Bioethics in Kenya: Who is Interested in Certificate Courses

Inadequate training in matters of ethics renders health care providers unprepared for dilemmas faced in public health, research, and clinical practice. Certificate course training offer opportunities to gain more knowledge and skills on all matter ethics. Over the past decade, the increase in research activities in Kenya has not been proportionate to training in ethics. The centre of Biomedical Ethics and Culture (CBEC), Kenya Medical Research Institute (KEMRI) Bioethics training Initiative (CK-BTI) is a Forgaty funded program for building capacity in research ethics for Kenya and Pakistan. This paper evaluates the characteristics of participants that attended the CK-BTI certificate level courses in Kenya between 2017 to 2021. This data was analysed for this paper and utilized information from the training application process. Between November 2017 and July 2021, a total of 1,359 applications were received and 457 (33.6%) trained. The target countries were Kenya and Pakistan but interest was drawn from Tanzania, Uganda, Nigeria, and Zambia. The continued interest in the certificate level ethics courses may imply a need to increase the number of ethics training offered within the East African region.

Promise and peril-defining ethical telehealth practice from the clinician and patient perspective: A qualitative study

Objectives We undertook a qualitative study to examine and compare the experience of ethical principles by telehealth practitioners and patients in relation to service delivery theory. The study was conducted prior to and during the recent global increase in the use of telehealth services due to the COVID-19 pandemic, Methods We conducted semi-structured interviews with 20 telehealth practitioners and patients using constructionist grounded theory methods to collect and analyse data. Twenty-five axial coded data categories were then unified and aligned through selective coding with the Beauchamp and Childress (2013) framework of biomedical ethics. The groups were then compared. Results Thirteen categories aligned to the ethical framework were identified for practitioners and 12 for patients. Variance existed between the groups. Practitioner results were non-maleficence 4/13 or (31%), beneficence 4/13 (31%), professional–patient relationships 3/12 (22%), autonomy 1/13 (8%) and justice 1/13 (8%). Patient data results were non-maleficence 4/12 (33%), professional–patient relationships 3/12 (33%), autonomy 2/12 (18%), beneficence 1/12 (8%) and justice 1/12 (8%). Conclusions Ethical principles are experienced differently between telehealth practitioners and patients. These differences can impact the quality and safety of care. Practitioners feel telehealth provides better care overall than patients do. Patients felt telehealth may force a greater share of costs and burdens onto them and reduce equity. Both patients and practitioners felt telehealth can be more harmful than face-to-face service delivery when it creates new or increased risk of harms. Building sufficient trust and mutual understanding are equally important to patients as privacy and confidentiality.

Biomedical Ethics for Jehovah’s Witnesses and Patient Blood Management

Jehovah’s Witnesses refuse blood transfusions according to religious beliefs, and for this reason, most hospitals and doctors have refused their treatment. There are more than 100,000 religious people in Korea, but there are few bloodless centers that can receive their treatment. So, the number of Jehovah’s Witnesses patients visiting bloodless centers in Soonchunhyang University Bucheon Hospital has been increasing every year. Despite this situation, no legal or medical countermeasure has yet been proposed against them. Therefore, I would like to take a bioethical approach based on “principles of biomedical ethics” and introduce “patient blood management” which is currently spreading in advanced medical countries.

Biomedical Ethics

Chapter 9 addresses the duties of medical practitioners such as doctors and nurses, mostly in relation to patients, but also in respect of each other and their society. It argues that the relational moral theory is at least no worse than, and is often to be preferred over, more Western principles when it comes to how to understand several biomedical obligations. For example, the chapter maintains that the communal ethic makes good sense of whom a medical professional has moral reason to treat and for which purposes. It further contends that rightness as friendliness grounds moderate positions on abortion and euthanasia that many will find convincing but that utilitarianism and Kantianism have difficulty entailing and explaining. For example, if utilitarianism and Kantianism permit abortion, it is hard for them to avoid also permitting infanticide, but the relational ethic can more easily avoid that implication.

Bioethical Aspects in Modern Cardiosurgery of Coronary Artery Disease

The paper focuses on ethical issues, provides data on personality qualities and socio-ethical factors necessary for the professional activity of a cardiovascular surgeon. The aim. To identify the most relevant bioethical aspects, personality traits necessary for a cardiovascular surgeon to carry out his/her professional activities. Materials and methods. Analytical review of scientific publications was performed using the abstract database of scientific libraries, text database of medical and biological publications as well as analysis of observations of our own research works. Results. The main stages of development of surgical treatment of coronary artery disease in Ukraine are highlighted. Analysis of the basic bioethical aspects which take place in a profession of cardiovascular surgeon is carried out. Important personality traits which are necessary for professional activity in cardiac surgery are established. Ethical principles and problems that take place in modern cardiovascular surgery are analyzed. Autologous transplantation which takes place during reconstructive shunt surgery is emphasized. Conclusions. High-tech diagnostic and treatment technologies in cardiac surgery, their specificity, irreversibility of biomedical experience and certain event (intervention) to prolong life and improve health of the patient place new demands on the cardiac surgeon and require special responsibility. Today’s cardiac surgery requires not only high-tech skills in using modern methods of operations, responsibility, but also comprehensive support of aspects of biomedical ethics in the treatment of patients.

Decision-making in paediatric palliative care interpreting

The interpreting profession has long used metaphors or rule statements to describe and teach the ways in which practitioners make decisions (Dean & Pollard, 2011, 2018). Interpreting students are also often taught that the context of an encounter will dictate their decision-making by way of statements such as “it depends”. Such pedagogical statements can make talk between a practitioner and a medical professional about the responsibilities of an interpreter during medical encounters difficult. This study is based on the work of Dean and Pollard (2011, 2018) on value-based decision-making and is guided by the four principles of biomedical ethics (respect for autonomy, non-maleficence, beneficence and justice). It has sought to provide evidence of the existence, applicability and usability of these frameworks through a single case study of a real-life appointment in which a parent of a palliative care outpatient and a medical professional communicated during a consultation, aided by a medical interpreter.

Ethical and Methodological Challenges in Research with Hard-to-Reach Groups: Examples from Research on Family Caregivers for Migrant Older Adults Living with Dementia

Family caregivers of migrants with dementia constitute a population group that is hard to reach for research participation due to factors such as shame about the disease and past experiences of discrimination. In this paper, research-ethical challenges associated with participant recruitment and qualitative data collection among relatives of migrants with dementia are discussed. Over a period of 8 years, three studies were conducted to investigate the experiences of family caregivers for persons with dementia of Turkish descent in Germany. Across these studies, a total of 32 family caregivers were interviewed. In this paper, based on the “Principles of Biomedical Ethics” according to Beauchamp and Childress (2009), research-ethical conflicts associated with sampling methods and the presence of third parties during qualitative interviews are discussed. The potential risks emanating from sampling strategies and the presence of third parties during interviews regarding the voluntary nature of study participation are examined. Additionally, this paper formulates recommendations for ensuring truly voluntary participation and protecting both the participants (family caregivers) and third parties (especially relatives with dementia) from harm. These practical recommendations aim to help future researchers to avoid ethical pitfalls and represent a roadmap for making necessary methodological decisions.

Interdisciplinary Ethics Certificate Program for Graduate Medical Education Trainees

ABSTRACT Background Ethics education is an essential component of developing physician competency and professionalism. Although prior studies have shown both a wide interest and a need for ethics education during residency, structured learning opportunities are not widely available at the graduate medical education (GME) level. Objective Through the Vanderbilt Center for Biomedical Ethics and Society, we developed a 1-year certificate program offering a Distinction in Biomedical Ethics, open to all active trainees in GME programs at the Vanderbilt University Medical Center. This certificate program provides advanced education in biomedical ethics and can be completed without additional cost to the trainee or time away from training. Methods This certificate program has been offered each academic year since 2017–2018. The program curriculum includes case-based seminars, a rotation on the Ethics Consultation Service, participation on the hospital ethics committee, and a capstone project. Outcomes were assessed using a post-course evaluation. Results During the first 4 years of the program, 65 trainees participated from 19 different specialties. Course evaluations were obtained from 58 participants (89.4% response rate) and were strongly favorable in most domains. All participants agreed that this program enhanced their knowledge of biomedical ethics and they would use something they learned in their future practice. Most participants (57 of 58, 98.3%) would recommend this course to a friend. Conclusions We designed and implemented a Distinction in Biomedical Ethics program to provide advanced training in clinical Bioethics, which has been favorably received by participants.