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Biomedical subjects

R L Berghmans

Publications and source records attributed to R L Berghmans.

11 recordsLinked to original sources
PubMed2003

[Terminal sedation in mentally competent patients: no overriding medical-ethical arguments against in the medical literature].

OBJECTIVE: To collect medical-ethical arguments for and against the practice of terminal sedation in mentally-competent patients. DESIGN: Literature search. METHOD: Medical-ethical arguments for and against the practice of terminal sedation were sought in electronic databases, for example Pubmed, Medline, and the Netherlands Institute for Scientific Information Services. The arguments found can help in making a well-considered and careful decision. RESULTS: Terminal sedation can be defined as deliberately inducing and maintaining deep sleep in terminally-ill patients with recalcitrant symptoms, by using high doses of sedatives but without the intention of hastening death. Arguments in favour of this approach included: good care provision, useful medical procedure, autonomy of the patient, the doctrine of the double effect and an alternative for euthanasia and assisted suicide. Arguments against included: impossible to communicate due to sedation, responsibility for unintended consequences, shortening the length of life, religious and cultural objections, incompetence, abuse by the care-provider or the patient and the interest of the physician. CONCLUSION: In the literature no overriding moral objections to the use of terminal sedation were found. This palliative option may be regarded as a useful addition to the existing range of interventions. Although it can never be excluded, abuse is not a decisive factor. There seems to be a need for a guideline with meticulous criteria and procedures that promotes the responsible use of this intervention.

Ethics, Clinical↗
PubMed2002

Ethical guidance on human embryonic and fetal tissue transplantation: a European overview.

This article presents an overview of regulations, guidelines and societal debates in eight member states of the EC about a) embryonic and fetal tissue transplantation (EFTT), and b) the use of human embryonic stem cells (hES cells) for research into cell therapy, including 'therapeutic' cloning. There appears to be a broad acceptance of EFTT in these countries. In most countries guidance has been developed. There is a 'strong' consensus about some of the central conditions for 'good clinical practice' regarding EFTT. International differences concern, amongst others, some of the informed consent issues involved, and the questions whether an intermediary organisation is necessary, whether the methods of abortion may be influenced by the possible use of EFT, and whether EFTT should only be used for the experimental treatment of rare disorders. The potential use of hES cells for research into cell therapy has given a new impetus to the debate about (human) embryo research. The therapeutic prospects with regard to the retrieval and research use of hES cells appear to function as a catalyst for the introduction of less restrictive regulations concerning research with spare embryos, at least in some European countries. It remains to be seen whether the prospect of treating patients suffering from serious disorders with transplants produced by therapeutic cloning will decrease the societal and moral resistance to allowing the generation of embryos for 'instrumental' use.

Bioethics↗
PubMed2001

Advance directives in dementia care: from instructions to instruments.

Advance directives are often regarded as instructions to the doctor about future care. This view is problematic, in that it obliterates that decisions about treatment and care always take place in a concrete situation, and require interpretation and communication. From a hermeneutic perspective, advance directives can be regarded as instruments which do not replace interpretation and communication, but sustain joint decision-making about treatment and care, including the patient and the family in a process of meaning-making.

Advance Directives↗
PubMed2000

[Anti-Alzheimer drugs: ethical aspects of research and practice].

The development and use of drugs that aim at positively influencing the cognitive decline in patients suffering from Alzheimer's disease raises a number of ethical questions. These concern, amongst others, the significance of these drugs for the well-being and quality of life of patients, as well as the informed consent for the use of these medicines, in particular in the context of medical-scientific research. Assessing the value and significance of antidementia drugs not only depends on the positive effect on cognitive decline, but also on the broader meaning for the quality of life of the patient and her primary carer(s). The subjective experiences of those directly involved deserve more attention in research.

Adaptation, Psychological↗
PubMed1999

[Physician-assisted suicide for a patient with a psychiatric disorder: guidelines for psychiatrists. Dutch Association of Psychiatry].

In September 1998, the Dutch Association of Psychiatry published guidelines for the psychiatrist concerning cases of psychiatric patients requesting assistance with suicide. Assistance with suicide is restricted to a psychiatrist in his role as a treating physician of a patient with a psychiatric disorder. Requests for assisted suicide should primarily be considered as requests for help with life. Individual psychiatrists have no moral or legal obligation to assist in suicide. The guidelines require that the request is voluntary, explicit and well considered, the desire for death long-lasting and the suffering unbearable and hopeless. In addition an independent psychiatrist should be consulted as well as former treating physicians, general practitioner, family members and other people involved. If a somatic specialist or a general practitioner is asked to assist in suicide consultation of two psychiatrists is required. The guidelines offer psychiatrists a framework for taking great care when their patients request assisted suicide and will certainly play a part in the legal control of assisted suicide.

Aged↗
PubMed1999

Informed consent for psychiatric research: the case of medication-free research.

Informed consent for research in psychiatry raises a number of ethical and legal issues. To illustrate some of the ethical problems involved, in particular issues of patient competence and proxy consent, as well as the motives of patients to become research participants, as an example the case of so-called medication-free research in schizophrenia is discussed. It is argued that an assessment of the competence of potential research subjects to consent to participation, based on explicit criteria, is necessary. In case of substituted consent it is shown that proxy decision makers may fail to protect the interests of incompetent patients in research. Finally, researchers ought to be aware that research subjects may be motivated to participate in research because they may mistakenly believe that the research project is designed to benefit them directly.

Antipsychotic Agents↗
PubMed1998

Advance directives for non-therapeutic dementia research: some ethical and policy considerations.

This paper explores the use of advance directives in clinical dementia research. The focus is on advance consent to participation of demented patients in non-therapeutic research involving more than minimal risks and/or burdens. First, morally relevant differences between advance directives for treatment and care, and advance directives for dementia research are discussed. Then attention is paid to the philosophical issue of dementia and personal identity, and the implications for the moral authority of research advance directives. Thirdly, a number of practical shortcomings of advance directives for non-therapeutic dementia research are explored and attention is paid to the role of proxies. It is concluded that upon a closer look the initial attractiveness of advance directives for dementia research is lessened, and that it is doubtful whether these instruments can compensate for the lack of subject consent in case of non-therapeutic dementia research involving more than minimal risks and/or burdens for the incompetent demented subject.

Advance Directives↗
PubMed1994

The bioethics of human fetal tissue research and therapy: moral decision making of professionals.

OBJECTIVE: We investigated the decision making of professionals regarding the ethical acceptability of using human fetal tissue from elective abortion for research or therapy. STUDY DESIGN: We surveyed 390 professionals from 20 European countries on their ethical beliefs regarding the scientific and medical use of human fetal tissue from elective abortion. We assessed the importance of basic medical ethics and beliefs regarding the morality of abortion and fetal rights to their decision making. RESULTS: Sixty-six percent of 198 responding professionals believed that use of fetal tissue from elective abortion was ethically acceptable. Beliefs regarding the morality of elective abortion and fetal exploitation overwhelmingly influenced individual ethics regarding fetal tissue research or therapy. CONCLUSION: Ethical decision making is a dynamic process and individuals are not altogether consistent in their beliefs. The important public policy issues raised in this study concern the rights of the dead fetus, whether these rights are exploited through fetal tissue therapy, and whether women's right of authority over the disposition of aborted fetal tissue is abdicated.

Aborted Fetus↗
PubMedDate not supplied

Ethics of end-of-life decisions in cases of dementia: views of the Royal Dutch Medical Association with some critical comments.

Some of the views of the Royal Dutch Medical Association on end-of-life decisions in cases of people suffering from Alzheimer disease and related disorders are presented. The focus of the present report is on the views of the commission regarding active life termination of demented patients with or without an actual and explicit request from the patient. Some comments on these views are made, particularly regarding the notion of "loss of human dignity" (ontluistering) with respect to dementia.

Advance Directives↗