Ethical Issues Concerning Patient Autonomy in Clinical Practice

2020 ◽  
pp. 123-135
Author(s):  
Alfred Simon
Keyword(s):  
Clinical Practice ◽  
Patient Autonomy ◽  
Ethical Issues

scholarly journals Ethical challenges of the healthcare transition to adult antiretroviral therapy (ART) clinics for adolescents and young people with HIV in Uganda

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Scovia Nalugo Mbalinda ◽  
Sabrina Bakeera-Kitaka ◽  
Derrick Lusota Amooti ◽  
Eleanor Namusoke Magongo ◽  
Philippa Musoke ◽  
...  
Keyword(s):  
Young People ◽  
Patient Autonomy ◽  
Ethical Issues ◽  
Transition Process ◽  
Hiv Care ◽  
Ethical Challenges ◽  
Successful Transition ◽  
Healthcare Transition ◽  
Increased Risk ◽  
Retention In Hiv Care

Abstract Background Whereas many adolescents and young people with HIV require the transfer of care from paediatric/adolescent clinics to adult ART clinics, this transition is beset with a multitude of factors that have the potential to hinder or facilitate the process, thereby raising ethical challenges of the transition process. Decisions made regarding therapy, such as when and how to transition to adult HIV care, should consider ethical benefits and risks. Understanding and addressing ethical challenges in the healthcare transition could ensure a smooth and successful transition. The purpose of this study was to analyze the ethical challenges of transitioning HIV care for adolescents into adult HIV clinics. Methods Data presented were derived from 191 adolescents attending nine different health facilities in Uganda, who constituted 18 focus group discussions. In the discussions, facilitators and barriers regarding adolescents transitioning to adult HIV clinics were explored. Guided by the Silences Framework for data interpretation, thematic data analysis was used to analyze the data. The principles of bioethics and the four-boxes ethics framework for clinical care (patient autonomy, medical indications, the context of care, and quality of life) were used to analyze the ethical issues surrounding the transition from adolescent to adult HIV care. Results The key emerging ethical issues were: reduced patient autonomy; increased risk of harm from stigma and loss of privacy and confidentiality; unfriendly adult clinics induce disengagement and disruption of the care continuum; patient preference to transition as a cohort, and contextual factors are critical to a successful transition. Conclusion The priority outcomes of the healthcare transition for adolescents should address ethical challenges of the healthcare transition such as loss of autonomy, stigma, loss of privacy, and discontinuity of care to ensure retention in HIV care, facilitate long-term self-care, offer ongoing all-inclusive healthcare, promote adolescent health and wellbeing and foster trust in the healthcare system. Identifying and addressing the ethical issues related to what hinders or facilitates successful transitions with targeted interventions for the transition process may ensure adolescents and young people with HIV infection remain healthy across the healthcare transition.

scholarly journals Genetic Testing for Minors: Comparison between Italian and British Guidelines

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Pamela Tozzo ◽  
Luciana Caenazzo ◽  
Daniele Rodriguez
Keyword(s):  
Clinical Practice ◽  
Genetic Testing ◽  
Ethical Issues ◽  
Social Issues ◽  
Carrier Testing ◽  
European Countries ◽  
National Guidelines ◽  
Common Framework ◽  
Professional Guidelines

Genetic testing in children raises many important ethical, legal, and social issues. One of the main concerns is the ethically inappropriate genetic testing of minors. Various European countries established professional guidelines which reflect the different countries perspectives regarding the main ethical issues involved. In this paper, we analyze the Italian and the British guidelines by highlighting differences and similarities. We discuss presymptomatic, predictive, and carrier testing because we consider them to be the more ethically problematic types of genetic testing in minors. In our opinion, national guidelines should take into account the different needs in clinical practice. At the same time, in the case of genetic testing the national and supranational protection of minors could be strengthened by approving guidelines based on a common framework of principles and values. We suggest that the Oviedo Convention could represent an example of such a common framework or, at least, it could lead to articulate it.

scholarly journals Computer knows best? The need for value-flexibility in medical AI

2018 ◽  
Vol 45 (3) ◽  
pp. 156-160 ◽  
Author(s):  
Rosalind J McDougall
Keyword(s):  
Decision Making ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Ethical Issues ◽  
Treatment Decision ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Value Judgements ◽  
The Relationship

Artificial intelligence (AI) is increasingly being developed for use in medicine, including for diagnosis and in treatment decision making. The use of AI in medical treatment raises many ethical issues that are yet to be explored in depth by bioethicists. In this paper, I focus specifically on the relationship between the ethical ideal of shared decision making and AI systems that generate treatment recommendations, using the example of IBM’s Watson for Oncology. I argue that use of this type of system creates both important risks and significant opportunities for promoting shared decision making. If value judgements are fixed and covert in AI systems, then we risk a shift back to more paternalistic medical care. However, if designed and used in an ethically informed way, AI could offer a potentially powerful way of supporting shared decision making. It could be used to incorporate explicit value reflection, promoting patient autonomy. In the context of medical treatment, we need value-flexible AI that can both respond to the values and treatment goals of individual patients and support clinicians to engage in shared decision making.

scholarly journals Charting Spiritual Care: Ethical Perspectives

2020 ◽  
pp. 199-211
Author(s):  
Guy Jobin
Keyword(s):  
Decision Making ◽  
Life History ◽  
Clinical Practice ◽  
Electronic Health Records ◽  
Ethical Issues ◽  
Care Team ◽  
Decision Making Process ◽  
Note Taking ◽  
Health Records ◽  
Joint Decision

Abstract The introduction of electronic health records (EHRs) into clinical practice appears to be irreversible. Where EHRs are used, chaplains have cooperated willingly with this way of reporting and sharing information with other members of the care team. They will have to, as a result, adapt their own note-taking practices to ensure effective, relevant and meaningful communication as part of the joint decision-making process. Although the specialized literature has addressed some of the “classic” ethical issues raised by EHRs, in particular those in connection with confidentiality and access, other questions, no less crucial, have received less attention and are addressed here. They include questions about the recognition of all players in the care relationship (both patients and caregivers) as subjects, and the communication of “non-generic” information about emotions, values, life history, etc. The fact that chaplains contribute to EHRs is both a sign of and a vector for recognition of their work within healthcare institutions – yet a recognition that could involve a price to pay for chaplains and patients.

Psychiatric Ethics

2021 ◽  
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Child And Adolescent Psychiatry ◽  
Social Contexts ◽  
Psychiatric Research ◽  
Liaison Psychiatry

Ethical issues inherent in psychiatric research and clinical practice are invariably complex and multifaceted. Well-reasoned ethical decision-making is essential to deal effectively with patients and enhance their care. Drawing on the positive reception of Psychiatric Ethics since its first publication in 1981, this highly anticipated fifth edition offers psychiatrists and other mental health professionals a coherent guide to dealing with the diverse ethical issues that challenge them. This edition has been substantially updated to reflect the many changes that have occurred in the field during the past decade. Its 25 chapters are grouped in three sections, as follows: 1) clinical practice in child and adolescent psychiatry, consultation-liaison psychiatry, psychogeriatrics, community psychiatry, and forensic psychiatry; 2) relevant basic sciences such as neuroethics and genetics; and 3) philosophical and social contexts including the history of ethics in psychiatry and the nature of professionalism. Principal aspects of clinical practice in general, such as confidentiality, boundary violations, and involuntary treatment, are covered comprehensively, as is a new chapter on diagnosis. Given the contributors’ expertise in their respective fields, Psychiatric Ethics will undoubtedly continue to serve as a significant resource for all mental health professionals, whatever the role they play in psychiatry. It will also benefit students of moral philosophy in their professional pursuits.

Social Media and Pediatric Research Recruitment

2018 ◽  
pp. 227-243
Author(s):  
Luke Gelinas ◽  
Jennifer C. Kesselheim
Keyword(s):  
Social Media ◽  
Clinical Practice ◽  
Clinical Research ◽  
Ethical Issues ◽  
Media Use ◽  
Pediatric Research ◽  
Research Recruitment ◽  
Pediatric Populations ◽  
Potential Risks ◽  
Use Of Social Media

Social media use has increased exponentially across all demographics. With social media’s widespread popularity comes an increased potential for research sponsors and investigators to use it as an effective tool for recruiting individuals into clinical research. Despite this, there has been relatively little attention paid to the general ethical issues implicated in social media recruitment and even less attention paid to the distinct ethical issues raised by using social media to recruit pediatric populations more specifically. This chapter examines these issues, providing an overview of the use of social media in clinical practice, an assessment of the general ethical issues associated with social media recruitment, and analysis of the potential risks and benefits of using social media to target adolescents for recruitment into clinical research.

scholarly journals International consensus conference on stool banking for faecal microbiota transplantation in clinical practice

Gut ◽  
2019 ◽  
Vol 68 (12) ◽  
pp. 2111-2121 ◽  
Author(s):  
Giovanni Cammarota ◽  
Gianluca Ianiro ◽  
Colleen R Kelly ◽  
Benjamin H Mullish ◽  
Jessica R Allegretti ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Ethical Issues ◽  
Consensus Conference ◽  
Faecal Microbiota ◽  
International Consensus ◽  
Face To Face ◽  
Faecal Microbiota Transplantation ◽  
Clostridioides Difficile

Although faecal microbiota transplantation (FMT) has a well-established role in the treatment of recurrent Clostridioides difficile infection (CDI), its widespread dissemination is limited by several obstacles, including lack of dedicated centres, difficulties with donor recruitment and complexities related to regulation and safety monitoring. Given the considerable burden of CDI on global healthcare systems, FMT should be widely available to most centres.Stool banks may guarantee reliable, timely and equitable access to FMT for patients and a traceable workflow that ensures safety and quality of procedures. In this consensus project, FMT experts from Europe, North America and Australia gathered and released statements on the following issues related to the stool banking: general principles, objectives and organisation of the stool bank; selection and screening of donors; collection, preparation and storage of faeces; services and clients; registries, monitoring of outcomes and ethical issues; and the evolving role of FMT in clinical practice,Consensus on each statement was achieved through a Delphi process and then in a plenary face-to-face meeting. For each key issue, the best available evidence was assessed, with the aim of providing guidance for the development of stool banks in order to promote accessibility to FMT in clinical practice.

A Comparison of Student Performance between Two Instructional Delivery Methods for a Healthcare Ethics Course

2011 ◽  
Vol 20 (3) ◽  
pp. 493-501 ◽  
Author(s):  
HUGH A. STODDARD ◽  
TOBY SCHONFELD
Keyword(s):  
Nursing Education ◽  
Clinical Practice ◽  
Student Performance ◽  
Interprofessional Education ◽  
Ethics Education ◽  
Ethical Issues ◽  
Well Being ◽  
Healthcare Ethics ◽  
Nursing Curricula ◽  
Ethics Course

Healthcare ethics has become part of the standard curriculum of students in the health professions. The goals of healthcare ethics education are to give students the skills they need to identify, assess, and address ethical issues in clinical practice and to develop virtuous practitioners. Incorporating the medical humanities into medical school, for example, is intended to foster empathy and professionalism among students and to provide mechanisms for enhanced physician well-being. Yet, despite the long-standing inclusion of the humanities in nursing curricula, increases in the amount and kinds of scientific knowledge essential for clinical practice has resulted in the erosion of the “humanistic arts” from nursing education. One potential solution to this challenge comes with the increase in interprofessional education, where students in a variety of healthcare professions programs come together to learn about issues common to all healthcare fields.

From Research to Clinical Practice: Ethical Issues with Neurotechnology and Industry Relationships

2020 ◽  
Vol 11 (3) ◽  
pp. 210-212
Author(s):  
Tristan McIntosh ◽  
James M DuBois
Keyword(s):  
Clinical Practice ◽  
Ethical Issues
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