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Teaching practical wisdom in medicine through clinical judgement, goals of care, and ethical reasoning

MedWorm: Medical Ethics - Fri, 09/03/2010 - 10:34am
Clinical decision making is a challenging task that requires practical wisdom—the practised ability to help patients choose wisely among available diagnostic and treatment options. But practical wisdom is not a concept one typically hears mentioned in medical training and practice. Instead, emphasis is placed on clinical judgement. The author draws from Aristotle and Aquinas to describe the virtue of practical wisdom and compare it with clinical judgement. From this comparison, the author suggests that a more complete understanding of clinical judgement requires its explicit integration with goals of care and ethical values. Although clinicians may be justified in assuming that goals of care and ethical values are implicit in routine decision making, it remains important for training...
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Complex calculations: ethical issues in involving at-risk healthy individuals in dementia research

MedWorm: Medical Ethics - Fri, 09/03/2010 - 10:34am
In dementia research evidence is mounting that therapeutic strategies that target moderate and even mild Alzheimer's disease may be missing the ‘therapeutic window’. Given that the neuropathology that leads to Alzheimer's disease probably begins somewhere between 10 and 15 years before symptoms manifest, many believe that the optimal therapeutic strategy would target persons in the earliest phases of disease development or even earlier. This would include, for example, persons with prodromal Alzheimer's and even persons who are deemed at risk. Given the nature of research involving the central nervous system, it is conceivable that some therapeutic investigations may involve an increase over minimal risk. This paper examines how, in dementia research, at-risk persons, alth...

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Ethics Committee or Community? examining the identity of Czech Ethics Committees in the period of transition

MedWorm: Medical Ethics - Fri, 09/03/2010 - 10:34am
Reflecting on a three year long exploratory research of ethics committees in the Czech Republic authors discuss the current role and identity of research ethics committees. The research of Czech ethics committees focused on both self-presentation and self-understanding of ECs members, and how other stakeholders (representatives of the pharmaceutical industry) view them. The exploratory research was based on formal and informal communication with the members of the ethics committees. Members of the research team took part at six regular voluntary meetings of the ethics committees' members, organised by the Forum of Czech Ethics Committees, and at three summer schools of medical ethics. There were realised twenty-five semi-structured interviews as well as six focus group sessions and a parti...
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Collection, storage and use of blood samples for future research: views of Egyptian patients expressed in a cross-sectional survey

MedWorm: Medical Ethics - Fri, 09/03/2010 - 10:34am
Conclusions This study shows that many individuals do not favour the donation of a blood sample for future research. Of those who do approve of such future research, many favour a consent model that includes an option restricting the future research to the illness being studied. Also, many Egyptians were hesitant to have their blood samples donated for genetic research or exported out of the Arab region to the USA and European countries. Further qualitative research should be performed to determine the underlying reasons for many of our results. (Source: Journal of Medical Ethics)
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The potential impact of an opt-out system for organ donation in the UK

MedWorm: Medical Ethics - Fri, 09/03/2010 - 10:34am
The recent report of the UK government's Organ Donation Taskforce is in favour of continuing with the current organ donation system rather than changing to an opt-out system where people are assumed to be willing to donate. How did it reach this decision and is it correct? (Source: Journal of Medical Ethics)
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Exceptional know how? Possible pitfalls of routinising genetic services

MedWorm: Medical Ethics - Fri, 09/03/2010 - 10:34am
Genetic testing practices are increasingly advancing clinical medicine. This process of ‘routinisation of genetics’ has been conceived as a medical and ethical problem mainly because of the assumption that non-geneticists might lack the necessary skills to provide these services. In particular, the relevant theoretical knowledge in clinical genetics is viewed as insufficient in general practitioners and physicians from other specialities. Empirical findings seem to indicate significant variations not only in theoretical but also in practical knowledge between geneticists and non-geneticists. Several fields of practical knowledge—regarding for example the focus of clinical action, the relevance of therapeutic action or the normative framework—can be identified that a...
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The problem of 'thick in status, thin in content' in Beauchamp and Childress' principlism

MedWorm: Medical Ethics - Fri, 09/03/2010 - 10:34am
For many, Thomas Beauchamp and James Childress have elaborated moral reasoning by using the four principles whereby all substantive problems of medical ethics (and of ethics more generally) can be properly analysed and cogent philosophical solutions for the problems can be found. It seems that their ‘principlism’ gets updated, with better features being added during the course of the six editions of Principles of Biomedical Ethics. Nonetheless, Beauchamp and Childress seem to have been losing their way when it comes to the common-morality justification, which is the epistemological (and perhaps metaphysical) backbone of their method, and this is shown more vividly in their most recent (2009) edition of Principles of Biomedical Ethics. The author points out what he calls the pro...

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Asperger syndrome and the supposed obligation not to bring disabled lives into the world

MedWorm: Medical Ethics - Fri, 09/03/2010 - 10:34am
Asperger syndrome (AS) is an autistic spectrum condition that shares the range of social impairments associated with classic autism widely regarded as disabling, while also often giving rise to high levels of ability in areas such as maths, science, engineering and music. The nature of this striking duality of disability and ability is examined, along with its implications for our thinking about disability and the relevance of levels and kinds of disability to reproductive choices. In particular, it may be seen as posing a challenge to John Harris's influential position in reproductive ethics relating to disability. The paper argues that if, as Harris maintains, there is a quite general moral obligation to avoid bringing disabled lives into the world regardless of the level of disability, ...
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A patient and relative centred evaluation of treatment escalation plans: a replacement for the do-not-resuscitate process

MedWorm: Medical Ethics - Fri, 09/03/2010 - 10:34am
Discussions are currently taking place in hospitals within our region to introduce the TEP form into other local trusts. (Source: Journal of Medical Ethics)
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Eyewitness in Erewhon academic hospital

MedWorm: Medical Ethics - Fri, 09/03/2010 - 10:34am
(Source: Journal of Medical Ethics)
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The concise argument

MedWorm: Medical Ethics - Fri, 09/03/2010 - 10:34am
(Source: Journal of Medical Ethics)
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Child’s Ordeal Shows Risks of Psychosis Drugs for Young

Bioethics.net - Fri, 09/03/2010 - 10:05am
Too Young, Too Many, Too Much--Are Psychiatric Drugs Costing Children Their Childhood?
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Social Networks Influence Health Behaviors

Bioethics.net - Fri, 09/03/2010 - 9:33am
Social networks may be good...or bad...for your health. It all depends on the behaviors your network is spreading. HT @k8ethics #bioethics
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Living in the hands of God. English Sunni e-fatwas on (non-)voluntary euthanasia and assisted suicide

MedWorm: Medical Ethics - Thu, 09/02/2010 - 3:38am
This study analyses Islamic views on (non-)voluntary euthanasia and assisted suicide as expressed in English Sunni fatwas published on independent—i.e. not created by established organisations—Islamic websites. We use Tyan’s definition of a fatwa to distinguish between fatwas and other types of texts offering Islamic guidance through the Internet. The study of e-fatwas is framed in the context of Bunt’s typology of Cyber Islamic Environments (Bunt 2009) and in the framework of Roy’s view on the virtual umma (Roy 2002). ‘(Non-)voluntary euthanasia and assisted suicide’ are defined using Broeckaert’s conceptual framework on treatment decisions at the end of life (Broeckaert 2008). We analysed 32 English Sunni e-fatwas. All of the e-fatwas discussed here firmly speak out ...

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First tests for stem cell therapy are near

Bioethics.net - Thu, 09/02/2010 - 1:47am
Optimism and angst surrounds stem cell trials as trials are stopped and started and funding is slashed.
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NIH Asks Judge to Suspend Stem Cell Research Injunction

Bioethics.net - Wed, 09/01/2010 - 12:53pm
NIH working with DOJ to arrange a stay to keep hESC research alive ASAP. Any other abbreviations I can use? #bioethics HT @bachinsky
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Judge Lamberth's stem cell opinion is disappointingly bad

Bioethics.net - Wed, 09/01/2010 - 12:31pm
Hank Greely's take on the stem cell decision: "disappointingly bad." Not to put too fine of a point on it or anything.... #bioethics
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Opinion: U.S. stem cell ruling invites Asian competition

Bioethics.net - Wed, 09/01/2010 - 12:24pm
Watch out US. Korea's poised to make a comeback in the stem cell business. HT @hsbioethics #bioethics
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Is genetically altered fish OK? U.S. to decide

Bioethics.net - Tue, 08/31/2010 - 11:39am
I'll have the GMO lox and bagel, please.
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Physicians use photos from patients' cellphones to deliver 'mobile health'

Bioethics.net - Tue, 08/31/2010 - 10:35am
Intake by cellphone: Is anyone else concerned about quality in this mHealth movement?
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