Journal of medical ethics
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Journal of medical ethics · Dec 2012
Randomized Controlled TrialDefault options and neonatal resuscitation decisions.
To determine whether presenting delivery room management options as defaults influences decisions to resuscitate extremely premature infants. ⋯ Presenting delivery room options for extremely premature infants as defaults may compromise autonomous decision-making.
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This case concerns aspects of the treatment of a post-surgical patient in a major public hospital in New Zealand during the author's experiences as a fourth year medical student. This case is used to consider the interlinked ethical issues of sympathy, moral virtue, dignity and how the medical environment can realign these values.
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The article considers three theses about postabortion regret which seek to illustrate its pertinence to reasoning about abortion, and which are often deployed, either explicitly or implicitly, to dissuade women out of that reproductive choice. The first is that postabortion regret renders an abortion morally unjustified. The second is that that a relatively high incidence of postabortion regret-compared with a lower incidence of postnatal regret in the relevant comparator field-is good evidence for the moral impermissibility of abortion choice. ⋯ In particular, it seeks to remind readers that feelings of regret directed at past decisions are often decoupled from the fact of the matter about their moral or rational justification. Moreover, certain features of reproductive decisions in particular make regret an especially unsuitable yardstick for actual justification in this context, and even less epistemically reliable as evidence for a lack of justification than it may be in other fields of decision-making. The implication is that rates of postabortion regret, even if they can be presumed to be higher than rates of postnatal regret, are not as pertinent to moral and practical reasoning about abortion as is sometimes suggested.
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Discussions on the ethics and regulation of clinical research have a great deal to say about the responsibilities of investigators, sponsors, research institutions and institutional review boards, but very little about the responsibilities of research participants. In this article, we discuss the responsibilities of participants in clinical research. We argue that competent adult participants are responsible for complying with study requirements and fulfilling other obligations they undertake when they make an informed choice to enroll in a study. ⋯ Investigators and research staff should inform participants about their responsibilities during the consent process, and should stress the importance of fulfilling study requirements. They should address any impediments to compliance, and they may provide participants with financial incentives for meeting study requirements. In very rare cases, coercive measures may be justified to prevent immanent harm to others resulting from non-compliance with study requirements.
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Journal of medical ethics · Dec 2012
CommentDeciphering the appropriateness of defaults: the need for domain-specific evidence.
In this issue of The Journal of Medical Ethics, xxx and colleagues report a randomized trial of the influence of default options on delivery room management of an extremely premature infant. They report that among respondents to the hypothetical vignette, those who received the resuscitation default were significantly more likely to choose resuscitation compared with those who were told that the default was comfort care. While the results warrant attention and further investigation, several methodological shortcomings limit the conclusions that can be drawn from this study.