Physician perspectives on placebo ethics

2021 ◽  
pp. medethics-2021-107446
Author(s):  
John Bliamptis ◽  
Anne Barnhill
Keyword(s):  
Focus Groups ◽  
Ethical Issues ◽  
Physician Attitudes ◽  
Clinical Use ◽  
Open Label ◽  
Ethical Concerns ◽  
Preferable Alternative ◽  
Physician Perspectives ◽  
Primary Focus ◽  
And Training

Clinical use of placebos is controversial among bioethicists. While placebos have been shown to provide benefit for patients with some conditions, offering placebos to patients without disclosing that they are placebos raises ethical concerns, including the concern that this lack of transparency about the nature of placebos amounts to deceiving patients. Some have proposed open-label placebos (OLPs) as an ethically preferable alternative: patients are offered placebos and told that the treatment being offered is a placebo. To contribute to the ongoing discussion about the ethics and feasibility of clinical use of placebos, we conducted focus groups to explore physician attitudes about clinical use of placebos, including non-disclosed and OLPs, and physician attitudes about the underlying ethical issues. We found that while the non-transparency and deceptiveness of offering non-disclosed placebos was a concern for some physicians, their primary focus when considering both non-disclosed and OLPs was identifying and weighing potential harms and benefits to patients. Some participants also felt further research and training in prescribing OLPs would be needed before they would be willing to use them in their practice.

Psychiatric Interventions in Virtual Reality: Why We Need an Ethical Framework

2020 ◽  
Vol 29 (4) ◽  
pp. 574-584
Author(s):  
MARIA MARLOTH ◽  
JENNIFER CHANDLER ◽  
KAI VOGELEY
Keyword(s):  
Virtual Reality ◽  
Virtual World ◽  
Ethical Issues ◽  
Biomedical Ethics ◽  
Ethical Framework ◽  
Clinical Settings ◽  
Clinical Use ◽  
Clinical Context ◽  
Ethical Concerns ◽  
Expectation Bias

AbstractRecent improvements in virtual reality (VR) allow for the representation of authentic environments and multiple users in a shared complex virtual world in real time. These advances have fostered clinical applications including in psychiatry. However, although VR is already used in clinical settings to help people with mental disorders (e.g., exposure therapy), the related ethical issues require greater attention. Based on a thematic literature search the authors identified five themes that raise ethical concerns related to the clinical use of VR: (1) reality and its representation, (2) autonomy, (3) privacy, (4) self-diagnosis and self-treatment, and (5) expectation bias. Reality and its representation is a theme that lies at the heart of VR, but is also of specific significance in a clinical context when perceptions of reality are concerned, for example, during psychosis. Closely associated is the autonomy of VR users. Although autonomy is a much-considered topic in biomedical ethics, it has not been sufficiently discussed when it comes to applications of VR in psychiatry. In this review, the authors address the different themes and recommend the development of an ethical framework for the clinical use of VR.

Survey of psychologists’ telebehavioral health practices: Technology use, ethical issues, and training needs.

2018 ◽  
Vol 49 (3) ◽  
pp. 205-219 ◽  
Author(s):  
Robert L. Glueckauf ◽  
Marlene M. Maheu ◽  
Kenneth P. Drude ◽  
Brittny A. Wells ◽  
Yuxia Wang ◽  
...  
Keyword(s):  
Technology Use ◽  
Ethical Issues ◽  
Training Needs ◽  
Health Practices ◽  
Telebehavioral Health ◽  
And Training

scholarly journals Big Data: Some Ethical Concerns for the Social Sciences

2021 ◽  
Vol 10 (2) ◽  
pp. 36
Author(s):  
Michael Weinhardt
Keyword(s):  
Social Sciences ◽  
Big Data ◽  
Ethical Issues ◽  
Online Behavior ◽  
Ethical Concerns ◽  
Ethical Implications ◽  
The Social ◽  
And Behaviors ◽  
State Actors

While big data (BD) has been around for a while now, the social sciences have been comparatively cautious in its adoption for research purposes. This article briefly discusses the scope and variety of BD, and its research potential and ethical implications for the social sciences and sociology, which derive from these characteristics. For example, BD allows for the analysis of actual (online) behavior and the analysis of networks on a grand scale. The sheer volume and variety of data allow for the detection of rare patterns and behaviors that would otherwise go unnoticed. However, there are also a range of ethical issues of BD that need consideration. These entail, amongst others, the imperative for documentation and dissemination of methods, data, and results, the problems of anonymization and re-identification, and the questions surrounding the ability of stakeholders in big data research and institutionalized bodies to handle ethical issues. There are also grave risks involved in the (mis)use of BD, as it holds great value for companies, criminals, and state actors alike. The article concludes that BD holds great potential for the social sciences, but that there are still a range of practical and ethical issues that need addressing.

scholarly journals SAT0636-HPR PATIENT EXPERIENCE WITH THE PRESCRIPTION, INFORMATION AND USE OF METHOTREXATE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1277.3-1278
Author(s):  
T. Oton ◽  
L. Carmona ◽  
J. L. Andréu Sánchez
Keyword(s):  
Side Effects ◽  
Focus Groups ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Physical Symptoms ◽  
Number Of Factors ◽  
Graphic Information ◽  
Main Barrier ◽  
And Training

Background:Methotrexate (MTX) is currently a mainstream drug in the treatment of rheumatic diseases. However, the response to MTX is not universal and may be conditioned by a number of factors, among which adherence could be crucial.Objectives:The aim of this study is to explore adherence to MTX in patients with rheumatic diseases, facilitators and perceived when taking and maintaining the prescription.Methods:A qualitative study of content analysis was performed. Focus groups with patients taking either oral or subcutaneous MTX (being the main or coadjuvant treatment) for any rheumatic disease was performed. The groups were moderated by a rheumatologist that was unknown for the patients. The speech was recorded and transcribed. Subsequently, an inductive coding was performed with the help of Atlas.ti and main themes and sub-themes were extracted, with examples of verbatim anonymized speech.Results:Three focus groups were conducted, with a total of 12 participants, of whom eight were women, seven had rheumatoid arthritis, three had psoriatic arthritis, one had spondyloarthritis, and one had systemic lupus erythematosus. All patients reported an adequate adherence to treatment. The barriers identified were: information in the leaflet, technical language in the consults, difficult access to doctor´s appointment, social environment, side effects and the subcutaneous device. As facilitators, the following aspects were discussed: good predisposition of the physician, reliable graphic information, role of associations and partners support.The unmet needs detected were: problems with travelling, protocols for eventualities, absence of a plan of care, neglection of “non-physical” symptoms, disinformation on side effects and training in complementary aspects.Conclusion:Getting reliable information was the main barrier identified. The environment and side effects may also negatively impact on adherence. Shared decision making is a goal to be achieved in the future in these patients.Disclosure of Interests:Teresa Oton Consultant of: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), José Luis Andréu Sánchez: None declared

Commentary: The Broader Context of Long-Term Care Ethics

2016 ◽  
Vol 25 (3) ◽  
pp. 554-556
Author(s):  
Jason Lesandrini ◽  
Carol O’Connell
Keyword(s):  
Care Setting ◽  
Long Term Care ◽  
Ethical Issues ◽  
Term Care ◽  
Ethical Concerns ◽  
Healthcare Settings ◽  
Care Facilities ◽  
Ethics Program ◽  
Made In

Ethical issues in long-term care settings, although having received attention in the literature, have not in our opinion received the appropriate level they require. Thus, we applaud the Cambridge Quarterly for publishing this case. We can attest to the significance of ethical issues arising in long-term care facilities, as Mr. Hope’s case is all too familiar to those practicing in these settings. What is unique about this case is that an actual ethics consult was made in a long-term care setting. We have seen very little in the published literature on the use of ethics structures in long-term care populations. Our experience is that these healthcare settings are ripe for ethical concerns and that providers, patients, families, and staff need/desire ethics resources to actively and preventively address ethical concerns. The popular press has begun to recognize the ethical issues involved in long-term care settings and the need for ethics structures. Recently, in California a nurse refused to initiate CPR for an elderly patient in a senior residence. In that case, the nurse was quoted as saying that the facility had a policy that nurses were not to start CPR for elderly patients.1 Although this case is not exactly the same as that of Mr. Hope, it highlights the need for developing robust ethics program infrastructures in long-term care settings that work toward addressing ethical issues through policy, education, and active consultation.

Ethical Issues in the Feeding of Patients Suffering from Dementia: a focus group study of hospital staff responses to conflicting principles

2002 ◽  
Vol 9 (6) ◽  
pp. 599-611 ◽  
Author(s):  
Stephen Wilmot ◽  
Lesley Legg ◽  
Janice Barratt
Keyword(s):  
Focus Groups ◽  
Ethical Issues ◽  
Hospital Staff ◽  
Care Staff ◽  
Ethical Principles ◽  
Focus Group Study ◽  
Feeding Difficulties ◽  
National Health Service Trust ◽  
Feeding Methods ◽  
Personal Attitudes

Feeding difficulties in older patients who are suffering from dementia present problems with balancing conflicting ethical principles. They have been considered by several writers in recent years, and the views of nursing and care staff have been studied in different contexts. The present study used focus groups to explore the way in which nursing and care staff in a National Health Service trust deal with conflict between ethical principles in this area. Three focus groups were convened, one each from the staff of three wards caring for patients with dementia. Case histories were discussed and transcripts analysed. It emerged that staff were aware of making fine judgements of utility concerning the spectrum of feeding methods available. Informants gave some weight to the principle of autonomy, but sought to balance that against their commitment to care. In explaining their perspectives, informants gave more weight to personal attitudes and trust culture than to professional ethics

Mapping the Ethical Issues of Digital Twins for Personalised Healthcare Service (Preprint)

2021 ◽  
Author(s):  
Pei-hua Huang ◽  
Ki-hun Kim ◽  
Maartje Schermer
Keyword(s):  
Ethical Issues ◽  
Digital Health ◽  
Personalised Medicine ◽  
Healthcare Services ◽  
Ethical Values ◽  
Ethical Concerns ◽  
Digital Twins ◽  
Research Gap ◽  
Process Oriented ◽  
Personalised Healthcare

BACKGROUND The concept of digital twins has great potential for transforming the existing healthcare system by making it more personalised. As a convergence of healthcare, artificial intelligence, and information and communication technologies, personalised healthcare services developed under the concept of digital twins raise a myriad of ethical issues. While some of the ethical issues are known to researchers working on digital health and personalised medicine, currently there is no comprehensive review that maps major ethical risks of digital twins for personalised healthcare services. OBJECTIVE This paper fills the research gap by identifying major ethical risks of digital twins for personalised healthcare services. We first propose a working definition for digital twins for personalised healthcare services (DTPHS) to facilitate future discussion on the ethical issues related to these emerging digital health services. We then developed a process-oriented ethical map to identify major ethical risks against each of the different data processing phases. METHODS This research aims to address this research gap by providing a comprehensive analysis of major ethical risks of DTPHSs. Due to the scarcity of literature on DTPHSs, we are unable to perform a systematic review of ethical concerns over DTPHSs. Thus, we resort to literature on eHealth, personalised medicine, precision medicine, and information engineering to identify potential issues. We develop a process-oriented ethical map to structure the inquiry in a more systematic way. The ethical map allows us to see how each of the major ethical concerns emerges during the process of transforming raw data into valuable information. RESULTS The process-oriented ethical analysis identified ten operational problems and the relevant ethical values. By structuring the operational problems and relevant ethical values in a clear logical flow, this process-oriented ethical map allows developers of DTPHSs and stakeholders to have a comprehensive overview of major ethical risks while refining the design of DTPHSs. The ethical values section on the map also helps developers of DTPHSs better understand which values they ought to consider while developing solutions for an operational problem they encounter.   CONCLUSIONS It is challenging to address all of the major ethical risks a DTPHS might encounter proactively without a conceptual map at hand. The process-oriented ethical map we propose here can assist developers of DTPHSs in analysing ethical risks in a more systematic manner. CLINICALTRIAL N/A

scholarly journals The ethical concerns of seeking consent from critically ill, mechanically ventilated patients for research – A matter of possessing capacity or surrogate insight

2018 ◽  
Vol 13 (3) ◽  
pp. 107-111 ◽  
Author(s):  
Avelino C Verceles ◽  
Waqas Bhatti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Informed Consent ◽  
Critically Ill ◽  
Ethical Issues ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ethical Concerns ◽  
Multiple Factors ◽  
Ventilated Patients

Conducting clinical research on subjects admitted to intensive care units is challenging, as they frequently lack the capacity to provide informed consent due to multiple factors including intensive care unit acquired delirium, coma, the need for sedation, or underlying critical illness. However, the presence of one or more of these characteristics does not automatically designate a potential subject as lacking capacity to provide their own informed consent. We review the ethical issues involved in obtaining informed consent for medical research from mechanically ventilated, critically ill patients, in addition to the concerns that may arise when a legally authorized representative is asked to provide informed consent on behalf of these patients.

scholarly journals ETHICAL CONCERNS REGARDING MALE CIRCUMCISION CULTURE: A SELECTED ETHNICAL GROUP

2017 ◽  
Vol 5 ◽  
pp. 737-740
Author(s):  
Cabangile N. Ngwane
Keyword(s):  
Male Circumcision ◽  
Ethical Issues ◽  
Cultural Practices ◽  
Target Population ◽  
Way Of Life ◽  
Community Culture ◽  
Ethical Concerns ◽  
Indigenous Group ◽  
Values And Beliefs ◽  
Hiv Aids

: Traditional cultural practices reflect values and beliefs of members of a community. Culture is an umbrella term, which explains common things people share such as language, customs, beliefs and the way of life. This paper seeks to look at male circumcision culture of a certain indigenous group in South Africa. Male circumcision is associated with ethnic marks, virility, masculinity, rite of passage to manhood however, there are many ethical concerns centering on male circumcision. Hence, this paper seeks to explore the ethical concerns surrounding male circumcision culture of a selected ethnical group in order to contribute to ethical execution of the practice. Little has been done on ethical issues surrounding male circumcision. The fallacy surrounding this phenomenon needs further investigation. The paper intends to contribute to the debate on male circumcision as a way of mitigating HIV/AIDS infections. The Social Norm Theory has been used to explain the phenomenon under study. The constructivist research paradigm enabled the interviewing of participants from the target population, as the study is inductive in nature. The key finding was that they do male circumcision mostly in an unethical way that it also affects women and children. They also do it based on the misconception and the fallacy that they will not get HIV/AIDS.

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