Information about a patient's inherited risk of disease has important ethical and legal implications in clinical practice. Because genetic information is by nature highly personal yet familial, issues of confidentiality arise. Counselling and informed consent before testing are important in view of the social and psychological risks that accompany testing, the complexity of information surrounding testing, and the fact that effective interventions are often not available. Follow-up counselling is also important to help patients integrate test results into their lives and the lives of their relatives. Genetic counselling should be provided by practitioners who have up-to-date knowledge of the genetics of and the tests available for specific diseases, are aware of the social and psychological risks associated with testing, and are able to provide appropriate clinical follow-up. Some physicians may elect to refer patients for genetic counselling and testing. However, it is inevitable that all physicians will be involved in long-term follow-up both by monitoring for disease and by supporting the integration of genetic information into patients' lives.
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In 1993, the authors introduced an interdisciplinary course in health care ethics at the University of British Columbia. They were motivated by two convictions: (1) an interdisciplinary approach to health care decision making is best; and (2) every significant health care decision has an ethical component. They wanted to encourage students from the various health care disciplines to participate in interdisciplinary decision making in their future practices by giving them an opportunity to study health care ethics together during their training. The authors give detailed descriptions of the objectives, format, curriculum, and evaluation of this innovative course in the hope that other educators who may want to develop similar courses can learn from their experience.
This paper has summarized a variety of methodological and ethical issues in conducting research with vulnerable women, and has also proposed strategies for dealing with these issues. Because vulnerable women are at increased risk for health problems, it is imperative that nurses and other health-care professionals make strenuous efforts to include vulnerable women in health research.
The new Communicable Diseases Control Act has come into force in Norway. It makes it compulsory for a physician to warn a third party if it is obvious that a HIV-positive patient, with a high degree of certainty, puts the third party at risk of being infected with HIV. Some philosophers characterize medical confidentiality as an intransigent and absolute obligation, others as a prima facie duty. This article supports the latter view, but the author still argues that strict conditions have to be fulfilled before a physician should consider breaking medical confidentiality: The doctor must try repeatedly to gain the consent or co-operation of the patient involved. Possible negative long-term consequences for the preventive HIV-work support strict medical confidentiality.
The author of this paper examines physicians' regard for the confidentiality of medical information in the light of their perception of their own role. Five case studies of increasing complexity of medical management and ethical issues, derived from practice and accompanied by questions relating to confidentiality and medical management, were submitted to randomly selected family physicians in Alberta. Analysis of the replies to determine attitudes to confidentiality and how the respondents perceived patients' best interests, and statements of how they would act in certain situations, disclosed that a substantial minority of the physicians were still prepared to breach confidentiality and exercise Hippocratic professional judgement in certain situations. The bases of confidentiality of medical information are reviewed, together with changing modes of medical ethics and the increasing trend to rights derived from patients, autonomy, and the ways in which these factors may affect the physician-patient relationship.
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