Medicine and law
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Most clinical ethical dilemmas are resolved when the facts are clear, communicated to all involved, and the stakeholders agree on goals consistent with the patient's best interests and values. However, in some instances, participants continue to remember and observe the same situation differently, and resolution remains elusive. This article refers to the classic film, Rashomon, in which the truth remains different for four observers of the same scene. The discussion explores the phenomenon, provides some examples and recommendations for what remain very difficult ethical dilemmas.
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The vast majority of hospitals use clinical ethics consultation (CEC) as a service to address ethical issues in patient care. Both proponents and critics alike recognize a need to evaluate CEC. I review three outcomes of CEC that have been formally evaluated: healthcare cost, clinical indicators in the intensive care unit, and user satisfaction. ⋯ However, the failure of outcomes-based assessment poses no threat to CEC since the service is continually justified by the fundamental necessity of resolving ethical problems in patient care. While outcome indicators can be used as heuristics to investigate quality issues in CEC, process indicators can capture the quality of CEC more directly. Therefore, further research should be directed toward developing process-based conceptual models for CEC and various methods for assessing these processes.
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The Avastin - Lucentis debacle illustrates the ethical, policy and legal dilemmas encountered with the off-label use of medication. Ophthalmologists are using intra-ocular injections of Avastin (off-label) to treat age-related macular degeneration (AMD). The off-label use of Avastin is controversial because there are anti-VEGF drugs on the market, authorized for AMD, such as Lucentis. ⋯ Currently there is conflict on the Avastin-issue between cost-conscious health authorities in EU Member States and the EU drug regulators. There are examples of cost-cutting solutions by health authorities, which risk undermining the fundamental principles of the regulatory framework. In the meantime risk is being shouldered by patients and doctors.
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Historical Article
Compilation of a casebook on bioethics and the Holocaust as a platform for bioethics education.
The Holocaust arose, in part, because of a profound and pervasive breakdown of medical professional ethics. This history is complex and powerfully instructive. ⋯ The casebook will provide a platform for deep reflection and discourse on historical ethical issues and their relevance for today. This teaching tool can also inspire healthcare professionals and students to practice with greater compassion, knowledge, tolerance, respect and justice on behalf of their patients.
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Recently the giant tobacco company Philip Morris served its notice to launch an investor-to-state dispute settlement proceeding against the Australian Government for its introduction of plain packaging requirements on tobacco products. It is an important event in the field of intellectual property, investment and international health law. The fundamental questions involved are whether the restriction of trademark rights as a result of the plain packaging requirement is a compensable indirect expropriation under BITs or whether it falls within the scope of government's right to regulate and thus become not compensable. ⋯ Thus, the interpreters of BITs need to pay higher respect to the host State's sovereign power concerning its right to regulate tobacco products for a legitimate purpose. The conclusion of the paper is that the host States should enjoy a defense of the right to regulate to refuse compensation. The author believes that this is the only reasonable conclusion to avoid possible conflicts between different treaty systems (BITs and the FCTC) and between different legal systems and fields (trademark law, investment law and international health law).