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PubMed1990

International perspectives on treatment choice in neonatal intensive care units.

Over the past 25 years, neonatal intensive care units (NICUs) have been established throughout the industrialized world and in some Third World nations to provide sophisticated medical interventions for critically ill newborns. This paper discusses the four major factors affecting treatment choices for newborns with disabilities or at risk for disabilities: the availability of resources, societal attitudes toward medical interventions and life with disabilities, the roles of physicians, parents and other decision-makers, and the role of the law. Much has been written on the bioethical issues surrounding such treatment as it is practiced in the United States, including analysis by social scientists; however, little has been written on how those issues are perceived and dealt with in most other nations, and very little comparative research has been conducted. The author provides an international perspective on the bioethical issues involved by comparing U.S. practice, which has received much attention, with a generalized commentary on practices in other parts of the world, which have received less examination. The nations surveyed include Australia, Brazil, Britain, Canada, China, France, India, Israel, Japan, the Netherlands, Poland, Sweden, and West Germany. The value of further comparative research is discussed in order to encourage others to do such research.

Attitude to Health↗
PubMed1992

Oocyte and embryo donation.

Oocyte and embryo donation, first reported in humans in 1983 has helped patients who do not possess functional ovarian tissues or whose oocyte cannot be used for fertilisation, to conceive. Though it is the female counterpart as the donor insemination in the male, it imposes quite different bioethical issues. The article is a review of the oocyte and embryo donation programme in general, with special discussion on regimes of Cyclic Steroid Replacement Therapy, the recruitment of oocyte donors, bioethical issues, and future applications of oocyte donation in medicine.

Embryo Transfer↗
PubMed1993

The European Convention on Bioethics.

For nearly 20 years, the Council of Europe, the organization for intergovernmental cooperation of the great Europe (26 countries are members of the council) has worked in the different fields of what is now called bioethics (reproductive technologies, organ transplants, human experimentation, etc). The council mainly proposes recommendations to member states in order to implement harmonized legislation. During the past ten years, this activity has been concentrated in a unique and multidisciplinary committee of experts; the CAHBI (ad hoc Committee of Experts on Bioethics). The recent development of national and very diverse legislation related to bioethical issues emphasized the necessity of adopting common binding principles at the European level. It was then decided at the end of 1991 by the Committee of Ministers of the council that the CAHBI would prepare a European Convention on Bioethics. This text, which is now being drafted, will in fact be composed of three documents. The Convention itself will list a set of general principles such as respect for human dignity, respect for the integrity of the person, the prohibition of any commercial arrangement on the human body and the principle of nondiscrimination. Two protocols will specifically deal with two important bioethical issues: organ transplants and human experimentation, but other topics could be covered in the future. All these texts will create obligations for member states and others that would like to ratify them to implement national regulations. An independent committee will have the duty to control how these obligations will be respected.

Bioethics↗
PubMedDate not supplied

Bioethics in the language of the law.

Law provides a rich language for thinking about bioethical issues and is a tool for action as well as talk. But the language of the law, often inapt, regularly fails to achieve its desired effect.

Bioethical Issues↗
PubMed2003

Bioethical theory and practice in genetic screening for type 1 diabetes.

Due to the potential ethical and psychological implications of screening, and especially in regard of screening on children without available and acceptable therapeutic measures, there is a common view that such procedures are not advisable. As part of an independent research- and bioethical case study, our aim was therefore to explore and describe bioethical issues among a representative sample of participant families (n = 17,055 children) in the ABIS (All Babies In South-east Sweden) research screening for Type 1 diabetes (IDDM). The primary aim is the identification of risk factors important for the development of diabetes and other multifactorial immune-mediated diseases. Four hundred, randomly chosen, participant mothers were asked to complete a questionnaire exploring issues of information, informed consent, bio-material, confidentiality and autonomy, and of prevention/intervention. 293 completed the questionnaire, resulting in a response rate of 73.3%. The majority of questions had the form of 6-point Likert-type response scales (1-6). We found that the majority of respondents felt calm in in regard of samples and written material, and also concerning the possibility of their child in the future being identified as having high risk of developing Type 1 diabetes. An important finding concerning access and control of mainly biological data was indicated, with the respondents expressing concern for potential future use. We believe our findings indicate that this kind of empirical studies can substantially contribute to our understanding of bioethical issues of medical research involving genetics. Issues, such as safeguards ensuring the ethical criteria of autonomy and respect, were emphasised by our respondents. We believe the issues brought up may promote further discussion, and do suggest issues for consideration by, among others, researchers, bioethicists and Institutional Review Boards.

Adult↗
PubMed1977

Bioethics: occupational therapy attitudes toward the prolongation of life.

A comprehensive array of bioethical issues have emerged from advances in biological technology. This report assesses the views of individuals at three occupational therapy levels concerning one such issue: The option of painless death for the incurable. A battery of measures used to study beliefs in occupational therapy students included an item dealing with euthanasia. Item analysis revealed that the mean response to the euthanasia item by groups of occupational therapy juniors, seniors, and supervising clinicians from two schools indicated approval of voluntary painless death for the incurably ill. The article concludes with a discussion of the inclusion of bioethical issues in occupational therapy educational programs.

Adult↗
PubMed1998

Is it good to make happy people?

Would it be good, other things being equal, for additional people to exist whose lives would be worth living? I examine and reject several arguments for the answer that it would not be good; then I offer opposing arguments that I believe are more successful. Thus, I agree with utilitarians who say that it is better for there to be more happy people. Next I argue for the stronger claim that the happiness of potential people is as important as that of adults. Potential quality of life, then, matters in a host of bioethical issues: abortion, commercial surrogacy, the treatment of defective newborns, and so on. What is the practical upshot of all this? I reject the idea that we must do whatever is necessary to prolong life worth living. But I also reject the view that the side-effects of overpopulation always outweigh the value of realizing potential happiness. So I advocate a middle position, which I do not identify precisely. Even from this middle position, however, potential happiness is more important that is commonly assumed in bioethics.

Age Factors↗
PubMed1997

When is thrombolysis justified in patients with acute ischemic stroke? A bioethical perspective.

BACKGROUND: Thrombolytic therapy for acute ischemic stroke raises several unsettled bioethical issues related to risk versus benefit. Excluding the National Institutes of Neurological Disorders and Stroke (NINDS) rt-PA trial, the risk of intracerebral hemorrhage averages 10.3%, and there is a 44% increase in the odds of death among fibrinolysis-treated patients. Some investigators have suggested that as yet unidentified subgroups may benefit despite an increased early risk of hemorrhage and death, while others have warned that the widespread use of thrombolysis cannot currently be recommended despite recent Food and Drug Administration approval. The NINDS rt-PA trial showed a net benefit, but the relative risk to benefit ratio in individual patients is uncertain because of incomplete subgroup analysis. We explore these and related issues by applying the bioethical principle of justification to the selection of stroke patients for thrombolysis. SUMMARY OF COMMENT: Justification of a therapy rests on the criteria of safety, efficacy (net benefit under ideal conditions), effectiveness (net benefit under routine conditions), efficiency (cost-effectiveness or cost benefit), and outcome (proportionality and informed consent). The ethical principal of proportionality states that positive outcomes must be proportional to negative outcomes; only the NINDS trial sets equipoise between risk and benefit. The relative risk to benefit ratio and cost-effectiveness of thrombolysis will likely vary among treating physicians and patient subgroups. Although some potential selection factors such as early CT changes, National Institutes of Health Stroke Scale score > 22, and age > 77 years have been identified, it is not yet possible to predict response to treatment in individual patients. The effectiveness of thrombolysis outside of a clinical trial has not yet been demonstrated, and it is not clear that thrombolysis is cost-effective for all potential patient subgroups. CONCLUSIONS: No stroke thrombolysis regimen has met all five justification criteria. Proportional outcome standards that take into account patient preferences must be established. The risk to benefit ratio of thrombolysis in patient subgroups requires clarification and should incorporate cost-efficiency analyses. These issues should be kept in mind when considering thrombolysis therapy in patients with acute ischemic stroke and when designing clinical trials.

Age Factors↗
PubMed1992

It never dies: assessing the Nazi analogy in bioethics.

... As should be evident from the foregoing analysis, I have significant reservations about the moral utility of the Nazi analogy in debates over bioethics issues. Nevertheless, I am unable to dismiss its force entirely. I want to suggest that the real threat to the moral and human values expressed by the analogy will come not from responsibly formulated and clearly articulated proposals that undergo debate and scrutiny in the public forum, and whose practical impact in a democratic society is limited by institutional review and procedural safeguards. My concern instead is with the psychology of moral distancing, in which moral conscience is compartmentalized from vocational interests, such as the pursuit of scientific knowledge through biomedical research. It is the kind of psychology that Robert Jay Lifton has referrred to as "doubling: the division of the self into two functioning wholes, so that a part-self acts as an entire self," and which Lifton believes enabled the transformation of physicians from healers to killers in Nazi Germany....

Bioethical Issues↗
PubMed2003

Issues in bioethics. Teaching research ethics.

All research should meet the highest ethical and scientific standards, and so persons who may be involved in conducting research should be fully conversant with the relevant ethical principles of biomedical research and its requirements. Further, scientists, academicians, physician-researchers, student-researchers, and members of research ethics committees should be able to distinguish between therapy and research, evaluate risk and benefit, be sensitive to various forms of conflicts of interest, and be fully aware of the special provisions necessary for vulnerable populations. This article recommends a number of subject areas that should be addressed as a part of this academic process.

Bioethics↗
PubMedDate not supplied

Nursing code of ethics: an international comparison.

In her worldwide search for a code of ethics to provide guidelines for professional practice, Linda Sawyer found that the codes of health care professionals were disappointing, mainly because they did not provide thoughtful and provocative discussion of the bioethical issues faced by the practitioner. Many organizations deal with controversial issues through the informal mechanism of policy statements, rather than through the more formal, rigid, public and political process needed to amend a code of ethics. While other professional organizations focus on commercial aspects of practice or are silent on ethical issues. Below, an analysis of the codes of selected national nurses' associations.

Bioethical Issues↗
PubMed1994

Bioethics and the limits of tolerance.

Since 1989 there has been an ongoing controversy about the limits of public discussion of bioethical issues in the German-speaking world. While a number of scholars have been involved, Peter Singer and Helga Kuhse have been the principal targets of those seeking to limit bioethical debates. Those who have supported silencing discussion of certain issues have argued that such public discussion leads to a loss of freedom. In the article we argue that toleration is not based on subjectivism but rather on reason. Furthermore, the efforts to suppress debate are often based on a failure to understand our position. Such efforts at suppression also rest on an elitist view of society that must assume that the general public cannot debate such topics.

Attitude↗
PubMed2001

Perspectives on legislation relating to the rights and protection of people with dementia in Europe.

This article focuses on the main legal provisions in Europe relating to the protection and rights of people with dementia. The information referred to was obtained in the framework of two EC funded projects, which involved the collection, translation and comparison of relevant legislation, and then the writing of legal recommendations to improve the legal rights and protection of people with dementia. The first project started in 1997 and was completed in 1999. The second project started in 1999 and was completed in November 2000. The article provides an overview of the main features of some of the laws in Europe on a few key issues, i.e. guardianship, coercive measures and bioethical issues. Some of the main differences between the systems in different countries are highlighted. An attempt is made to show how the adequacy and appropriateness of legal provisions differ vastly from one country to the next and also to identify the emergence of a few trends, which seem to reflect a movement towards a greater awareness of the nature of mental incapacity and hence a better provision for the rights and protection of people with dementia.

Bioethics↗
PubMedDate not supplied

Training physicians to care for the dying.

PROBLEM: The education of medical students and house staff regarding management of death and timely discussions of death with patients and families has been deficient, leaving physicians ill-equipped to provide appropriate care to dying patients. METHOD: We propose a five-pronged curriculum in terminal care to be ongoing from medical school through postgraduate training. This program includes: Clinical skills--including pain and symptom management, prognostication and care in various settings; Communication skills--including listening and how to discuss bad news with patient and family; Psychosocial issues; Administrative/management and team interaction, and Bioethical issues, including DNR and living wills. CONCLUSION: It is hoped that such training will teach physicians to accept death as inevitable, to recognize and acknowledge the state of dying and, finally, to understand that appropriate care includes appropriate death, which is one arrived at with minimal suffering, with minimal social and emotional impoverishment, with preservation or restoration of important relationships and with resolution of residual conflicts.

Clinical Competence↗
PubMed1989

Ethics committees for "high tech" innovations in Japan.

Although ethics committees in Japan have been developing in major medical schools and in some hospitals, their members are usually medical professionals from the same institution. The lack of national legislation for setting up ethics committees permits only a voluntary code of standards for doing clinical research work in high tech medical applications. The author argues for the necessity of more open debate on bioethical issues and proposes the participation of the lay public and bioethicists in Ethics Committee in Japan.

Advisory Committees↗