Journal of medical ethics
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Journal of medical ethics · Oct 1996
At the coalface--medical ethics in practice. Futility and death in paediatric medical intensive care.
We have conducted a retrospective study of deaths on a paediatric medical intensive care unit over a two-year period and reviewed similar series from outside the UK. There were 89 deaths out of 651 admission (13.7% mortality). ⋯ More comprehensive studies are needed to help clinicians derive consensus on what constitutes a futile intervention, and therefore when such an intervention should be withheld. This will help families and society better understand the limitations of intensive care.
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The practical problem of assuaging the opponents of animal research may be solved without formally addressing (or resolving) the underlying ethical questions of the debate. Specifically, a peaceful boycott of the "fruits" of animal research may lead to a wider cessation of such research, than, say, vocal or even violent protest. To assist those who might wish to participate in such a boycott- and, moreover, to critically inform them of the implications of their actions-1 offer a modest proposal: the use of an "animal research advance directive", a form which enumerates precisely which "fruits of research" are declined.
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We sent a questionnaire survey to a random sample of 125 correspondents to the BMJ who had previously sent a letter which had been rejected. The objective was to evaluate the policy of sending on some unpublished letters to the authors of the articles to which they referred. There were 94 replies, a response rate of 75%. ⋯ A quarter of the respondents said that the BMJ policy would discourage them from sending a letter to the journal for publication. This survey has led to a change of policy at the BMJ. Letters which are not published are not now sent on to the authors of the original articles.
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The main current application of placebo is in clinical research. The term placebo effect refers to diverse non-specific, desired or non-desired effects of substances or procedures and interactions between patient and therapist. Unpredictability of the placebo effect necessitates placebo-controlled designs for most trials. ⋯ Conflicts may exist between the therapist's Hippocratic and scientific obligations. The authors provide examples in neuropsychiatry, illustrating that objective scientific data and well-considered guidelines may solve the ethical dilemma. Placebo control might even be considered an ethical obligation but some provisos should be kept in mind: (a) no adequate therapy for the disease should exist and/or (presumed) active therapy should have serious side-effects; (b) placebo treatment should not last too long; (c) placebo treatment should not inflict unacceptable risks, and (d) the experimental subject should be adequately informed and informed consent given.
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Journal of medical ethics · Jun 1996
ReviewDo brain tissue transplants alter personal identity? Inadequacies of some "standard" arguments.
Currently, brain tissue transplantations are being developed as a clinical-therapeutic tool in neurodegenerative diseases such as Parkinson's or Alzheimer's disease. From an ethical point of view, distinguishing between the preservation and an alteration of personal identity seems to be central to determining the scope for further application of brain tissue transplantation therapy. The purpose of this article is to review "standard" arguments which are used on the one hand by proponents to prove preservation of personal identity and by opponents on the other hand to prove that brain tissue transplantation results in an altered personal identity. ⋯ These presuppositions concern the meaning of the term "identity", either numerical or qualitative, the definition of brain identity, either structurally or functionally, and the relationship between mental states, psychological functions and neurophysiological properties as criteria for personal identity. Furthermore the respective neurophysiological, clinical and philosophical evidence for the different presuppositions are discussed. It is concluded that evaluation of personal identity in brain tissue transplantation should not only rely on the "standard" arguments but, additionally, neurophysiological, clinical and philosophical implications should be discussed.