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Gavrilovska-Brzanov A, Gjambaz D, Naumovski F, Brzanov N, Jovanovski Srceva M, Sivevski A, Biljana K. Major abdominal surgery for Jehovah's Witnesses: Challenge while practicing bloodless medicine in a middle income country. SAGE Open Med Case Rep 2023; 11:2050313X231220836. [PMID: 38144674 PMCID: PMC10748892 DOI: 10.1177/2050313x231220836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
We present a 59-year-old female Jehovah's Witness patient transferred from another facility to our tertiary center as an emergency case owing to anemia due to gastrointestinal bleeding. A computed tomography scan and gastroscopy confirmed an invasion of the duodenum by a malignant process. The patient underwent a Whipple procedure and a right hemicolectomy refusing blood transfusion. On the 17th postoperative day, the patient was discharged following a successful surgery. This article's objectives are to first highlight the moral and ethical quandary and then share our surgical experiences with this particular patient population. In conclusion, Jehovah's Witnesses' management of major abdominal surgery poses considerable clinical, moral, and legal difficulties. Despite them, doctors must put the patients' needs first while also honoring their religious convictions. However, urgent situations continue to arise, forcing medical professionals to weigh their religious convictions against the need to save a patient's life.
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Affiliation(s)
- Aleksandra Gavrilovska-Brzanov
- Medical Faculty, University Clinic for Traumatology, Orthopaedic Diseases, Anaesthesia, Reanimation, Intensive Care and Emergency Centre, University “SS Cyril and Methodius,” Skopje, Macedonia
| | - Darko Gjambaz
- Medical Faculty, University Clinic for Abdominal Surgery, University “SS Cyril and Methodius,” Skopje, Macedonia
| | - Filip Naumovski
- Medical Faculty, University Clinic for Traumatology, Orthopaedic Diseases, Anaesthesia, Reanimation, Intensive Care and Emergency Centre, University “SS Cyril and Methodius,” Skopje, Macedonia
| | - Nikola Brzanov
- Medical Faculty, University Clinic for Traumatology, Orthopaedic Diseases, Anaesthesia, Reanimation, Intensive Care and Emergency Centre, University “SS Cyril and Methodius,” Skopje, Macedonia
| | - Marija Jovanovski Srceva
- Medical Faculty, University Clinic for Traumatology, Orthopaedic Diseases, Anaesthesia, Reanimation, Intensive Care and Emergency Centre, University “SS Cyril and Methodius,” Skopje, Macedonia
| | - Atanas Sivevski
- Medical Faculty, University Clinic for Gynecology and Obstetrics, University “SS Cyril and Methodius,” Skopje, Macedonia
| | - Kuzmanovska Biljana
- Medical Faculty, University Clinic for Traumatology, Orthopaedic Diseases, Anaesthesia, Reanimation, Intensive Care and Emergency Centre, University “SS Cyril and Methodius,” Skopje, Macedonia
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Nair B, Gupta R, Prakash A. Perceptions of the first-year MBBS students about professionalism and ethics after foundation course of competency-based medical education curriculum. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_202_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Persaud-Sharma D, Govea M, Hernandez R. Medical Ethics and the Biopsychosocial Model for Patient Care: A Case Analysis for Improved Communication, Clinical Time, and Error Avoidance. Cureus 2020; 12:e8535. [PMID: 32665882 PMCID: PMC7352746 DOI: 10.7759/cureus.8535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The practice of interdisciplinary medicine is one of the most effective and cooperative forms of medical management, which optimizes clinical care and outcomes for a patient. This model of care affords the patient the benefit of receiving the best available therapeutic options from specialists who are experts in their respective disciplines, which would otherwise be limited when compared with the clinical expertise from a single provider managing multiple co-morbidities. However, poor communication between each specialized team managing a patient's care can result in redundancies and superfluous treatment that can have deleterious clinical outcomes that impede the physician-patient relationship and question the bioethical principles of clinical practice. Having a medical provider like an internist who is the primary medical provider for a patient anchors reinforces the physician-patient relationship through familiarity and continuous involvement in the gross clinical course of a patient. Specialty care provides a very focused and limiting scope of practice. However, whether practicing specialty care or being a generalist, utilizing clinical tools, such as the biopsychosocial model and routinely using bioethical principles during clinical encounters, not only help extract pertinent information from the patient's medical history but also furthers the continuity of clinical care by understanding the global context of the patient's medical history. This is a case analysis that exemplifies sub-optimal outcomes in patient care due to undermining the critical role of an internist in patient care and clinical management in addition to challenging several bioethical principles of clinical care. It also highlights the importance of how using the biopsychosocial model of care can avoid clinical errors, improve interdisciplinary and patient communication, and, ultimately, optimize the patient-physician relationship and clinical care.
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Affiliation(s)
- Dharam Persaud-Sharma
- Internal Medicine, Kendall Regional Medical Center, Herbert Wertheim College of Medicine Florida International University, Miami, USA
| | - Marien Govea
- Internal Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Robert Hernandez
- Internal Medicine/Infectious Disease, Kendall Regional Medical Center, Miami, USA
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Bar M, Fish E, Mendlovic S. Mental-health care under threat: a pragmatic approach for ethical decision-making for practitioners in COVID-19. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1777939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M. Bar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Psychiatric Division, Sheba Medical Center, Ramat-Gan, Israel
| | - E. Fish
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S. Mendlovic
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Director, the Shalvata Mental Health Center, Shalvata Mental Health Center, Hod Hasharon, Israel
- Psychotherapy Program, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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de Miguel Beriain I. Should we have a right to refuse diagnostics and treatment planning by artificial intelligence? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:247-252. [PMID: 31960228 DOI: 10.1007/s11019-020-09939-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Should we be allowed to refuse any involvement of artificial intelligence (AI) technology in diagnosis and treatment planning? This is the relevant question posed by Ploug and Holm in a recent article in Medicine, Health Care and Philosophy. In this article, I adhere to their conclusions, but not necessarily to the rationale that supports them. First, I argue that the idea that we should recognize this right on the basis of a rational interest defence is not plausible, unless we are willing to judge each patient's ideology or religion. Instead, I consider that the right must be recognized by virtue of values such as social pluralism or individual autonomy. Second, I point out that the scope of such a right should be limited at least under three circumstances: (1) if it is against a physician's obligation to not cause unnecessary harm to a patient or to not provide futile treatment, (2) in cases where the costs of implementing this right are too high, or (3) if recognizing the right would deprive other patients of their own rights to adequate health care.
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Affiliation(s)
- Iñigo de Miguel Beriain
- Chair in Law and the Human Genome Research Group, Department of Public Law, University of the Basque Country, UPV/EHU, Barrio Sarriena S/N, Leioa, Bizkaia, Spain.
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.
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Medić Brkić B, Stopić B, Savić Vujović K, Divac N, Vučković S, Stojanović R, Srebro D, Basailović M, Prostran M. Pharmacotherapy of Rare Diseases in Serbia: The Current State of Art. Rare Dis 2020. [DOI: 10.5772/intechopen.91262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Hammami MM, Hammami MB, Aboushaar R. Modeling Lay People's Ethical Attitudes to Organ Donation: A Q-Methodology Study. Patient Prefer Adherence 2020; 14:173-189. [PMID: 32099336 PMCID: PMC6996217 DOI: 10.2147/ppa.s230286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/18/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Organ donation is commonly evaluated by biomedical ethicists based largely on principlism with autonomy at the top of the "moral mountain." Lay people may differ in the way they invoke and balance the various ethical interests. We explored lay people's ethical attitudes to organ donation. METHODS Respondents (n=196) ranked 42 opinion-statements on organ donation according to a 9-category symmetrical distribution. Statements' scores were analyzed by averaging-analysis and Q-methodology. RESULTS Respondents' mean (SD) age was 34.5 (10.6) years, 53% were women, 69% Muslims (30% Christians), 29% Saudis (26% Filipinos), and 38% healthcare-related. The most-agreeable statements were "Acceptable if benefit to recipient large," "Explicit donor consent and family approval for live donation," "Acceptable if directed to family member," and "Explicit donor consent and family approval for postmortem donation." The most-disagreeable statements were "Donor consent and family approval not required for postmortem donation," "Acceptable with purely materialistic motivation," and "Only donor no-known objection for postmortem donation." Women, Christians, and healthcare respondents gave higher rank to "Explicit donor consent and family approval for live donation," "Only donor family consent required for postmortem donation," and "Acceptable if organ distribution equitable," respectively, and Muslims gave more weight to donor/family harm (p ≤0.001). Q-methodology identified various ethical resolution models that were associated with religious affiliation and included relatively "motives-concerned," "family-benefit-concerned," "familism-oriented," and "religious or non-religious altruism-concerned" models. Of 23 neutral statements on averaging-analysis, 48% and 65% received extreme ranks in ≥1 women and men Q-methodology models, respectively. CONCLUSION 1) On average, recipient benefit, requirement of both explicit donor consent and family approval, donor-recipient relationship, and motives were predominant considerations; 2) ranking of some statements was associated with respondents' demographics; 3) Q-methodology identified various ethical resolution models that were partially masked by averaging-analysis; and 4) strong virtue and familism approaches in our respondents provide some empirical evidence against principlism adequacy.
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Affiliation(s)
- Muhammad M Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University College of Medicine, Riyadh, Saudi Arabia
- Correspondence: Muhammad M Hammami Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh11211, Saudi ArabiaTel +966-11-442-4527Fax +966-11-442-7894 Email
| | - Muhammad B Hammami
- Division of Gastroenterology, Department of Medicine, John Hopkins University, Baltimore, MD, USA
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Lim WY, Loh L, Desai SR, Tien SL, Goh BK, Wong P. Major liver surgery in a Jehovah’s Witness patient: challenges for safe surgery. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2019. [DOI: 10.36303/sajaa.2019.25.3.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Jehovah’s Witnesses presenting for major surgery run the risk of major bleeding, which is complicated by the refusal to accept blood transfusion. We present a case of a 63-year-old woman, a Jehovah’s Witness, who was diagnosed with hepatocellular carcinoma and advised for curative laparoscopic liver segmentectomy. Due to the risk of significant intraoperative haemorrhage, her perioperative care was coordinated in a multidisciplinary manner. Informed consent requires the physician to advise on the material risks of undertaking major surgery without blood transfusion and the possible alternatives. Conflicting ethical issues of patient autonomy and beneficence related to refusal of blood products also arise. Perioperative strategies to minimise blood loss, maximise haematopoiesis and tolerance of anaemia to facilitate safe surgery in such patients are also presented. Written patient consent obtained.
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Affiliation(s)
- WY Lim
- Singapore General Hospital
| | - L Loh
- Singapore General Hospital
| | | | | | - BK Goh
- Singapore General Hospital
| | - P Wong
- Singapore General Hospital
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Cay D. Contemporary issues in law and ethics: Exploring the family veto for organ donation. J Perioper Pract 2019; 29:361-367. [PMID: 30638138 DOI: 10.1177/1750458918818998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article explores current issues surrounding the impact of family veto for organ donation in the UK. A critical, reflective analysis of the theoretical, legal and ethical aspects aims to evaluate how the deceased’s explicit wish to donate may be revoked. Under current UK legislation and upon death, money and property are protected; however, the body is not. When investigating personal wishes, interests and decisions must be weighed against the moral legitimacy of the family veto.
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Affiliation(s)
- Debbie Cay
- Maidstone & Tunbridge Wells Hospitals Trust, Kent, UK
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Al-Shaghana M, Bentall A, Jesky MD, Lester W, Lipkin G. Early eculizumab use in atypical haemolytic uraemic syndrome in a Jehovah’s Witness refusing blood products. Oxf Med Case Reports 2017. [PMID: 28638625 PMCID: PMC5471596 DOI: 10.1093/omcr/omx025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- May Al-Shaghana
- Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew Bentall
- Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Immunity and Infection, University of Birmingham, Birmingham, UK
- Correspondence address. Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2WB, UK. Tel: +44-121-371-2000; Fax: +44-121-371-5858. E-mail:
| | - Mark D. Jesky
- Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Immunity and Infection, University of Birmingham, Birmingham, UK
| | - William Lester
- Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Graham Lipkin
- Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Affiliation(s)
- Hani Jaouni
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Rollins KE, Contractor U, Inumerable R, Lobo DN. Major abdominal surgery in Jehovah's Witnesses. Ann R Coll Surg Engl 2016; 98:532-537. [PMID: 27412808 PMCID: PMC5392872 DOI: 10.1308/rcsann.2016.0210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2015] [Indexed: 01/13/2023] Open
Abstract
Introduction Patients who are Jehovah's Witnesses pose difficult ethical and moral dilemmas for surgeons because of their refusal to receive blood and blood products. This article outlines the personal experiences of six Jehovah's Witnesses who underwent major abdominal surgery at a single institution and also summarises the literature on the perioperative care of these patients. Methods The patients recorded their thoughts and the dilemmas they faced during their surgical journey. We also reviewed the recent literature on the ethical principles involved in treating such patients and strategies recommended to make surgery safer. Results All patients were supported in their decision making by the clinical team and the Hospital Liaison Committee for Jehovah's Witnesses. The patients recognised the ethical and moral difficulties experienced by clinicians in this setting. However, they described taking strength from their belief in Jehovah. A multitude of techniques are available to minimise the risk associated with major surgery in Jehovah's Witness patients, many of which have been adopted to minimise unnecessary use of blood products in general. Nevertheless, the risks of catastrophic haemorrhage and consequent mortality remain an unresolved issue for the treating team. Conclusions Respect for a patient's autonomy in this setting is the overriding ethical principle, with detailed discussion forming an important part of the preparation of a Jehovah's Witness for major abdominal surgery. Clinicians must be diligent in the documentation of the patient's wishes to ensure all members of the team can abide by these.
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Affiliation(s)
- K E Rollins
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals and University of Nottingham , UK
| | - U Contractor
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals and University of Nottingham , UK
| | - R Inumerable
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals and University of Nottingham , UK
| | - D N Lobo
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals and University of Nottingham , UK
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Henning MA, Malpas P, Ram S, Rajput V, Krstić V, Boyd M, Hawken SJ. Students' responses to scenarios depicting ethical dilemmas: a study of pharmacy and medical students in New Zealand. JOURNAL OF MEDICAL ETHICS 2016; 42:466-473. [PMID: 27154898 DOI: 10.1136/medethics-2015-103253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/12/2016] [Indexed: 06/05/2023]
Abstract
One of the key learning objectives in any health professional course is to develop ethical and judicious practice. Therefore, it is important to address how medical and pharmacy students respond to, and deal with, ethical dilemmas in their clinical environments. In this paper, we examined how students communicated their resolution of ethical dilemmas and the alignment between these communications and the four principles developed by Beauchamp and Childress. Three hundred and fifty-seven pharmacy and medical students (overall response rate=63%) completed a questionnaire containing four clinical case scenarios with an ethical dilemma. Data were analysed using multiple methods. The findings revealed that 73% of the qualitative responses could be exclusively coded to one of the 'four principles' determined by the Beauchamp and Childress' framework. Additionally, 14% of responses overlapped between the four principles (multiple codes) and 13% of responses could not be coded using the framework. The subsequent subgroup analysis revealed different response patterns depending on the case being reviewed. The findings showed that when students are faced with challenging ethical dilemmas their responses can be aligned with the Beauchamp and Childress framework, although more contentious dilemmas involving issues of law are less easily categorised. The differences between year and discipline groups show students are developing ethical frames of reference that may be linked with their teaching environments and their levels of understanding. Analysis of these response patterns provides insight into the way students will likely respond in 'real' settings and this information may help educators prepare students for these clinical ethical dilemmas.
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Affiliation(s)
- Marcus A Henning
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Phillipa Malpas
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sanya Ram
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Vijay Rajput
- Ross University School of Medicine, Miramar, Florida, USA
| | - Vladimir Krstić
- Department of Philosophy, University of Auckland, Auckland, New Zealand
| | - Matt Boyd
- Independent researcher, formerly University of Auckland, Auckland, New Zealand
| | - Susan J Hawken
- Department of General Practice and Primary Healthcare, Faculty of Medical and Health Sciences, University of Auckland, Auckland New Zealand
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Irmak N. Right to refuse treatment in Turkey: a diagnosis and a slightly less than modest proposal for reform. JOURNAL OF MEDICAL ETHICS 2016; 42:435-438. [PMID: 27101835 DOI: 10.1136/medethics-2015-103266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/31/2016] [Indexed: 06/05/2023]
Abstract
This paper examines the current state of right to refuse medical treatment in Turkey. Even though there are only a few studies carried out with Turkish physicians on their attitude towards the right to refuse treatment, I argue that recent studies on physicians' views on informed consent and honest disclosure show that Turkish physicians do not tend to recognise their patients' right to decline treatment. This is because the refusal of treatment crucially requires that patients be properly informed and asked for their consent before the treatment. Turkish physicians and healthcare providers' tendency to ignore the right to decline medical treatment cannot be separated from their paternalistic approach to patients and their rights. I argue that part of the problem is the legal framework, which, in essence, is still paternalistic. More specifically, the frequent appearance of the phrase 'medical necessity' in the relevant legislation is conveniently used to justify medical intervention against a patient's will. I conclude the paper by proposing reforms in the legal documents defining and regulating patient rights, including the Constitution of the Turkish Republic, and I will argue that these reforms will help enhance patient rights in Turkey. Turkey has been discussing a new Constitution for the past several years, so my proposal should best be understood as contributing to public discussion of the new Constitution by initiating debate about medical paternalism and patient autonomy in Turkish medicine.
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The Genetic Counselor’s Role in Managing Ethical Dilemmas Arising in the Laboratory Setting. J Genet Couns 2016; 25:838-54. [DOI: 10.1007/s10897-016-9957-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/31/2016] [Indexed: 01/23/2023]
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Hirani SAA, Rahman A. Child with idiopathic pulmonary hemosiderosis: a case report from Pakistan with multiple ethical and moral issues. J Pediatr Nurs 2012; 27:e22-8. [PMID: 21968218 DOI: 10.1016/j.pedn.2011.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Revised: 08/12/2011] [Accepted: 08/30/2011] [Indexed: 10/16/2022]
Abstract
This report discusses the case of a young Pakistani child diagnosed with idiopathic pulmonary hemosiderosis (IPH). The key features of IPH were iron deficiency anemia and pulmonary symptoms due to recurrent pulmonary hemorrhages. The child showed complications of the disease process because of late diagnosis. Because various ethical and moral issues were associated with the diagnosis and management of IPH, this case provides insights about the care burden of health care professionals and a child's parents in a Pakistani pediatric setting. During the course of the child's treatment at one of the private tertiary care settings of Karachi, Pakistan, the key challenges were as follows: declaring the diagnosis to the parents, dealing with the request of the child's parents for withdrawal of ventilatory support and withholding treatment, deciding the code status of the child, and ensuring the quality of the child's life after discharge from the hospital. It was learned from this case report that shared decision making and open communication with the child's family enabled the pediatric health care professionals to determine what was in the best interest of the child, resulting in provision of effective palliative care to the child. Moreover, it was realized that early detection of the disease and availability of hospice care can facilitate palliative care of children diagnosed with IPH.
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Abstract
In its guidelines for hand care professionals, the American Society for Surgery of the Hand has set the following criteria as guidelines for the ethical hand surgeon in the 21st century: decency, honor, and integrity. This article reviews these criteria in detail, relates how they apply in practice, and describes how they interact with state and federal law in both legislative and judicial aspects. Matters pertaining to informed consent, privacy issues, patient autonomy, shared decision making, and conflict of interest are described, and recent developments in this area are examined. Are hand surgeons ready for an enforceable system of ethics to be handed down by the ASSH or by the government?
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Cheyette CM. Communitarianism and the ethics of communicable disease: some preliminary thoughts. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2011; 39:678-689. [PMID: 22084854 DOI: 10.1111/j.1748-720x.2011.00635.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Communicable diseases, especially those that are highly contagious, are on the rise and each of us, no matter who we are or where we live, is equally at risk of transmitting contagious diseases to others as we are of contracting such diseases from others. Because contagious diseases are as readily passed state-to-state as person-to-person, we all have a stake in every country's ability to enact effective infectious disease control policies, while policies grounded in shared values are more likely to gain widespread acceptance and thereby prove most effective. This paper suggests that principlism proved invaluable as an ethical framework for resolving hard medical cases and setting health care policy because it nicely "fits" dilemmas that arise in the context of the special relationship between doctors and patients or within family units. It then argues that communitarianism provides the better foundation for crafting infectious diseases control policies because contagious diseases, which often pass between perfect strangers, raise questions about the moral obligations we owe to (or are entitled to demand of) people with whom we share no "special" relationship. Accordingly, a socially embedded framework such as communitarianism may be a better fit for the more socially embedded ethical dilemmas of communicable diseases.
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Hammami MM, Attalah S, Al Qadire M. Which medical error to disclose to patients and by whom? Public preference and perceptions of norm and current practice. BMC Med Ethics 2010; 11:17. [PMID: 20955579 PMCID: PMC2967555 DOI: 10.1186/1472-6939-11-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 10/18/2010] [Indexed: 11/10/2022] Open
Abstract
Background Disclosure of near miss medical error (ME) and who should disclose ME to patients continue to be controversial. Further, available recommendations on disclosure of ME have emerged largely in Western culture; their suitability to Islamic/Arabic culture is not known. Methods We surveyed 902 individuals attending the outpatient's clinics of a tertiary care hospital in Saudi Arabia. Personal preference and perceptions of norm and current practice regarding which ME to be disclosed (5 options: don't disclose; disclose if associated with major, moderate, or minor harm; disclose near miss) and by whom (6 options: any employee, any physician, at-fault-physician, manager of at-fault-physician, medical director, or chief executive director) were explored. Results Mean (SD) age of respondents was 33.9 (10) year, 47% were males, 90% Saudis, 37% patients, 49% employed, and 61% with college or higher education. The percentage (95% confidence interval) of respondents who preferred to be informed of harmful ME, of near miss ME, or by at-fault physician were 60.0% (56.8 to 63.2), 35.5% (32.4 to 38.6), and 59.7% (56.5 to 63.0), respectively. Respectively, 68.2% (65.2 to 71.2) and 17.3% (14.7 to 19.8) believed that as currently practiced, harmful ME and near miss ME are disclosed, and 34.0% (30.7 to 37.4) that ME are disclosed by at-fault-physician. Distributions of perception of norm and preference were similar but significantly different from the distribution of perception of current practice (P < 0.001). In a forward stepwise regression analysis, older age, female gender, and being healthy predicted preference of disclosure of near miss ME, while younger age and male gender predicted preference of no-disclosure of ME. Female gender also predicted preferring disclosure by the at-fault-physician. Conclusions We conclude that: 1) there is a considerable diversity in preferences and perceptions of norm and current practice among respondents regarding which ME to be disclosed and by whom, 2) Distributions of preference and perception of norm were similar but significantly different from the distribution of perception of current practice, 3) most respondents preferred to be informed of ME and by at-fault physician, and 4) one third of respondents preferred to be informed of near-miss ME, with a higher percentage among females, older, and healthy individuals.
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Affiliation(s)
- Muhammad M Hammami
- Centre for Clinical Studies and Empirical Ethics King Faisal Specialist Hospital and Research Centre Riyadh, Saudi Arabia.
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Abstract
BACKGROUND Sociological understandings of chronic illness have revealed tensions and complexities around help-seeking. Although ethics underpins healthcare, its application in the area of chronic illness is limited. Here we apply an ethical framework to interview accounts and identify ethical challenges in the early rheumatoid arthritis (RA) experience. METHODS In-depth interviews were conducted with eight participants who had been diagnosed with RA in the 12 months prior to recruitment. Applying the concepts of autonomous decision-making and procedural justice highlighted ethical concerns which arose throughout the help-seeking process. Analysis was based on the constant-comparison approach. RESULTS Individuals described decision-making, illness actions and the medical encounter. The process was complicated by inadequate knowledge about symptoms, common-sense understandings about the GP appointment, difficulties concerning access to specialists, and patient-practitioner interactions. Autonomous decision-making and procedural justice were compromised. The accounts revealed contradictions between the policy ideals of active self-management, patient-centred care and shared decision-making, and the everyday experiences of individuals. CONCLUSIONS For ethical healthcare there is a need for: public knowledge about early RA symptoms; more effective patient-practitioner communication; and increased support during the wait between primary and secondary care. Healthcare facilities and the government may consider different models to deliver services to people requiring rheumatology consults.
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Affiliation(s)
- A Townsend
- CIHR Ethics of Health Research Health and Training Program, The W. Maurice Young Centre for Applied Ethics, University of British Columbia, 235-6356 Agricultural Road, Klinck Building, Vancouver, British Columbia V6T 1Z2, Canada.
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Kenny B, Lincoln M, Balandin S. Experienced speech-language pathologists' responses to ethical dilemmas: an integrated approach to ethical reasoning. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2010; 19:121-134. [PMID: 20008471 DOI: 10.1044/1058-0360(2009/08-0007)] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To investigate the approaches of experienced speech-language pathologists (SLPs) to ethical reasoning and the processes they use to resolve ethical dilemmas. METHOD Ten experienced SLPs participated in in-depth interviews. A narrative approach was used to guide participants' descriptions of how they resolved ethical dilemmas. Individual narrative transcriptions were analyzed by using the participant's words to develop an ethical story that described and interpreted their responses to dilemmas. Key concepts from individual stories were then coded into group themes to reflect participants' reasoning processes. RESULTS Five major themes reflected participants' approaches to ethical reasoning: (a) focusing on the well-being of the client, (b) fulfilling professional roles and responsibilities, (c) attending to professional relationships, (d) managing resources, and (e) integrating personal and professional values. SLPs demonstrated a range of ethical reasoning processes: applying bioethical principles, casuistry, and narrative reasoning when managing ethical dilemmas in the workplace. CONCLUSIONS The results indicate that experienced SLPs adopted an integrated approach to ethical reasoning. They supported clients' rights to make health care choices. Bioethical principles, casuistry, and narrative reasoning provided useful frameworks for facilitating health professionals' application of codes of ethics to complex professional practice issues.
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Affiliation(s)
- Belinda Kenny
- University of Sydney-Speech Pathology, Faculty of Health Sciences, Cumberland Campus, Lidcombe, New South Wales 1825, Australia.
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Philosophy, freedom and the public good: a review and analysis of ‘Public Health Ethics’�Holland, S. (2007). J Eval Clin Pract 2009. [DOI: 10.1111/j.1365-2753.2009.01269.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Richards FH. Predictive genetic testing of adolescents for Huntington disease: a question of autonomy and harm. Am J Med Genet A 2008; 146A:2443-6; author reply 2447-8. [PMID: 18698623 DOI: 10.1002/ajmg.a.32477] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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White AP, Vaccaro AR, Zdeblick T. Counterpoint: physician-industry relationships can be ethically established, and conflicts of interest can be ethically managed. Spine (Phila Pa 1976) 2007; 32:S53-7. [PMID: 17495588 DOI: 10.1097/brs.0b013e318053d54f] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Review of the nature of conflicts of interest in physician-industry relationships, with a focus on the efforts to ethically manage physician-industry relationships. OBJECTIVE To illustrate the perspective that physician-industry relationships can be ethically established, and conflicts of interest can be ethically managed. SUMMARY OF BACKGROUND DATA The interest in considering the appropriateness of physician-industry relationships has recently become focused on spine surgery. Many of the conflicts of interest inherent to these relationships have been interpreted as problematic, and have been scrutinized by the media, industry, medical and legal professions, and Federal government. METHODS The basis for conflicts of interest, manner in which bias may be introduced, and methods to reduce bias are presented. The potential risks and benefits to patients that are inherent to physician-industry relationships are considered. A framework, developed by medical ethicists, is provided to guide analysis of conflicts of interest in physician-industry relationships. RESULTS Collaboration between spine surgeons and industry is necessary to improve patient care. The conflicts of interest that often arise in physician-industry relationships must be recognized, and keenly managed in order to eliminate the risk and maximize the benefit to the patient. Ethical management of conflicts must include disclosure. To preserve patient autonomy, management should also include a discussion of the quality of the medical evidence on which treatment recommendations are made. Guidelines from industry and medical professional organizations, including the "Standards of Professionalism" currently under development by the American Academy of Orthopedic Surgery, are also expected to aid in the ethical establishment and management of conflicts of interest. CONCLUSIONS Careful consideration of conflicts of interest in physician-industry relationships has provided an opportunity to review our goals as physicians in society, and to continue collaborative advancement of our field for the benefit of our patients.
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Affiliation(s)
- Andrew P White
- Department of Orthopaedic and Neurological Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
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Coors ME, Townsend SF. Supporting Pregnant Women through Difficult Decisions: A Case of Prenatal Diagnosis of Osteogenesis Imperfecta. THE JOURNAL OF CLINICAL ETHICS 2006. [DOI: 10.1086/jce200617309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Thornton T. Judgement and the role of the metaphysics of values in medical ethics. JOURNAL OF MEDICAL ETHICS 2006; 32:365-70. [PMID: 16731739 PMCID: PMC2563362 DOI: 10.1136/jme.2005.012518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Despite its authors' intentions, the four principles approach to medical ethics can become crudely algorithmic in practice. The first section sets out the bare bones of the four principles approach drawing out those aspects of Beauchamp and Childress's Principles of biomedical ethics that encourage this misreading. The second section argues that if the emphasis on the guidance of moral judgement is augmented by a particularist account of what disciplines it, then the danger can be reduced. In the third section, I consider how much the resultant picture diverges from Beauchamp and Childress's actual position.
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Affiliation(s)
- T Thornton
- Centre for Ethnicity and Health, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK.
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Abstract
Recent advances in neonatal care have greatly improved the chances for survival of very sick and/or very preterm neonates and have in fact changed the concept and the limits of viability. However, in some situations, when the infant's demise can only be postponed at the price of great suffering or when survival is associated with severe disabilities and an intolerable life for the patient and the parents, it may be unwise to employ the full armamentarium of modern neonatal intensive care. In those circumstances withholding or withdrawing mechanical ventilation and other life-saving, though invasive and painful, procedures might be a better option. This review examines the ethical principles underlying those difficult decisions, the most frequent circumstances where they should be considered, the role of parents and other parties in the decision-making process and the reported behavior of neonatologists in many American and European neonatal intensive care units.
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Abstract
This paper examines whether the modern bioethical principles of respect for autonomy, beneficence, non-maleficence, and justice proposed by Beauchamp and Childress are existent in, compatible with, or acceptable to the leading Chinese moral philosophy-the ethics of Confucius. The author concludes that the moral values which the four prima facie principles uphold are expressly identifiable in Confucius' teachings. However, Confucius' emphasis on the filial piety, family values, the "love of gradation", altruism of people, and the "role specified relation oriented ethics" will inevitably influence the "specification" and application of these bioethical principles and hence tend to grant "beneficence" a favourable position that diminishes the respect for individual rights and autonomy. In contrast, the centrality of respect for autonomy and its stance of "first among equals" are more and more stressed in Western liberal viewpoints. Nevertheless, if the Confucian "doctrine of Mean" (chung-yung) and a balanced "two dimensional personhood" approach are properly employed, this will require both theorists and clinicians, who are facing medical ethical dilemmas, of searching to attain due mean out of competing moral principles thus preventing "giving beneficence a priority" or "asserting autonomy must triumph".
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Affiliation(s)
- D F-C Tsai
- Department of Social Medicine, College of Medicine, National Taiwan University Hospital, No 1, Section 1, Jen-Ai Road, Taipei 100, Taiwan.
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De Lay P, Manda V. Politics of monitoring and evaluation: Lessons from the AIDS epidemic. NEW DIRECTIONS FOR EVALUATION 2004; 2004:13-31. [PMID: 32313419 PMCID: PMC7163920 DOI: 10.1002/ev.120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Monitoring and evaluation programs must strike a balance between generating meaningful tactical information for program managers while taking steps to ensure that public data use does not worsen discrimination and stigma toward people who are positive for the human immunodeficiency virus.
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Affiliation(s)
- Paul De Lay
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Valerie Manda
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
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