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Ghezloo S, Bayatiani MR, Karimi M. Ishāq bin Ali al-Ruhawi, a pioneer in medical professionalism in the 9th century AD. JOURNAL OF MEDICAL BIOGRAPHY 2024:9677720241286589. [PMID: 39397545 DOI: 10.1177/09677720241286589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
Professionalism and medical ethics, while similar, are often viewed in different contexts. An historical and social science analysis reveals that professionalism is a complex skill that can be developed over time. The key components of professionalism, as defined by the American Physical Therapy Association, include accountability, altruism, compassion, excellence, integrity, professional duty, and social responsibility. Throughout history, physicians have been concerned with medical ethics and professionalism. In the Golden Age of Islam, principles such as excellence, honour, integrity, accountability, and duty were important in shaping the professional behavior of physicians. Adab al-Tabib, an ancient work, by Ishāq bin Ali al-Ruhawi focuses on ethical guidelines and teachings related to medical ethics in the Islamic civilization. Many of the ethical issues in this book are of foremost importance as components of professionalism. However while the examples of medical ethics guidelines that pre-existed Adab al-Tabib such as the Hippocratic Oath, are not mentioned. As one of the first statutes of medical ethics in Islamic civilization, Ruhawi is a model for many doctors in the Golden Age of Islam, and over the years his principles have greatly influenced the professional view of physicians.
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Affiliation(s)
- Sobhan Ghezloo
- Department of History of Medicine, School of Persian Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Mohamad Reza Bayatiani
- Department of Radiotherapy and Medical Physics, Faculty of Para Medicine, Arak University of Medical Sciences and Khansari Hospital, Arak, Iran
| | - Mehrdad Karimi
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Science, Tehran, Iran
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Science, Shiraz, Iran
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van Gils-Schmidt HJ, Salloch S. Taking a moral holiday? Physicians' practical identities at the margins of professional ethics. JOURNAL OF MEDICAL ETHICS 2024; 50:626-633. [PMID: 36175125 PMCID: PMC11347259 DOI: 10.1136/jme-2022-108500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Physicians frequently encounter situations in which their professional practice is intermingled with moral affordances stemming from other domains of the physician's lifeworld, such as family and friends, or from general morality pertaining to all humans. This article offers a typology of moral conflicts 'at the margins of professionalism' as well as a new theoretical framework for dealing with them. We start out by arguing that established theories of professional ethics do not offer sufficient guidance in situations where professional ethics overlaps with moral duties of other origins. Therefore, we introduce the moral theory developed by Christine M. Korsgaard, that centres around the concept of practical identity. We show how Korsgaard's account offers a framework for interpreting different types of moral conflicts 'at the margins of professionalism' to provide either orientation for solving the conflict or an explanation for the emotional and moral burden involved in moral dilemmas.
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Affiliation(s)
| | - Sabine Salloch
- Institute of Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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Baliga MS, Marakala V, Madathil LP, George T, D'souza RF, Palatty PL. Ethical and moral principles for oncology healthcare workers: A brief report from a Bioethics consortium emphasizing on need for education. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:145. [PMID: 38784285 PMCID: PMC11114567 DOI: 10.4103/jehp.jehp_1048_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/02/2023] [Indexed: 05/25/2024]
Abstract
The medical sub-specialty of Oncology presents diverse ethical dilemmas, often challenging cancer healthcare workers with difficult-to-handle clinical scenarios that are tough from a personal and professional perspective. Making decisions on patient care in various circumstances is a defining obligation of an oncologist and those duty-based judgments entail more than just selecting the best treatment or solution. Ethics is an essential and inseparable aspect of clinical medicine and the oncologists as well as the allied health care workers are ethically committed to helping the patient, avoiding or minimizing harm, and respecting the patient's values and choices. This review provides an overview of ethics and clinical ethics and the four main ethical principles of autonomy, beneficence, non-maleficence, and justice are stated and explained. At times there are frequently contradictions between ethical principles in patient care scenarios, especially between beneficence and autonomy. In addition, truth-telling, professionalism, empathy, and cultural competence; which are recently considered important in cancer care, are also addressed from an Indian perspective.
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Affiliation(s)
- Manjeshwar S. Baliga
- Department of Education, International Program, International Chair in Bioethics, World Medical Association Cooperating Centre (Formerly UNESCO Chair in Bioethics University of Haifa), Melbourne, Australia
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala, India
- Bioethics Education and Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka, India
| | - Vijaya Marakala
- Department of Biochemistry, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Oman
| | - Lal P. Madathil
- Department of Education, International Program, International Chair in Bioethics, World Medical Association Cooperating Centre (Formerly UNESCO Chair in Bioethics University of Haifa), Melbourne, Australia
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala, India
| | - Thomas George
- Internal Medicine, Coney Island Hospital, 2601 Ocean Pkwy, Brooklyn, New York, USA
| | - Russell F. D'souza
- Department of Education, International Program, International Chair in Bioethics, World Medical Association Cooperating Centre (Formerly UNESCO Chair in Bioethics University of Haifa), Melbourne, Australia
| | - Princy L. Palatty
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala, India
- Department of Pharmacology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
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Cunha SDM, Catrib AMF, Brilhante AVM, Brasil CCP, Feitosa ES, Ferreira MAD. The doctor I want to be: professional self-image in Brazil and Portugal. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2023. [DOI: 10.1590/interface.220489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This qualitative study evaluated the perception of academics about their self-image as future doctors and the factors that influenced the construction of their professional identity. Thirty-two sixth-year medical students in Brazil and Portugal were interviewed. Content analysis in the thematic modality and Goffman’s dramaturgy were used for data analysis and interpretation. The idealized self-image was revealed in two themes: the doctor centered on himself and the one who values the interpersonal relationship. A third theme showed the influence of the University and of elements brought a priori in the doctor’s identity. The results indicate the influence of the hidden curriculum in the construction of professional identity and reinforce the importance of social and humanistic aspects in medical education.
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Cunha SDM, Catrib AMF, Brilhante AVM, Brasil CCP, Feitosa ES, Ferreira MAD. O médico que eu quero ser: autoimagem profissional no Brasil e em Portugal. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2023. [DOI: 10.1590/interface.220374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Este estudo qualitativo avaliou a percepção de acadêmicos sobre sua autoimagem como futuros médicos e os fatores que influenciaram a construção da sua identidade profissional. Foram entrevistados 32 estudantes do sexto ano de Medicina no Brasil e em Portugal. Utilizou-se a análise de conteúdo na modalidade temática e a dramaturgia de Goffman para análise e interpretação dos dados. A autoimagem idealizada revelou-se em duas temáticas: o médico centrado em si e aquele que valoriza a relação interpessoal. Uma terceira temática mostrou a influência da universidade e de elementos trazidos a priori na identidade do médico. Os resultados indicam a influência do currículo oculto na construção da identidade profissional e reforçam a importância dos aspectos sociais e humanísticos na formação médica.
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Metselaar S, van Schaik M, Widdershoven G. CURA: A clinical ethics support instrument for caregivers in palliative care. Nurs Ethics 2022; 29:1562-1577. [PMID: 35622018 PMCID: PMC9667086 DOI: 10.1177/09697330221074014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article presents an ethics support instrument for healthcare professionals
called CURA. It is designed with a focus on and together with nurses and nurse
assistants in palliative care. First, we shortly go into the background and the
development study of the instrument. Next, we describe the four steps CURA
prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and
(4) Act. In order to demonstrate how CURA can structure a moral reflection among
caregivers, we discuss how a case was discussed with CURA at a psychogeriatric
ward of an elderly care home. Furthermore, we go into some considerations
regarding the use of the instrument in clinical practice. Finally, we focus on
the need for further research on the effectiveness and implementation of
CURA.
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Affiliation(s)
- Suzanne Metselaar
- Suzanne Metselaar, Department of Ethics,
Law & Humanities, Amsterdam University Medical Centers, De Boelelaan 1089a,
Amsterdam 1081 HV, The Netherlands.
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Kulsum K, Suryadi T. Critical Care Problem in a Case of Intracerebral Hemorrhage Due to Eclampsia and Its Ethics and Medicolegal Consideration. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8341] [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] Open
Abstract
BACKGROUND: Eclampsia accompanied by hemolysis elevated liver enzymes low platelet (HELLP) syndrome is an emergency condition during late trimester pregnancy characterized by hypertension, seizures, and coma. Obstetric history is known that the patient does not conducted antenatal care regularly to the doctor so that the patient does not know she has eclampsia. One of which complications due to eclampsia is intracerebral hemorrhage which is a major cause of death and morbidity in pregnant woman. This case report discusses how ethical and medicolegal decision-making for procedures to withholding or withdrawing life support for the critical care problem. The ethical dilemma faced by neuroanesthesia and critical care (NACC) consultants is whether to continue to treat patients in the intensive care unit (ICU) even though the results will be in vain or to restrict critical care because they concluded that the condition of the patient has a terminal stage.
CASE REPORT: A reported case of a 23-year-old woman, pregnant, and had a caesarian section for the indication of eclampsia accompanied by HELLP syndrome in rural hospital. Because the patient’s condition worsened, she was referred to Zainoel Abidin hospital due to decrease in consciousness and a computed tomography scan of the head showed extensive bleeding. The results of the neuroanesthesia and neurosurgery team’s assessment stated that there was no indication of surgery on the patient because extensive bleeding had occurred accompanied by brain edema. The patient then undergoes treatment in the ICU to improve the patient’s critical condition. In an effort to overcome this problem, the NACC consultant consults with an ethics and medicolegal consultant as a representation of the medical committee and ethical committee to determine the withholding or withdrawing of life support therapy to the patient.
CONCLUSION: Life support therapies that can be withhold or withdraw are simply an extraordinary treatment that provides no benefit. The basic principles of ethics in making decisions to do withholding and withdrawing life support in these patients are beneficence and non-maleficence, while the medicolegal principle in these patients lies in the patient’s condition being medically incurable (terminal state) and medical treatment is useless (futile treatment).
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Turillazzi E, Maiese A, Frati P, Scopetti M, Di Paolo M. Physician-Patient Relationship, Assisted Suicide and the Italian Constitutional Court. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:671-681. [PMID: 34674155 DOI: 10.1007/s11673-021-10136-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
In 2017, Italy passed a law that provides for a systematic discipline on informed consent, advance directives, and advance care planning. It ranges from decisions contextual to clinical necessity through the tool of consent/refusal to decisions anticipating future events through the tools of shared care planning and advance directives. Nothing is said in the law regarding the issue of physician assisted suicide. Following the DJ Fabo case, the Italian Constitutional Court declared the constitutional illegitimacy of article 580 of the criminal code in the part in which it does not exclude the punishment of those who facilitate the suicide when the decision has been freely and autonomously made by a person kept alive by life-support treatments and suffering from an irreversible pathology, the source of physical or psychological suffering that he/she considers intolerable, but fully capable of making free and conscious decisions. Such conditions and methods of execution must be verified by a public structure of the national health service, after consulting the territorially competent ethics committee. This statement admits, within strict and regulated bounds, physician assisted suicide, so widening the range of end-of-life decisions for Italian patients. Future application and critical topics will be called into question by the Italian legislator.
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Affiliation(s)
- E Turillazzi
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy.
| | - A Maiese
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy
| | - P Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - M Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - M Di Paolo
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126, Pisa, Italy
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Martínez-Sellés M, Martín-Sánchez FJ. Medical associations in the 21st century. Reflections in the wake of the agreement between the Spanish Heart Foundation and the Official Physicians Association of Madrid. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:727-728. [PMID: 34172406 DOI: 10.1016/j.rec.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Facultad de Ciencias Biomédicas, Universidad Europea, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Ilustre Colegio Oficial de Médicos de Madrid, Madrid, Spain.
| | - Francisco Javier Martín-Sánchez
- Facultad de Medicina, Universidad Complutense, Madrid, Spain; Ilustre Colegio Oficial de Médicos de Madrid, Madrid, Spain; Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
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Martínez-Sellés M, Martín-Sánchez FJ. Los colegios de médicos en el siglo XXI. Reflexiones a raíz del acuerdo de la Fundación Española del Corazón y el Ilustre Colegio Oficial de Médicos de Madrid. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tsungmey T, Kim JP, Dunn LB, Ryan K, Lane-McKinley K, Roberts LW. Negative association of perceived risk and willingness to participate in innovative psychiatric research protocols. J Psychiatr Res 2020; 122:9-16. [PMID: 31891880 PMCID: PMC7243412 DOI: 10.1016/j.jpsychires.2019.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023]
Abstract
Psychiatric researchers grapple with concerns that individuals with mental illness may be less likely to appreciate risks of research participation, particularly compared to people not suffering from mental illness. Therefore, empirical studies that directly compare the perspectives of such individuals are needed. In addition, it is important to evaluate perspectives regarding varied types of research protocols, particularly as innovative psychiatric research protocols emerge. In this pilot study, respondents with a mood disorder (n = 25) as well as respondents without a mood disorder (n = 55) were recruited using Amazon's Mechanical Turk (MTurk) platform. These respondents were surveyed regarding four psychiatric research projects (i.e., experimental medication [pill form]; non-invasive magnetic brain stimulation; experimental medication [intravenous infusion]; and implantation of a device in the brain). Regardless of health status, respondents rated the four research protocols as somewhat to highly risky. The brain-device implant protocol was seen as the most risky, while the magnetic brain stimulation project was viewed as "somewhat risky". Respondents, on average and regardless of health status, rated their willingness at or below "somewhat willing." Respondents were least willing to participate in the brain-device implant protocol, whereas they were "somewhat willing" to participate in the magnetic brain stimulation protocol. Trust in medical research was negatively associated with perceived risk of research protocols. Perceived risk was negatively associated with willingness to participate, even when adjusting for potential confounders, suggesting that attunement to risk crosses diagnostic, gender, and ethnic categories, and is more salient to research decision-making than trust in medical research and dispositional optimism. The findings of this study may offer reassurance about the underlying decision-making processes of individuals considering participation in innovative neuroscience studies.
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Affiliation(s)
- Tenzin Tsungmey
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717.
| | - Laura B Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Katie Ryan
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Kyle Lane-McKinley
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Laura Weiss Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
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Salloch S. Clinical Ethics as a Profession? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:87-89. [PMID: 31661420 DOI: 10.1080/15265161.2019.1665747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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13
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Di Paolo M, Gori F, Papi L, Turillazzi E. A review and analysis of new Italian law 219/2017: 'provisions for informed consent and advance directives treatment'. BMC Med Ethics 2019; 20:17. [PMID: 30832644 PMCID: PMC6399822 DOI: 10.1186/s12910-019-0353-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 02/21/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In December 2017, Law 219/2017, 'Provisions for informed consent and advance directives', was approved in Italy. The law is the culmination of a year-long process and the subject of heated debate throughout Italian society. Contentious issues (advance directives, the possibility to refuse medical treatment, the withdrawal of medical treatment, nutrition and hydration) are addressed in the law. MAIN TEXT What emerges clearly are concepts such as quality of life, autonomy, and the right to accept or refuse any medical treatment - concepts that should be part of an optimal relationship between the patient and healthcare professionals. The law maximizes the value of the patient's time to decide. Every patient is allowed to make choices for the present (consenting to or refusing current treatment) as well as for the future, conceived as a continuation of the present, and to decide what comes next, based on what he/she already knows. The law identifies three distinct but converging paths towards the affirmation of a care relationship based on reciprocal trust and respect: the possibility to consent to or refuse treatment, the shared care planning, and advance directives. CONCLUSIONS The fundamental point to emerge from the new Italian law is that consensus is an essential connotation of the treatment relationship. Consensus is not limited to the acceptance/rejection of medical treatment but is ongoing. It is projected into the future through shared care planning and advance directives which act as tools for self-determination and the manifestation of the beliefs and preferences of persons unable to express their will. These principles are in line with the idea of appropriate care as evaluated from two different perspectives, one of scientific adequacy and the other commensurate with the individual's resources, fragility, values, and beliefs. Surely, however, the new law is not the end of the matter on issues such as conscientious objection, which is deeply rooted within the Italian cultural and political debate. In this regard, healthcare institutions and policymakers will be called upon to develop and implement organizational policies aimed at the management of foreseeable conscientious objection in this field.
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Affiliation(s)
- Marco Di Paolo
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126 Pisa, Italy
| | - Federica Gori
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126 Pisa, Italy
| | - Luigi Papi
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126 Pisa, Italy
| | - Emanuela Turillazzi
- Section of Legal Medicine, Department of Clinical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Via Paolo Savi 57, 56126 Pisa, Italy
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Salloch S. The dual use of research ethics committees: why professional self-governance falls short in preserving biosecurity. BMC Med Ethics 2018; 19:53. [PMID: 29871633 PMCID: PMC5989368 DOI: 10.1186/s12910-018-0295-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022] Open
Abstract
Background Dual Use Research of Concern (DURC) constitutes a major challenge for research practice and oversight on the local, national and international level. The situation in Germany is shaped by two partly competing suggestions of how to regulate security-related research: The German Ethics Council, as an independent political advisory body, recommended a series of measures, including national legislation on DURC. Competing with that, the German National Academy of Sciences and the German Research Foundation, as two major professional bodies, presented a strategy which draws on the self-control of science and, inter alia, suggests expanding the scope of research ethics committees (RECs) to an evaluation of DURC. Main body This situation is taken as an occasion to further discuss the scope and limits of professional self-control with respect to security-related research. The role of RECs as professional bodies of science is particularly analyzed, referring to the theoretical backgrounds of professionalism. Two key sociological features of professionalism – ethical orientation and professional self-control – are discussed with respect to the practice of biomedical science. Both attributes are then analyzed with respect to the assessment of DURC by RECs. Conclusion In conclusion, it is stated that issues of biosecurity transcend the boundaries of the scientific community and that a more comprehensive strategy should be implemented encompassing both professional self-control and legal oversight.
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Affiliation(s)
- Sabine Salloch
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Germany.
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15
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Sung C, Herbst JL. The ethics of caring for hospital-dependent patients. BMC Med Ethics 2017; 18:75. [PMID: 29228939 PMCID: PMC5725784 DOI: 10.1186/s12910-017-0238-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 12/04/2017] [Indexed: 12/05/2022] Open
Abstract
Background Hospital-dependent patients are individuals who are repeatedly readmitted to the hospital because their acute medical needs cannot be met elsewhere. Unlike the chronically critically ill, these patients do not have a continuous need for life-sustaining equipment and can experience periods of relative stability where they have a good quality of life. However, some end up spending months or even years in the hospital receiving resource-intensive care because they are unable to be safely discharged, despite an initial optimistic prognosis. It is hard to reliably identify these patients on admission and more research is needed to better understand the unique medical needs of this population. But the inability to safely discharge these patients to their home or to a skilled nursing facility without rapid readmissions also creates ethical implications for the physicians who care for them. The aim of this paper is to clarify some of the ethical considerations involved in caring for hospital-dependent patients. Main body Among physicians, the care of hospital-dependent patients is likely to disproportionately affect hospitalists and intensivists, whose care is often evaluated in terms of reducing patient length of stay and readmissions. Because hospital-dependent patients’ medical needs thwart the traditional goal of safe discharge, both clinical ethics and physicians’ professional obligations are implicated by their care. The inability to reliably identify these patients early can complicate discussions about treatment goals and informed consent. Similarly, the tremendous dedication of limited resources to these patients without safe discharge back to the community may raise concerns about the just allocation of healthcare resources. Conclusion Our current acute care hospitals are not designed to provide long-term care for hospital-dependent patients. Unfortunately, safe discharge options remain elusive for these patients. Further research and support of this population is needed to more reliably identify hospital-dependent patients on admission, better inform the discussions of short- and long-term treatment goals, and more wisely allocate resources both within our acute care hospitals and larger healthcare system.
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Affiliation(s)
- Calvin Sung
- Frank H. Netter MD School of Medicine at Quinnipiac University, 275 Mount Carmel Ave, Hamden, CT, 06518-1908, USA.
| | - Jennifer L Herbst
- Frank H. Netter MD School of Medicine at Quinnipiac University, 275 Mount Carmel Ave, Hamden, CT, 06518-1908, USA.,Quinnipiac University School of Law, 275 Mount Carmel Ave., Hamden, CT, 06518-1908, USA
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Salloch S. Who's afraid of EBM? Medical professionalism from the perspective of evidence-based medicine. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2017; 20:61-66. [PMID: 27581425 DOI: 10.1007/s11019-016-9726-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Evidence-based medicine (EBM) and medical professionalism are two prominent notions in current medical debates. However, proponents of professionalism fear a restriction in doctors' freedom to make their best decisions for individual patients caused by the influence of EBM and highly standardised decision procedures. The challenge which EBM allegedly poses to physicians' discretion forms the starting point for an analysis of the relationship between professionalism, as an inherent value system of medical practice, and EBM, as an approach to optimise the decision-making for individual patients. The analysis starts with a brief conceptual clarification of the ambiguous term "professionalism". It then focuses on three key aspects of medical professionalism which may come into conflict with the basic tenets of EBM. The potential tensions between (a) professional autonomy and clinical practice guidelines, (b) individualised care and standardisation, and (c) esoteric authority and public accountability are analysed and a suggestion for reconcilement regarding each point is made. The article closes with a summary on how a better reflection on medical professionalism may help towards a fuller understanding of EBM and vice versa.
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Affiliation(s)
- Sabine Salloch
- Institute for Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany.
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