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Law and ethics.

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Ethics, Medical↗

AIDS, activism, and ethics.

From the treatment IND to drug importation, to the parallel track and beyond, AIDS advocates have largely succeeded in doing what earlier FDA critics were unable to do: take more decisions out of the hands of government and the research establishment and cede them to patients and their physicians. The profound ethical and clinical implications are discussed.

Acquired Immunodeficiency Syndrome↗

ESHRE Task Force on Ethics and Law 11: Posthumous assisted reproduction.

This article analyses the different ethical aspects of posthumous assisted reproduction. Two situations are distinguished: cases in which the gametes or embryos are used by the surviving partner and cases in which the gametes or embryos are made available for third persons. The moral evaluation of the procedure depends on whether the act is restricted to the existing parental project. A major difficulty for the moral evaluation is the inconclusiveness of the empirical data on the psychosocial development of children born after this procedure. The Task Force concluded that posthumous reproduction by a partner is acceptable if the following conditions are met: written consent has been given by the deceased person, the partner received extensive counselling and a minimum waiting period of 1 year is imposed before a treatment can be started. For use by third parties, the usual conditions for gamete and embryo donation apply.

Advisory Committees↗

Graduate medical education: focus for change.

The author documents a significant broadening of the interest of both state and federal government in influencing graduate medical education. He states that the unwillingness of the academic medical community to address the issues of manpower supply and specialty distribution, the limited effectiveness of minority enhancement programs, and an ambiguous position on foreign medical graduates have invited government intervention. The author maintains that such intervention was inevitable because academic medical centers have focused only on the educational process and the quality of graduates but have not dealt with the need to shape the output of their training programs to meet national health needs. He challenges the academic medical community to seize the initiative in seeking the difficult-to-find solutions to major issues of medical training or be prepared to yield to the decisions of lawmakers and regulators.

Academic Medical Centers↗

Ethical and legal considerations in the provision of nutritional support to the perioperative patient.

Despite the extensive current literature on ethics, very few publications have specifically addressed the ethical issues surrounding the provision of nutrition to perioperative patients. Four publications are particularly relevant and highly recommended [1-4]. This review is an attempt to draw attention to those ethical issues that are relevant to the use of nutritional support in the perioperative patient and offer guidance on appropriate action by clinicians. Emphasis is on adult patients rather than children and not on the issues that surround the terminally ill patient. General principles are discussed first and then the application of these principles.

Adult↗

When is the physician "Playing God"?

In the author's opinion, the medical profession is committed to the preservation and prolongation of life through use of all ordinary remedies, but is not obliged ethically or morally to apply extraordinary measures when there is no realistic hope of recovery. In addition to the proper medical therapy, the care given during the dying phase of life by the physician includes the responsibility of deciding whether the geriatric patient should be allowed to die in a dignified manner. The question of who should bear this responsibility is discussed.

Decision Making↗