Hasil untuk "Medical philosophy. Medical ethics"

C. Tan, Ruth Neo

Marcial Orlando Cabrera Cantarero, Diana María del Consuelo Arce Sosa

La disponibilidad de tecnología avanzada, la proximidad a medidas terapéuticas especializadas y el personal médico altamente calificado son algunas de las características que convierten a las Unidades de Cuidados Intensivos (UCIs) en piezas imprescindibles en las instituciones hospitalarias. El ingreso de pacientes con patologías complejas, las situaciones de alto estrés emocional, la toma de decisiones cruciales y la resolución de problemas éticamente desafiantes conforman el “día a día” de las UCIs.

Qingqing HUANG

Civil Code of the People's Republic of China stipulates that when a patient "cannot or should not" be informed of their medical condition, such information should instead be disclosed to close relatives. But in practice, the surrogate exercise of cancer patients' right to informed consent by family members has shown signs of expansion and abuse, seriously infringing upon patients' personal rights and dignity. There is a pressing need to regulate the legal interpretation of the "cannot or should not" clause through legislation, judicial interpretations, and guiding case law. The scope of protective medical measures must be narrowly defined, and medical institutions should be granted limited discretionary authority when fulfilling their duty of disclosure. Additionally, a statutory procedure or third-party evaluation mechanism should be established to assess a patient's capacity for medical decision-making. These measures would reduce the legal risk of subrogation of informed consent and better safeguard the rights and interests of patients.

Ming SUN, Lianting LIAO

Emperor Huizong's reverence for Taoism exerted far-reaching influences on society, politics, economy, and culture, with medicine being deeply influenced as well. His medical views were deeply rooted in Taoism. He regarded medicine as a form of Taoist practice and the Yellow Emperor's Inner Canon as a vessel of the "Great Tao". Therefore, in advancing state healthcare, he integrated medical promotion with Taoist reverence, implementing many medical initiatives with Taoist characteristics. These initiatives had complex effects on the development of medicine. On one hand, they elevated medicine from the level of mere "technique" to the realm of "Tao". This elevation enhanced the social status of medicine, expanded the community of "superior physicians", stimulated theoretical discussions and promoted the development of Yunqi theory. As a result, medicine during this era demonstrated a new style that emphasized Tao, valued rational thinking and advocated the study of Yunqi theory. On the other hand, they revived mystical therapies like elixir ingestion and talismanic rituals, endangering public health and medical progress.

Zhe LIN, Ruiwu ZHUANG, Ce ZHANG et al.

Clinical research projects data that were reviewed by the ethics committee of the authors' institution and registered on an online public platform from January 2019 to December 2021 were collected. High-frequency words were identified using the jieba word segmentation and word cloud visualization of Python 3.11.5 to analyze the key points of ethical review and propose reflections. A total of 227 clinical research projects data were collected. High-frequency words were clustered into four categories: disease types, drug applications, protocol design, and participant selection. Based on these findings, four areas for improvement were proposed: strengthening valuation of clinical research on tumors, ensuring rational drug applications, improving the scientific rigor of study design, and protecting the rights and safety of participants. Utilizing data mining techniques to analyze and reflect on clinical research projects data undergoing hospital ethical review can provide key directional cues and decision-making grounds for improving the quality and efficiency of precise ethical reviews in hospitals.

Marcos Antonio Aravena Flores

La experimentación genética con células animales y humanas ha dado lugar a la creación de las denominadas quimeras o animales quiméricos en etapas tempranas de gestación embrionaria, generando desafíos éticos y jurídicos. Desde la perspectiva ética, se enfrenta la visión antropocéntrica con la biocéntrica, mientras que en el ámbito legal se observa una regulación insuficiente que permite o tolera estas prácticas. Frente a ello, este trabajo contribuye a la discusión de estos desafíos y sostiene que la investigación debe desarrollarse con precaución y responsabilidad científica, respetando los límites de la dignidad humana y animal. Aunque la creación de quimeras humano-animales se encuentra en una etapa inicial, el progreso tecnológico sitúa estos experimentos en un punto crítico que limita las fronteras de lo éticamente aceptable, demandando una reflexión profunda sobre las implicancias de estas prácticas en la protección de la dignidad de todas las especies involucradas.

Aldo Houterman

Svava Sigurdardottir

Over the last four decades, Vilhjálmur Árnason professor emeritus in philosophy, has been at the forefront in the academic fields of moral and political philosophy, and medical – and bioethics in Iceland. His research and in-depth understanding of the ethical aspects of medicine and life sciences in Icelandic society are demonstrated by his extensive written work on these issues. In 1993, the first edition of his book Ethics of life and death was published in Iceland, a comprehensive book on ethical issues related to healthcare, research, and public health. A second and improved edition of the book was published in 2003, and a German version in 2004. The third and latest edition was published in August 2023, which takes into account developments in the aforementioned fields in recent years, and as before with a particular focus on Iceland. The contents of this influential book will be discussed in this article, with special emphasis on comparing current subjects with previous editions. Moreover, it will be addressed if and how Árnason‘s thinking and perspective have changed over the years.

R. Valentine

V. Przhilenskiy

The research analyzes the process of formation of the ethics committee as a new institution in the system of regulation of genetic research. The external factors of this process are the increasing digitalization of medical and research practices, as well as the special situation that is developing in the field of genomic research and the use of genetic technologies, where issues of philosophy, jurisprudence and administration have generated many fundamentally new, and sometimes unexpected contexts. The author shows the similarity and difference of approaches to the inclusion of the ethics committee in the national regulatory systems of different countries and determines the prospects for further integration of the new institution into normative and administrative-regulatory and law enforcement practices. The research applies all the main methods of system analysis and structural and functional analysis, as well as the comparative legal method. At the stage of generalization of empirical material, the author turns to the means and methods of philosophical phenomenology and phenomenological sociology. The study revealed that the ethics committee may have different institutional and regulatory functions in a variety of management and legal systems. Being hybrid in nature, the ethics committee performs various functions, and in various state legal systems and traditions it can combine elements of legislative, executive and judicial power. At times, the ethics committee may go beyond the scope of both a purely administrative and exclusively legal regulator. All this indicates that the integration of this institution into the legal system and into a variety of social practices is far from being completed.

Gabrielle Samuel

Abstract Background The health sector aims to improve health outcomes and access to healthcare. At the same time, the sector relies on unsustainable environmental practices that are increasingly recognised to be catastrophic threats to human health and health inequities. As such, a moral imperative exists for the sector to address these practices. While strides are currently underway to mitigate the environmental impacts of healthcare, less is known about how health researchers are addressing these issues, if at all. Methods This paper uses an interview methodology to explore the attitudes of UK health researchers using data-intensive methodologies about the adverse environmental impacts of their practices, and how they view the importance of these considerations within wider health goals. Results Interviews with 26 researchers showed that participants wanted to address the environmental and related health harms associated with their research and they reflected on how they could do so in alignment with their own research goals. However, when tensions emerged, their own research was prioritised. This was related to their own desires as researchers and driven by the broader socio-political context of their research endeavours. Conclusion To help mitigate the environmental and health harms associated with data-intensive health research, the socio-political context of research culture must be addressed.

M. Srivastava, S. Shrivastava, Pradyumn Srivastava et al.

Introduction: Ethics is defined as a system of moral principles or standards governing conduct; a system of principles by which human actions and proposals may be judged good or bad, right, or wrong. However, ethics for medical teachers with respect to their students has been largely unnoted. Therefore, it seems necessary to know the status of teaching ethics practiced by medical educators which are the major assets in good quality medical education. Objectives: The objectives were to study the changes in the understanding and practices of teaching ethics and principles of medical professionals. Methodology: A prospective interventional study had conducted with 30 medical faculties. Results: Only one-third of the medical educators (33.33%) had reported that they have ever read any literature in “Teaching Ethics,” but after e-intervention, this purport increased to 90.48% as indicated by the posttest results. Conclusion: It could be concluded that faculties were quite aware of the basic philosophy of teaching ethics, but they also agreed with the fact that still, medical teaching is not up to the mark as per the norms of teaching ethics, although most of them were not in agreement of those unethical teaching practices.

Suzanne Mistretta

Photo by Amador Loureiro on Unsplash ABSTRACT As English is the predominant language of research protocols in the United States, non-English speaking subjects face language barriers during clinical trial enrollment. Federal regulation 45 C.F.R. 46 requires that a research subject receive information about a clinical trial “in language understandable to the subject or the legally authorized representative." A researcher may enroll a subject using short-form consent when a long-form translation in the subject’s native language is not available. However, the abbreviated short form does not adequately inform the subject of the study’s purpose and potential risks. United States Department of Health and Human Services (HHS) leaders should amend federal guidance to provide specific details on obtaining proper informed consent when there is a language barrier. The code of federal regulations should also establish a standard for quality translation services and interpreters. This paper will review current federal regulations and draft policy, analyze literature describing hospital experiences, and discuss non-compliance areas. This author recommends an amendment to federal policy, which is important because it helps ensure the rights of study participants under the principle of justice. INTRODUCTION As English is the predominant language of research protocols in the United States, non-English speaking subjects face language barriers during clinical trial enrollment. Law requires that a research subject should receive information about a clinical trial “inlanguage understandable to the subject or the legally authorized representative.”[1]This law states that a researcher may enroll a subject using a “short-form” consent when a “long-form” translation in the subject’s native language is not available.[2]However, the abbreviated short form does not adequately inform the subject of the study’s purpose and potential risks. Furthermore, the law does not outline a standard for quality translators. United States Department of Health and Human Services (HHS) leaders should amend federal guidance to provide specific details on obtaining proper informed consent when there is a language barrier.[3]The Code of Federal Regulations should also establish a standard for quality translation services and interpreters. This paper will review current federal regulations and draft policy, analyze literature describing hospital experiences, and discuss non-compliance areas. I. Draft Guidance In 1995, HHS issued a policy memo clarifying the informed consent process for individuals who do not speak English.[4]The policy states that the witness required for the signing of consent documents should be fluent in both languages and that the study team should issue a translated short form.[5]The guidance still does not require an official translator in the short-form process. However, if used, the translator may serve as witness as well.[6]The policy does not mention the translator’s language proficiency requirements or whether the institution must provide the translator.[7] In 2014, HHS issued draft guidance to expand upon the requirements for informed consent. Per its disclaimer, the guidance is non-binding and not intended for implementation.[8]First, the guidance attempts to clarify the phrase “language understandable”, by adding “the information presented to potential subjects is in a language, and at a level they can comprehend, including an explanation of scientific and medical terms.”[9]The draft guidance also notes that all potential research subjects needing translation might have a low level of health literacy and education. Suppose the research subjects expect a non-English speaking group of participants for enrollment. In that case, the guidance suggests that the researchers provide a long-form translation of study materials before an institutional review board (IRB) initial review of the “appropriately translated consent documents (i.e., either a long form or a short  form with written summary).”[10]To satisfy the guidance, researchers would need to provide multiple translations of the same document as the study progresses and the IRB proposes edits to the long-form English document. Because translating the informed consent forms is costly and time-consuming, having a long form available is not always feasible or practical. Foreseeing this problem, HHS outlined three steps for what to do when a subject’s language is not expected or planned for in the population. First, the guidance suggests that the investigator “determine that there is Sufficient Justification to Enroll the Subject Without Using a Translated Long-form to Document the Subject’s Informed Consent.”[11]Although this provision protects non-English-speaking subjects from uninformed consent, it adds a barrier to enrollment. The investigator must justify the registration of the individual based on the individual’s language. The justification process may delay enrollment, placing individuals at a disadvantage based on their language. If the researcher can adequately justify and use the short-form consent process, the investigator must then translate the long-form consent. After the subject starts participating in research, the investigator then provides the long-form translated document. II. Short Form and Noncompliance Vagueness in the federal regulations has caused disparate interpretation among institutions, leading to noncompliance.[12]Each institution has its own interpretation of 45 CFR 46, also known as the Common Rule, which protects vulnerable research subjects and provides research teams with a short-form template.[13]As noted above, the regulations do not require a translator, nor do they specify the translator’s specific role or qualifications.[14]HHS has not made it clear whether the witness may be a member of the study team or related to the patient, or whether the witness providing interpretation must be independent. Furthermore, it is not clear if the witness is overseeing merely the signing of the document or serving as a witness to the informed consent process.[15]In review of noncompliance areas, the institution should clarify the use of short-form consent, the witness’s role, and impose qualification requirements for translators.[16]Each institution will have its own resources and interpretations. Therefore, non-English speakers will find different translation quality across many research institutions. An individual may receive a different research experience and quality of language resources based on location and the degree to which their language was expected by the research team. This barrier is an implicit form of discrimination and violates the principle of justice. III. Equitable Selection of Subjects Minority populations are underrepresented in research due to a lack of cultural competence and language barriers to subject recruitment.[17]Paradoxically, minority populations are most impacted by many of the diseases for which there are clinical trials.[18]In 2015, researchers surveyed 10,000 studies registered on clinicaltrials.gov.[19]The authors found, “English fluency requirements have been increasing over time, from 1.7% of trials having such requirements before 2000 to 9.0% after 2010.”[20]Researchers who often exclude non-English speaking ethnic minorities claim that diversity may impact whether the studied intervention’s effect is noticed.[21]This manipulation of the subject population goes against the principle of justice outlined in the Belmont Report. Of 14,367 clinical research studies registered on clinicaltrials.gov between 2010 and 2020, 18.98 percent required subjects to be fluent in English.[22]Regulations and institutions do not compel researchers to include non-English speaking subjects; the researcher is not breaking any federal regulations by excluding them. From an ethical standpoint, the deliberate exclusion based on an inability to read/write in English is inequitable and unjust. In 2018, researchers reviewed enrollment rates and staff competency for subject enrollment.[23]Researchers found low levels of cultural competency among research staff and a misunderstanding of the federal regulations.[24]In 2005, researchers reviewed the importance of cultural competency training for healthcare providers.[25]Authors synthesized data based on 34 programs and found that competency programs improved provider “knowledge, attitudes, and skills, and patients’ ratings of care.”[26]However, cultural competency programs did not improve or impact patient compliance and health outcomes.[27]Authors requested more research to evaluate cultural training’s impact on researcher bias and attitudes toward subject inclusion.[28] IV. Institutional Barriers In 2018, researchers conducted a review of approximately 1,500 clinical trials at Boston Children’s Hospital and its Anesthesia Research Unit to identify enrollment barriers for non-English-speaking subjects.[29]The researchers discovered that the number of potential non-English speaking subjects increased, while the number of studies approved to enroll non-English speaking subjects did not grow at the same rate.[30]Of 1,492 studies that were open to enrollment between 2011 and 2016, 714 did not allow non-English speaking subjects.[31]The institution cited six barriers to enrollment that precluded these minority-language populations (Table 1).[32] The barriers described in Categories 1, 3, and 5 are due to a lack of translators, funding, or validated translated material. Categories 2, 4, and 6 may reflect an implicit bias on the institution’s part and suggest a lack of cultural understanding. Some researchers[33]called on the institution to increase cultural awareness and to provide resources to address the effects of the language barrier on enrollment.[34]However, with no set standard on the institutional level, it is up to the researchers to address this discrepancy and uphold the principle of justice. The uneven distribution of resources requires the research subjects to counteract their own language barrier. In many clinical cases, as time is of the essence, a person may need to seek several research options before participating in their desired study. Until each institution discloses its barriers and noncompliance, we have no way of knowing the full extent of this problem. V. Policy Recommendations The current HHS regulations and draft guidance are not sufficient to resolve implicit bias and logistical problems that arise when enrolling non-English speaking subjects. HHS should take the following actions. First, HHS should translate short-form consent forms for the most common languages in the US. HHS should then publish the translated documents for use as a template on its website for centers that lack adequate translation resources. Second, HHS should create a federal database of qualified translators who meet language proficiency benchmarks established by HHS. Individuals listed on this database should provide written translation of study materials and verbal translations during the consent process. The database should contain individuals affiliated and unaffiliated with an institution to track credentials and verify language proficiency. Third, HHS should create a federal fund for institutions to draw from when they need resources for long-form translations or translators. HHS should amend the Common Rule to add specificity. It should define the role of the witness in the short-form consent process to eliminate unequal interpretations across study sites. Second, it should mandate that the IRB obtain strong justification for the exclusion of subjects based on English-fluency criteria. Third, it should recommend cultural competency programs for investigators at the institutional level. VI. Limitations The proposed actions and policy may face objections from the federal government and industry. At the federal level, the government may not have the resources or funding needed to establish a nationwide registry of translators or quality check for fluency. HHS may need to develop a separate office to track these credentials and select a proficiency baseline. Perhaps an independent organization should be contracted by the government to perform these quality checks on a regional basis and call on the states to help fund the project. Also, the federal government may not have adequate resources to create a national fund for institutional-level translation services. One solution may be to include a flat rate of translation in the site budget during start-up activities. The government would be responsible for translations for government-sponsored research when the institution cannot feasibly provide a translation. Research centers can pull from the translator database for institutional studies if they cannot translate in-house. For pharmaceutical corporation-led protocols, industry sponsors may not appreciate the added cost of translation. However, by mandating the fee, the government would eliminate systemic discrimination based on English fluency. VII. Support Researchers should show support for more specific guidance on the institutional level, granted they receive adequate resources to meet the regulations. By clarifying the use of a translator and the role of a witness, and establishing common resources, every institution will benefit. Furthermore, it is crucial to hold institutions accountable for supporting cultural competency initiatives. These programs do not need to be intensive or expensive; there are many resources available to the public on websites such as YouTube. Institutions should make cultural competency programming a mandatory requirement for staff training during the orientation and continuing education. Encouraging cultural competency programs will improve provider attitudes and subject treatment. CONCLUSION Federal regulations do not require the use of resources when enrolling a subject who is non-English speaking, nor do they mandate the inclusion of “unexpected” populations based on language. Lack of clarity and specificity on the federal level places the onus of responsibility on the institution to mitigate language barriers. The lack of universal policy leads to an unequal research experience among institutions and locations. Furthermore, clinical trial sponsors may manipulate data based on limiting the study population and engaging in studies that overly represent homogeneous populations. Influencing the study population will skew results and will not lead to generalizable knowledge. To uphold the principle of justice, the research community must gather its resources to support non-English speaking subjects who wish to participate in research. [1]“45 C.F.R. 46 FAQs,” 45 C.F.R. §46.116 (a)(3), Office for Human Research Protections, last modified 2018, https://www.hhs.gov/ohrp/regulations-and-policy/guidance/faq/45-cfr-46/index.html#:~:text=Basic%20regulations%20governing%20the%20protection,were%20first%20published%20in%201974. [2]Office for Human Research Protections, “45 C.F.R. 46 FAQs.” [3]“Protection of Human Subjects, 45 C.F.R.§ 46,” United States Department of Health and Human Services, last modified 2018, https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=83cd09e1c0f5c6937cd9d7513160fc3f&pitd=20180719&n=pt45.1.46&r=PART&ty=HTML. [4]Office for Human Research Protections, 45 C.F.R. §46.117(b)(2), “45 C.F.R. 46 FAQs.”  [5]The researcher can orally present the information to the subject or LAR, with a witness present, and provide a short-form of consent with a brief written summary of the research. [6]“Informed Consent of Subjects Who Do Not Speak English,” Office for Human Research Protections, last modified February 25, 2016, https://www.hhs.gov/ohrp/regulations-and-policy/guidance/obtaining-and-documenting-infomed-consent-non-english-speakers/index.html. [7]Lad, Pramod M., and Rebecca Dahl. "Overcoming Language Barriers in the Informed Consent Process: Regulatory and Compliance Issues With the use of the ‘Short Form.’” Accountability in Research 21, no. 5 (2014): 315-320. https://doi.org/10.1080/08989621.2013.848801. [8]“Informed Consent Information Sheet Guidance for IRBs, Clinical Investigators, and Sponsors Draft Guidance,” Office of the Commissioner, last modified 2014, https://www.fda.gov/media/88915/download. [9]Office of the Commissioner, “Informed Consent Information Sheet Guidance.” [10]Office of the Commissioner, “Informed Consent Information Sheet Guidance.” [11]Office of the Commissioner, “Informed Consent Information Sheet Guidance.” [12]Lad and Dahl, “Regulatory and Compliance Issues.” [13]Lad and Dahl, “Regulatory and Compliance Issues.” [14]Lad and Dahl, “Regulatory and Compliance Issues.” [15]Lad and Dahl, “Regulatory and Compliance Issues.” [16]Lad and Dahl, “Regulatory and Compliance Issues.” [17]Staples, Jeanine N. et al., "Language as a Barrier to Cancer Clinical Trial Accrual: Assessing Consenting Team Knowledge and Practices for Cancer Clinical Trial Consent Among Low English Fluency Patients." Applied Cancer Research 38, no. 1 (2018): 1-7.https://doi.org/10.1186/s41241-018-0065-9. [18]Staples et al., “Language as a Barrier.” [19]Egleston, Brian L. et al., "Characteristics of Clinical Trials That Require Participants to be Fluent in English." Clinical Trials 12, no. 6 (2015): 618-626.https://doi.org/10.1177/1740774515592881. [20]Egleston et al., “Characteristics of Clinical Trials.” [21]Egleston et al., “Characteristics of Clinical Trials.” [22]Muthukumar AV, Morrell W, Bierer BE (2021) Evaluating the frequency of English language requirements in clinical trial eligibility criteria: A systematic analysis using ClinicalTrials.gov. PLoS Med 18(9): e1003758. https://doi.org/10.1371/journal.pmed.1003758 https://doi.org/10.1080/08989620600654043. [23]Staples et al., “Language as a Barrier.” [24]Staples et al., “Language as a Barrier.” [25]Beach, Mary Catherine et al., "Cultural Competency: A Systematic Review of Health Care Provider Educational Interventions." Medical Care 43, no. 4 (2005): 356. https://doi.org/10.1097/01.mlr.0000156861.58905.96. [26]Beach et al., “Cultural Competence,” 8. [27]Beach et al., “Cultural Competence,” 8. [28]Beach et al., “Cultural Competence,” 8. [29]Bernier, Rachel et al., "Inclusion of Non‐English‐Speaking Patients in Research: A Single Institution Experience." Pediatric Anesthesia 28, no. 5 (2018): 415-420. https://doi.org/10.1111/pan.13363. [30]Bernier et al., “Inclusion of Non-English-Speaking Patients.” [31]Bernier et al., “Inclusion of Non-English-Speaking Patients.” [32]Bernier et al., “Inclusion of Non-English-Speaking Patients.” [33]Lad and Dahl, “Regulatory and Compliance Issues.” [34]Bernier et al., “Inclusion of Non-English-Speaking Patients.”

Diana Špoljar, Marinko Vučić, Jasminka Peršec et al.

Abstract Background Decisions about limitations of life sustaining treatments (LST) are made for end-of-life patients in intensive care units (ICUs). The aim of this research was to explore the professional and ethical attitudes and experiences of medical professionals on treatment of end-of-life patients in ICUs in the Republic of Croatia. Methods A cross-sectional study was conducted among physicians and nurses working in surgical, medical, neurological, and multidisciplinary ICUs in the total of 9 hospitals throughout Croatia using a questionnaire with closed and open type questions. Exploratory factor analysis was conducted to reduce data to a smaller set of summary variables. Mann–Whitney U test was used to analyse the differences between two groups and Kruskal–Wallis tests were used to analyse the differences between more than two groups. Results Less than third of participants (29.2%) stated they were included in the decision-making process, and physicians are much more included than nurses (p < 0.001). Sixty two percent of participants stated that the decision-making process took place between physicians. Eighteen percent of participants stated that ‘do-not-attempt cardiopulmonary resuscitations’ orders were frequently made in their ICUs. A decision to withdraw inotropes and antibiotics was frequently made as stated by 22.4% and 19.9% of participants, respectively. Withholding/withdrawing of LST were ethically acceptable to 64.2% of participants. Thirty seven percent of participants thought there was a significant difference between withholding and withdrawing LST from an ethical standpoint. Seventy-nine percent of participants stated that a verbal or written decision made by a capable patient should be respected. Physicians were more inclined to respect patient’s wishes then nurses with high school education (p = 0.038). Nurses were more included in the decision-making process in neurological than in surgical, medical, or multidisciplinary ICUs (p < 0.001, p = 0.005, p = 0.023 respectively). Male participants in comparison to female (p = 0.002), and physicians in comparison to nurses with high school and college education (p < 0.001) displayed more liberal attitudes about LST limitation. Conclusions DNACPR orders are not commonly made in Croatian ICUs, even though limitations of LST were found ethically acceptable by most of the participants. Attitudes of paternalistic and conservative nature were expected considering Croatia’s geographical location in Southern Europe.

Neil Jeyasingam

Abhishek Anicca

This is a poem I wrote in the hospital while recovering from COVID this year. It is always difficult for people to find my veins for inserting an IV and it always turns into a theater of the absurd. This poem talks about that experience in the hope that it also reflects how, everyday, all of us are play pricking, trying to find the veins of our life.

Agustín Antonio Herrera Fragoso

Hoy se vive una grave crisis de valores. A la inmensa mayoría de la humanidad le resulta difícil saber lo que es correcto de lo que no lo es. Es una costumbre utilizar los principios bioéticos expuestos por Beauchamp y Childress, autonomia, no maleficencia, beneficencia y justicia, mismos que deben estar dentro de la ética y del derecho y más aún en la biojurídica. En ese sentido, el presente trabajo realiza un breve recorrido desde la sindéresis, la regla de oro, los principios éticos: mal menor, doble efecto, totali- dad, libertad y responsabilidad, sociabilidad y subsidiariedad en conjunción con los principialistas; por último los que debe utilizar la biojurídica ya reconocidos por Ulpiano junto a sus dos pilares: de prevención y precaución.

Sandip Talukdar

Abstract Background The assessment of patients’ decision-making capacity is ubiquitous in contemporary healthcare. This paper examines the ethics of undisclosed probing of capacity by psychiatrists. The discussion will refer to the law in England and Wales, though the highlighted issues are likely to be relevant in similar jurisdictions. Main text Decision-making capacity is a private attribute, and patients may not necessarily be aware that one of their personal abilities is being explored. Routine exploration of capacity has not historically been a part of psychiatric examination, but it is now difficult to avoid during psychiatric interview.Ethical practice and shared decision-making require patients to be aware that their decision-making may be evaluated by the doctor at some point, and the potential implications of an objective professional conclusion of incapacity. Case law directs that patients should be informed about any assessment of their decision-making ability, though the extent to which this has translated into practice is unclear. However, explanation about the assessment may cause a patient to react negatively, which may impede therapeutic engagement and constitute an ethical dilemma. It is argued that in the absence of systemic measures, professionals should retain the discretion to decide whether a particular patient should be informed about the impending probe into their decision-making ability, or not. In the latter instance, concealment of information about the assessment or its purpose should be subject to the caveats and safeguards associated with any recourse to therapeutic exception. Conclusion The necessity to mandatorily inform patients about assessment of their capacity introduces a novel ethical dilemma for psychiatrists. The negotiation of this dilemma should not be the prerogative of the clinician, and requires systemic initiatives to ensure universal awareness of patients about the possibility of their capacity being assessed during their journeys through healthcare systems.

Rhyddhi Chakraborty 

With its origin in the Hippocrates Oath (5th-3rd Century BC), The Nuremberg Codes (1947), and The Declaration of Helsinki (1964), medical ethics set the rules of the professional conducts for the physicians and other medical specialists. It amounts to the deployment of bioethical concepts, values (Autonomy, Non-maleficence, Beneficence, and Justice) and methods within medical set up to suggest the day-to-day decision-making procedures by combining theory and practice. It is a multidisciplinary study as it seeks to develop a set of guidelines for moral decision-making utilizing the resources of not only medicine and biology, but also of law, philosophy, theology, and the social sciences. As the branch of Bioethics, it investigates the complex ethical problems which arise for human life and society from sophisticated medical-technological usages and biological practices. The problems specifically include the nature and distribution of treatment and medical resources, the informed consent and authority of the patient, the physician and others involved in the medical practices, the scope and limits of confidentiality, the limits of acceptable intervention and experimentation, and the propriety of research involving humans and their applications. It also deals with the questions of moral dimensions and professional responsibilities involving all forms of ‘life-related’ issues such as research involving foetal tissues, withdrawal of life-sustaining medical treatment, issues over death, prenatal diagnosis and abortion, the storage of frozen embryos. Medical ethics is intricately linked to the culture and glocal values. To emphasise such aspect, the following papers come together to enrich this volume.

Daniel Pizzolato, Kris Dierickx

Abstract Background Even though research integrity (RI) training programs have been developed in the last decades, it is argued that current training practices are not always able to increase RI-related awareness within the scientific community. Defining and understanding the capacities and lacunas of existing RI training are becoming extremely important for developing up-to-date educational practices to tackle present-day challenges. Recommendations on how to implement RI education have been primarily made by selected people with specific RI-related expertise. Those recommendations were developed mainly without consulting a broader audience with no specific RI expertise. Moreover, the academic literature lacks qualitative studies on RI training practices. For these reasons, performing in-depth focus groups with non-RI expert stakeholders are of a primary necessity to understand and outline how RI education should be implemented. Methods In this qualitative analysis, different focus groups were conducted to examine stakeholders’ perspectives on RI training practices. Five stakeholders' groups, namely publishers and peer reviewers, researchers on RI, RI trainers, PhDs and postdoctoral researchers, and research administrators working within academia, have been identified to have a broader overview of state of the art. Results A total of 39 participants participated in five focus group sessions. Eight training-related themes were highlighted during the focus group discussions. The training goals, timing and frequency, customisation, format and teaching approach, mentoring, compulsoriness, certification and evaluation, and RI-related responsibilities were discussed. Although confirming what was already proposed by research integrity experts in terms of timing, frequency, duration, and target audience in organising RI education, participants proposed other possible implementations strategies concerning the teaching approach, researchers' obligations, and development an evaluation-certification system. Conclusions This research aims to be a starting point for a better understanding of necessary, definitive, and consistent ways of structuring RI education. The research gives an overview of what has to be considered needed in planning RI training sessions regarding objectives, organisation, and teaching approach.