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1
Meacham, Katharine R., Ira Sloan, and Robyn A. Latessa. "Practical tips for teaching ethics and humanism to medical students." MedEdPublish 12 (March 23, 2022): 23. http://dx.doi.org/10.12688/mep.19022.1.
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This article presents the results of a decade’s experiment in creating a longitudinal ethics and humanism curriculum for the core clinical year at UNC School of Medicine, North Carolina, United States. This curriculum applies published research on best practices in medical ethics education. Sample comments from course evaluations of the students who have completed this curriculum provide support for its success at achieving its desired learning outcomes. To create a similar ethics curriculum in the core clinical year at other medical schools, there are twelve practical tips: preparation: read the research on the ethical challenges for medical students; recruit an interdisciplinary teaching team; create cohorts for this aspect of the curriculum that will stay together for the year; grade only with pass/fail; have the students bring the cases from their clinical experiences; feed them if possible, and structure the time together carefully. Use a narrative ethics methodology and introduce alternative methods for student writing and group process. Connect students with literature in medical humanities and bioethics and encourage publication of their narratives. As with any good creation, the whole is more than the sum of its parts, and each campus can adapt these guidelines for their people and programs.
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Wild, V., M. Frick, and J. Denholm. "WHO ethics guidance on TB care and migration: challenges to the implementation process." International Journal of Tuberculosis and Lung Disease 24, no. 5 (May 1, 2020): 32–37. http://dx.doi.org/10.5588/ijtld.17.0882.
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We summarise the current ethical guidance on tuberculosis (TB) care and migration, as set out in the WHO “Ethics Guidance for the Implementation of the End TB Strategy.” Among other aspects, the Ethics Guidance states that there should be firm legal principles in place that ensure the enforcement of migration law on the one hand and the protection of human rights, including the right to health, on the other are separated from one another. As a challenge to the Ethics Guidance and its implementation, we describe two cases, each of which typifies particular problems. Case one describes the experience of a migrant worker in the United Arab Emirates who is deported when mandatory medical exams show evidence of current or prior TB. Case two raises the issue of providing more than TB care, which may also be needed for holistic care. The paper concludes with our suggestions for ways in which we could make progress towards ethically optimal TB care for migrants.
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Landa, Amy Snow, and Carl Elliott. "From Community to Commodity: The Ethics of Pharma-Funded Social Networking Sites for Physicians." Journal of Law, Medicine & Ethics 41, no. 3 (2013): 673–79. http://dx.doi.org/10.1111/jlme.12077.
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In September 2006, a small start-up company in Cambridge, MA called Sermo, Inc., launched a social networking site with an unusual twist: only physicians practicing medicine in the United States would be allowed to participate. Sermo, which means “conversation” in Latin, marketed its website as an online community exclusively for doctors that would allow them to talk openly (and anonymously) about a range of topics, from challenging and unusual medical cases to the relative merits of one treatment versus another. “Sermo enables the private and instant exchange of knowledge among MDs,” the company announced in its first press release. Even better, participation was free and the site carried no advertising.
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Kelly, Carly N., and Michelle M. Mello. "Are Medical Malpractice Damages Caps Constitutional? An Overview of State Litigation." Journal of Law, Medicine & Ethics 33, no. 3 (2005): 515–34. http://dx.doi.org/10.1111/j.1748-720x.2005.tb00515.x.
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The United States is in its fifth year of what is now widely referred to as “the new medical malpractice crisis.” Although some professional liability insurers have begun to report improvements in their overall financial margins, there are few signs that the trend toward higher costs is reversing itself - particularly for doctors and hospitals. In 2003-2004, the presidential election and tort reform proposals in Congress brought heightened public attention to the need for some type of policy intervention to ease the effects of the crisis.The darling of tort reformers at both the federal and state levels has been legislation to limit, or “cap,” damages awarded to plaintiffs in malpractice cases. Health care provider groups, liability insurers, and the Bush Administration have all seized on the example of California's MICRA law, which since 1975 has capped noneconomic damages in malpractice cases at a flat $250,000, as the path to financial recovery.
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GRAZI, RICHARD V., JOEL B. WOLOWELSKY, and DAVID J. KRIEGER. "Sex Selection by Preimplantation Genetic Diagnosis (PGD) for Nonmedical Reasons in Contemporary Israeli Regulations." Cambridge Quarterly of Healthcare Ethics 17, no. 3 (May 21, 2008): 293–99. http://dx.doi.org/10.1017/s0963180108080353.
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We report here on recent developments in Israel on the issue of sex selection for nonmedical reasons by preimplantation genetic diagnosis (PGD). Sex selection for medical reasons (such as in cases of sex-linked genetic diseases) is generally viewed as uncontroversial and legal in European and American law. Its use for nonmedical reasons (like “balancing” the gender ratio in a family) is generally illegal in European countries. In the United States, it is not illegal, although in the opinion of the Ethics Committee of the American Society for Reproductive Medicine (ASRM), it is problematic. This position is undergoing reconsideration, albeit in a limited way.
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Modlin, Chelsea E., Andrea C. Vilorio, Benjamin Stoff, Dawn L. Comeau, Tewodros H. Gebremariam, Miliard Derbew, Henry M. Blumberg, Carlos del Rio, and Russell R. Kempker. "American Medical Trainee Perspectives on Ethical Conflicts during a Short-Term Global Health Rotation in Ethiopia: A Qualitative Analysis of 30 Cases." American Journal of Tropical Medicine and Hygiene 106, no. 2 (February 2, 2022): 398–411. http://dx.doi.org/10.4269/ajtmh.21-0179.
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ABSTRACT. There has been a significant increase in the number of students, residents, and fellows from high-income settings participating in short-term global health experiences (STGHEs) during their medical training. This analysis explores a series of ethical conflicts reported by medical residents and fellows from Emory University School of Medicine in the United States who participated in a 1-month global health rotation in Ethiopia. A constant comparative analysis was conducted using 30 consecutive reflective essays to identify emerging categories and themes of ethical conflicts experienced by the trainees. Ethical conflicts were internal; based in the presence of the visiting trainee and their personal interactions; or external, occurring due to witnessed events. Themes within internal conflicts include issues around professional identity and insufficient preparation for the rotation. External experiences were further stratified by the trainee’s perception that Ethiopian colleagues agreed that the scenario represented an ethical conflict (congruent) or disagreed with the visiting trainee’s perspective (incongruent). Examples of congruent themes included recognizing opportunities for collaboration and witnessing ethical conflicts that are similar to those experienced in the United States. Incongruent themes included utilization of existing resources, issues surrounding informed consent, and differing expectations of clinical outcomes. By acknowledging the frequency and roots of ethical conflicts experienced during STGHEs, sponsors may better prepare visiting trainees and reframe these conflicts as collaborative educational experiences that benefit both the visiting trainee and host providers.
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Veerapen, Richard J. "Informed Consent: Physician Inexperience is a Material Risk for Patients." Journal of Law, Medicine & Ethics 35, no. 3 (2007): 478–85. http://dx.doi.org/10.1111/j.1748-720x.2007.00170.x.
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The Canadian law governing informed consent was significantly influenced by the decision of its Supreme Court in Reibl v. Hughes, a case that involved a physician’s failure to warn the patient about the risk of stroke after carotid endarterectomy. Even though most Canadian plaintiffs after Reibl have continued to lose informed consent cases, it is likely that the judgement in this case has significantly influenced the manner in which physicians now approach the discussion of risk while obtaining consent not only in Canada but also in several other jurisdictions.The development of informed consent law in the United States similarly became one of the drivers for change in physicians’ practices of information disclosure to their patients. The effect of Reibl on clinical practice is an outstanding example of the law’s positive influence on medical practice, especially in protecting patient autonomy during collaborative medical decision-making.
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Safyer, Steven M., Lynn Richmond, Eran Bellin, and David Fletcher. "Tuberculosis in Correctional Facilities: The Tuberculosis Control Program of the Montefiore Medical Center Rikers Island Health Services." Journal of Law, Medicine & Ethics 21, no. 3-4 (1993): 342–51. http://dx.doi.org/10.1111/j.1748-720x.1993.tb01259.x.
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“Recognizing that prisons disproportionately confine sick people, with mental illness, substance abuse, HIV disease among other illnesses; and that prisoners are subject to further morbidity and mortality in these institutions, due to lack of access and/or resources for health care, overcrowding, violence, emotional deprivation, and suicide.…(APHA) condemns the social practice of mass imprisonment.”After decades of steady decline, tuberculosis has emerged as a significant public health threat in the United States. The rising rates of tuberculosis cases, an increasing proportion of which are resistant to standard chemotherapies, are linked to the many scourges threatening our communities: the explosion of poverty, drug use, violence, the HIV epidemic, and the concomitant rise in congregate housing including homeless shelters, residential drug treatment programs and incarceration facilities. Jails and prisons have disproportionately high rates of tuberculosis infection and have been implicated as points of tuberculosis spread and, as such, are a critical point for tuberculosis control interventions.
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Acosta, Nefi D., and Sidney H. Golub. "The New Federalism: State Policies Regarding Embryonic Stem Cell Research." Journal of Law, Medicine & Ethics 44, no. 3 (2016): 419–36. http://dx.doi.org/10.1177/1073110516667939.
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Stem cell policy in the United States is an amalgam of federal and state policies. The scientific development of human pluripotent embryonic stem cells (ESCs) triggered a contentious national stem cell policy debate during the administration of President George W. Bush. The Bush “compromise” that allowed federal funding to study only a very limited number of ESC derived cell lines did not satisfy either the researchers or the patient advocates who saw great medical potential being stifled. Neither more restrictive legislation nor expansion of federal funding proved politically possible and the federal impasse opened the door for a variety of state-based experiments. In 2004, California became the largest and most influential state venture into stem cell research by passing “Prop 71,” a voter initiative that created a new stem cell agency and funded it with $3 billion. Several states followed suit with similar programs to protect the right of investigators to do stem cell research and in some cases to invest state funding in such projects. Other states devised legislation to restrict stem cell research and in five states, criminal penalties were included. Thus, the US stem cell policy is a patchwork of multiple, often conflicting, state and federal policies.
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Barnes, Mark, and Patrik S. Florencio. "Financial Conflicts of Interest in Human Subjects Research: The Problem of Institutional Conflicts." Journal of Law, Medicine & Ethics 30, no. 3 (2002): 390–402. http://dx.doi.org/10.1111/j.1748-720x.2002.tb00408.x.
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In both academic literature and the media, financial conflicts of interest in human subjects research have come center-stage. The cover of a recent edition of Time magazine features a research subject in a cage with the caption human guinea pigs, signifying perhaps that human research subjects are no more protected from research abuses than are laboratory animals. That magazine issue highlights three well-publicized cases of human subjects research violations that occurred at the University of Oklahoma, the University of Pennsylvania, and Johns Hopkins University.At St. John Medical Center in Tulsa, Oklahoma, a study that was co-sponsored by the University of Oklahoma Health Sciences Center investigated an experimental vaccine for malignant melanoma. In that case, the chair of the university's institutional review board (IRB) — the committee within each medical institution charged with ethics review of human research projects undertaken at that institution — and the dean of the University's College of Medicine allegedly concealed from both the IRB and the United States Food and Drug Administration (FDA) a report by an outside consulting firm that had found severe deficiencies with the melanoma vaccine study being conducted at the medical center.
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Pegalis, Steven E. "The American medical liability system: An alliance between legal and medical professionals can promote patient safety and be cost effective." Journal of Hospital Administration 2, no. 3 (March 27, 2013): 97. http://dx.doi.org/10.5430/jha.v2n3p97.
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Objective: The aim of this paper is to evaluate a hypothesis premised on the idea that if medical leaders in the United States support an unfettered access for patients injured by medical error to the American civil justice system, that approach would improve patient safety and be cost effective. Method: An analysis of the relevant legal and medical literature. Results: Medical liability in the American civil justice system derived from traditional tort law is based on accountability. Reforms applied to medical liability cases urged by healthcare providers limit and in some cases eliminate legal rights of patients injured by healthcare error which rights exist for all others in non-medical cases. Yet medical liability cases have promoted a culture of safety. Information learned from medical liability cases has been used to make care safer with a reduced incidence of adverse outcomes and lower costs. A just culture of safety can limit provider emotional stress. Using the external pressures to reduce the incidence of law suits and promoting ethical mandates to be safer and disclose the truth can promote provider satisfaction. Conclusions: An alliance between legal and medical professionals on the common ground of respect for the due process legal rights of patients in the American system of justice and the need for accountability can make care safer and can be cost effective.
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Parker, Christine W. "Practice Guidelines and Private Insurers." Journal of Law, Medicine & Ethics 23, no. 1 (1995): 57–61. http://dx.doi.org/10.1111/j.1748-720x.1995.tb01331.x.
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Practice guidelines are an increasingly relevant feature of health insurance. One hundred and seventy-eight million people in the United States have some form of private health insurance coverage; coverage for 150 million of them is employment-related. Traditionally, this coverage was provided by employers purchasing a group contract under which an insurance carrier provided indemnity coverage for employees—that is, the insurance company paid all usual, customary, and reasonable charges incurred by an employee for medical care, subject in some cases to an annual deductible and to a percentage of covered expenses, co-paid by the employee, for each service. In recent years, however, employers in greater numbers have switched to so-called self-insurance plans in which employees’ health care claims are paid directly by the employer (although an insurance company or other third party may be retained to administer the claim payment process).
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PAUL, NORBERT W., ARTHUR CAPLAN, MICHAEL E. SHAPIRO, CHARL ELS, KIRK C. ALLISON, and HUIGE LI. "Determination of Death in Execution by Lethal Injection in China." Cambridge Quarterly of Healthcare Ethics 27, no. 3 (May 30, 2018): 459–66. http://dx.doi.org/10.1017/s0963180117000846.
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Abstract:Since 1997, execution in China has been increasingly performed by lethal injection. The current criteria for determination of death for execution by lethal injection (cessation of heartbeat, cessation of respiration, and dilated pupils) neither conform to current medical science nor to any standard of medical ethics. In practice, death is pronounced in China within tens of seconds after starting the lethal injection. At this stage, however, neither the common criteria for cardiopulmonary death (irreversible cessation of heartbeat and breathing) nor that of brain death (irreversible cessation of brain functions) have been met. To declare a still-living person dead is incompatible with human dignity, regardless of the processes following death pronouncement. This ethical concern is further aggravated if organs are procured from the prisoners. Analysis of postmortem blood thiopental level data from the United States indicates that thiopental, as used, may not provide sufficient surgical anesthesia. The dose of thiopental used in China is kept secret. It cannot be excluded that some of the organ explantation surgeries on prisoners subjected to lethal injection are performed under insufficient anesthesia in China. In such cases, the inmate may potentially experience asphyxiation and pain. Yet this can be easily overlooked by the medical professionals performing the explantation surgery because pancuronium prevents muscle responses to pain, resulting in an extremely inhumane situation. We call for an immediate revision of the death determination criteria in execution by lethal injection in China. Biological death must be ensured before death pronouncement, regardless of whether organ procurement is involved or not.
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Bremer, Anders, Karin Dahlberg, and Lars Sandman. "Balancing Between Closeness and Distance: Emergency Medical Services Personnel’s Experiences of Caring for Families at Out-of-Hospital Cardiac Arrest and Sudden Death." Prehospital and Disaster Medicine 27, no. 1 (February 2012): 42–52. http://dx.doi.org/10.1017/s1049023x12000167.
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AbstractIntroduction: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects between 236,000 and 325,000 people in the United States each year. As resuscitation attempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services (EMS) personnel often face the needs of bereaved family members.Problem: Decisions to continue or terminate resuscitation at OHCA are influenced by factors other than patient clinical characteristics, such as EMS personnel’s knowledge, attitudes, and beliefs regarding family emotional preparedness. However, there is little research exploring how EMS personnel care for bereaved family members, or how they are affected by family dynamics and the emotional contexts. The aim of this study is to analyze EMS personnel’s experiences of caring for families when patients suffer cardiac arrest and sudden death.Methods: The study is based on a hermeneutic lifeworld approach. Qualitative interviews were conducted with 10 EMS personnel from an EMS agency in southern Sweden.Results: The EMS personnel interviewed felt responsible for both patient care and family care, and sometimes failed to prioritize these responsibilities as a result of their own perceptions, feelings and reactions. Moving from patient care to family care implied a movement from well-structured guidance to a situational response, where the personnel were forced to balance between interpretive reasoning and a more direct emotional response, at their own discretion. With such affective responses in decision-making, the personnel risked erroneous conclusions and care relationships with elements of dishonesty, misguided benevolence and false hopes. The ability to recognize and respond to people’s existential questions and needs was essential. It was dependent on the EMS personnel’s balance between closeness and distance, and on their courage in facing the emotional expressions of the families, as well as the personnel’s own vulnerability. The presence of family members placed great demands on mobility (moving from patient care to family care) in the decision-making process, invoking a need for ethical competence.Conclusion: Ethical caring competence is needed in the care of bereaved family members to avoid additional suffering. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Support in dealing with personal discomfort and clear guidelines on family support could benefit EMS personnel.
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Martin, Ariana. "False Hope: A Bioethics Case Study." Archives of Evidence-Based Medicine 1, no. 2 (November 24, 2023): 8–11. http://dx.doi.org/10.59706/aebmedicine.v1i2.7863.
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This text portrays the case study of a newborn who was diagnosed with gastroschisis, a congenital structural defect of the abdominal wall. The narrative explores the ethical questions raised by the complications of this case, focusing on three key issues: the bioethics principle of beneficence, patient transfer guidelines and parent decision-making capacity. The conclusion highlights the tension between parental autonomy and the potential for harm to the child, citing the parens patriae doctrine and the Harm Principle as possible grounds for state intervention in the United States. Overall, the text highlights the complexity of ethical considerations in medical cases involving children and calls for individual analysis and collaboration among healthcare professionals to find optimal solutions.
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Struc, Aleksy Tarasenko. "Do Suicide Attempters Have a Right Not to Be Stabilized in an Emergency?" Hastings Center Report 54, no. 2 (March 2024): 22–33. http://dx.doi.org/10.1002/hast.1576.
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AbstractThe standard of care in the United States favors stabilizing any adult who arrives in an emergency department after a failed suicide attempt, even if he appears decisionally capacitated and refuses life‐sustaining treatment. I challenge this ubiquitous practice. Emergency clinicians generally have a moral obligation to err on the side of stabilizing even suicide attempters who refuse such interventions. This obligation reflects the fact that it is typically infeasible to determine these patients’ level of decisional capacitation—among other relevant information—in this unique setting. Nevertheless, I argue, stabilizing suicide attempters over their objection sometimes violates a basic yet insufficiently appreciated right of theirs—the right against bodily invasion. In such cases, it is at least prima facie wrong to stabilize a patient who wants to die even if they lack a contrary advance directive or medical order and suffer from no terminal physical illness.
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SEAY, GARY. "Can There Be a “Duty to Die” without a Normative Theory?" Cambridge Quarterly of Healthcare Ethics 11, no. 3 (May 17, 2002): 266–72. http://dx.doi.org/10.1017/s0963180102113077.
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Unlike many philosophers who write on biomedical ethics, John Hardwig is not primarily concerned to test our intuitions about the limits of normative theories by thought experiments or problematic borderline cases. Rather, he presses us to accept the conclusions to which our most firmly held principles commit us. But these conclusions, if Hardwig is right, turn out to be quite startling claims about moral duty that would undermine much of contemporary bioethical theory regarding end-of-life decisions. On his view, we must face squarely the moral implications of our present arrangement of healthcare funding in the United States, where more and more of the financial responsibility of care is being shifted onto the families of patients, often with disastrous results. Yet, in the context of this increasingly unstable arrangement, our chief principle of medical decisionmaking also holds that their interests are not morally relevant at all in deciding what should be done for the patient, and only the patient's wishes count (insofar as we can determine them). Now Hardwig thinks that this rule is irrational in the present circumstances, and that it would make more sense to admit the moral relevance of the interests of family members, but also that if we do give appropriate weight to their concerns, we shall be led in some cases to the conclusion that the patient has a duty to die.
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Friesen, Phoebe, and Nada Gligorov. "Surrogate decision making for unrepresented patients: Proposing a harm reduction interpretation of the best interest standard." Clinical Ethics 15, no. 2 (February 4, 2020): 57–64. http://dx.doi.org/10.1177/1477750920903459.
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Unrepresented patients are individuals who lack decision makingcapacity and have no family or friends to make medical decisions for them. This population is growing in number in the United States, particularly within emergency and intensive care settings. While some bioethical discussion has taken place in response to the question of who ought to make decisions for these patients, the issue of how surrogate medical decisions ought to be made for this population remains unexplored. In this paper, we argue that standard applications of surrogate decision making principles in health care are not well suited to many unrepresented patients with long-term mental health diagnosis. We argue that when applied to this population, the substituted judgment standard, designed to preserve patient preferences and values, may lead to the exclusion of their preferences. We argue further that the application of the best interest standard runs the risk of leading to harmful cases of overtreatment or undertreatment. We offer an alternative interpretation of the best interest principle that is better able to promote the well-being of unrepresented patients, especially for those who lack capacity because of mental disorders. This alternative is based on the practices and principles of harm reduction and includes three components: emphasis on considering the expressed preferences of unrepresented patients, a focus on reducing harm as well as the delivery of clinical benefits, and a recognition of the importance of promoting trust.
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Bhatia, Shailender, Paul Nghiem, S. Phani Veeranki, Alejandro Vanegas, Kristina Lachance, Lisa Tachiki, Kevin Chiu, Emily Boller, and Murtuza Bharmal. "628 Real-world clinical outcomes among patients with advanced Merkel cell carcinoma treated with avelumab in academic medical centers in the United States." Journal for ImmunoTherapy of Cancer 9, Suppl 2 (November 2021): A658. http://dx.doi.org/10.1136/jitc-2021-sitc2021.628.
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BackgroundMerkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine neoplasm with annual incidence rates ranging from 0.13 to 1.6 cases per 100,000 per year.1 Chemotherapy for metastatic MCC (mMCC) has high objective response rates (ORRs), but responses are not durable and overall survival (OS) is poor. In March 2017, avelumab (anti–PD-L1) was approved for the treatment of mMCC and has demonstrated meaningful survival benefit and durable response.2 This study sought to investigate real-world clinical outcomes of avelumab-treated patients with advanced (stage IIIB/IV) MCC in academic medical centers in the United States (US).MethodsA retrospective chart review study of patients with advanced MCC who initiated avelumab between March 1, 2017, and July 31, 2019 was conducted at 6 US academic medical centers across the 4 US census regions. Eligible patients were followed through December 30, 2020. Descriptive analyses were conducted to assess demographics, clinical characteristics, and outcomes. Kaplan-Meier curves were constructed to illustrate real-world duration of response (rwDOR), real-world progression free survival (rwPFS), OS, and time-to-treatment discontinuation.ResultsNinety patients with advanced MCC were treated with avelumab, with a median follow-up of 15.0 months (95% CI, 13.1–17.8). Median age was 68 years; the majority were male (58%) and White (93%). During the time of avelumab initiation, 74 patients had stage IV MCC and 16 patients had stage IIIB MCC. Primary tumor was located most commonly on the lower limb (38%), with metastasis primarily to lymph nodes (67%) and lung (52%); 52% of patients had visceral metastases. Approximately 42% and 26% of patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 2 and 3, respectively. Seventy-three patients (81%) received avelumab as first-line treatment of advanced MCC, whereas 17 (19%) received avelumab as second-line or later. Median duration of avelumab treatment was 13.5 months (95% CI, 6.4–30.6); 58% discontinued by the end of follow-up. Patients with avelumab treatment (n=90) had a rwORR of 73% (95% CI, 64–83), median rwPFS of 24.4 months (95% CI, 8.3-not reached [NR]), and median OS of 30.7 months (95% CI, 11.2-NR). Other clinical outcomes by line of avelumab treatment and stage at avelumab initiation are reported in table 1.ConclusionsThis real-world study of patients with advanced MCC treated with avelumab demonstrates high response rate with durable responses and prolonged survival. The study findings are consistent with the efficacy results demonstrated in pivotal clinical trials2 and other recent observational studies.3 4AcknowledgementsThe authors would like to acknowledge all physicians at the respective sites who participated in the data collection process for the study.ReferencesMüller-Richter UDA, Gesierich A, Kübler AC, Hartmann S, Brands RC. Merkel cell carcinoma of the head and neck: recommendations for diagnostics and treatment. Ann Surg Oncol 2017;24:3430–3437.D'Angelo SP, Bhatia S, Brohl AS, et al. Avelumab in patients with previously treated metastatic Merkel cell carcinoma: long-term data and biomarker analyses from the single-arm phase 2 JAVELIN Merkel 200 trial. J Immunother Cancer 2020;8:e000674.Cowey CL, Liu FX, Kim R, et al. Real-world clinical outcomes with first-line avelumab in locally advanced/metastatic Merkel cell carcinoma in the USA: SPEAR-Merkel. Future Oncol 2021;17:2339–2350.Levy S, Aarts MJB, Eskens FALM, et al. Avelumab for advanced Merkel cell carcinoma in the Netherlands: a real-world cohort. J Immunother Cancer 2020;8:e001076.Ethics ApprovalThe study was approved by New England Institutional Review Board.Abstract 628 Table 1Clinical outcomes among avelumab-treated patients with advanced MCC by line-of-treatment and stage at avelumab initiation
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Norman, Armando Henrique. "Medical ethics and screening: on what evidence should we support ourselves?" Revista Brasileira de Medicina de Família e Comunidade 9, no. 31 (May 4, 2014): 108–10. http://dx.doi.org/10.5712/rbmfc9(31)933.
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If screening had been a drug, it would have been withdrawn from the market. Thus, which country will be first to stop mammography screening? (Peter C. Gøtzsche) 1This issue of RBMFC addresses the subject of medical ethics, the backbone that should guide both the demands in health services and health technologies provision, as well as the practice of family and community physicians. As a stimulus for reflection, the Debate section tackles the “Preventive mandatory mammography” policy in Uruguay, while in the Section Essays, Jamoulle and Gomez discuss the concept of quaternary prevention: action that aims to offer ethically acceptable alternatives to patients in order to prevent the excess of medical interventions.2 Despite considerable technological and social transformations that directly affect people’s health, ethics in medicine continues to morally shape health problems and health policy decisions with implications for patients, physicians and health institutions.In a practical analytical and easy to understand guidance for health professionals, Gillon3 discusses the four principles and scope of medical ethics: autonomy, beneficence, non-maleficence and justice. The latter encompasses the distributive justice, individual right justice and legal justice. These four principles provide a baseline for dialogue across different cultures, religious beliefs and political positions, as these principles are considered to be prima facie: a duty which is compulsory on all occasions unless it is in conflict with equal or stronger duties.4 Thus, based on these four principles that underlie ethics in medicine and consequently the application of the quaternary prevention, cancer screening programme will be critically analysed as a preventative strategy.Screening programmes entails the use of an initial selective tool or a sieve phase (i.e. mammography) to separate asymptomatic persons within the target population, that will need to undergo a classificatory or diagnostic phase - which involves a ‘gold standard’ for defining a disease (i.e. anatomopathology) – to finally offer patients a definitive preventive treatment for the condition screened.5 Since this type of intervention is performed on healthy individuals, the ethical requirements in the cases of screening programmes are very high, because the risks of damage are not balanced against real suffering (a clinically manifested disease), but are anchored in a potential future of illness and death. In this case, the principle of non-maleficence (do not harm) prevails over the principle of beneficence (the desire to promote the patients’ wellbeing), since asymptomatic persons, who perceive themselves as healthy, may have their health perception shaken indefinitely due to a biomedical intervention. The most often cited damages in the literature are psychological (due to the uncertainties of false positives, false assurance of false negatives, and borderline conditions that require a closer monitoring such as Cervical Intraepithelial Neoplasia - CIN I, II, III), as well as the physical consequences resulting from treatment itself, such as impotence or urinary incontinence, in the case of screening and treatment of prostate cancer.Since in the screening and/or health check ups the intervention is usually a ‘mirage-guided’ or ‘probability-guided’, it can result in ‘damage without the potential benefits’,6 as in the case of invasive procedures (to clarify ‘images’ or ‘positive’ exam results produced in the selective or sieving phase) which can result in complications, but the biopsy turnout to be normal. For instance, colonoscopy, laparoscopy, biopsies (liver, kidney, prostate), in which those procedures may end up producing complications (intestinal perforation, anaesthesia complications, major artery perforation, sepsis) with the potential to scale up into hospital readmission, with stress for patients and families and/or an even worse scenario: patients’ death with a benign finding. Therefore, screening programmes intrinsically carry the potential to convert healthy people into sick individuals at the population level, and consequently are highly iatrogenic and could be summarized as follows: “For many are called, but few are chosen…,” but many will need to suffer for to very few be cured.This is particularly true in the case of breast cancer screening with mammography, which renders physiopathologically insignificant cancers (overdiagnosis) exposing previously healthy women to significant damages due to radiotherapy. Gotzsche et al.7 highlighted important risks of adverse effects as consequence of radiotherapy, such as heart failure (27%) from circulatory cardiac damage and/or induction of lung cancer (78%). Furthermore, a recently published systematic review in the British Medical Journal8 on the adverse effects of cancer screening, found that only a third of randomized controlled clinical trials was concerned in measuring and controlling for potential harms of screening intervention. This article is very important because it has a direct effect upon the practice of health professionals, who cannot address security parameters on cancer screening interventions with their patients, since there is an information selection bias that emphasizes only the positive aspects of screening, for lack of controlling and monitoring of potential harms in most screening clinical trials.From an ethical stance, this context of uncertainty undermines the patients’ autonomy, creating false empowerment, since women do not have a more complete view on the potential harms and benefits of breast cancer screening programmes.9 To truly empower women and strengthen their autonomy for deciding upon interventions that directly affect their health, there is a need for information to be more transparent and also to reveal potential harms of the interventions. Moreover, the language used for the dissemination of information should be neutral, of simple understanding, culturally accessible, so that the users of the health system can better decide about their own health.3From the perspective of public health, distributive ethic justice, and limited healthcare budget - that any health system faces - screening programmes diverts financial resources - which should primarily be allocated to the treatment and care of sick individuals - towards healthy people, with the potential to produce new real patients, due to the damage of the interventions on healthy bodies, generating more costs to the health system and society in general.Fortunately, screening programmes are increasingly losing their strength, especially in Europe. For instance, the Swiss Medical Board10 found no scientific rational for the maintenance of breast screening programmes in light of current available scientific evidence. In Denmark, the rate of mortality attributable to breast cancer have not reduced due to the implementation of systematic breast cancer screening programme with mammography over 17 years follow up,11 however, it has produced an overdiagnosis rate of 33%.12 Similar trends in mortality over the last 30 years were also observed in the United States,13 as well as in Canada, the accumulated 25 years monitoring of the effects of breast cancer screening, did not render reduction in mortality from breast cancer, but resulted in 22% of overdiagnosis.14 Thus, to Peter C. Gotzsche,1 one of the world ‘s leading authorities on the subject, the best method we have to reduce the occurrence of breast cancer is to stop screening with mammography.From an ethical and scientific point of view,10 screening programmes should be discontinued or restricted to high-risk groups or very specific situations, and the focus of prevention should be redirected towards interventions on early-symptomatic patients, since breast cancer treatment has improved considerably in recent decades, and this is likely to be the responsible for improving the quality of life of affected women.1 The Canadian Task Force15 on preventive health care in their last update (2011) regarded as weak recommendation the breast cancer screening with mammography every 2-3 years in age group 50-69 years-old, because they considered the evidence for screening only of moderate quality. The Brazilian Ministry of Health16 also acted correctly in limiting the financial incentives for breast cancer screening for the age group 50-69 years.Therefore, ‘there is nothing wrong saying no to mammography’,9 because when acting upon asymptomatic healthy people, the principle of non-maleficence should override the principle of beneficence. Thus, the challenge left for family and community doctors is to individualize each case in this ‘sea of uncertainty’, sharing with their patients the often hidden potential harms attributed to cancer screening in order to operationalize in daily practice the concept of quaternary prevention.
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Farrukh Nagi, Muhammad Luqman, Syed Tehseen Haider Kazmi, Khadija Zafar Qureshi, Kiran Wasiq, Khadija Sajid, and Khyzer Butt. "DEPRESSION." Professional Medical Journal 23, no. 07 (July 10, 2016): 858–63. http://dx.doi.org/10.29309/tpmj/2016.23.07.1652.
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Psychological stress is prevalent in medical schools and is associated withdepression. The personal and social sacrifices young medical apprentices have to makein order to sustain a fine academic outcome in an exceedingly competitive education setsthem under enormous strain. The estimated prevalence of depression among private medicalstudents has been 19% in United States, 49% in India, and 60% in Pakistan. Pakistan boastshighest prevalence of depression globally among undergraduate private medical students.Additionally a lack of any prior study in this institution, this study aimed to find prevalence ofdepression in the undergraduate private medical college of Lahore. Setting: The subjects werestudents of Shalamar Medical and Dental College, Lahore a private institution, in a metropolitanurban population. Study Design: Cross sectional study based on systematic random samplingtechnique. Methods: A modified, self-administered, structured questionnaire based onGoldberg’s depression scale was distributed to a sample of 240 subjects during March 2014,till October 2014. Higher total scores refer to higher depression levels. Prior to the initiation ofresearch permission was sought from the institution’s ethical review committee. The data entryand analyses were done in SPSS for Windows version 20.0. Results: The response rate was80%. The age of students (n= 164) averaged 21.1 ±1.4 years. The prevalence of depressionamong undergraduate medical students of our setting was almost 63% (n= 122). Thirty onepercent (n=59) were possibly mildly depressed, 9% (n=17) borderline depressed, 19%(n=37) mild to moderate cases, 20% (n=39) moderate to severe cases and 3 % (n=6) wereseverely depressed students. Almost 85% (n= 40) of the students from second year sufferedfrom depression the highest prevalence among all undergraduate medical years. A substantial41% (n= 36) and 42 % (n= 37) of students suffering from depression admitted to the use oftaking stimulants like amphetamines and caffeine respectively. Conclusion: The prevalence ofdepression is highest among the students of second academic year. Terminal illness of a familymember and effect of law and order situation of the country also compromise the mental healthof undergraduate medical students.
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Shelstad, Kirsten. "Landmark United States Biomedical Ethics Cases." Medical Reference Services Quarterly 18, no. 2 (June 1999): 27–53. http://dx.doi.org/10.1300/j115v18n02_03.
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Murphy, Timothy F. "War Surgery in Afghanistan and Iraq: A Series of Cases, 2003–2007, edited by Shawn C. Nessen, Dave E. Lounsbury, and Stephen P. Hertz. Falls Church, VA: Office of the Surgeon General, United States Army; Washington, DC: Borden Institute: Walter Reed Army Medical Center; 2008." Cambridge Quarterly of Healthcare Ethics 19, no. 2 (March 12, 2010): 261–64. http://dx.doi.org/10.1017/s0963180109990545.
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Readers are invited to contact Greg S. Loeben in writing at Midwestern University, Glendale Campus, Bioethics Program, 19555 N. 59th Ave., Glendale, AZ 85308 (gloebe@midwestern.edu) regarding books they would like to see reviewed or books they are interested in reviewing.
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Voinov, A. "On contemporary aspects of assisted suicide at plato." European Psychiatry 64, S1 (April 2021): S447—S448. http://dx.doi.org/10.1192/j.eurpsy.2021.1195.
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IntroductionUsually, Plato is not considered a philosopher that comprehensively treated the matter of suicide. By studying Plato’s work (especially Crito, Phaedo, the Republic and the Laws), we observe that Plato was concerned with the problem of suicide and that he gave an elaborate answer regarding the problem of suicide, laws against its practice as well as exceptions from them, customs and punishments.ObjectivesThis paper, in the light of a trial to overcome the monistic approaches of the matter of suicide, proposes the modest but fundamental goal to point out the resemblance between Plato’s position (especially from the Laws and the Republic) regarding the matter of suicide and the nowadays reasons invoked by the patients requesting assisted suicide.MethodsLooking at the patients from the United States of America which requested assisted suicide, by analyzing the available annual reports (at the time of writing this abstract, only 6 out of 9 states that have a legal status that permits assisted suicide are publishing annual reports regarding the patients and their assisted suicide requests), we compare them with Plato’s attitude towards suicide.ResultsWe observe that the most invoked reasons (concerns and underlying illnesses), by the patients wich request assisted suicide, are also the cases in which Plato permitted suicide.ConclusionsThis comparison and insight into Plato’s philosophy does not resolve any particular issues of the medical praxis but is binging out the utility of a multidisciplinary, especially philosophical and ethical, approach to the practice of assisted suicide.
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Cohen, Jeremy. "Frozen Bodies and Future Imaginaries: Assisted Dying, Cryonics, and a Good Death." Religions 11, no. 11 (November 5, 2020): 584. http://dx.doi.org/10.3390/rel11110584.
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In October of 2018, Norman Hardy became the first individual to be cryopreserved after successful recourse to California’s then recently passed End of Life Options Act. This was a right not afforded to Thomas Donaldson, who in 1993 was legally denied the ability to end his own life before a tumor irreversibly destroyed his brain tissue. The cases of Norman Hardy and Thomas Donaldson reflect ethical and moral issues common to the practice of assisted dying, but unique to cryonics. In this essay, I explore the intersections between ideologies of immortality and assisted dying among two social movements with seemingly opposing epistemologies: cryonicists and medical aid in dying (MAiD) advocates. How is MAiD understood among cryonicists, and how has it been deployed by cryonicists in the United States? What are the historical and cultural circumstances that have made access to euthanasia a moral necessity for proponents of cryonics and MAiD? In this comparative essay, I examine the similarities between the biotechnological and future imaginaries of cryonics and MAiD. I aim to show that proponents of both practices are in search of a good death, and how both conceptualize dying as an ethical good. Cryonics members and terminal patients constitute unique biosocial worlds, which can intersect in unconventional ways. As temporalizing practices, both cryonics and MAiD reflect a will to master the time and manner of death.
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Thakur, Srishti, Manjit Kaur Mohi, Nayana Pathak, and Kandy Sandhu. "A longitudinal cross-sectional study on awareness of contraception." Indian Journal of Obstetrics and Gynecology Research 10, no. 1 (February 15, 2023): 54–58. http://dx.doi.org/10.18231/j.ijogr.2023.011.
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Contraception is a method or a way to stop or prevent pregnancy. Since from ancient times birth control has its prevalence but the safest and most efficient methods of contraception was only introduced in 20th century. An ideal contraceptive is considered when it is user-friendly, effective and reversible with less or zero side effects and lesser adverse complications and more importantly one which is easily available. There are wide range of contraception or birth control methods currently available which includes traditional methods, barriers, oral contraceptives pills (OCP), implants, Intra Uterine Devices (IUDs) and Surgical methods along with injectable. The United States Center for Disease Control and Prevention jointly with World Health Organization has provided with guidelines on the safety of contraception for women with specific medical condition. According to another report documented by World Health organization, which stated that most effective and safest methods of contraception is sterilization by means of vasectomy in males and in cases of females by means of tubal linguation, intra uterine devices and implantable birth control. This data of safest birth control method also includes vaginal rings, oral pills, patches and injections. World Health Organization Department of Reproductive Health and Research has also stated that less effective methods includes physical barriers & spermicide and the least effective methods of contraception is traditional or natural method.A longitudinal cross-sectional study was conducted in the Department of Obstetrics and Gynecology at Gyan Sagar Medical College and Hospital in Punjab, India. Ethical approval was taken from the committee before commencing of this study. To determine the prevalence of awareness of Contraception and to determine the most commonly used contraceptive method among subjects. We hereby conclude our longitudinal cross-sectional study by indicating the fact that prevalence of awareness of contraception is higher in urban and educated classes of our society. We thereby wanted to spread one message through our study so that special initiative on birth control method should be mandated by Government in various medical colleges and hospitals in India to create awareness in rural sections and interior villages, social awareness of safe sexual practice could be spread each and every section of our country because contraception does not only prevent pregnancy it also protects the mankind and save one’s life from HIV and other sexually transmitted infections. As is always quoted correctly that “Prevention is better than cure”.
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Shah, Nirmish, Ralph Boccia, Walter K. Kraft, Brandon M. Hardesty, Jincy Paulose, Dram Laine, Das Purkayastha, Savita Nandal, and Abdullah Kutlar. "A Multicenter Retrospective Noninterventional Follow-up Study in Patients with Sickle Cell Pain Crisis Who Previously Participated in the Sustain Trial in the United States Successor Study." Blood 132, Supplement 1 (November 29, 2018): 4910. http://dx.doi.org/10.1182/blood-2018-99-111332.
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Abstract INTRODUCTION SUSTAIN was a randomized, double-blind, placebo-controlled, phase 2, 52-week study that compared the effect of crizanlizumab, a P-selectin inhibitor, versus placebo on the frequency of sickle cell pain crises (SCPCs, or vaso-occlusive crises [VOCs] leading to a health care visit) in patients with any genotype of sickle cell disease (SCD). Crizanlizumab 5.0 mg/kg significantly reduced the annual frequency of VOCs versus placebo (1.6 vs 3.0, P=0.01) and increased the time to first on-treatment VOC (4.1 vs 1.4 months, P=0.001). The current study, SUCCESSOR (SUSTAIN Chart-review of Crizanlizumab to Evaluate Sickle-cell Study One-year Retrospective), reviewed medical records of patients who completed the SUSTAIN study at US sites to assess additional cases of significant pain crisis events, and to generate real-world data on treatment patterns and health care resource utilization upon completion of treatment with crizanlizumab. METHODS SUCCESSOR is a retrospective cohort study of adult patients (≥18 years old) who participated in the SUSTAIN study in the United States to evaluate outcomes related to SCD up to 52 weeks following their completion of the trial. SUCCESSOR included the per protocol population from SUSTAIN, which included the intent-to-treat patients who received at least 12 of the 14 planned study drug doses, completed a visit at least 14 days after the final dose of study drug, and had no major protocol violations that impacted the efficacy assessments. The overall study period for the retrospective study was from September 2015 to March 2017 and patient data were obtained from medical records. Crizanlizumab was not administered post-SUSTAIN. Patient consent was obtained prior to data collection if required by local and/or central research ethics review. RESULTS In this preliminary analysis, a total of 6 patient data sets were extracted. These patients had been randomized to the following treatment arms in the SUSTAIN study: 1 placebo, 1 crizanlizumab 2.5 mg/kg, and 4 crizanlizumab 5.0 mg/kg. The patient who had received placebo during SUSTAIN was a 27-year-old male with HbS/β0-thalassemia SCD. The patient who had received crizanlizumab 2.5 mg/kg was a 42-year-old female with HbSC SCD. The patients who had received crizanlizumab 5.0 mg/kg were: a 28-year-old male with HbSS SCD; a 32-year-old female with HbSS SCD; a 56-year-old female with HbSC SCD; and a 65-year-old female with HbSS SCD. All patients were Black or African-American. In the 52 weeks following completion of the SUSTAIN study, patients who had received placebo or crizanlizumab 2.5 mg/kg reported 4 and 5 VOC events, respectively, while crizanlizumab 5.0 mg/kg patients reported 0-2 VOC events (Table). Four patients (3 crizanlizumab 5.0 mg/kg, 1 placebo) reported hydroxyurea (HU) usage during and after SUSTAIN. One patient who had received crizanlizumab 5.0 mg/kg and did not report HU usage during SUSTAIN reported HU usage post-SUSTAIN. All patients reported opioid usage after SUSTAIN. Transfusions were not allowed during SUSTAIN; 2 patients, 1 who had received crizanlizumab 5.0 mg/kg and 1 who had received placebo, reported transfusions post-SUSTAIN. Five of the 6 patients reported utilizing health care resources (eg, clinic visits, emergency department visits, or hospitalizations) post-SUSTAIN. One patient who received crizanlizumab 5.0 mg/kg did not report utilizing any health care resources post-SUSTAIN and did not report any VOC events in the 52 weeks after SUSTAIN. CONCLUSIONS We report our initial results from a limited number of patients from SUCCESSOR and therefore summarized post-SUSTAIN outcomes without analysis. In 5 of the 6 patients, the annual frequency of VOC events remained the same or increased in the post-SUSTAIN period compared to that during the SUSTAIN study. Data collection is ongoing in additional eligible patients. Disclosures Shah: Novartis: Consultancy, Research Funding, Speakers Bureau. Boccia:Amgen: Honoraria, Research Funding, Speakers Bureau; Celgene: Research Funding, Speakers Bureau; BMS: Research Funding, Speakers Bureau. Hardesty:Biomarin: Research Funding; Bioverativ: Research Funding; Global Blood Therapeutics: Research Funding; Novo Nordisk: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Octapharma: Consultancy, Honoraria, Research Funding; Pfizer: Honoraria, Research Funding; Prometic: Research Funding; Sangamo: Research Funding; Shire: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Paulose:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Laine:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Purkayastha:Novartis Pharmaceuticals Corporation: Employment. Nandal:Novartis Pharmaceuticals Corporation: Employment. Kutlar:Sancilio: Other: DSMB Chair; Bluebird Bio: Other: DSMB Member; Novartis: Consultancy, Honoraria, Other: Personal fees, Research Funding.
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Pope, Thaddeus Mason, Joshua J. Gagne, and Aaron S. Kesselheim. "Reviews in Medical Ethics." Journal of Law, Medicine & Ethics 38, no. 2 (2010): 427–35. http://dx.doi.org/10.1111/j.1748-720x.2010.00501.x.
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Through the Louisiana Purchase in 1803, the United States expanded its size by over 800,000 square miles. But neither President Thomas Jefferson nor Congress knew exactly what they had bought until 1806, when Meriwether Lewis and William Clark returned from their famous expedition. One of the most significant contributions of the Expedition was a better perception of the geography of the Northwest. Lewis and Clark prepared approximately 140 maps and filled in the main outlines of the previously blank map of the northwestern United States. Robert I. Field has done much the same for the vast territory of U.S. health care regulation.On the front cover of Fields new book, Health Care Regulation in America: Complexity, Confrontation, and Compromise, is a picture of a giant three-dimensional labyrinth. Rarely is cover art so perfectly appropriate.
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Braunack-Mayer, Annette Joy. "Ethics, DRGs and Medical Record Administrators." Australian Medical Record Journal 23, no. 1 (March 1993): 5–8. http://dx.doi.org/10.1177/183335839302300103.
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Medical record administrators in the United States have documented a range of ethical problems which they have experienced as a result of the advent of DRGs. This paper considers the similarities and differences between the Australian and United States experience of DRGs, and the implications of these for Australian medical record administrators. Some ethical problems are described, and it is argued that these problems relate particularly to power imbalances between medical record administrators and other health professions.
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Chaudhary, Shatdal, Smriti Shakya, Niraj Kumar Jaiswal, Aakash Shahi, Pushpa Raj Dhakal, and Nagendra Chaudhary. "CLINICAL PROFILE AND OUTCOME OF PATIENTS PRESENTING WITH ACUTE UPPER GI BLEEDING IN A TERTIARY CARE CENTRE OF WESTERN NEPAL." Journal of Universal College of Medical Sciences 6, no. 1 (November 20, 2018): 3–7. http://dx.doi.org/10.3126/jucms.v6i1.21656.
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Introduction: Acute upper gastrointestinal (UGI) bleeding is a common medical emergency which is associated with significant morbidity and mortality. The annual incidence of UGI bleeding varies from 48 to 160 cases per 100,000 populations in the United States of America (USA), with a mortality rate of 7% to 10%. The aetiology and outcome of UGI bleeding varies significantly in different geographic regions depending on the demographic and socioeconomic characteristics of the local population. This study was done to evaluate the clinical profile and outcome of patients presenting with acute UGI bleeding at a tertiary care centre in Lumbini zone of Nepal.Material and Methods: This was a hospital based prospective observational study. All the patients who presented with acute UGI bleeding and fulfilled the inclusion criteria from 1st August 2013 to 31st July 2014 were included in the study. The study was cleared by the ethical review committee of the institute and written informed consent was taken from all the patients.Results: During the study period, 70 patients fulfilled the inclusion criteria and were subjected to statistical analysis. The mean age of patients in the present study was 55.11 ± 19.93 years. The majority of patients (30, 43%) were elder, belonging to the age group of more than 60 years. There were 55 (79%) male and 15 (21 %) female. The patients were mostly farmers by occupation accounting 29 (41 %) cases. Ethnically, 26 (3 7%) patients of UGI bleeding were from janajati group where majority of them had esophageal varices. Overall, the peptic ulcer disease was the leading cause of UGI bleeding seen in 26 (37%) patients followed by esophageal varices seen in 23 (33%) patients. 0 positive was the commonest blood group which was found in 28 (40%) of our patients. In our study 44 (63%) patients were alcohol consumers and 37 (53%) had coexisting comorbidities that added for the UGI bleeding related complications. During admission, 7 patients expired causing 10% mortality.Conclusion: Acute UGI bleeding was commonly seen in older age group patients with male preponderance. Peptic ulcer disease was the leading cause of the UGI bleeding. The mortality rate was found to be 10%. The mortality also increased with increasing age and patients with pre-existing co morbidities. Journal of Universal College of Medical ScienceVol. 6, No. 1, 2018, Page: 3-7
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Wertz, Dorothy C., John C. Fletcher, and Philip Reilly. "Ethics and medical genetics in the United States. A national survey." American Journal of Medical Genetics 29, no. 4 (April 1988): 815–27. http://dx.doi.org/10.1002/ajmg.1320290411.
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Hirose, Masahiro. "Is patient safety sufficient in Japan? Differences in patient safety between Japan and the United States – Learning from the United States." Journal of Hospital Administration 5, no. 6 (August 16, 2016): 1. http://dx.doi.org/10.5430/jha.v5n6p1.
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In Japan, patient safety has been promoted at all levels since the 1999 landmark adverse medical event at Yokohama City University Hospital (YCUH). However, patients do not believe that health care is becoming safer. Furthermore, two university hospitals (UHs) that were designated as “advanced treatment hospitals” had their status revoked by the Health Ministry as of June 1, 2015 due to patient safety problems. The history of patient safety in Japan can be roughly divided into two terms: 1999-2009 and since 2010. In the first term, a basic patient safety system was established that included the creation of a patient safety division and an incident-reporting system from the perspective of systems error rather than individual responsibility. Additionally, many companies have promoted the improvement and development of drugs and medical devices in collaboration with health care providers. The two recent serious medical errors at UHs seemed to occur partially due to a lack of medical ethics. Unlike in the United States (US), in Japan, there is no medical license renewal system, the organizations that govern physicians are weak, and the framework of lifelong education is inadequate. Therefore, the second term involves a mindset of quality-driven patient safety. It requires health care providers and policy makers to change their mindset toward medical ethics and patient safety by learning from the US and demands a strong organization and framework to govern physicians in Japan.
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CHAN, Ho-mun. "末期病人的決策倫理: 三個模式的比較." International Journal of Chinese & Comparative Philosophy of Medicine 3, no. 4 (January 1, 2001): 45–55. http://dx.doi.org/10.24112/ijccpm.31411.
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LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文討論末期病人的決策過程的三個模式，即個人主義、家長主義和家庭本位主義。個人主義過份偏重病人的抉擇，家長主義只強調從專業角度照顧病人的個人最佳利益，這兩個模式均會令家庭角色邊緣化。本丈認為家庭本位主義，更符合東方社會文化，從倫理角度來看亦較其他兩個模式可取。This paper critically examines the liberal, the medical paternalist, and the familial models of decision making for the terminally ill. It is argued that the liberal model is excessively patient centered while the medical paternalist model overemphasizes the role of the physician. The paper concludes that since both models marginalize the role of the family in the decision-making process, they are morally inadequate and not suitable for societies with strong family ethics, particularly those in Asia.The liberal model is predominant in the United States. According to this model, a competent patient can express in an advance directive her prior wish of how she is to be treated when she lapses into incompetency. In the absence of an advance directive or in cases where the directive is vague or ambiguous, the surrogate decision-making process will be invoked, which is normally a procedure in which the family makes the decision on the patient's behalf. In this process, the family serves to assist the incompetent patient to exercise her self-determination by figuring out and then following her counterfactual choice in accordance with the substituted judgment standard. If it is impossible to arrive at a decision by following this standard, the family, with the assistance of the physician, will follow the standard of best interests to promote the well-being of the patient. In sum, in the process of surrogate decision making, only the individual choice and interests of the patient are a matter of concern. Thus, the liberal model is entirely patient-centered. The role of the family is marginalized in the sense of being subordinated to the (previous or counterfactual) choice and interests of the patient. The family therefore becomes a "shadow" of the patient with no independent status and is deprived of its self-sufficiency.In the United Kingdom, medical paternalism is more influential. There is a preference for a code of practice to legislation for advance directives, and the prevalence of the best interest standard. Yet, unlike the liberal model, the best interests of the patient are not determined by the family in accordance with the standard of a reasonable person. Rather the doctor is expected to make decision for the patient in accordance with a responsible and competent body of relevant professional opinion in determining the patient's best interests. Though the family will often be consulted, the principal decision maker is the physician. So the role of the family is also marginal in this model.In Asian societies, e.g., Japan, Mainland China and Hong Kong, the family plays a fundamental role in the decision making for the terminally ill, so the model of familialism prevails. In these societies, it is common that the patient will not be informed directly of her terminal illness by the physician. The decision for the incompetent patient is regarded not as an individual but a family decision, and the dying process is viewed a sharing process, the last journey that the patient undergoes together with her significant others.In the familial model, the decision for a terminally ill patient is regarded not entirely as an individual matter because other members will be affected by the patient's choice. Should a son merely consider the wishes or the best interests of his father without considering the burden of care and the feelings of his mother while his father is going through the last stage of his life? Should the mother also consider the financial burden that her son might have to bear for his father if he were to be kept alive at all costs? Such issues would not have a place in the liberal and the medical paternalist models, for what matters is only the choice or the best interests of the patient. On the contrary, due considerations are given to these issues in the familial model, which makes it more plausible than the other two models.DOWNLOAD HISTORY | This article has been downloaded 15 times in Digital Commons before migrating into this platform.
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BUTLER, WILLIAM ELLIOTT. "Legal Ethics in the American Practice of Law." Право України, no. 2019/12 (2019): 196. http://dx.doi.org/10.33498/louu-2019-12-196.
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The author examines in this article the professional legal ethics in the United States, more commonly known as “professional responsibility”, as a subject to an unusual pattern of “codification”. Detailed rules historically originated with the legal profession itself, initially in legal doctrine and then a Code of Ethics published in 1887 by the Alabama State Bar Association. Whatever borrowing occurred among states when introducing their own “codes of ethics”, the Alabama model was drawn upon when, in 1908, the American Bar Association approved “32 Canons of Professional Ethics”. The sources of law regulating the professional conduct of lawyers in the United States are several. The legal ethics within state courts is regulated by the courts, the legislative (or parliamentary) organ, and the Bar of each state. Professional responsibility, in the spirit of David Hoffman, has become an integral part of legal education and licensing. Law students take a compulsory course in professional responsibility and are required to pass the Multistate Professional Responsibility Examination administered nationally in the United States by the National Conference of Bar Examiners. The author concludes, that legal ethics has been an integral part of American legal education since the early nineteenth century. In the twentieth century the legal profession itself introduced “private” canons of ethics which were then accepted by the highest courts in virtually all states as rules of professional conduct binding upon all members of the Bar. It remains a distinctive element of the American legal system that binding rules of professional conduct are formed mostly by the courts, and not by the legislature. These rules are initially “codified” by a voluntary non-State organization, adopted by the courts, and then applied by the courts in cases which ultimately become components of the law of precedent; that is, a separate and distinct source of law.
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Domen, Ronald E. "A survey of ethics committees in national medical organizations in the United States." HEC Forum 7, no. 6 (November 1995): 333–38. http://dx.doi.org/10.1007/bf01789033.
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Wong, Joshua M., Aidsa Rivera, Hannah R. Volkman, Brenda Torres-Velasquez, Dania M. Rodriguez, Gabriela Paz-Bailey, and Laura E. Adams. "Travel-Associated Dengue Cases — United States, 2010–2021." American Journal of Transplantation 23, no. 9 (September 2023): 1455–61. http://dx.doi.org/10.1016/j.ajt.2023.08.001.
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Laethem, Erica. "Ethics Education of Medical Staff and Associates." Ethics & Medics 45, no. 2 (2020): 1–2. http://dx.doi.org/10.5840/em202045217.
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Ethics education is an essential obligation of a robust health care ethics service. Although there is no one-size-fits all approach, all ethics education should be proactive and therefore should avoid portraying ethics as mere compliance with moral norms or as an esoteric activity that applies only in cases of moral conflict. Such a negative approach can lead to an ethics of minimums and to the disempowerment of moral agency. In addition, ethics education should promote ethics competency and virtue for the sake of human flourishing through instruction and habituation. To serve the individuals from diverse backgrounds who work in Catholic health care, ethics education should reflect the Catholic teaching that faith and reason are compatible, and that ethics need not be bound to an exclusively theological approach. This will foster a flourishing moral community where medical staff and associates are united by a common mission and ethical commitments.
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David A. Dawson. "Trust decay in the American healthcare delivery system." GSC Biological and Pharmaceutical Sciences 20, no. 2 (August 30, 2022): 072–79. http://dx.doi.org/10.30574/gscbps.2022.20.2.0318.
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This treatise examines the four main principles of biomedical ethics, i.e., beneficence, nonmaleficence, autonomy, and justice, and their impact on the healthcare system and providers legally permitted to prescribe or recommend medicines in the United States. It defines the four principles of biomedical ethics and describes how failure to achieve them has contributed to trust decay in the United States healthcare delivery system over the last several decades, that is to say, medical mistrust. An illustrative case of conflicts will be presented that provides insight into whether protocols practiced by the healthcare delivery system to treat intractable pain conform to the principles of biomedical ethics. The increasing distrust in the American healthcare delivery system of two disparate minority populations will be examined. An illustrative case study of a disabled patient’s experiences with the standardized healthcare delivery system provides insight into healthcare delivery system administratively mandated policies that may violate the principles of biomedical ethics resulting in established medical protocols that require disabled intractable pain patients to succumb to an addiction disorder.
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Hisrich, Robert D., Branko Bucar, and Sevgi Oztark. "A cross‐cultural comparison of business ethics: cases of Russia, Slovenia, Turkey, and United States." Cross Cultural Management: An International Journal 10, no. 1 (March 2003): 3–28. http://dx.doi.org/10.1108/13527600310797504.
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O.V., Dudina. "TEACHING MEDICAL ETHICS IN LEADING UNIVERSITIES OF CHINA." Collection of Research Papers Pedagogical sciences, no. 91 (January 11, 2021): 61–64. http://dx.doi.org/10.32999/ksu2413-1865/2020-91-8.
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The article examines the issue of teaching medical ethics in leading Chinese universities in the training of medical professionals and found that medical ethics courses for physicians are an innovation for Chinese medical high schools. Due to different cultural traditions, researchers of Chinese medical ethics hold conflicting views on the scientific importance and practical necessity of medical ethics and bioethics. The study found that medical ethics education in China has gradually adapted the experience of leading countries such as the United States and the United Kingdom in teaching ethics. China is now in the process of discussing how to develop its own traditional ethics in the context of globalization. It is established that in the program of masters in medicine the formation of ethical knowledge is a mandatory subject. The teaching of medical ethics takes place not only while studying in Chinese universities, but is a long-term lifelong process in which the student summarizes the results of their efforts, combining moral reflection, learning and leadership. The article analyzes the methods and content of teaching medical ethics, which include relevant cultural, social and personal development, and the education of masters in medicine at Chinese universities.Teaching ethics in medical universities is a relatively new area of medical education in China, ethics curricula have different levels of development. In order to determine the peculiarities in the contents of curricula, teaching and learning methods, forms of evaluation and quality of teaching ethics in China, it was analyzed ethical education in several leading medical universities in China: Wuhan University School of Medicine, Guangzhou Medical University and Peking University School of Medicine. In the process of scientific research on the teaching of ethics in universities, it was found that medical ethics for some time was part of the mandatory course of disciplines, with a strong tendency to emphasize the correct ideological thinking of future physicians.Key words: specialist in medicine, medical ethics, master’s degree, higher medical education in China, professional competence of doctor.
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O.V., Dudina. "TEACHING MEDICAL ETHICS IN LEADING UNIVERSITIES OF CHINA." Collection of Research Papers Pedagogical sciences, no. 91 (January 11, 2021): 61–64. http://dx.doi.org/10.32999/ksu2413-1865/2020-91-8.
Full textAbstract:
The article examines the issue of teaching medical ethics in leading Chinese universities in the training of medical professionals and found that medical ethics courses for physicians are an innovation for Chinese medical high schools. Due to different cultural traditions, researchers of Chinese medical ethics hold conflicting views on the scientific importance and practical necessity of medical ethics and bioethics. The study found that medical ethics education in China has gradually adapted the experience of leading countries such as the United States and the United Kingdom in teaching ethics. China is now in the process of discussing how to develop its own traditional ethics in the context of globalization. It is established that in the program of masters in medicine the formation of ethical knowledge is a mandatory subject. The teaching of medical ethics takes place not only while studying in Chinese universities, but is a long-term lifelong process in which the student summarizes the results of their efforts, combining moral reflection, learning and leadership. The article analyzes the methods and content of teaching medical ethics, which include relevant cultural, social and personal development, and the education of masters in medicine at Chinese universities.Teaching ethics in medical universities is a relatively new area of medical education in China, ethics curricula have different levels of development. In order to determine the peculiarities in the contents of curricula, teaching and learning methods, forms of evaluation and quality of teaching ethics in China, it was analyzed ethical education in several leading medical universities in China: Wuhan University School of Medicine, Guangzhou Medical University and Peking University School of Medicine. In the process of scientific research on the teaching of ethics in universities, it was found that medical ethics for some time was part of the mandatory course of disciplines, with a strong tendency to emphasize the correct ideological thinking of future physicians.Key words: specialist in medicine, medical ethics, master’s degree, higher medical education in China, professional competence of doctor.
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Chester R. Burns. "Fictional Doctors and the Evolution of Medical Ethics in the United States, 1875-1900." Literature and Medicine 7, no. 1 (1988): 39–55. http://dx.doi.org/10.1353/lm.2011.0173.
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MENG, Kwang-ho. "Student-Specific Ethics in Clinical Clerkships." Korean Journal of Medical Ethics 3, no. 2 (November 2000): 153–59. http://dx.doi.org/10.35301/ksme.2000.3.2.153.
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The importance and the role of ethics courses in medical school education has expanded significantly in recent years. Along with this development, most of the medical schools have provided with the concepts and skills needed to deal successfully with the issues that they will confront as physicians in the future. But medical students are not physicians, and the issues they face are quite different from those faced by physicians. Accordingly, many existing ethics curricula fail to address the subtle yet critical ethical issues that medical students encounter everyday in their clinical clerkships. This paper reviews several literatures on the current status of the student-specific ethics in the United States, and calls for a special attention of medical educators in this particular area in Korea.
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Morgan, David L., Michael P. Wainscott, and Heidi C. Knowles. "Emergency Medical Services Liability Litigation in the United States: 1987 to 1992." Prehospital and Disaster Medicine 9, no. 4 (December 1994): 214–20. http://dx.doi.org/10.1017/s1049023x0004142x.
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AbstractIntroduction:Although emergency medical services (EMS) liability litigation is a concern of many prehospital health care providers, there have been no studies of these legal cases nationwide and no local case studies since 1987.Methods:A retrospective case series was obtained from a computerized database of trial court cases filed against EMS agencies nation-wide. All legal cases that met the inclusion criteria were included in the study sample. These cases must have involved either ambulance collisions (AC) or patient care (PC) incidents, and they must have been closed between 1987 and 1992.Results:There were 76 cases that met the inclusion criteria. Half of these cases involved an AC, and the other cases alleged negligence of a PC encounter. Thirty (78.9%) of the plaintiffs in the AC cases were other motorists, and 35 (92.1%) of the plaintiffs in the PC cases were EMS patients. Almost half of the cases named an individual (usually an emergency medical technician or paramedic) as a codefendant. Thirty-one (40.8%) of the cases were closed without any payment to the plaintiff. There were five cases with plaintiffs' awards or settlements greater than [US] $1 million. Most (71.0%) ofthe ACs occurred in an intersection or when one vehicle rear-ended another vehicle. The most common negligence allegations in the PC cases were arrival delay, inadequate assessment, inadequate treatment, patient transport delay, and no patient transport.Conclusion:Risk management for EMS requires specific knowledge of the common sources of EMS liability litigation. This sample of recent legal cases provides the common allegations of negligence. Recommendations to decrease the legal risk of EMS agencies and prehospital providers are suggested.
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Swanson, Megan, Amy Pickrel, John Williamson, and Susan Montgomery. "Trends in Reported Babesiosis Cases — United States, 2011–2019." American Journal of Transplantation 23, no. 4 (April 2023): 582–84. http://dx.doi.org/10.1016/j.ajt.2023.03.013.
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Sharling, Lisa, Suzanne M. Marks, Michael Goodman, Terence Chorba, and Sundari Mase. "Rifampin-resistant Tuberculosis in the United States, 1998–2014." Clinical Infectious Diseases 70, no. 8 (June 22, 2019): 1596–605. http://dx.doi.org/10.1093/cid/ciz491.
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Abstract Background Monoresistance to rifamycins necessitates longer and more toxic regimens for tuberculosis (TB). We examined characteristics and mortality associated with rifampin-monoresistant (RMR) TB in the United States. Methods We analyzed Mycobacterium tuberculosis culture-positive cases reported to the National TB Surveillance System (excluding California) between 1998 and 2014. We defined RMR TB found on initial drug susceptibility testing and possible acquired rifampin-resistant (ARR) TB. We assessed temporal trends in RMR TB. For both classifications of rifampin resistance, we calculated adjusted risk ratios (adjRRs) and 95% confidence intervals (CIs) for characteristics associated with mortality when compared with drug-susceptible TB in multivariable models using backward selection. Results Of 180 329 TB cases, 126 431 (70%) were eligible for analysis, with 359 (0.28%) of eligible cases reported as RMR. The percentage of RMR TB cases with HIV declined 4% annually between 1998 and 2014. Persons with HIV and prior TB were more likely to have RMR TB (adjRR, 25.9; 95% CI, 17.6–38.1), as were persons with HIV and no prior TB (adjRR, 3.1; 95% CI, 2.4–4.1) vs those without either characteristic, controlling for other statistically significant variables. RMR cases had greater mortality (adjRR, 1.4; 95% CI, 1.04–1.8), controlling for HIV and other variables. Persons with HIV had greater risk of ARR than persons without HIV (adjRR, 9.6; 95% CI, 6.9–13.3), and ARR was also associated with increased mortality, controlling for HIV and other variables. Conclusions All forms of rifampin resistance were positively associated with HIV infection and increased mortality.
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Earnest, M. P., L. B. Reller, C. M. Filley, and A. J. Grek. "Neurocysticercosis in the United States: 3S Cases and a Review." Clinical Infectious Diseases 9, no. 5 (September 1, 1987): 961–79. http://dx.doi.org/10.1093/clinids/9.5.961.
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Kwak, Jae Hyun. "Research Publication Ethics for Medical Researchers." Journal of Korean Medical Library Association 44, no. 1_2 (December 2017): 27–38. http://dx.doi.org/10.69528/jkmla.2017.44.1_2.27.
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Research ethics has been underlined as environments of research became result-oriented. It has various regulations and guidelines today, and researchers have to aware of each cases of them. Research integrity is the key principles to guarantee the transparency and truthfulness of the scientific content. Based on research integrity, ethics includes regulations and guidelines which regulate both research misconduct and questionable research practices. Most important and critical misconduct is fabrication, falsification, and plagiarism. It seriously damage the research integrity. Researchers should be readied to provide their raw data to prove there was no fabrication, falsification, or plagiarism. A proper research note is vital in the research documents. Plagiarism should be avoided by citing the references properly. In medical journals, authors should avoid verbatim. Duplicated publication is a reuse of data, texts or scientific contents from author's previous publications. Every new publications should carry their own original content. But there are some exceptions so called secondary publication. There is 4 conditions to become an author defined by International Committee of Medical Journal Editors. Authors should transparently declare all conflicts of interest to make readers figure out possible biases. All researches that use human subjects should have permissions by Institutional Review. All clinical trials should be registered their detailed protocols to a registry to avoid selective reporting and bias. Researchers should aware the codes of conduct. Research support departments like medical libraries have to ready to cope with the complex states of research publication ethics cases.
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Jayawardena, Hemamal. "AIDS and Professional Secrecy in the United States." Medicine, Science and the Law 36, no. 1 (January 1996): 37–42. http://dx.doi.org/10.1177/002580249603600108.
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Objective: To create a legal awareness of AIDS patients' right to privacy among the medical profession. Discussion and recommendations: Doctors should recognize confidentiality as a patient's right, since in most countries the AIDS patient is practically considered a person who is going through a punishment, having no legal rights, rather than a patient suffering from a grave illness. Originally the common law did not recognize the concept of professional secrecy as a right of the patient. It was only regarded as an ethical duty not actionable in court. But with the eruption of diseases such as AIDS, statutes requiring written authorization for the release of confidential information were enacted. A problem with our hospital records is that they are freely available to almost all the staff in the hospitals and sometimes even to outsiders. In the case of AIDS at least, strict measures should be taken to enforce secrecy in relation to all disease-related information such as sexual history, HIV status and CD4 cell counts. The duty to keep medical information confidential is not absolute. An overriding duty towards society, occurs when the benefits of disclosure outweigh its harm. This Utopian argument is even more convincing when an HIV-positive person is acting irresponsibly, engaging in risky behaviour without warning the partner. All persons who have a compelling interest, such as sexual partners, needle sharers, medical and nursing personnel, should be provided with this information. It should also extend to mortuary attendants when the patient dies. A person having a STD has a legal duty to take precautions against transmission. In Berner v. Caldwell (543 So. 2d. 686), the US court held that one who knows or should reasonably know that he has genital herpes is under a duty to abstain from sex or warn others before risky contact. As doctors we should familiarize ourselves now with the concepts and laws regarding patients' rights, without waiting until a malpractice crisis develops to correct ourselves.
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Benedict, Kaitlin, and Brendan R. Jackson. "Sporotrichosis Cases in Commercial Insurance Data, United States, 2012–2018." Emerging Infectious Diseases 26, no. 11 (November 2020): 2783–85. http://dx.doi.org/10.3201/eid2611.201693.
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