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Journal of Medical Ethics

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https://www.readbyqxmd.com/read/28716978/how-do-clinicians-prepare-family-members-for-the-role-of-surrogate-decision-maker
#1
Thomas V Cunningham, Leslie P Scheunemann, Robert M Arnold, Douglas White
PURPOSE: Although surrogate decision-making (SDM) is prevalent in intensive care units (ICUs) and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. SUBJECTS AND METHODS: We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death...
July 17, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28716977/vulnerability-of-pregnant-women-in-clinical-research
#2
Indira S E van der Zande, Rieke van der Graaf, Martijn A Oudijk, Johannes J M van Delden
BACKGROUND: Notwithstanding the need to produce evidence-based knowledge on medications for pregnant women, they remain underrepresented in clinical research. Sometimes they are excluded because of their supposed vulnerability, but there are no universally accepted criteria for considering pregnant women as vulnerable. Our aim was to explore whether and if so to what extent pregnant women are vulnerable as research subjects. METHOD: We performed a conceptual and empirical analysis of vulnerability applied to pregnant women...
July 17, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28716976/pregnant-women-should-not-be-categorised-as-a-vulnerable-population-in-biomedical-research-studies-ending-a-vicious-cycle-of-vulnerability
#3
EDITORIAL
Carleigh B Krubiner, Ruth R Faden
No abstract text is available yet for this article.
July 17, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28663259/what-trial-participants-need-to-be-told-about-placebo-effects-to-give-informed-consent-a-survey-to-establish-existing-knowledge-among-patients-with-back-pain
#4
John Hughes, Maddy Greville-Harris, Cynthia A Graham, George Lewith, Peter White, Felicity L Bishop
INTRODUCTION: Patients require an accurate knowledge about placebos and their possible effects to ensure consent for placebo-controlled clinical trials is adequately informed. However, few previous studies have explored patients' baseline (ie, pretrial recruitment) levels of understanding and knowledge about placebos. The present online survey aimed to assess knowledge about placebos among patients with a history of back pain. DESIGN: A 15-item questionnaire was constructed to measure knowledge about placebos...
June 29, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28646035/a-matter-of-life-and-death
#5
Justice Baker
Cases concerning the withdrawal or withholding of artificial nutrition and hydration from patients in a vegetative or minimally conscious state raise difficult medical, legal and ethical questions including the diagnosis and classification of disorders of consciousness, the legal processes to be followed, and the legal and ethical principles to be applied when making decisions. There is also an issue as to whether it is necessary or appropriate for such decisions to be taken by judges. This article, based on a lecture given in Oxford in October 2016, considers a number of these issues and concludes that any consideration of the question from the patient's point of view must include an objective analysis of what is in his or her best interests, as well as subjective expressions of wishes and feelings...
June 23, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28642353/when-sanctity-of-life-and-self-determination-clash-briggs-versus-briggs-2016-ewcop-53-implications-for-policy-and-practice
#6
Jenny Kitzinger, Celia Kitzinger, Jakki Cowley
In a landmark judgment in the English Court of Protection, the judge (Charles J) found it to be in the best interests of a minimally conscious patient for clinically assisted nutrition and hydration (CANH) to be withdrawn, with the inevitable consequence that the patient would die. In making this judgment, it was accepted that the patient's level of consciousness - if CANH were continued and rehabilitation provided - might improve, and that he might become capable of expressing emotions and making simple choices...
June 22, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28588147/a-plutocratic-proposal-an-ethical-way-for-rich-patients-to-pay-for-a-place-on-a-clinical-trial
#7
Alexander Masters, Dominic Nutt
Many potential therapeutic agents are discarded before they are tested in humans. These are not quack medications. They are drugs and other interventions that have been developed by responsible scientists in respectable companies or universities and are often backed up by publications in peer-reviewed journals. These possible treatments might ease suffering and prolong the lives of innumerable patients, yet they have been put aside. In this paper, we outline a novel mechanism-the Plutocratic Proposal-to revive such neglected research and fund early phase clinical trials...
June 6, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28526778/nudges-in-a-post-truth-world
#8
Neil Levy
Nudges-policy proposals informed by work in behavioural economics and psychology that are designed to lead to better decision-making or better behaviour-are controversial. Critics allege that they bypass our deliberative capacities, thereby undermining autonomy and responsible agency. In this paper, I identify a kind of nudge I call a nudge to reason, which make us more responsive to genuine evidence. I argue that at least some nudges to reason do not bypass our deliberative capacities. Instead, use of these nudges should be seen as appeals to mechanisms partially constitutive of these capacities, and therefore as benign (so far as autonomy and responsible agency are concerned)...
May 19, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28507223/should-neurotechnological-treatments-offered-to-offenders-always-be-in-their-best-interests
#9
Thomas Søbirk Petersen
The paper critically discusses the moral view that neurotechnological behavioural treatment for criminal offenders should only be offered if it is in their best interests. First, I show that it is difficult to apply and assess the notion of the offender's best interests unless one has a clear idea of what 'best interests' means. Second, I argue that if one accepts that harmful punishment of offenders has a place in the criminal justice system, it seems inconsistent not to accept the practice of offering offenders treatment even when the state will harm them in applying the treatment...
May 15, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28507222/meeting-the-goal-of-concurrent-adolescent-and-adult-licensure-of-hiv-prevention-and-treatment-strategies
#10
Michelle Hume, Linda L Lewis, Robert M Nelson
The ability of adolescents to access safe and effective new products for HIV prevention and treatment is optimised by adolescent licensure at the same time these products are approved and marketed for adults. Many adolescent product development programmes for HIV prevention or treatment products may proceed simultaneously with adult phase III development programmes. Appropriately implemented, this strategy is not expected to delay licensure as information regarding product efficacy can often be extrapolated from adults to adolescents, and pharmacokinetic properties of drugs in adolescents are expected to be similar to those in adults...
May 15, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28507221/allocation-of-antiretroviral-drugs-to-hiv-infected-patients-in-togo-perspectives-of-people-living-with-hiv-and-healthcare-providers
#11
Lonzozou Kpanake, Paul Clay Sorum, Etienne Mullet
AIM: To explore the way people living with HIV and healthcare providers in Togo judge the priority of HIV-infected patients regarding the allocation of antiretroviral drugs. METHOD: From June to September 2015, 200 adults living with HIV and 121 healthcare providers living in Togo were recruited for the study. They were presented with stories of a few lines depicting the situation of an HIV-infected patient and were instructed to judge the extent to which the patient should be given priority for antiretroviral drugs...
May 15, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28483804/towards-coherent-data-policy-for-biomedical-research-with-elsi-2-0-orchestrating-ethical-legal-and-social-strategies
#12
J Patrick Woolley
As the recent inaugural Ethical, Legal, and Social Issues (ELSI) 2.0 conference made clear, the effects of information communication technology (ICT) are pervasive in biomedical research. Data initiatives are arising in all corners of biomedicine. Data sharing efforts already promised to surpass even the ambitious goals of the National Human Genome Research Institute, only 5 years after publication of its 10-year vision. ELSI research was established, in part, to address challenges of open data access and data sharing...
May 8, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28473627/everything-in-moderation-even-hype-learning-from-vaccine-controversies-to-strike-a-balance-with-crispr
#13
Shawna Benston
The ease and applicability of CRISPR/Cas9--a new and precise gene editing and reproductive technology--have garnered hype and heightened concern about its potential 'unprecedented and horrific consequences' and have led many scientific leaders to call for a moratorium on its research and use. CRISPR appears distinctly more controversial than previous technological innovations (genetic or otherwise), with a greater reach and speed of human treatment and enhancement; however, we have seen similarly inflated hopes and fears in response to other medical innovations for well over a century...
May 4, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28450403/pathways-to-genetic-parenthood-for-same-sex-couples
#14
Timothy F Murphy
Researchers are pursuing various ways to synthesise human male and female gametes, which would be useful for people facing infertility. Some people are unable to conceive children with their partner because one of them is infertile in the sense of having an anatomical or physiological deficit. Other people-in same sex couples-may not be individually infertile but situationally infertile in relation to one another. Segers et al have described a pathway towards synthetic gametes that would rely on embryonic stem cells, rather than somatic cells...
April 27, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28450402/designing-methuselah-an-ethical-argument-against-germline-genetic-modification-to-prolong-human-longevity
#15
Isabelle L Robertson
Precise editing of the human germline has been considered an unlikely and an unethical proposition. Recently, tools to edit the human germline have been developed and it is now a realistic prospect. Consequently, the ethical arguments around prohibiting human genome editing need to be re-evaluated. It is anticipatable that using it to eradicate disease-causing mutations will be acceptable if clinical risks can be shown to be sufficiently low. Some go further and advocate that genetically 'enhancing' humans will also be permissible...
April 27, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28438784/professional-and-conscience-based-refusals-the-case-of-the-psychiatrist-s-harmful-prescription
#16
Morten Magelssen
By way of a case story, two common presuppositions in the academic debate on conscientious objection in healthcare are challenged. First, the debate typically presupposes a sharp division between conscience-based refusals based on personal core moral beliefs and refusals based on professional (eg, medical) reasons. Only the former might involve the moral gravity to warrant accommodation. The case story challenges this division, and it is argued that just as much might sometimes be at stake morally in refusals based on professional reasons...
April 24, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28438783/mistakes-and-missed-opportunities-regarding-cosmetic-surgery-and-conscientious-objection
#17
Toni C Saad
In her paper 'Cosmetic surgery and conscientious objection', Minerva rightly identifies cosmetic surgery as an interesting test case for the question of conscientious objection in medicine. Her treatment of this important subject, however, seems problematic. It is argued that Minerva's suggestion that a doctor has a prima facie duty to satisfy patient preferences even against his better clinical judgment, which we call Patient Preference Absolutism, must be regarded with scepticism. This is because (1) it overlooks an important distinction regarding autonomy's meaning and place in clinical practice, and (2) it makes obsolete the important concepts of expert clinical judgment and beneficence...
April 24, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28663410/procedure-practice-and-legal-requirements-a-commentary-on-why-i-wrote-my-advance-decision
#18
Alexander Ruck Keene
No abstract text is available yet for this article.
July 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28663409/persistent-vegetative-state-and-minimally-conscious-state-ethical-legal-and-practical-dilemmas
#19
EDITORIAL
Lindy Willmott, Ben White
No abstract text is available yet for this article.
July 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28615196/withdrawing-clinically-assisted-nutrition-and-hydration-canh-in-patients-with-prolonged-disorders-of-consciousness-is-there-still-a-role-for-the-courts
#20
Veronica English, Julian C Sheather
Currently, in England and Wales, Court of Protection's Practice Directive 9E (PD9E) requires all cases of proposed withdrawal or withholding of life-sustaining treatment in relation to adults in a permanent vegetative state (PVS) or minimally conscious state be referred to the Court. This paper looks at the origins of PD9E and contrasts the routine requirement to refer cases to court with the complex clinical terrain that comprises those suffering from prolonged disorders of consciousness. We look at the role of the court in decision making in these contexts and we ask what role the courts are called on to play in these decisions...
July 2017: Journal of Medical Ethics
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