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BMC Medical Ethics

Michael Dunn, Jonathan Ives, Bert Molewijk, Jan Schildmann
This paper responds to the commentaries from Stacy Carter and Alan Cribb. We pick up on two main themes in our response. First, we reflect on how the process of setting standards for empirical bioethics research entails drawing boundaries around what research counts as empirical bioethics research, and we discuss whether the standards agreed in the consensus process draw these boundaries correctly. Second, we expand on the discussion in the original paper of the role and significance of the concept of 'integrating' empirical methods and ethical argument as a standard for research practice within empirical bioethics...
July 13, 2018: BMC Medical Ethics
Stacy M Carter
This article provides a commentary on Standards of practice in empirical bioethics research by Ives and colleagues (in this Issue). There is much to admire in the paper, and in the demanding consensus-building process on which it reports. I discuss the problems and limits of methodological standardisation, and a central conceptual tension that appears to have divided participants. I suggest that the finished product should be understood as a record of a methodological conversation, rather than being used as a disciplinary tool to limit the evolution of empirical bioethics...
July 12, 2018: BMC Medical Ethics
Megan M Campbell, Jantina de Vries, Sibonile G Mqulwana, Michael M Mndini, Odwa A Ntola, Deborah Jonker, Megan Malan, Adele Pretorius, Zukiswa Zingela, Stephanus Van Wyk, Dan J Stein, Ezra Susser
BACKGROUND: Cell line immortalisation is a growing component of African genomics research and biobanking. However, little is known about the factors influencing consent to cell line creation and immortalisation in African research settings. We contribute to addressing this gap by exploring three questions in a sample of Xhosa participants recruited for a South African psychiatric genomics study: First, what proportion of participants consented to cell line storage? Second, what were predictors of this consent? Third, what questions were raised by participants during this consent process? METHODS: 760 Xhose people with schizophrenia and 760 controls were matched to sex, age, level of education and recruitment region...
July 11, 2018: BMC Medical Ethics
Alan Cribb
This commentary welcomes the work of Ives et al. on Standards of practice in Empirical Bioethics, and especially the dialogical spirit in which the standards have been constructed and offered. It also raises some questions about the consistent interpretation and use of such standards.
July 11, 2018: BMC Medical Ethics
Jonathan Ives, Michael Dunn, Bert Molewijk, Jan Schildmann, Kristine Bærøe, Lucy Frith, Richard Huxtable, Elleke Landeweer, Marcel Mertz, Veerle Provoost, Annette Rid, Sabine Salloch, Mark Sheehan, Daniel Strech, Martine de Vries, Guy Widdershoven
BACKGROUND: This paper reports the process and outcome of a consensus finding project, which began with a meeting at the Brocher Foundation in May 2015. The project sought to generate and reach consensus on standards of practice for Empirical Bioethics research. The project involved 16 academics from 5 different European Countries, with a range of disciplinary backgrounds. METHODS: The consensus process used a modified Delphi approach. RESULTS: Consensus was reached on 15 standards of practice, organised into 6 domains of research practice (Aims, Questions, Integration, Conduct of Empirical Work, Conduct of Normative Work; Training & Expertise)...
July 10, 2018: BMC Medical Ethics
Kristina Würth, Wolf Langewitz, Stella Reiter-Theil, Sylvie Schuster
BACKGROUND: In todays' super-diverse societies, communication and interaction in clinical encounters are increasingly shaped by linguistic, cultural, social and ethnic complexities. It is crucial to better understand the difficulties patients with migration background and healthcare professionals experience in their shared clinical encounters and to explore ethical aspects involved. METHODS: We accompanied 32 migrant patients (16 of Albanian and Turkish origin each) during their medical encounters at two outpatient clinics using an ethnographic approach (participant observation and semi-structured interviews with patients and healthcare professionals)...
July 4, 2018: BMC Medical Ethics
Hayley Mundeva, Jeremy Snyder, David Paul Ngilangwa, Angela Kaida
BACKGROUND: Task shifting is increasingly used to address human resource shortages impacting HIV service delivery in low- and middle-income countries. By shifting basic tasks from higher- to lower-trained cadres, such as Community Health Workers (CHWs), task shifting can reduce overhead costs, improve community outreach, and provide efficient scale-up of essential treatments like antiretroviral therapies. Although there is rich evidence outlining positive outcomes that CHWs bring into HIV programs, important questions remain over their place in service delivery...
July 4, 2018: BMC Medical Ethics
Hendrik Napierala, Luise Schäfer, Gisela Schott, Niklas Schurig, Thomas Lempert
BACKGROUND: The reliability of clinical practice guidelines has been disputed because guideline panel members are often burdened with financial conflicts of interest (COI). Current recommendations for COI regulation advise not only detailed declaration but also active management of conflicts. To continuously assess COI declaration and management in German guidelines we established the public database LeitlinienWatch (GuidelineWatch). METHODS: We analyzed all German guidelines at the highest methodological level (S3) that included recommendations for pharmacological therapy (n = 67) according to five criteria: declaration and assessment of COI, composition of the guideline development group, independence of the coordinators and lead authors, imposed abstentions because of COI and public external review...
June 28, 2018: BMC Medical Ethics
Yrrah H Stol, Eva C A Asscher, Maartje H N Schermer
BACKGROUND: Health checks or health screenings identify (risk factors for) disease in people without a specific medical indication. So far, the perspective of (potential) health check users has remained underexposed in discussions about the ethics and regulation of health checks. METHODS: In 2017, we conducted a qualitative study with lay people from the Netherlands (four focus groups). We asked what participants consider characteristics of good and bad health checks, and whether they saw a role for the Dutch government...
June 22, 2018: BMC Medical Ethics
H Bruun, S G Lystbaek, E Stenager, L Huniche, R Pedersen
BACKGROUND: The aim of this article is to give more insight into what ethical challenges clinicians in mental healthcare experience and discuss with a Clinical Ethics Committee in psychiatry in the Region of Southern Denmark. Ethical considerations are an important part of the daily decision-making processes and thereby for the quality of care in mental healthcare. However, such ethical challenges have been given little systematic attention - both in research and in practices. METHODS: A qualitative content analysis of 55 written case-reports from the Clinical Ethics Committee...
June 19, 2018: BMC Medical Ethics
Mona Pettersson, Mariann Hedström, Anna T Höglund
BACKGROUND: DNR decisions are frequently made in oncology and hematology care and physicians and nurses may face related ethical dilemmas. Ethics is considered a basic competence in health care and can be understood as a capacity to handle a task that involves an ethical dilemma in an adequate, ethically responsible manner. One model of ethical competence for healthcare staff includes three main aspects: being, doing and knowing, suggesting that ethical competence requires abilities of character, action and knowledge...
June 19, 2018: BMC Medical Ethics
Kyoko Takashima, Yuichi Maru, Seiichi Mori, Hiroyuki Mano, Tetsuo Noda, Kaori Muto
BACKGROUND: Platforms for sharing genomic and phenotype data have been developed to promote genomic research, while maximizing the utility of existing datasets and minimizing the burden on participants. The value of genomic analysis of trios or family members has increased, especially in rare diseases and cancers. This article aims to argue the necessity of protection when sharing data from both patients and family members. MAIN TEXT: Sharing patients' and family members' data collectively raises an ethical tension between the value of datasets and the rights of participants, and increases the risk of re-identification...
June 18, 2018: BMC Medical Ethics
Thomas Druetz
BACKGROUND: The lack of primary healthcare integration has been identified as one of the main limits to programs' efficacy in low- and middle-income countries. This is especially relevant to the Millennium Development Goals, whose health objectives were not attained in many countries at their term in 2015. While global health scholars and decision-makers are unanimous in calling for integration, the objective here is to go further and contribute to its promotion by presenting two of the most important challenges to be met for its achievement: 1) developing a "crosswise approach" to implementation that is operational and effective; and 2) creating synergy between national programs and interventions driven by non-State actors...
June 15, 2018: BMC Medical Ethics
Marium Salwa, Tarek Abdullah Al-Munim
BACKGROUND: Human Papilloma Virus (HPV) vaccine was introduced in Bangladesh through the arrangement of a demonstration project in Gazipur district in 2016, targeting grade five female students and non-school going girls (age range 10-12 years). HPV vaccination is expected to be eventually included in the nationwide immunization program if the demonstration project is successful. However, introduction and implementation of such a vaccination program raises various ethical concerns. This review paper illustrates a step by step assessment of the ethical concerns surrounding the HPV vaccination implementation in Bangladesh considering specific elements in administering and conducting the program as well as the intended results...
June 15, 2018: BMC Medical Ethics
Ibrahim Bienvenu Mouliom Moungbakou
BACKGROUND: Since the mid-1980s, there has been a gradual ethical drift in the provision of maternal care in African health facilities in general, and in Cameroon in particular, despite government efforts. In fact, in Cameroon, an increasing number of caregivers are reportedly not providing compassionate care in maternity services. Consequently, many women, particularly the financially vulnerable, experience numerous difficulties in accessing these health services. In this article, we highlight the unequal access to care in public maternity services in Cameroon in general and the Noun Division in particular...
June 15, 2018: BMC Medical Ethics
Anne-Marie Turcotte-Tremblay, Esther Mc Sween-Cadieux
BACKGROUND: Researchers studying health systems in low-income countries face a myriad of ethical challenges throughout the entire research process. In this article, we discuss one of the greatest ethical challenges that we encountered during our fieldwork in West Africa: the difficulty of protecting the confidentiality of participants (or groups of participants) while locally disseminating results of health systems research to stakeholders. METHODS: This reflection is based on experiences of authors involved in conducting evaluative research of interventions aimed at improving health systems in West Africa...
June 15, 2018: BMC Medical Ethics
Federica Fregonese
BACKGROUND: Community involvement in research has been advocated by researchers, communities, regulatory agencies, and funders with the aim of reinforcing subjects' protection and improving research efficiency. Community involvement also has the potential to improve dissemination, uptake, and implementation of research findings. The fields of community based participatory research conducted with indigenous populations and of participatory action research offer a large base of experience in community involvement in research...
June 15, 2018: BMC Medical Ethics
Lara Gautier, Isidore Sieleunou, Albino Kalolo
BACKGROUND: Global health conceives the notion of partnership between North and South as central to the foundations of this academic field. Indeed, global health aspires to an equal positioning of Northern and Southern actors. While the notion of partnership may be used to position the field of global health morally, this politicization may mask persisting inequalities in global health. In this paper, we reflect on global health partnerships by revisiting the origins of global health and deconstructing the notion of partnership...
June 15, 2018: BMC Medical Ethics
Sohana Shafique, Dipika S Bhattacharyya, Iqbal Anwar, Alayne Adams
BACKGROUND: The world is urbanizing rapidly; more than half the world's population now lives in urban areas, leading to significant transition in lifestyles and social behaviours globally. While offering many advantages, urban environments also concentrate health risks and introduce health hazards for the poor. In Bangladesh, although many public policies are directed towards equity and protecting people's rights, these are not comprehensively and inclusively applied in ways that prioritize the health rights of citizens...
June 15, 2018: BMC Medical Ethics
Mark Daku
BACKGROUND: Research ethics boards (REBs) exist for good reason. By setting rules of ethical behaviour, REBs can help mitigate the risk of researchers causing harm to their research participants. However, the current method by which REBs promote ethical behaviour does little more than send researchers into the field with a set of rules to follow. While appropriate for most situations, rule-based approaches are often insufficient, and leave significant gaps where researchers are not provided institutional ethical direction...
June 15, 2018: BMC Medical Ethics
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