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Indian Journal of Medical Ethics

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https://www.readbyqxmd.com/read/28537222/the-revision-of-the-ich-good-clinical-practice-guidelines-a-missed-opportunity
#1
Raffaella Ravinetto
The Guideline for Good Clinical Practice (GCP) of the International Conference of Harmonisation (ICH) is an international standard for the ethical and scientific quality of the designing, conducting, recording and reporting of trials that involve the participation of human subjects. Today, most regulators and funding agencies follow the ICH guidelines. These were drawn up by a small number of regulatory agencies and drug companies from high-income countries and do not pay sufficient heed to the problematic aspects of clinical trials in the low- and middle-income countries...
May 23, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28537221/ethical-stumbling-blocks-in-uncovering-folate-deficiency-as-a-preventable-cause-of-spina-bifida
#2
Lars H Breimer, Torbjörn K Nilsson
The year 2016 witnessed the anniversaries of several key events related to the prevention of neural tube defects (NTD) with folate supplementation. However, the road leading up to this achievement was full of stumbling blocks, both in terms of research ethics and researcher ethics. First, the decisions of ethics review boards differed with respect to allowing placebo groups in folate trials, thus reducing the level of evidence obtained from the earliest studies. Second, statisticians insisted on analysing the outcome of a trial by intention-to-treat - which turned out to be non-significant - rather than by treatment received, which was statistically significant...
May 18, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28501793/ethical-issues-in-death-dying-and-palliation-the-ijme-sixth-national-bioethics-conference
#3
Rakhi Ghoshal, V Deepa, Sunita Simon Kurpad
The IJME Sixth National Bioethics Conference (6th NBC), on the theme "Healing and dying with dignity: ethical issues in palliative care, end-of-life care and euthanasia", was held in Pune, Maharashtra from January 12-15, 2017. Palliative care (PC) and end-of-life care (EOLC) are closely related areas of concern, yet they have been neglected so far. There is an urgent need to discuss these issues in India due to the changing demographics, socioeconomic and work profiles of the population, people's living conditions and health status, and the contexts of the country's population...
May 10, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28501792/healing-ministry-and-palliative-care-in-christianity
#4
S Stephen Jayard, Nishant A Irudayadason, J Charles Davis
Death is inevitable, but that does not mean it can be planned or imposed. It is an ethical imperative that we attend to the unbearable pain and suffering of patients with incurable and terminal illnesses. This is where palliative care plays a vital role. Palliative care has been growing faster in the world of medicine since its emergence as a specialty in the last decade. Palliative care helps to reduce physical pain while affirming the aspect of human suffering and dying as a normal process. The goal of palliative care is to improve the quality of life both of the patient and the family...
May 3, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28501791/the-jurisprudence-of-emergency-medical-care-in-india-an-ethics-perspective
#5
Edward Premdas Pinto
This paper, which is part of a primary interdisciplinary doctoral research work with a qualitative research design, seeks to understand the ethical principles that intersect healthcare jurisprudence in litigations where citizens, who have encountered death or violations in the provision of critical care, have had to take recourse to the courts to get justice.
April 25, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28433962/ten-minute-snapshots-a-team-approach-to-teaching-postgraduates-about-professional-dilemmas
#6
Prabha S Chandra, G Ragesh, Santosh K Chaturvedi
As medical professionals, most of us face professional dilemmas that catch us unawares and are not discussed in medical training. One often learns about these dilemmas on one's own and deals with them with a common sense approach, rather than reflection. The professional dilemmas may concern receiving gifts from patients, handling issues of confidentiality or dealing with personal questions. There is seldom any formal instruction in competencies related to professionalism, especially in India. We adopted a team approach to provide training in these issues to postgraduate trainees in mental health and to engage them in discussion, using team feedback on snapshots of real-life professional situations, which were simulated through role play...
April 12, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28433965/national-health-policy-2017-a-cautious-welcome
#7
T Sundararaman
On March 15, 2017 the union cabinet approved the new National Health Policy. The next day a 28-page policy text and an accompanying 13-page situational analysis were placed in Parliament and in the public domain. To have, at all times, a health policy in place that shows a road map on how a nation would show "progressive realization" of health as a basic human right is an obligation under the International Covenant on Economic, Social and Cultural Rights. This is an international treaty adopted in 1976, to which India became a signatory in 1979, and this was one of the catalysts for the adoption of the first National Health Policy in 1 983...
April 4, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28433964/ethical-management-of-substance-use-disorders-the-indian-scenario
#8
Arpit Parmar, Vaibhav Patil, Siddharth Sarkar
Substance use disorders are among the most prevalent and emergent public health problems in India. The treatment of individuals with these disorders is associated with many ethical dilemmas. Due to the pervasiveness of substance use disorders, the majority of mental health professionals working in the area of addiction medicine face several ethical dilemmas. When discussing substance use disorders, it must be borne in mind that there are important differences between India and the western countries in terms of the social and cultural aspects, as well as the legislative framework and healthcare delivery system...
April 4, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28433963/schuklenk-s-critique-of-the-cioms-guidelines-all-procedure-no-substance
#9
Ruth Macklin
In his article on the 2016 revision of the CIOMS International Ethical Guidelines (​1), Udo Schuklenk criticises the guidelines but adds a few words of faint praise. His criticisms are primarily procedural, and comprise the following main points: the guidelines aren't really ethical guidelines; the process used by the work group that wrote the guidelines involves "appeals to authority"; the work group used a method of consensus to reach conclusions on controversial points; the work group consisted of twice the number of participants from the global North as from the global South, yet the guidelines are largely directed at low-resource countries...
March 29, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28433961/harnessing-the-medical-humanities-for-experiential-learning
#10
Satendra Singh, Purnima Barua, Upreet Dhaliwal, Navjeevan Singh
A month-long workshop on medical humanities was held in the Jorhat Medical College, Assam in September 2015. It employed experiential learning (both online and onsite) using humanities tools, such as the theatre of the oppressed, art, literature, reflective narratives, movies, the history of medicine, graphic medicine, poetry and diversity studies. As a result of the interactions, 28 volunteer participants, comprising students and faculty members, wrote reflective narratives on doctor​-patient relationships, produced a newsletter and a logo for their medical humanities group, and staged cultural performances and forum theatre...
March 29, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28428154/bias-in-medicine-in-the-context-of-the-film-aligarh
#11
Aiswarya Sasi
In today's world, I feel another sin needs to be added to the list of the seven deadly sins, viz the sin of intolerance. We hear this term on the news every other day and see society display this attitude more often than not. While the movie Aligarh raised myriad social issues, as a medical student, I would like to speak of one in particular - the influence of stigma on healthcare.
March 21, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28343147/ethical-ramifications-of-the-paolo-macchiarini-case
#12
Jaime A Teixeira da Silva
The Paolo Macchiarini case has several ethical ramifications. Professor Macchiarini, formerly of the Karolinska Institutet (KI), became famous for the tracheal surgeries he conducted between 2008 and 2014. His rapid rise to fame was followed by an almost equally rapid fall from grace as official reports, articles in newspapers and television programmes revealed several aspects related to misconduct in his curriculum vitae, professional practices and publishing-related activity. Formal misconduct reports issued by four KI co-workers in late 2014, then again in 2016, coupled with social scandals, including the tricking of a famous US television newscaster into a false marriage, a previous arrest in Italy for apparent bribery, and acute narcissism, all tainted Macchiarini's legend...
March 15, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28285263/research-ethics-for-a-globalised-world-the-revised-cioms-international-guidelines
#13
Hans-Jöerg Ehni, Urban Wiesing
On December 6, 2016, the Council of International Organisations of Medical Sciences published a new version of its guidelines with the title "International Ethical Guidelines for Health-related Research Involving Humans." In this article we briefly describe the revision process and the structure and content of these guidelines. We outline some of its main guidelines such as the ones on social value, post-trial access, and risk-benefit ratio. In our overall evaluation we come to the conclusion that the CIOMS guidelines manage to strike a balance between the protection of human participants in health-related research and the promotion of such research activities in an exemplary way...
March 7, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28285262/revised-cioms-research-ethics-guidance-on-the-importance-of-process-for-credibility
#14
Udo Schuklenk
This paper reviews the 2016 CIOMS International Ethical Guidelines for Health-related Research Involving Humans. I argue that these new guidelines constitute a significant improvement over the guidelines they replace. However, the procedures put in place by CIOMS resulted in an authoring group consisting of a majority of authors and advisors hailing from the global North, while the guidelines squarely aim at influencing policies in the global South. I question CIOMS' strategy to produce a consensus based document, and raise concerns about frequent appeals to authority designed to establish the credibility of these guidelines and the processes that led to them...
March 7, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28279947/abortion-rights-judgment-a-ray-of-hope
#15
Veena Johari, Uma Jadhav
While granting a prisoner the right to abort her foetus, a recent Bombay High Court judgment recognised a woman's absolute right to abortion. This article discusses the judgment in detail and the bioethical debates over abortion rights. It deals with the restrictions imposed by the law not only on when the foetus can be aborted, but also who can get the abortion done and in what circumstances.
February 28, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28512078/is-mci-over-emphasising-publication-for-promotion-of-medical-teachers
#16
Shobhit Jain, Harjeet Jain, Ashok Kumar Jain
Over the past year, there has been constant debate in various journals on the circular issued by the Medical Council of India (MCI) in September 2015, regarding the requirements for promotion of teaching faculty. The lack of a time-bound promotion system of medical faculty results in higher stress, dissatisfaction, lower productivity and quality of life and work. The critics have highlighted several issues in assessment of publication for teacher's promotion, eg the exclusion of publications in "electronic-only" journals, awarding points only to "original research" papers and first or second authors, listing of indexing databases for journals, categorising journals as national or international...
April 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28512077/vaccine-delivery-to-disease-control-a-paradigm-shift-in-health-policy
#17
T Jacob John, Yogesh Jain, Sarojini Nadimpally, Amar Jesani
India's Universal Immunisation Programme (UIP) has resulted in the creation of infrastructure, human resources and systems for the procurement and delivery of vaccines. Recently, new vaccines have been added and there are plans for the introduction of more. However, the outcomes in terms of reduction of the diseases for which the vaccines are being administered remain ambiguous. This is evident from the persistent health issues that children continue to experience, despite immunisation. This situation raises a fundamental ethical question for public health: vaccinations are one of the tools of disease control, but are they properly aligned to the control of disease so as to produce the expected public health utility or benefit?...
April 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28512076/considering-the-public-in-public-health-popular-resistance-to-the-smallpox-eradication-programme-in-india
#18
Luke Juran, Jennifer Trivedi, Korine N Kolivras
Public health initiatives, including large-scale vaccination and disease eradication programmes, regularly pit the rights of the individual against broader benefits to society. At times, the public resists such initiatives, with the World Health Organisation's Smallpox Eradication Programme (SEP) in India being a case in point. Here, we critically investigate resistance to smallpox vaccines in India and argue that while the SEP successfully eradicated a global killer; individuals were stripped of human rights through coercion, forcible vaccination and quarantine...
April 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28512075/public-trust-in-vaccination-an-analytical-framework
#19
Vijayaprasad Gopichandran
While vaccination is one of the most successful public health interventions, there has always been a parallel movement against vaccines. Apart from scientific factors, the uptake of vaccinations is influenced by historical, political, sociocultural and economic factors. In India, the health system is struggling with logistical weaknesses in taking vaccination to the remotest corners; while on the other hand, some people in places where vaccination is available resist it. Unwillingness to be vaccinated is a growing problem in the developed world...
April 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28512074/an-idea-whose-time-has-come-compensation-for-vaccine-related-injuries-and-death-in-india
#20
Sarojini Nadimpally, Sneha Banerjee, Deepa Venkatachalam, Divya Bhagianadh
This paper emphasises the urgent need for a compensation policy for those affected by adverse events following immunisation in India. In the absence of such a mechanism in the country, people claim compensation by taking recourse to tort law and have to face the ensuing uncertainty and challenges with regard to the award of compensation. The paper argues that people should be provided compensation in the event of death and serious adverse events following compulsory immunisation, irrespective of whether there is a causal association between the adverse event and the vaccine, on the basis of no fault compensation...
April 2017: Indian Journal of Medical Ethics
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