scholarly journals How precision medicine changes medical epistemology: A formative case from Norway

2021 ◽  
Author(s):  
Henrik Vogt ◽  
Bjørn Hofmann
Keyword(s):  
Precision Medicine ◽  
Ethical Issues ◽  
Health Sector ◽  
Individual Case ◽  
Population Based ◽  
Ethical Challenges ◽  
Ethical Implications ◽  
What Works ◽  
Depth Analysis ◽  
The Individual

Rationale and aims: Precision medicine (PM) raises a key question: How can we know what works when the number of people with a health problem becomes small or one (n=1)? We here present a formative case from Norway. The Norwegian Board of Health Supervision was faced with a cancer patient, who had improved after treatment with a drug in the private health sector but was refused continued treatment in the public health service due to lack of clinical trial evidence. The Board overturned this decision, arguing that the drug had been unambiguously documented to work in the individual case. We aim to provide an in-depth analysis of this case and The Board´s decision and thereby to illustrate and elucidate key epistemological and ethical issues and developments in PM. Method: We provide our analysis and discussion using tools of critical thinking and concepts from philosophy of science and medicine such as uncertainty, evidence, forms of inference and causation. We also examine the case in the light of the history of evidence-based medicine (EBM). Results and discussion: The case reflects an epistemological shift in medicine where PM puts greater emphasis on evidence that arises in individual patients after the treatment is provided over preexisting population-based evidence. PM may rely more heavily on abduction to decide what works and qualitative, rather than quantitative judgments. The case also illustrates a possible shift in the concept of causation from regularity accounts to mechanistic and process accounts. We discuss ethical implications of a shift from more “traditional” to “personalized EBM”. Conclusion: A framework that is more based on abductions and evidence arising in the individual case has problems in creating quantifiable, reliable, and generalizable evidence, and in promoting transparency and accountability. PM currently lacks clear criteria for deciding what works in an individual, posing ethical challenges.

scholarly journals Splenomegaly in relation to Schistosoma mansoni egg counts: a population based study

1986 ◽  
Vol 28 (6) ◽  
pp. 389-394 ◽  
Author(s):  
Maria Fernanda Furtado de Lima e Costa ◽  
R. S. Bocha ◽  
Naftale Katz
Keyword(s):  
Geometric Mean ◽  
Age Groups ◽  
Individual Case ◽  
Population Based ◽  
Control Analysis ◽  
Ecological Data ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Individual Analysis ◽  
The Individual

A cross: sectional survey on schistosomiasis was done in Comercinho (Minas Gerais State, Brazil), a town with 1474 inhabitants. Stool (Kato-Katz method) and physical examinations were done on 90% of the population and on 84% of the individuals over 2 years of age, respectively. The ecological and individual (case-control) analysis were used to investigate the relation between splenomegaly and S. mansoni egg counts in different age groups. In the ecological analysis there was a clearly correspondence between higher geometric mean of eggs and higher percentage of splenomegaly in the age groups 5-9 and 10-12 years. In the individual analysis it was found that only in the youngest individuals (5-8 or 5-9 years old) the splenomegaly was related with higher mean egg counts in the feces, having been a tendency to the decrease of excretion of eggs in patients with splenomegaly as the age increased. These results strongly suggest that the ecological data are' better indicator of the severity of schistosomiasis in endemic areas, as the decrease of the egg excretion in patients with splenomegaly may be a confounding variable for the individual analysis.

Ethical rationales for past and present military medical practices

2018 ◽  
Vol 165 (4) ◽  
pp. 273-278
Author(s):  
Edmund Howe
Keyword(s):  
Ethical Issues ◽  
Military Medicine ◽  
Service Members ◽  
Ethical Challenges ◽  
The Past ◽  
Occupied Territory ◽  
The Usa ◽  
The Individual ◽  
Hearts And Minds ◽  
Extract Information

This paper reviews changes in the ethical challenges that have arisen in military medicine over the past four decades. This includes the degree, if any, to which providers during the Vietnam conflict have carried out what we now refer to as harsh interrogation measures in an attempt to extract information from captured enemy soldiers, the extent, if any, to which the USA used medicine as a means to try to win over the hearts and minds of civilians in occupied territory and how providers should treat service members who return from the front with combat fatigue. An issue that arose during the first Gulf War in 1991 is discussed, namely US service persons being required to take botulism vaccine without their consent. Finally, present challenges are discussed including interrogation measures such as waterboarding and the ethical issues posed in the recent past by the exclusion of gay service members and those posed presently by the inclusion of transgender members. Two ethical values are suggested that have remained constant, namely giving priority to the individual needs of service personnel over those of the unit when there are no urgent combat needs and the reliance on individual virtue when what they should do is morally unclear.

Drama: A Tool for Teaching Business Ethics

1998 ◽  
Vol 8 (3) ◽  
pp. 535-545 ◽  
Author(s):  
Eugene Garaventa
Keyword(s):  
Business Ethics ◽  
Ethical Issues ◽  
Dynamic Environment ◽  
Current Mode ◽  
Ethical Challenges ◽  
Teaching Business Ethics ◽  
Alternative Source ◽  
Teaching Business ◽  
Wide Range ◽  
The Individual

Abstract:The concept of business ethics has continued to remain a major item on the agenda of corporate America for the last twenty years. Regrettably, this longevity of interest has not been matched by equal attention to the pedagogical methods and techniques used to address these issues. The current mode of teaching business ethics generally involves reliance on “war stories,” case studies, and seminars. Today’s dynamic environment creates pressures for higher levels of ethical behavior by business. Many ethical challenges faced by contemporary managers are not easily resolved by existing guidelines, and require managers to expand their scope of analysis in attempting to arrive at satisfactory resolutions. Literature can be an especially alternative source of insights, as authors are able to highlight behaviors that may not be available from traditional sources. Historically, the use of literature in examining business ethics has been focused primarily on novels such as The Jungle, Babbit, and The Great Gatsby. Plays are more useful than novels in attempting to inculcate moral and ethical values since they more sharply address the interactions of characters, and the reader becomes more involved in their situations. The plays selected for analysis, Henrik Ibsen’s An Enemy of the People, Arthur Miller’s Death of a Salesman, and David Mamet’s Glengarry Glen Ross, have intense plots and characters and allow the reader to observe a wide range motives, emotions, and traits. This untraditional approach to teaching business ethics enhances the ability to relate to the increasingly complex ethical issues facing the individual and the organization.

Ethical Practice in Sex Offender Assessment

Sexual Abuse ◽  
2010 ◽  
Vol 23 (3) ◽  
pp. 381-396 ◽  
Author(s):  
James Vess
Keyword(s):  
Sex Offenders ◽  
Sex Offender ◽  
Ethical Issues ◽  
Individual Case ◽  
Careful Consideration ◽  
Research Literature ◽  
Ethical Practice ◽  
Professional Literature ◽  
Ethical Concerns ◽  
The Individual

The current generation of community protection laws represents a shift in priorities that may see the individual rights of sex offenders compromised for the goal of public safety. At the center of many judicial decisions under these laws are the risk assessment reports provided by mental health practitioners. The widespread enactment of laws allowing for additional sanctions for sex offenders, and a burgeoning research literature regarding the methods used to assess risk have served to heighten rather than resolve the ethical concerns associated with professional practice in this area. This article examines ethical issues inherent in the use of two assessment methods commonly used with sex offenders in the correctional context, focusing on actuarial measures and polygraph tests. Properly conducted and adequately reported actuarial findings are considered to provide useful information of sufficient accuracy to inform rather than mislead judicial decision makers, although careful consideration must be given to the limitations of current measures in each individual case. Despite its increasing use, polygraph testing is considered controversial, with little consensus regarding its accuracy or appropriate applications. On the basis of the current state of the professional literature regarding the polygraph, its use with sex offenders raises unresolved ethical concerns.

Die Doppelstellung des Opferzeugen

2019 ◽  
Author(s):  
Marius Endler
Keyword(s):  
Individual Case ◽  
Dual Role ◽  
Individual Rights ◽  
Criminal Trials ◽  
Depth Analysis ◽  
Comprehensive Examination ◽  
Victim Participation ◽  
The Individual

This thesis offers a comprehensive examination of the tensions resulting from the dual role of victim witnesses in criminal trials. Based on an in-depth analysis of their interdependent functions as victims and witnesses, it establishes the tense relationship between active victim participation and the ascertainment of truth. The author concludes that active victim participation certainly has a right to exist but needs to step back if that right hinders the truth being established. On this basis, he then examines the individual rights of active victims. For this purpose, he evinces the influence of each of those respective rights on the ascertainment of truth by means of psychological principles, in order to then draw conclusions which are partly addressed to legislators but in particular to the practitioner of law in each individual case.

Public Health Interventions: Ethical Implications

2019 ◽  
pp. 76-88
Author(s):  
David R. Buchanan
Keyword(s):  
Public Health ◽  
Educational Interventions ◽  
Health Interventions ◽  
Social Solidarity ◽  
Ethical Challenges ◽  
Individual Liberty ◽  
Public Health Interventions ◽  
Environmental Interventions ◽  
Ethical Implications ◽  
The Individual

Public health interventions present distinct ethical challenges relative to clinical medical interventions, primarily because of their focus on prevention (rather than treatment) and their intended impact on the health of a population as a whole (rather than the individual). Public health interventions can be broadly categorized as falling into two main types: educational and environmental. Educational interventions aim to change individual behaviors, whereas environmental interventions seek to change the social and environmental conditions that encourage, require, or reinforce behaviors that are either beneficial or harmful to health. Public health interventions raise normative concerns with respect to three key ethical principles: the potential for harm (including stigmatization, lost opportunity costs, and threats to autonomy), justice, and social solidarity, particularly with respect to the problem of free riders. The high value placed on individual liberty in the modern era makes the task of asking individuals to give up freedoms to protect and promote population health increasingly difficult.

Users’ Views of Palliative Care Services: ethical implications

2000 ◽  
Vol 7 (4) ◽  
pp. 314-326 ◽  
Author(s):  
Simon Woods ◽  
Kinta Beaver ◽  
Karen Luker
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Ethical Issues ◽  
Community Services ◽  
Ethical Challenges ◽  
Best Interest ◽  
Ethical Implications ◽  
Care Services ◽  
The Family ◽  
Palliative Care Services

This article is based on the findings of a study that elicited the views of terminally ill patients ( n = 15), their carers ( n = 10) and bereaved carers ( n = 19) on the palliative care services they received. It explores the range of ethical issues revealed by the data. Although the focus of the original study was on community services, the participants frequently commented on all aspects of their experience. They described some of its positive and negative aspects. Of concern was the reported lack of sensitivity to the role of the family among health professionals. The family, as carers, service users and advocates, represent a challenge to professional boundaries and the ethical norms of confidentiality and best interest. The accounts reveal the complexity of the ethical issues that characterize terminal care, issuing specific ethical challenges to nurses and other health professionals involved in this field.

Ethical Issues in Couple and Family Research and Therapy

2019 ◽  
pp. 226-242
Author(s):  
Maria Nicoleta Turliuc ◽  
Octav Sorin Candel
Keyword(s):  
Intimate Partner Violence ◽  
Partner Violence ◽  
Ethical Issues ◽  
Family System ◽  
Ethical Dilemmas ◽  
Intimate Partner ◽  
Family Research ◽  
Ethical Implications ◽  
The Family ◽  
The Individual

In couple and family research and therapy, the perspective changes from the individual to the dyad or group. As such, professionals in this field discuss some new ethical dilemmas that are particular to their line of work. While some authors present problems such as confidentiality and allegiance to only one part of the family system, others address a series of ethical consideration caused by the state of current research. The aim of this chapter is to present an overview of modern research topics such as intimate partner violence, illness, or multiculturalism and their ethical implications and effects on the family functioning, child development, and the research results. Also, the authors want to present the most relevant ways in which professionals can work within such ethical dilemmas without damaging either the outcomes of therapy or research or to cause harm to the participants.

Ethical Issues in Digital Information Technology

2011 ◽  
pp. 455-464
Author(s):  
Konrad Morgan ◽  
Madeleine Morgan
Keyword(s):  
Ethical Issues ◽  
Communications Technology ◽  
Digital Information ◽  
Ethical Challenges ◽  
Ethical Implications ◽  
Information Communications Technology ◽  
Technological Advances ◽  
Digital Information Technology ◽  
The Impact ◽  
Vast Network

Since the inception of the Internet in the late 1960´s, technological advances in the field of Information Communications Technology (ICT) have created an ever-expanding digital arena for the development of human innovation, education, expression, communication and interaction. However, the creation and use of this vast network of knowledge, whether it is for educational, commercial, entertainment or creative purposes, has also produced its own set of ethical challenges. This paper discusses the ethical implications associated with the topics of veracity, identity and ownership and the impact of these fundamental ethical issues on human behaviour in emerging digital technologies.

Discussant: Ethical challenges

2016 ◽  
Vol 33 (S1) ◽  
pp. S36-S36
Author(s):  
M. Kastrup
Keyword(s):  
Mental Health ◽  
Health Services ◽  
Adverse Effects ◽  
Ethical Issues ◽  
Health Sector ◽  
Economic Policies ◽  
Ethical Challenges ◽  
Health Security ◽  
Economic Changes ◽  
The Impact

Europe has undergone considerable economic changes that have an impact on mental health of its citizens; have consequences for the organization of mental health services; and raise ethical issues, such as the distribution of wealth, and equity in access to care. Furthermore, Europe is current undergoing serious economic problems that will produce adverse effects on the mental health of its citizens, among them increase in substance abuse related disorders as well as an increase in suicide.The consequences that economic changes have on mental health relate to the conditions of the particular country, as countries with better health security nets would be less likely to experience adverse effects. Different policy measures may reduce the impact on mental health not only within the health sector, but other sectors of society have to be engaged in the process.The symposium will consider these problems from different selected perspectives.An overview of the impact of economic policies on health services will be followed by a presentation of the important role of international organizations like EPA in outlining the problem and finally a presentation of the initiative Choosing Wisely that focuses on communication between health professionals and patients with recommendations of decisions about the most appropriate care based on the patient's individual situation.Disclosure of interestThe author has not supplied his declaration of competing interest.

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