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Including more than 50'000 documents - as well as 500 doctoral theses - the Globethics Health Ethics collection is a unique online resource covering topics related to health ethics such as pharmaceuticals, health economics, health politics, access to medical care, environmental issues and bioethics.
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Behind the Mask of Morality: (E)urochristian Bioethics and the Colonial-Racial DiscourseThe discipline of bioethics is insufficient and ineffective in addressing the persistent issues of racism and racial inequalities in healthcare. A minority of bioethicists are indeed attentive to issues such as implicit bias, structural racism, power inequalities, and the social determinants of health. Yet, these efforts do not consider the colonial-racial discourse -- that racism is an instrument of eurochristian colonialism, and bioethics is a product of that same colonial worldview. Exposing mainstream bioethicists to the work of anti-colonial scholars and activists would provide bioethicists a framework through which they would be better equipped to address issues of race through: 1) a deeper understanding of their complicity with colonialism, and 2) the importance of anti-colonial methods and approaches to ethical decision-making in healthcare. Three contemporary bioethics cases involving issues of race are examined including Jahi McMath and the diagnosis of brain death, the Havasupai diabetes research protocol, and the treatment of Latinx undocumented immigrants with end-stage renal disease. These cases serve as the focal point for 1) the extrication of eurochristian colonial themes within three foundational bioethics texts, and 2) the application of the knowledge and praxis of three anti-colonial scholars toward racially responsive case analyses and outcomes. I conclude that the combination of a robust self-examination of the discipline's eurochristian worldview and the prioritization of a range of anti-colonial perspectives would serve bioethics more fully in the imagining of a racially conscious bioethics practice, scholarship, and policy that aims to reject colonial constructs and normalize difference.
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Happiness, welfare and ethics: dissonant consequences and conflicting valuesThis paper draws attention to an uncomfortable ethical issue with regard to happiness and welfare. The introduction of Western healthcare to Africa has resulted in significant population growth, with implications for human and animal welfare. However, the issue of population control or withdrawing health aid raises serious ethical concerns. This paper introduces the ethical problem and the factors giving rise to it. It then provides an exploratory analysis of the various ethical positions from which this problem can be viewed, with an eye to maximising human and animal welfare. Recent psychological work on welfare is considered when discussing the different ethical approaches. The discussion highlights the fact that conflicts in values can occur, and ways of resolving these are discussed.
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Reimagining Children’s Rights in the USImportanceThe US faces a pivotal moment of opportunity and risk regarding issues affecting children (aged 0-17 years). Although the US remains the only United Nations member state to not have ratified the Convention on the Rights of the Child (CRC), a child rights framework is essential for child health professionals seeking to advance many issues affecting children in the US. The Reimagining Children's Rights project (2020-2021) conducted an in-depth environmental scan of relevant literature and policy analysis using the Three Horizons design process to assess strategies that could advance the rights and well-being of children in the US. The project was overseen by a steering committee and informed by an advisory committee composed of youth leaders and experts in children's rights, advocacy, health, law, and a range of child-specific issues (eg, youth justice, early childhood development), who provided expert input on strategic considerations for advancing children's rights.ObservationsSeven findings about advancing children's rights in the US are notable, all reflecting current gaps and opportunities for using a whole-child rights framework in the US, even without formal adoption of the CRC. Actionable strategies, tactics, and tools to leverage sustainable change in the multitude of issue areas can advance the current state of children's rights. High-potential strategies for catalyzing advancement of children's rights include youth activism, innovations in governance and accountability, legislative action, impact litigation, place-based initiatives, education and public awareness, alignment with other children's movements, and research. The child rights framework is unifying and adaptive to future unforeseen challenges.Conclusions and relevanceChildren's rights provide a powerful, synergistic framework for child health professionals-in partnership with youth and other leaders-to increase equity and protect the rights and well-being of all children in the US.
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The Outcomes of Ethics Education to Medical Students Based on Moral Reasoning ModelsIntroduction: For years, the importance of medical ethics education in medical schools has been emphasized but there is no consensus over learning goals yet. This study aimed to investigate the learning outcomes of medical ethics education based on models of moral reasoning. Methods: This study is a review using proper keywords in databases such as Medline, Web of Science, Scoupus, and Eric limiting the results to papers published from 1990 to 2012 which resulted in finding61 articles. Seven articles related to learning objectives and 12 articles related to the model were investigated. Results: Researchers have different views on learning objectives of medical ethics education. Some believe that the goal of ethics education is to train virtuous physicians. Others believe that the more practical and measurable goal is moral reasoning skills. Showing the cognitive and attitudinal elements of an ethical behavior, however, Rest Model postulates the four components for ethical behavior to flourish. Conclusion: For teaching ethics education, skills such as emotional control, tolerance of ambiguity for multiple perspectives, and empathy in difficult situations should be taught in addition to teaching ethical principles. Moreover, appropriate environments regarding role modeling and encouraging ethical values must be provided for learners. Providing reflective opportunities also will bring insight on ethical codes that results in increasing moral commitment.
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Framework for Algorithmically Optimizing Longitudinal Health Outcomes: Examples in Cancer Radiotherapy and Occupational Radiation ProtectionBackground: Advancements in the treatment of non-infectious disease have enabled survival rates to steadily increase in recent decades (e.g., diabetes, heart disease, and cancer). Epidemiological studies have revealed that the treatments for these diseases can have life-threatening and/or life–altering effects. Thus, realizing the full beneficial potential of advanced treatments necessitates new tools to algorithmically consider all major components of the health outcome, including benefit and detriment. The goal of this dissertation was to develop a framework for improving projected health outcomes following planned radiation exposures in consideration of all beneficial and detrimental, early and late, and fatal and non-fatal effects. Methods: We designed a generally applicable framework for aggregating the benefits and detriments of planned exposures to individuals, groups, and populations. We demonstrated the utility of this framework with illustrative hypothetical example applications to emergency response, diagnostic radiology, and cancer radiotherapy. Finally, we used this new framework to directly optimize health outcomes in a population of men with prostate cancer receiving radiotherapy. We compared the resulting projected outcomes to those of conventional treatment-planning methods. Results: Applications of the comprehensive framework to three illustrative scenarios revealed the utility of this framework for guiding objective and algorithmic decision making. Radiotherapy outcome-optimization methods yielded equivalent or superior projected health outcomes compared to conventional dose-optimization methods for every patient in the population. On average, outcome-optimized plans increased the probability of treatment benefit by 1%, while simultaneously decreasing the cumulative probability of long- and short-term treatment side effects by 3% compared to conventional treatment plans. We estimate that this would add up to 7 additional healthy-life months to each patients’ life expectancy compared to that from conventional treatment plans. Conclusions: The major finding is that it is feasible to directly optimize the projected health outcome of planned radiation exposures (e.g., industrial, diagnostic, or therapeutic) in a personalized or population-averaged manner. Furthermore, these methods are entirely compatible with current approaches and limits. This work, taken together, provides a comprehensive methodological framework that could enable a paradigm shift towards more objective and automated approaches to realizing the full beneficial potential of planned exposures.
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Is Professionalism Teachable in Medical Education? A Literature ReviewIntroduction: Over the last two decades, members of the medical education community have devoted a great deal of time and effort trying to ensure that medical professionalism is being inculcated in medical students and residents. There is a set of educational principles that apply to professionalism teaching during undergraduate and postgraduate education. This study aimed to investigate whether and how teaching medical professionalism is possible in medical education. Methods: This review study was conducted by searching through the databases of Medlib, Magiran, SID, ERIC, Scopus, Medline, and Web of Science for publications from 1995-2015, using the keywords professionalism, medical professionalism, medical education, medical ethics, and medical ethics curriculum. Out of 60 articles and 4 e-booksfound, a number of 28 articles and two books were selected for review. Results:Review of the publications showed that professionalism in medical education is achieved in two explicit and implicit forms. The result will be a physicianas a “professional” with all of the necessary qualities Conclusion:Moving towards the teachings of situated learning theory shows that there should be a balance between explicit teaching of the cognitive basis of professionalism and providing opportunities for making learning happen in real-life settings. In doing so, the curriculum of medical education needs to be reformed.
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Let’s Talk LMCC (S01E04): Legal, Ethical and Organizational Aspects of Medicine - Confidentiality and Legal SystemsWelcome to the McGill Journal of Medicine (MJM) Let’s Talk LMCC Review. This podcast series was created to aid medical students studying for the Canadian Medical Council (MCC)’s licensing exam. Each episode is created based on specific LMCC objectives and is divided into two sections. In Section 1 we provide an overview of the topic with the help of experts in the field, followed by Section 2 where we review LMCC styled questions to help consolidate knowledge. In this episode, we welcome our expert advisor, Prof. Lara Khoury, an Associate Professor in the McGil Faculty of Law and Associate Member of McGill’s Institute for Health & Social Policy and Biomedical Ethics Unit, to speak on LMCC Objectives 121-4 Confidentiality and 121-5 Legal Systems. This episode was written by MJM Podcast Team members, Esther Kang, Sarah Grech, and Professor Lara Khoury.
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World Health OrganizationOver the past 60 years the World Health Organization (WHO) has succeeded in improving the general standard of health around the world. The WHO is an international agency within the United Nations and is comprised of 192 countries. The World Health Assembly, a 34 member elected board, meets annually to determine new regulations and budgetary needs for the organization. Rights-based policy is integrated throughout the World Health Organization’s programs. The WHO works with several entities, including non-governmental organizations, U.N. agencies and private organizations to achieve goals and implement new programs. Key topics for the WHO include gender rights, policy, and medical ethics. The Millennium Development Goals are a prime example of rights-based integration and universal collaboration that WHO strives to achieve, as these goals encompass the areas of poverty, education, environment, development and gender.
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Equity, Diversity and Inclusion (EDI) in Organ Transplantation : An ESOT Survey About EDI Within ESOT as an Organization and its Educational Activities, and Transplantation Research and ScienceThe European Society of Organ Transplantation (ESOT) strives to promote equity, diversity, and inclusion (EDI) across all its activities. We surveyed the transplant community’s experiences and perspectives regarding EDI within ESOT as an organization and its educational activities, and research in general. A total of 299 respondents completed the questionnaire. About half agreed that ESOT’s Executive Committee, Council, and Sections/Committees are diverse and inclusive (51%) and that ESOT promotes EDI in its live and digital educational activities (54%). Forty percent of respondents agreed that scientific and clinical trials in the field of transplantation are diverse and inclusive. Despite the wide distribution of the survey, most of the respondents self-identified as White and were either physician or surgeon. However, the results contribute a unique insight into the experiences and perspectives of the transplantation community regarding EDI. Whilst ESOT is committed to the principles of EDI, perceptions and the high number of proposals show the apparent need to prioritize efforts to embed EDI across ESOT and transplantation science. These data should constitute a starting point for change and provide guidance for future efforts to promote EDI within the transplantation community.
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Development of Strategies for Advancement of Medical Ethics Education in Isfahan University of Medical SciencesIntroduction: Medical ethics is an analytical attempt that deals with various aspects of ethical decision making in medicine. According to the importance and goals of medical ethics, this study is an endeavor to evaluate strengths and weaknesses (internal factors) as well as opportunities and threats to medical ethics education (external factors) using SWOT (Strengths,Weakness, Opportunities, and Threats) model and represent helpful strategies in medical ethics education in Isfahan University of Medical Sciences. Methods: In this cross sectional study, the opinions of 48 faculty members of Isfahan University of Medical Sciences in year 2011 were studied. After collecting the opinions, each factor was weighed (level of importance) and ranked and finally the strategies were formulated in SWOT model. Results: Evaluating internal factors of strength points, it was deriven that the most importance level (weight) belongs to “having rich Islamic and historical resources on medical ethics” with the weight of 0.10 and the grade of 2.9. Among weekness points, the top importance belonged to “using traditional methods for medical ethics education” with weight of 0.12 and ranking of 2.6. Furthermore, the sum of grades in analysis table was 2.85 for internal factors and 2.87 for external factors. The results showed that the first three priorities of formulated strategies were “inter-disciplinary medical ethics education by medical ethics and clinical sciences teachers”, “teaching medical ethics in clinical settings”, and “employing new methods in medical ethics education”, respectively. Conclusion:The analysis of internal and external factors in medical ethics education in Isfahan University of Medical Sciences which studies the weekness and strength points, opportunities, and threats to medical ethics education shows that the faculty reaction to these factors is lower than medium. On the other hand, the validity of strategies for medical ethics education development using SWOT model is high, so these strategies can play an important role in strategic planning of medical ethics education in Isfahan University of Medical Sciences.
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Let’s Talk LMCC (S01E03): Legal, Ethical and Organizational Aspects of Medicine - Consent, Truth Telling and NegligenceWelcome to the McGill Journal of Medicine (MJM) Let’s Talk LMCC Review. This podcast series was created to aid medical students studying for the Canadian Medical Council (MCC)’s licensing exam. Each episode is created based on specific LMCC objectives and is divided into two sections. In Section 1 we provide an overview of the topic with the help of experts in the field, followed by Section 2 where we review LMCC styled questions to help consolidate knowledge. In this episode, we welcome our expert advisor, Dr. Carolyn Ells, a recently retired Associate Professor in the Department of Medicine at McGill, based at the Biomedical Ethics Unit, to speak on LMCC Objectives 121-1 Consent, 121-2 Truth Telling, and 121-3 Negligence. This episode was written by MJM Podcast Team members Amanda Sears and Esther Kang and Dr. Carolyn Ells.
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The perspective of allergy and immunology specialists on the innovations of metaverse: A survey studyBackground: New technologies have resulted in dramatic shifts in the field of medicine, and it stands to reason that metaverse will also affect the practice of allergy and immunology. This study aimed to determine the attitudes of allergists and raise awareness about metaverse applications in allergy and immunology. Methods: A nationwide survey-based study was conducted in Turkey. First, a 28-item questionnaire was developed and sent to Turkish allergists. After completing the first questionnaire, the participants were asked to watch a 5-min informative video about the metaverse. Lastly, a second survey was conducted to evaluate the changes in the views of the participants. Results: A total of 148 allergy doctors in Turkey participated in the survey. After watching a video containing updated information about the metaverse, there was a significant increase in the importance that participants attributed to the use of virtual reality and augmented reality applications in the field of immunology and allergy (P 0.05). Additionally, there was a significant increase in the percentage of participants who thought that Metaverse applications could be integrated into the existing system and said that this possibility excited them (P 0.05). There was also a significant increase in the percentage of participants who thought this innovative technology could be helpful in patient examination, student and physician education, allergy testing, and patient education (P 0.05). Conclusions: Our results demonstrate that providing information to professionals working in the field can positively influence physicians’ views on the potential of the metaverse, which is a valuable tool in the field of immunology and allergy © 2023 Codon Publications. Published by Codon Publications
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COVID Vaccination Challenges: Ethical Imperatives and Local RealitiesBerkley Center for Religion, Peace, and World Affairs, 2023-11-01Lessons from the lived, ongoing experiences of religious communities can contribute to national and global COVID-19 vaccination campaigns, with applications ranging from the very global to the very local. New demands for cooperation and partnerships highlight the complex relationships between governments and religious communities. These involve shared and divergent concerns about ethical and practical aspects of equitable vaccine allocation and access, mechanisms to meet urgent logistical challenges, communications about needs and process, and addressing doubts and fears. This event summary highlights contributions to a virtual meeting on “COVID Vaccination Challenges: Ethical Imperatives and Local Realities,” held on February 24, 2021. The event featured health experts and development leaders, who reflected on faith engagement in COVID-19 vaccination.
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Audience Segmentation Ethics in Health PromotionAudience segmentation is a crucial component of health promotion campaigns as it is believed to support health-related campaigns to achieve greater benefits. However, there are numerous concerns about the ethicality of audience segmentation. For instance, Newton, Newton, Turk, and Ewing (2013) stated that audience segmentation can create inequalities between different groups of audiences. In addition, unintended audience and consequences are often excluded from health campaign planning and execution. These factors can negatively affect the campaign by creating adverse impacts. As a matter of fact, the prominent challenge of health promotion is sustaining the connection between ethics and effectiveness for promotional activities and processes. Thus, it is important to investigate this relationship under a health-related lens to support health campaigns to be more audience-centric and contextually and culturally appropriate, and better providing fair health distribution and producing long-term beneficial outcomes. The study used a binge drinking prevention campaign on campus to test the hypotheses. It conducted an online survey with 360 participants from the students and employees at the University of Denver (DU) to examine three aspects: 1) The impacts of health messages on the intended and unintended audiences; 2) The effects of ethical segmentation on the audience; And 3) The relationship between audience, intended and unintended, and consequences, intended and unintended. In particular, there was not a distinguishing difference in the cognitive, emotional, and behavioral impacts between intended audience members who were assigned targeted messages and those assigned non-targeted messages or between intended audience members and unintended audience members. Additionally, non-consequentialist targeting can create the same level of impacts on the intended and unintended audiences as consequentialist targeting. Moreover, unintended audience members were less likely to stigmatize the targeted audience than intended audience members when consequentialist targeting was used. In conclusion, the study finds that non-consequentialism can be a useful tool to ensure the ethicality and effectiveness of audience segmentation in health promotion as it takes into consideration the intended and unintended effects health campaign may have on both intended and unintended audiences.
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Attitudes of Medical Malpractice in Pediatric SurgeryWOS: 000418537000006
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Faculty-Related Challenges in Medical Ethics Education: A Qualitative StudyIntroduction: Medical ethics education is a key subject in medical occupations, as learning ethics is fundamental for their relationship with patients. Teachers are of the most important elements in medical ethics education, because they are one of the most important factors of forming the morality and the professional character in students. The aim of this study is to explain challenges and problems which threaten the medical ethics education. Methods: Fourteen medical ethics teachers of universities of medical sciences in Tehran took part in this qualitative content analysis study performed in year 2010. Data was collected through semi-structured interviews and analyzed via content analysis approach (Mayring method). Results: The analysis of participants’ interviews led to the extraction of three themes as follows: 1)professional capability of medical ethics teachers 2)medical ethics education using active teaching methods and 3)the gap between teaching in theory and practice. Each of these themes includes several major and minor classifications, each describe a specific aspect of existing challenges in medical ethics teaching related to the teachers. Conclusion: Results indicate that medical educators in general and medical ethics teachers in particular, haven’t been efficient enough in moral development of students. Therefore, short-term professional teaching courses on medical ethics and active teaching methods are suggested to be held for all medical teachers. Besides, all medical teachers are recommended to be obliged to, as behavioral models, facilitate moral and professional development of their students in practice.
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Can Oncologists Prompt Patient Prognostic Awareness to Enhance Decision-Making? Data From the NEOetic StudyINTRODUCTION: Anti-neoplastic therapy improves the prognosis for advanced cancer, albeit it is not curative. An ethical dilemma that often arises during patients’ first appointment with the oncologist is to give them only the prognostic information they can tolerate, even at the cost of compromising preference-based decision-making, versus giving them full information to force prompt prognostic awareness, at the risk of causing psychological harm. METHODS: We recruited 550 participants with advanced cancer. After the appointment, patients and clinicians completed several questionnaires about preferences, expectations, prognostic awareness, hope, psychological symptoms, and other treatment-related aspects. The aim was to characterize the prevalence, explanatory factors, and consequences of inaccurate prognostic awareness and interest in therapy. RESULTS: Inaccurate prognostic awareness affected 74%, conditioned by the administration of vague information without alluding to death (odds ratio [OR] 2.54; 95% CI, 1.47-4.37, adjusted P = .006). A full 68% agreed to low-efficacy therapies. Ethical and psychological factors oriented first-line decision-making, in a trade-off in which some lose quality of life and mood, for others to gain autonomy. Imprecise prognostic awareness was associated with greater interest in low-efficacy treatments (OR 2.27; 95% CI, 1.31-3.84; adjusted P = .017), whereas realistic understanding increased anxiety (OR 1.63; 95% CI, 1.01-2.65; adjusted P = 0.038), depression (OR 1.96; 95% CI, 1.23-3.11; adjusted P = .020), and diminished quality of life (OR 0.47; 95% CI, 0.29-0.75; adjusted P = .011). CONCLUSION: In the age of immunotherapy and targeted therapies, many appear not to understand that antineoplastic therapy is not curative. Within the mix of inputs that comprise inaccurate prognostic awareness, many psychosocial factors are as relevant as the physicians’ disclosure of information. Thus, the desire for better decision-making can actually harm the patient.
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Organ Transplants for Prison Inmates: A Pragmatic ApproachPrison inmates are the only population in the United States with a Constitutional right to healthcare, but should this entitle them to receive organ transplants? Current consensus emphasizes the importance of using only medical criteria to determine a patient's transplant eligibility, avoiding consideration of incarcerated status. This project raises the question whether the conditions of confinement jeopardize an inmate's post-transplant survival benefit measure such that a patient's incarcerated status qualifies as medical criteria. The comparison between current literature and inquiry of prison health professionals reveals a significant incongruence in our understanding of this issue, a lack of concrete data to support a finding, and an indication that further research is vital to definitively answer this question.