Ethical philanthropy in academic psychiatry

OBJECTIVE

From an ethical perspective, psychiatrists cannot accept gifts of significant monetary value from their patients. This guideline raises important questions regarding institutional practices related to gift-giving in academic psychiatry. The first aim of this article is to explain the ethical tensions and shared ethical commitments of the professions of psychiatry and philanthropy. The second aim is to outline a series of steps that may be undertaken to assure ethical philanthropic practices within an institution, including the establishment of a committed advisory workgroup and the creation of ground rules and safeguards for gift-giving. Each situation should be evaluated for "ethical risk," and specific measures to safeguard donors should be considered.

METHOD

The author outlines methods to manage, minimize, or eliminate conflict of interest issues, including identification and disclosure of conflicting interests, role separation, goal clarification, confidentiality protections, proper timing, and ongoing oversight. Three case illustrations are provided and discussed.

RESULTS

The process of institutional engagement, dialogue, and shared problem-solving is especially important. A shared, constructive ethic will be attained only if leaders and diverse stakeholders communicate the value of the new approach through their words, expectations, and actions.

CONCLUSIONS

Through these efforts, greater attention will be given to the concerns of people with mental illness, and academic institutions may be better able to fulfill their responsibilities to this important but neglected population now and in the future.

Violence against women in Turkey and the role of women physicians

Violence against women is a serious problem in Turkey. The Women and Ethics Commission of the Turkish Physicians' Association (Ankara Physicians' Chamber) has undertaken significant work to counteract this. This article gives some indications of the sources of violence and discusses its social and health care implications. The Commission is pivotal in the education of women physicians and in heightening awareness of the situation. An outline is given of this work and recommendations are made on how violence against women can be tackled and eliminated.

Ethics and the European countries in transition--the past and the future

This paper surveys the situation regarding bioethical issues in the European transitional societies. It aims at exploring past, present and future characteristics of bioethics in the European countries in transitions, analysing similarities, differences and common themes together with the historical development of bioethics. By carefully studying articles published since the early 1990s, one can perceive a number of bioethical issues, varying from specificities for certain countries to similar problems for all transitional European societies. It seems that more than 15 years after the fall of the Berlin Wall, Central and Eastern European societies were able to achieve significant improvements in the development of bioethics. However, looking at the bioethical issues important for European transitional societies, it seems that the invisible wall between eastern and western European societies is still there and that it will take years to remove it.

When Does Expert Witness Testimony Constitute a Violation of the ACR Code of Ethics?

The ACR established the Committee on Ethics in 1997. As outlined in a prior article in JACR, the committee reviews allegations that an ACR member violated the Code of Ethics. One type of complaint is that an ACR member provided biased or inaccurate expert medical testimony. This article describes how the committee reviews expert witness complaints, decides whether to investigate them, and in some cases imposes disciplinary sanctions against a member.

Relationships between the Central ("National") Ethics Committee and local ethics committees in the Slovak Republic

A brief outline about the present relationships between Central ("National") Ethics Committee at the Ministry of Health of the Slovak Republic, and the local ethics committees in Slovakia is given. The planned improvements concerning the function of the system of ethics committees in the Slovak Republic are also outlined.

Research and developing countries: hopes and hypes

The paper outlines the universal problem of ensuring ethical practices in human subject research, and focuses on specific difficulties faced in the developing world with particular reference to Pakistan. It discusses the influence of traditional and hierarchical social norms of physician-patient relationships in heightening these problems. Two emerging issues of specific concern in Pakistan are described: an exponential rise in multinational clinical drug trials, and commercial ventures offering unproven stem cell "therapy" for all kinds of diseases. The importance of introducing ethical practices in research within the context of local cultural and socioeconomic realities is highlighted.

An ethics conflict and culture: should this kidney be used?

The practice of nursing in transplant medicine is often fraught with ethical complexity. It is especially so when children are involved as potential living donors. This is no less true when the donor "child" is of consenting age, and when the intended recipient is the parent. This case is presented by a clinical ethics consultant to whom a nurse turned with her discomfort over the situation faced as a renal transplant coordinator. The part played by ethnicity and traditional Korean culture is highlighted.

Ethics committees and consensus in the post-totalitarian society

Ethics committees are usually expected to reach and frame their decisions by consensus. In a post-totalitarian society the conception of consensus might somewhat differ from the one present in societies with a long-term, uninterrupted tradition of democratic development. In 1990s, post totalitarian societies of Central and East Europe have been walking difficult paths from the situation, when matters of public interest had been decided almost solely within the structures of a totalitarian power (usually a 'communist' party and by the party dominated governmental or municipal structures) and the political decisions implemented by more or less coercive exercise of that power (while requiring the broadest community attainment--'imposed consensus'); toward societies deciding their fate and matters of public interest via institutions of a modern, pluralistic, parliamentary democracy (subscribing implicitly or even explicitly to consensus, perceived mostly as 'overlapping' or 'procedural'). The paper gives an analysis of evolution of the notion of consensus in the post-totalitarian Slovakia as seen within the frame of the first decade of establishment and work of ethics committees in the institutions of biomedical research and health care. Examples of present challenges for ethics committees' consensual decision making are outlined.

Under the shelter of ethics

Problems of ethics committees in post-communist Russia are briefly discussed. The first ethics committees were established in 1980s upon the initiative of international pharmaceutical companies involved in clinical trials. Generally, such committees exist at hospitals conducting these trials and at research institutions dealing with human experimentation. They are bureaucratic structures heavily dependent on hospital or institution administration. Publication of research results in international periodicals is the main reason for their existence. An officially recognized National Ethics Committee is non-existent although there are several competing ethics committees at a national level (at the Ministry of Health, Academy of Sciences, Academy of Medical Sciences, Russian Medical association etc.). There is no federal legislation on the structure and status of ethics committees.

The Benefits of Serving on a Hospital Ethics Committee

Community hospitals ethics committees rarely have formal support from persons within the academic community. The author discusses a liaison between a suburban hospital system and a nearby university school of nursing that garners positive educational, service, and programmatic benefits, related to ethics, for both. The lessons learned and insights gained by a faculty member serving on the ethics committee are examined.

Governing UK Biobank: the importance of ensuring public trust

In the autumn of 2003, UK Biobank published the first draft of its Ethics and Governance Framework. Subsequently, this document has been available for interested parties to comment on and the UK Biobank Board of Directors is expected to adopt the final version in 2004. Here, we aim to contribute to this process and highlight to a wider audience some of the inconsistencies in the issues of consent, governance and right of withdrawal that emerge from the draft of the Framework. These issues will have implications for securing the public trust and long-term support that the success of the project depends on. Therefore, they must be considered carefully because the UK Biobank will be the first ever genetic database of a general population of this size to become operational, and will be used as a model for other projects of this kind.

Neuordnung des Verfahrens und der Aufgaben der zust�ndigen Ethik-Kommissionen

Since 12(th) of August 2004 the EU Directive 2001/20/EG has been implemented into the national law. The 12th AMG amendment of 30 July 2004 and the good clinical practice decree on the conduct of clinical trials on drugs for human use of 9 August 2004 have been authorized and must be considered for new clinical trials with investigational medical products (drugs). The scope of the changes are to increase the quality of clinical trials and to continue the process of harmonization within the European Community. Based on the new law the sponsor has to apply for approval by the competent authority and for a favourable opinion by the responsible ethics committee. Both procedures are independent; a favourable opinion of the responsible ethics committee is a necessary condition before starting the trial. Thus, the role of the ethics committees has been changed; the committees are considered as an institution comparable to an authority to protect the rights and safety of human subjects involved in clinical trials. The permanent working group of the medical ethics committees in Germany has established a procedure to meet these requirements, particularly in the case of multicentre clinical trials, where only a single opinion shall be given for each member state. This article describes this procedure (application, process of ethical consideration among the leading and local ethics committees in multicentre trials, responsibilities during the trial).

Understanding the structure and practices of research ethics committees through research and audit: a study from Mexico

This paper reports on a series of studies that were conducted at the Mexican Institute of Social Security (IMSS) between 2001 and 2002 to determine the role, structure and workings of their local research ethics committees (LRECs). The IMSS, unlike other Mexican health institutions, has a formal system of committees. Such committees operate under a regulatory system and are charged with scrutinising all research proposals in order to ensure their scientific validity and to protect the rights and well being of research subjects [Instituto Mexicano del Seguro Social. Dirección de Prestaciones Médicas (México). Manual de Investigación Médica en el IMSS: Instituto Mexicano del Seguro Social; 1999]. The organisation wanted to know how the committees were functioning and if the work of the committees needed to be improved. The problems that were encountered included issues with the composition of the committees, the process of project assessment, the continuing review process, and a lack of motivation of staff. In addition a qualitative study [Valdez-Martínez E, Turnbull B, Garduño-Espinosa J, Porter JDH. Descriptive ethics: a qualitative study of local research ethics committees in Mexico, Developing World Bioethics, 2005, in press] highlighted the focus of the committees on rules, regulations and the law with little understanding of the important individual role of members in complementing and adding to these structures and perspectives. The paper suggests that, to support staff and to protect research subjects, the organizational structure, management and decision making process of the IMSS's LRECs ought to be assessed regularly through audit cycles. In order to support the further development of the committees, the aim of the audit cycles should be focused on education and development of the vision, perspectives, values, and working processes of each LREC.