Journal of Medical Ethics最新文献

The invasiveness of a medical intervention is considered to be morally important and can have a significant influence on acceptability and uptake. De Marco et al propose a novel account of the invasiveness of medical interventions that better reflects the common understanding of the term. Using the example of non-invasive prenatal testing, I develop this account and argue that comparisons should only occur between medical interventions of clinically and morally significant differences.

Background: Organ donation improves patient survival and quality of life, yet family refusal is a major barrier. This study aimed to explore the role of family discussions in shaping attitudes and decisions about organ donation in China, while also examining the influencing factors at the individual, family, community and societal levels.

Method: Participatory interviews with family members were conducted based on the social-ecological model (SEM). A snowball sampling strategy was adopted to recruit volunteer interviewers. Of 52 interviewers, 25 completed the family group interviews, involving 94 participants in total. Interviews were audio-recorded and transcribed verbatim within 24 hours. Two researchers coded the data in line with SEM. Themes were identified through an inductive process.

Results: Four themes were identified out of family discussions about deceased organ donation: (i) individual perceptions on the value of lives and organ donation (value of organ donation, death attitudes, knowledge about organ donation), (ii) family consensus and conflicts (family structure, family altruism), (iii) collective conformity (conformity, individualism, negativity bias) and (IV) culture and social environment (traditional beliefs, incentive policy, education, media promotion).

Conclusion: This study is the first to systematically examine the factors influencing deceased organ donation in the Chinese family context. Obtaining family consent for organ donation appears to be challenging in Chinese families due to limited knowledge and traditional beliefs. Incentive policies that benefit the family are crucial. While media promotion is effective in increasing awareness of organ donation, education and family discussions are critical in alleviating fears and misunderstandings about deceased organ donation.

Patient-centred communication is widely regarded as a best practice in contemporary medical care, both in terms of maximising health outcomes and respecting persons. However, not all patients communicate in ways that are easily understood by clinicians and other healthcare professionals. This is especially so for patients with non-speaking intellectual disabilities. We argue that assumptions about intellectual disability-including those in diagnostic criteria, providers' implicit attitudes and master narratives of disability-negatively affect communicative approaches towards intellectually disabled patients. Non-speaking intellectually disabled patients may also be taken to lack decision-making capacity and resultingly, may be given very little role in determining their care. But, given evidence of the heterogeneous communicative practices available to non-speaking patients, efforts should be made to extend patient-centred communication to them. We offer four suggestions for doing so: (1) treating those with non-speaking intellectual disabilities as potential communicators; (2) lengthening appointment times to develop relationships necessary for communication; (3) disentangling capacity from communication in concept and in practice; and (4) recognising the bidirectional connection between supported decision-making and patient-centred communication.

Restraint is regularly used in somatic healthcare settings, and countries have chosen different paths to regulate restraint in somatic healthcare. One overarching problem when regulating restraint is to ensure that patients with reduced decision-making capacity receive the care they need and at the same time ensure that patients with a sufficient degree of decision-making capacity are not forced into care that they do not want. Here, arguments of justice, trust in the healthcare system, minimising harm and respecting autonomy are contrasted with different national regulations. We conclude that a regulation that incorporates an assessment of patients' decision-making capacity and considers the patient's best interests is preferable, in contrast to regulations based on psychiatric diagnoses or regulations where there are no legal possibilities to exercise restraint at all in somatic care.

Background: End-of-life (EOL) care involves providing quality medical attention to the dying patient. It is fraught with some ethical challenges, often underexplored in African settings. This communication presents a qualitative analysis of ethical issues encountered by caregivers and their patients receiving EOL care in a teaching hospital in Nigeria.

Methods: Ethical issues in EOL care encountered by 40 people (dying patients, their families, nurses and doctors) at the University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria, were explored over 2 months. The participants' sociodemographic data were analysed using descriptive statistics, while qualitative data were analysed using a thematic framework. The transcripts were coded using NVivo V.12 software.

Results: All participant groups encountered commonly reported ethical challenges in EOL care, including issues of medical futility, treatment refusal, truthful disclosures, families requesting that a competent patient not be informed about their condition, confidentiality, limiting or withdrawing a treatment, limited or insufficient pain management, conflicting interests in care, an unfair financial burden without the patient consent and an unfair burden on the healthcare system. Additionally, the uncommon issues included the patient's unwillingness to discuss their terminal status, families withdrawing due care and support prematurely and delayed referrals.

Conclusion: Ethical issues are commonly encountered in caring for the patient at EOL in the Nigerian environment, notwithstanding the paucity of literature on them. This underscores the importance of adopting known preventive measures to eliminate or minimise these issues.

Background: Payment of healthy volunteers in medical research is a prevalent practice but is the subject of ethical debate. Although regulations to protect healthy volunteers exist, these regulations differ between countries. Few data are available on the disparities between countries regarding guidance on payment of healthy volunteers in medical research.

Methods: This study aims to analyse guidance regarding payment of healthy volunteers in medical research in different countries, to identify common characteristics and differences, and to assess whether these are ethically significant. To this end, we analysed policies and guidance documents on payment of medical research subjects in the 11 countries with the most clinical trials registered as of 12 December 2022.

Results: 41 guidelines addressing the treatment of research participants were identified. Of these, only six mention healthy volunteers, none of which are legally binding. All guidance documents identified lack details, and none define key terms such as "undue inducement".

Conclusions: Local research ethics committees (RECs) have a huge role in determining what payment is acceptable, but there is little guidance provided for them. This gives RECs the freedom to make context-specific decisions, but also leads to variation in the protection of research subjects. Based on these findings, we make the following recommendations: (1) More countries need guidelines addressing payment of healthy volunteers in medical research. (2) These guidelines need more details than are currently included. (3) RECs also need guidelines to aid them in context-specific decisions on payment of research participants.