M.D. has fueled the debate raging in the scientific community regarding the ethics of clinical AIDS research in developing countries. Quinn's conducted a community-based, randomized, controlled study of 15,127 rural Ugandans to determine whether intermittent antibiotic treatment to reduce the prevalence of other sexually transmitted diseases would also reduce the rate of HIV transmission. Subsequently, the study identified 415 couples in which one partner was HIV positive and one was initially HIV negative and followed them prospectively for up to 30 months. Researchers were not permitted to inform the seronegative partner of the HIV status of the other partner. As a result, 90 of the initially HIV negative partners (21.7%) seroconverted during a follow-up period of 30 months. To allow for research studies in developing countries that are not permitted in the United States appears to make the Third World equivalent to a 'research sweat shop'. Developing nations offer easy access to patients, reduced costs, and less stringent regulations. This appears to create a double standard for medical research that is both ethically and humanly unacceptable, especially when other viable option exist. To allow relativism to seep into the international and national ethical standards will open the door to an idea that condones the possible abuse of those least able to protect themselves. Researchers have an ethical responsibility to uphold the integrity of these ethical standards. Failure to do so today may have a devastating impact on humanity in the future.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Confidentiality and the physician-patient relationship -- ethical reflections from a surgical waiting room.

The physician-patient relationship is the primary focus of ethics in medicine. It is both a personal and a professional relationship that is founded on trust, confidence, dignity and mutual respect. Trust is the bridge to the physician-patient relationship, and the burden is on the physician not only to expect the patient's trust but also to build a solid foundation upon which the patient can place his or her trust. Great strides have been made by physicians in refining the physician-patient relationship especially in understanding and respecting the patients' right of self-determination regarding medical decision-making and protecting their rights of privacy and confidentiality. However, further refinements are needed on both sides regarding this relationship. Breaches of confidentiality are occurring in places like surgical waiting rooms and as a result, the physician-patient relationship is being damaged. This article identifies some legitimate concerns and offers some concrete solutions so that the physician-patient relationship can be further refined and the virtues and rights that support it can be reinforced.

Confidentiality↗