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Accounting for vulnerability to illness and social disadvantage in pandemic critical care triage.

https://arctichealth.org/en/permalink/ahliterature96997
Source
J Clin Ethics. 2010;21(1):23-9
Publication Type
Article
Date
2010
Author
Chris Kaposy
Author Affiliation
Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada. christopher.kaposy@med.mun.ca
Source
J Clin Ethics. 2010;21(1):23-9
Date
2010
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Critical Care
Cultural Characteristics
Disaster Planning - trends
Disease Outbreaks
Health Care Rationing - ethics
Health Policy - trends
Humans
Indians, North American - statistics & numerical data
Influenza A Virus, H1N1 Subtype - isolation & purification
Influenza, Human - ethnology - mortality - virology
Intensive Care Units - organization & administration - standards
Inuits - statistics & numerical data
Newfoundland and Labrador - epidemiology
Patient Selection - ethics
Prognosis
Risk assessment
Social Class
Triage - methods - organization & administration - standards - trends
Vulnerable Populations
Abstract
In a pandemic situation, resources in intensive care units may be stretched to the breaking point, and critical care triage may become necessary. In such a situation, I argue that a patient's combined vulnerability to illness and social disadvantage should be a justification for giving that patient some priority for critical care. In this article I present an example of a critical care triage protocol that recognizes the moral relevance of vulnerability to illness and social disadvantage, from the Canadian province of Newfoundland and Labrador.
PubMed ID
20465071 View in PubMed
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Adequate trust avails, mistaken trust matters: on the moral responsibility of doctors as proxies for patients' trust in biobank research.

https://arctichealth.org/en/permalink/ahliterature123635
Source
Bioethics. 2013 Nov;27(9):485-92
Publication Type
Article
Date
Nov-2013
Author
Linus Johnsson
Gert Helgesson
Mats G Hansson
Stefan Eriksson
Author Affiliation
Centre for Research Ethics & Bioethics at Uppsala UniversityStockholm Centre for Healthcare Ethics, Karolinska Institutet, Stockholm.
Source
Bioethics. 2013 Nov;27(9):485-92
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Attitude
Biological Specimen Banks
Clinical Competence
Culture
Humans
Morals
Motivation
Patient Selection - ethics
Physician-Patient Relations - ethics
Physicians
Questionnaires
Research
Sweden
Trust
Abstract
In Sweden, most patients are recruited into biobank research by non-researcher doctors. Patients' trust in doctors may therefore be important to their willingness to participate. We suggest a model of trust that makes sense of such transitions of trust between domains and distinguishes adequate trust from mistaken trust. The unique position of doctors implies, we argue, a Kantian imperfect duty to compensate for patients' mistaken trust. There are at least three kinds of mistaken trust, each of which requires a different set of countermeasures. First, trust is mistaken when necessary competence is lacking; the competence must be developed or the illusion dispelled. Second, trust is irrational whenever the patient is mistaken about his actual reasons for trusting. Care must therefore be taken to support the patient's reasoning and moral agency. Third, some patients inappropriately trust doctors to recommend only research that will benefit them directly. Such trust should be counteracted by nurturing a culture where patients expect to be asked occasionally to contribute to the common good.
PubMed ID
22681564 View in PubMed
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Alzheimer disease ethics--informed consent and related issues in clinical trials: results of a survey among the members of the Research Ethics Committees in Sweden.

https://arctichealth.org/en/permalink/ahliterature71207
Source
Int Psychogeriatr. 2003 Jun;15(2):157-70
Publication Type
Article
Date
Jun-2003
Author
Gunbrith Peterson
Anders Wallin
Author Affiliation
Janssen-Cilag AB, Sollentuna, Sweden.
Source
Int Psychogeriatr. 2003 Jun;15(2):157-70
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alzheimer Disease - diagnosis - drug therapy
Attitude of Health Personnel
Clinical Trials - ethics
Comorbidity
Data Collection
Ethics Committees
Ethics, Medical
Ethics, Research
Female
Humans
Informed Consent - legislation & jurisprudence
Legal Guardians
Male
Mental Competency - legislation & jurisprudence
Middle Aged
Patient Participation - legislation & jurisprudence
Patient Selection - ethics
Psychotic Disorders - diagnosis
Research Support, Non-U.S. Gov't
Sweden
Abstract
The rapid advances in biomedical sciences have induced special moral and ethical attitudes, which ought to be taken into account. One of the most essential issues is the principles for participation in research of subjects with reduced decision-making capacity. We conducted a questionnaire survey among members of the research ethics committees in Sweden to find out their attitudes to a range of ethical issues related to research on subjects with Alzheimer's disease. One hundred thirty-six of those approached responded (66%), and 117 of the responses (56%) were considered substantially complete. There were 16 questions with fixed reply alternatives. Some central questions concerned the informed consent process. With a few exceptions, there were no significant differences in attitudes between the experts and laypersons, between persons of different ages, and between men and women. However, women and laypersons were in general keener to preserve the patient's integrity and the experts were more willing than the laypersons to allow participation of subjects with dementia in placebo-controlled trials.
PubMed ID
14620074 View in PubMed
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Are Canadians providing advance directives about health care and research participation in the event of decisional incapacity?

https://arctichealth.org/en/permalink/ahliterature135134
Source
Can J Psychiatry. 2011 Apr;56(4):209-18
Publication Type
Article
Date
Apr-2011
Author
Gina Bravo
Marie-France Dubois
Carole Cohen
Sheila Wildeman
Janice Graham
Karen Painter
Suzanne Bellemare
Author Affiliation
Department of Community Health Sciences, University of Sherbrooke, Sherbrooke, Quebec. Gina.Bravo@USherbrooke.ca
Source
Can J Psychiatry. 2011 Apr;56(4):209-18
Date
Apr-2011
Language
English
Publication Type
Article
Keywords
Adult
Advance Care Planning - ethics - organization & administration - statistics & numerical data
Advance Directive Adherence - standards
Advance Directives - ethics - psychology
Aged
Attitude of Health Personnel
Bioethical Issues
Canada
Choice Behavior
Decision Making
Female
Health services needs and demand
Humans
Male
Mental Competency
Middle Aged
Patient Advocacy
Patient Participation - psychology
Patient Rights
Patient Selection - ethics
Physician-Patient Relations - ethics
Abstract
Advance planning for health care and research participation has been promoted as a mechanism to retain some control over one's life, and ease substitute decision making, in the event of decisional incapacity. Limited data are available on Canadians' current advance planning activities. We conducted a postal survey to estimate the frequency with which Canadians communicate their preferences about health care and research should they become incapacitated.
We surveyed 5 populations (older adults, informal caregivers, physicians, researchers in aging, and research ethics board members) from Nova Scotia, Ontario, Alberta, and British Columbia. We asked respondents whether they had expressed their preferences regarding a substitute decision maker, health care, and research participation in the event of incapacity.
Two out of 3 respondents (62.0%; 95% CI 59.1% to 64.8%) had been advised to communicate their health care preferences in advance. Oral expression of wishes was reported by 69.1% of respondents (95% CI 66.8% to 71.3%), and written expression by 46.7% (95% CI 44.3% to 49.2%). Among respondents who had expressed wishes in advance (orally or in writing), 91.2% had chosen a substitute decision maker, 80.9% had voiced health care preferences, and 19.5% had voiced preferences regarding research participation. Having been advised to communicate wishes was a strong predictor of the likelihood of having done so.
Advance planning has increased over the last 2 decades in Canada. Nonetheless, further efforts are needed to encourage Canadians to voice their health care and research preferences in the event of incapacity. Physicians are well situated to promote advance planning to Canadians.
PubMed ID
21507277 View in PubMed
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Balancing relevant criteria in allocating scarce life-saving interventions.

https://arctichealth.org/en/permalink/ahliterature97418
Source
Am J Bioeth. 2010 Apr;10(4):56-8
Publication Type
Article
Date
Apr-2010
Author
Erik Nord
Author Affiliation
Department of Mental Health, Norwegian Institute of Public Health, Oslo, 1403, Norway. erik.nord@fhi.no
Source
Am J Bioeth. 2010 Apr;10(4):56-8
Date
Apr-2010
Language
English
Geographic Location
Norway
Multi-National
Publication Type
Article
Keywords
Adolescent
Adult
Aging
Decision Making - ethics
Great Britain
Health Care Rationing - ethics
Humans
Infant
Life expectancy
Morals
Norway
Patient Selection - ethics
Prognosis
Quality-Adjusted Life Years
Social Justice
Social Values
Young Adult
Notes
RefSource: Am J Bioeth. 2010 Apr;10(4):37-45
PubMed ID
20379926 View in PubMed
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Challenging the rhetoric of choice in prenatal screening.

https://arctichealth.org/en/permalink/ahliterature153701
Source
Bioethics. 2009 Jan;23(1):68-77
Publication Type
Article
Date
Jan-2009
Author
Victoria Seavilleklein
Author Affiliation
University of Toronto, Toronto, Ontario, Canada. v.seavilleklein@utoronto.ca
Source
Bioethics. 2009 Jan;23(1):68-77
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Canada
Choice Behavior - ethics
Humans
Informed Consent - ethics - psychology
Mass Screening - ethics - psychology
Parents - psychology
Patient Acceptance of Health Care - psychology
Patient Education as Topic - ethics
Patient Selection - ethics
Personal Autonomy
Prenatal Diagnosis - ethics - psychology
Reproductive Rights - ethics - psychology
Abstract
Prenatal screening, consisting of maternal serum screening and nuchal translucency screening, is on the verge of expansion, both by being offered to more pregnant women and by screening for more conditions. The Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists have each recently recommended that screening be extended to all pregnant women regardless of age, disease history, or risk status. This screening is commonly justified by appeal to the value of autonomy, or women's choice. In this paper, I critically examine the value of autonomy in the context of prenatal screening to determine whether it justifies the routine offer of screening and the expansion of screening services. I argue that in the vast majority of cases the option of prenatal screening does not promote or protect women's autonomy. Both a narrow conception of choice as informed consent and a broad conception of choice as relational reveal difficulties in achieving adequate standards of free informed choice. While there are reasons to worry that women's autonomy is not being protected or promoted within the limited scope of current practice, we should hesitate before normalizing it as part of standard prenatal care for all.
PubMed ID
19076943 View in PubMed
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Clinical trials in Canada: whose interests are paramount?

https://arctichealth.org/en/permalink/ahliterature155515
Source
Int J Health Serv. 2008;38(3):525-42
Publication Type
Article
Date
2008
Author
Joel Lexchin
Author Affiliation
School of Health Policy and Management, York University, Toronto, ON, Canada. jlexchin@yorku.ca
Source
Int J Health Serv. 2008;38(3):525-42
Date
2008
Language
English
Publication Type
Article
Keywords
Canada
Clinical Trials as Topic - ethics
Conflict of Interest
Drug Approval
Drug Industry - ethics
Ethics, Research
Humans
Patient Selection - ethics
Research Support as Topic - ethics
Abstract
More than 80 percent of clinical drug trials in Canada are funded by the pharmaceutical industry. This article evaluates the overall state of clinical trials in Canada and looks at the interplay between public and private interests. Health Canada has adopted standards developed by the International Conference on Harmonization, a body that is heavily influenced by industry. Commercial interests are increasingly involved in recruiting patients into clinical trials and in running these trials. It is in industry's interests to conduct drug tests on people for which it is easiest to see benefits. These interests are not fundamentally challenged by Health Canada's policy of issuing nonmandatory guidelines on who should and should not be included in clinical trials. The outcome of clinical trials is heavily influenced by commercial sponsorship, with the result that trials may favor corporate interests rather than the interests of the public. How Health Canada deals with that possibility is not known, because of its strict policy of treating clinical trial data as private property. If clinical trials are to serve the purpose for which they are designed, developing reliable and objective information about new drugs, then commercial interests cannot be allowed to take precedence over health interests.
PubMed ID
18724580 View in PubMed
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Community-building versus career-building research: the challenges, risks, and responsibilities of conducting research with Aboriginal and Native American communities.

https://arctichealth.org/en/permalink/ahliterature3870
Source
J Cancer Educ. 2005;20(1 Suppl):41-6
Publication Type
Article
Date
2005
Author
Terry Leigh Mitchell
Emerance Baker
Author Affiliation
Native American Cancer Research, Pine, CO 80470-7830, USA.
Source
J Cancer Educ. 2005;20(1 Suppl):41-6
Date
2005
Language
English
Publication Type
Article
Keywords
Biomedical Research - ethics - methods
Breast Neoplasms - ethnology
Canada
Community-Institutional Relations
Consumer Participation - methods
Cultural Characteristics
Female
Genital Neoplasms, Female - ethnology
Humans
Indians, North American
Inuits
Patient Selection - ethics
Research Support, Non-U.S. Gov't
United States
Abstract
BACKGROUND: The Aboriginal Women's Cancer Care Project used a participatory research model guided by an Aboriginal advisory group. METHODS: The researchers attempted to conduct cancer research with 5 culturally and geographically different communities in North America. RESULTS: We discuss the challenges of conducting ethical research in keeping with the emergent research principles of community ownership and control of the research process and products. CONCLUSIONS: Although there are many perils for researchers and communities in conducting participatory research, clearer practice guidelines will ensure that research in Aboriginal communities will increasingly prioritize community- versus career-building outcomes.
PubMed ID
15916520 View in PubMed
Less detail

A comprehensive analysis of MRI research risks: in support of full disclosure.

https://arctichealth.org/en/permalink/ahliterature164724
Source
Can J Neurol Sci. 2007 Feb;34(1):11-7
Publication Type
Article
Date
Feb-2007
Author
Jennifer Marshall
Toby Martin
Jocelyn Downie
Krisztina Malisza
Author Affiliation
Health Law Institute, Dalhousie University, Halifax, NS.
Source
Can J Neurol Sci. 2007 Feb;34(1):11-7
Date
Feb-2007
Language
English
Publication Type
Article
Keywords
Biomedical Research - ethics - standards
Canada
Consent Forms - ethics - standards
Disclosure - ethics - legislation & jurisprudence - standards
Electromagnetic fields - adverse effects
Humans
Magnetic Resonance Imaging - adverse effects - ethics - standards
Panic Disorder - etiology - prevention & control - psychology
Patient Selection - ethics
Risk Assessment - ethics - standards
Abstract
Magnetic resonance imaging (MRI) procedures have been used for over 20 years. This modality is considered relatively safe and holds great promise. Yet, MRI has a number of risks. In order for MRI research to meet the Canadian standard of disclosure, the investigator must communicate and make note of all risks in their research protocols and consent forms. Those creating and reviewing research protocols and consent forms must take notice of the different circumstances under which MRI poses a risk. First, this paper will describe the current standard of disclosure in Canada for research participants. Second, the paper will provide a comprehensive synthesis of the known physical and psychological risks associated with MRI. Third, the paper will provide recommendations concerning areas for further investigation and risk reduction strategies. This information will thus equip researchers and research ethics boards (REBs) with the criteria needed for the composition of research protocols that meet the Canadian disclosure standard.
PubMed ID
17352342 View in PubMed
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42 records – page 1 of 5.