Journal of medical ethics
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Journal of medical ethics · Jun 2012
Testing for sexually transmitted infections in a population-based sexual health survey: development of an acceptable ethical approach.
Population-based research is enhanced by biological measures, but biological sampling raises complex ethical issues. The third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) will estimate the population prevalence of five sexually transmitted infections (STIs) (Chlamydia trachomatis, Neisseria gonorrhoeae, human papillomavirus (HPV), HIV and Mycoplasma genitalium) in a probability sample aged 16-44 years. The present work describes the development of an ethical approach to urine testing for STIs, including the process of reaching consensus on whether to return results. ⋯ The agreed approach, to perform voluntary anonymous testing with specific consent for five STIs without returning results, was approved by stakeholders and a research ethics committee. Overall, this was acceptable to respondents in developmental piloting; 61% (68 of 111) of respondents agreed to provide a sample. The experiences reported here may inform the ethical decision making of researchers, research ethics committees and funders considering population-based biological sampling.
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Journal of medical ethics · May 2012
A survey of the perspectives of patients who are seriously ill regarding end-of-life decisions in some medical institutions of Korea, China and Japan.
The debate about the end-of-life care decision is becoming a serious ethical and legal concern in the Far-Eastern countries of Korea, China and Japan. However, the issues regarding end-of-life care will reflect the cultural background, current medical practices and socioeconomic conditions of the countries, which are different from Western countries and between each other. Understanding the genuine thoughts of patients who are critically ill is the first step in confronting the issues, and a comparative descriptive study of these perspectives was conducted by collaboration between researchers in all three countries. ⋯ Patients in Far-Eastern countries gave various responses regarding end-of-life care decisions. Although familial input is still influential, most patients think of themselves as the major decision maker and accept the necessity of advance directives with Westernization of the society. Artificial ventilation withdrawal and even active euthanasia may be acceptable to them.
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Journal of medical ethics · May 2012
Are general practitioners prepared to end life on request in a country where euthanasia is legalised?
In 2002, Belgium set a legal framework for euthanasia, whereby granting and performing euthanasia is entrusted entirely to physicians, and-as advised by Belgian Medical Deontology--in the context of a trusted patient--physician relationship. Euthanasia is, however, rarely practiced, so the average physician will not attain routine in this matter. ⋯ Four attitudes can be identified: (1) willing to perform euthanasia; (2) only willing to perform as a last resort; (3) feeling incapable of performing; (4) refusing on principle. The situation where GPs have to consider the request and-if they grant it-to perform the act may result in arbitrary access to euthanasia for the patient. The possibility of installing transparent referral and support strategies for the GPs should be further examined. Further discussion is needed in the medical profession about the exact content of the euthanasia law.
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Journal of medical ethics · Apr 2012
'Equivalence of care' in prison medicine: is equivalence of process the right measure of equity?
In recent years, the principle of equivalence has been accepted in many countries as the standard against which healthcare provision for prisoners should be measured. There are several ways in which this principle can be interpreted, but current policy in the UK and elsewhere seems to focus on the measurement and achievement of equivalence in the process of healthcare provision. We argue that it is not appropriate to apply this interpretation to all aspects of prisoner healthcare, as it does not necessarily address the challenges inherent to the prisoner population and prison setting. Consequently equivalence of health outcomes should also be considered alongside processes in the interests of providing healthcare in prison that is equivalent to that outside prison.
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Journal of medical ethics · Apr 2012
Retractions in the medical literature: how can patients be protected from risk?
Medical research so flawed as to be retracted may put patients at risk by influencing treatments. ⋯ If the goal is to minimise risk to patients, the appropriate focus is on clinical trials. Clinical trials form the foundation of evidence-based medicine; hence, the integrity of clinical trials must be protected.