Bioethics and Medical Ethics Commons^™

Impact Of A Multifaceted Intervention On Physicians' Knowledge, Attitudes And Practices In Relation To Pharmaceutical Incentivisation: Protocol For A Randomised Control Trial, Muhammad Naveed Noor, Mishal Khan, Afifah Rahman-Shepherd, Amna Rehana Siddiqui, Sabeen Sharif Khan, Iqbal Azam, Sadia Shakoor, Rumina Hasan

Department of Pathology and Laboratory Medicine

Introduction: In settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients' well-being. In their interactions with pharmaceutical companies, private general practitioners (GPs) can experience the conflict of interest (COI), a situation whereby the impartiality of GPs' professional decision making may be influenced by secondary interests such as financial gains from prescribing specific pharmaceutical brands.
Methods and analysis: This study is a randomised controlled trial to assess the impact of a multifaceted intervention on GPs' medical practice. The study sample consists of 419 registered GPs who own/work in private clinics and …

Adolescent Medical Decisionmaking Rights: Reconciling Medicine And Law, Doriane Lambelet Coleman, Philip M. Rosoff

Faculty Scholarship

Dennis Lindberg came into his aunt’s care when he was in the 4th grade because his parents struggled with drug addiction and could not provide for him. At thirteen, he was baptized in his aunt’s faith as a Jehovah’s Witness. Just days after he turned fourteen, on November 6, he was diagnosed with acute lymphoblastic leukemia.

The prognosis was that Dennis had a 75% chance of cure with standard oncology treatment. Consistent with the requirements of his new faith, however, Dennis told his doctors, “I do not want to be treated if the requirement is that I would have to …

Ethical Considerations Regarding Paternalism In Medicine, Lola Holcomb

Richard T. Schellhase Essay Prize in Ethics

Paternalism and autonomy are typically conceptualized as opposing theoretical frameworks. With respect to medical ethics, autonomy is practiced by the patient when he/she has liberty and control over his/her own medical matters, and his/her opinions supersede those of the physician. Paternalism is practiced by the physician when he/she restricts the patient’s autonomy (sometimes against the patient’s will) to promote health and well-being while discouraging undesirable behaviors. This paper details and analyzes a number of cases of medical paternalism in practice, both from the past and in the present day, with the purpose of examining associated ethical considerations. Attention is given …

Disease Mongering: How Sickness Sells, Vanessa C. Iroegbulem

Augustana Center for the Study of Ethics Essay Contest

“Disease mongering” is the practice of widening diagnostic boundaries of an illness and promoting their public awareness to expand the markets for treatment and to increase profits. This tactic typically used by pharmaceutical companies, medical equipment manufacturers, insurance companies, and even some doctors and patient groups, has become a great concern. Disease mongering has since increased in parallel with “medicalization,” which attempts to label normal human conditions as medical problems, thus becoming the subject of medical study, diagnosis, prevention, or treatment. This paper first seeks to examine how an increasing amount of life’s natural conditions and ailments are being seen …

Turning Passion Into Purpose: A Journey To Medicine Through Global Health, Laurenie Louissaint Md

Family Medicine

No abstract provided.

"Farewell" To Prognosis In Shared Decision-Making, Robert F. Johnson

Peer Reviewed Articles

Whether because of a cultural pattern or personal preference, palliative care clinicians encounter persons approaching the end of life who wish to limit or forego prognostic information relating to their situation. This scenario has received attention in a recent motion picture as well as a newly available advance directive modification—the Prognosis Declaration form. The ordinary expectation for end-of-life shared decision-making with a capable person is clinician disclosure of the best effort at prognostic assessment. The optimal match between the expressed values, goals, and preferences of the person with available clinician expertise is hopefully achieved. For the clinician, a person’s choice …

The Role Of Compassion In Medical Ethics And Its Reintegration In Modern Practice, Hannah E. Borchers

Senior Honors Theses

Compassion has been an integral part of medical ethics since its origins, but as medicine progressed, compassion slowly disappeared from practice. The development of any industry results from many complex factors, but the decline of compassion in medicine can be largely attributed to the evolution of technology and role of medical ethics committees. Change is not always negative, but in this case, medicine neglected one of its foundational principles. This is seen by analyzing the history and progression of medical ethics and its four pillars. Plato and Aristotle defined justice in Greek philosophy, Hippocrates used the concept of non-maleficence in …

The Ethics Of An Unlicensed Medical Practitioner, Charles C. Escott

Writing Across the Curriculum

For option A of this assignment, the prompt is that Harry, a manufacturer of medical equipment and an avid reader of medical textbooks, has developed a program that will allow its users to self-diagnose and self-treat their ailments, without a doctor’s help. Harry wants to sell his program to “ordinary folk” as a replacement for consulting licensed medical practitioners. An important point here is that Harry is not licensed to practice medicine and has only read books on the subject. The posed question is whether or not his program should be published (from an ethical standpoint—not necessarily a profit-driven one). …

Policy Of Current Hospital Translation Services And Recommendations For Future Adjustments For Spanish-Speaking Patients, Isidora Rose Beach

Baker Scholar Projects

It is a seldom-discussed fact that English-speakers in America enjoy a quality of health care that is not necessarily afforded to non-native speakers receiving care at the same facilities. Policy regarding what is required of health institutions in terms of translation services is exceedingly vague, and implementation of this policy is inconsistent. This lack of guidance makes it possible for many patients needing interpreters to fall through the cracks. This project will examine current policy guiding interpretive services in the U.S., and will recommend more specific guidelines that would improve quality of care for limited English proficiency individuals. This project …

Going Beyond ‘Do No Harm’: A Critical Annotation, Robert F. Johnson

Peer Reviewed Articles

The Op-Ed article in the New York Times (November 4th, 2016), “On Assisted Suicide, Going Beyond Do No Harm” by Haider Javed Warraich provided an articulate and timely plea for more widespread availability and application of physician-assisted dying, or “suicide”, as part of end-of-life medical care. While this profound intervention should be considered by physicians and others as an option for those able to express their wishes at the end-of-life, it must be considered in the context of the ethical principles appropriate for all health care interventions and recognized for its limited role in the overall approach to compassionate care …

Antecedent Law And Ethics Of Aid In Dying, Alan Meisel

Articles

Scholarly discussion of physician aid in dying – physicians actively aiding patients in ending their lives – has noticeably increased in recent years. While conversations and examinations of end-of-life treatment have been ongoing for decades, the antecedent law and ethics of aid in dying that have developed in the United States have recently moved into the spotlight. In this essay, written for a symposium at Quinnipiac School of Law, the author takes his audience on a brief journey through the history of end-of-life decision-making in the U.S., beginning with the early days of the Karen Quinlan case in 1976 and …

Closed Cases? - The Mentioning Of Medical Errors In Doctors' Memoirs, Angelika Potempa

Philosophy Faculty Publications and Presentations

The concession of errors in the pursuit of the art of medicine, where mishaps can lead to deleterious consequences is at the center of this paper. The social costs of medical errors and a professional culture with a strong tradition of self-regulation and shielding itself via a more or less permeable “Wall of Silence” make the issue not only interesting but keep it timely. The focus is on how and within what framework medical errors are admitted in the memoirs of American doctors. The times remembered reach from the 1950s and 1960s to the present.

Neuroprediction: New Technology, Old Problems, Stephen J. Morse

All Faculty Scholarship

Neuroprediction is the use of structural or functional brain or nervous system variables to make any type of prediction, including medical prognoses and behavioral forecasts, such as an indicator of future dangerous behavior. This commentary will focus on behavioral predictions, but the analysis applies to any context. The general thesis is that using neurovariables for prediction is a new technology, but that it raises no new ethical issues, at least for now. Only if neuroscience achieves the ability to “read” mental content will genuinely new ethical issues be raised, but that is not possible at present.

Resolving Ethical Dilemma: An Application Of A Theoretical Model, Lubna Ghazal, Zulekha Saleem, Gulzar Amlani

School of Nursing & Midwifery

Human error can occur in any profession. Medical errors most commonly occur in a health care system, which may delay patient’s recovery and produce harm to patients. However, when a medical error occurs, it is challenging to inform the incident to patients and their family. Health care professionals follow a professional code of ethics to do well and not harm patients. Historically, many of these errors were not disclosed to patients but the trend for more open disclosure of medical errors to patients and their families is a mutually beneficial and welcomed change.

Money, Sex, And Religion--The Supreme Court's Aca Sequel, George J. Annas, Theodore Ruger, Jennifer Prah Ruger

All Faculty Scholarship

The Supreme Court decision in the Hobby Lobby case is in many ways a sequel to the Court's 2012 decision on the constitutionality of the Affordable Care Act (ACA). The majority decision, written by Justice Samuel Alito, is a setback for both the ACA's foundational goal of access to universal health care and for women's health care specifically. The Court's ruling can be viewed as a direct consequence of our fragmented health care system, in which fundamental duties are incrementally delegated and imposed on a range of public and private actors. Our incremental, fragmented, and incomplete health insurance system means …

Shots For Tots?, Eric A. Feldman

All Faculty Scholarship

By endorsing the use of a vaccine that makes the experience of puffing on a cigarette deeply distasteful, Lieber and Millum have taken the first few tentative steps into a future filled with medical interventions that manipulate individual preferences. It is tempting to embrace the careful arguments of “Preventing Sin” and celebrate the possibility that the profound individual and social costs of smoking will finally be tamed. Yet there is something unsettling about the possibility that parental discretion may be on the cusp of a radical expansion, one that involves a new and unexplored approach to behavior modification.

Magic From Human Regenerative Technologies -- Stem Cells, John M. Ritz

STEMPS Faculty Publications

The article discusses the developments in stem cell research and development. It mentions that through tissue engineering or regenerative medicine, many diseases are finding techniques for improvement and cure. It discusses the role of stem cells in mending the human body and the ethics associated with this technology . It is mentioned that stem cells are divided in 2 types: embryonic stem cells and adult stem cells. It includes the process of cell differentiation which determines the properties and characteristics of cells. It mentions several diseases related to sports injury, spinal cord injuries, blood and heart disorders to be to …

On The Scope Of A Professional’S Right Of Conscience, David Lefkowitz

Philosophy Faculty Publications

Under what conditions, if any, do medical professionals enjoy a right of conscience? That is, when must a just state accommodate a physician’s, pharmacist’s, or other medical professional’s refusal to provide legally and professionally sanctioned services to which she morally objects; for example, by enacting laws that enable her to do so without fear of losing her job or her professional privileges? Recent assertions by several pharmacists of a right to conscientiously refuse to fill prescriptions for the so-called morning-after pill, and by a California fertility doctor of a right to conscientiously refuse to provide fertility treatment to a lesbian, …

Deep Ecology And End-Of-Life Care, Paul Carrick

Philosophy Faculty Publications

Physicians and nurses caring for terminally ill patients are expected to center their moral concerns almost exclusively on the needs and welfare of the dying patient and the patients family. But what about the relationship of traditional medical ethics to the emerging new theories of environmental ethics, like deep ecology? As we glide into the twenty-first century, can anyone seriously doubt that the mounting global concerns of environmental ethics will eventually influence the ethics of medicine too?

For example, suppose physicians were to integrate the core values of an ecocentric environmental ethic like deep ecology into contemporary North American norms …

Rescuing Baby Doe, Mary Crossley

Articles

The twenty-fifth anniversary of the Baby Doe Rules offers a valuable opportunity to reflect on how much has changed during the past two-and-one-half decades and how much has stayed the same, at least in situations when parents and physicians face the birth of an infant who comes into the world with its life in peril.

The most salient changes are the medical advances in the treatment of premature infants and the changes in social attitudes towards and legal protections for people with disabilities. The threshold at which a prematurely delivered infant is considered viable has advanced steadily earlier into pregnancy, …

Revisiting The Ethics Of Hiv Prevention Research In Developing Countries, Charles Weijer, Guy Leblanc

Philosophy Presentations

Issues: We present key aspects of our paper, commissioned by UNAIDS in 2005, entitled, “Revisiting the ethics of HIV prevention research in developing countries.” In 2004 and 2005 we witnessed the closure or suspension of three international clinical trials testing tenofovir in the prevention of HIV infection in high risk groups due to the failure to provide free treatment to those who seroconvert during the conduct of the study. We examine critically moral claims for the provision of treatment to those who seroconvert in HIV prevention trials and ask whether it is a matter of moral obligation or moral negotiation? …

The Pedagogical Significance Of The Bush Stem Cell Policy: A Window Into Bioethical Regulation In The United States (President George W. Bush, Fifth Anniversary Essay Collection), O. Carter Snead

Journal Articles

The enormous significance of the Bush stem cell funding policy has been evident since its inception. The announcement of the policy on August 9, 2001 marked the first time a U.S. president had ever taken up a matter of bioethical import as the sole subject of a major national policy address. Indeed, the August 9th speech was the President's first nationally televised policy address of any kind. Since then, the policy has been a constant focus of attention and discussion by political commentators, the print and broadcast media, advocacy organizations, scientists, elected officials, and candidates for all levels of office …

Cases And Guidelines In Genetics, Roger B. Dworkin

Articles by Maurer Faculty

No abstract provided.

The Girl Who Cried Pain: A Bias Against Women In The Treatment Of Pain, Diane E. Hoffmann, Anita J. Tarzian

Faculty Scholarship

In general, women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively. The authors investigate this paradox from two perspectives: Do men and women in fact experience pain differently - whether biologically, cognitively, and/or emotionally? And regardless of the answer, what accounts for the differences in the pain treatment they receive, and what can we do to correct this situation?

Hard Cases For Autonomy, Respect, And Professionalism In Medical Genetics, Roger B. Dworkin

Articles by Maurer Faculty

No abstract provided.

The Market For Medical Ethics, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

At the core of Kenneth Arrow’s classic 1963 essay on medical uncertainty is a claim that has failed to carry the day among economists. This claim—that physician adherence to an anti-competitive ethic of fidelity to patients and suppression of pecuniary influences on clinical judgment pushes medical markets toward social optimality—has won Arrow near-iconic status among medical ethicists (and many physicians). Yet conventional wisdom among health economists, including several participants in this symposium, holds that this claim is either naïve or outdated. Health economists admire Arrow’s article for its path-breaking analysis of market failures resulting from information asymmetry, uncertainty, and moral …

The Human Genome Project's Implications For Autonomy, Respect, And Professionalism In Medical Genetics, Roger B. Dworkin

Articles by Maurer Faculty

No abstract provided.

Selecting Subjects For Participation In Clinical Research: An Empirical Inquiry And Ethical Analysis, Charles Weijer

Philosophy Publications

Procedures for the selection of subjects for participation in randomized clinical trials--usually formalized as eligibility criteria in the study protocol--have both scientific and ethical implications. In this thesis, I undertake an examination of eligibility criteria at three stages in the genesis and dissemination of medical knowledge: clinical trial protocol, interpretation by investigators, and reporting of study results.

In the first chapter, ethical issues in subject selection are reviewed and the main study questions are presented. In the second chapter, the results of an examination of eligibility criteria in two sets of clinical trials, one sponsored by the NSABP, the other …

Characterizing The Population In Clinical Trials: Barriers, Comparability, And Implications For Review, Charles Weijer

Philosophy Publications

The definition of the study population for a clinical trial via the criteria for trial eligibility has implications for the validity of the study and its applicability to clinical practice. Though issues of equity regarding the selection of subjects for research have long been a concern of ethicists, issues regarding the impact of subject selection on a trial's generalizability have only recently attracted ethical scrutiny. After a review of the history of the ethics of subject selection, I focus on three empirical questions regarding the generalizability of clinical trials. (1) What proportion of diseased populations are studied in clinical trials? …

Medical Law And Ethics In The Post-Autonomy Age, Roger B. Dworkin

Articles by Maurer Faculty

No abstract provided.