Medical Ethics

A doctor works on-and worries about-a way to care for needy patients who use free drug samples from pharmaceutical companies. b y J o n a t h a n H a n O n a s u n n y fa ll m o r n i n g Mr. Waite limped into my office carrying a newspaper. Grinning, he pointed to a front-page article and announced, "You're famous now!" As a family physician practicing in a hardscrabble steel-mill town, I accepted his greeting and assessment with trepidation. It was September 2007, and I hadn't seen Mr. Waite in more than a year. Although he still had the strong handshake and calloused hands that had built a successful construction business, he was now a frail sixty-two-year-old. A few months before his last visit, I'd diagnosed him with prostate cancer, and he'd started radiation and hormone therapy, tolerating numerous side effects with stoic acceptance. Then his health insurance premiums rose to unaffordable heights-and, three months into his cancer treatment, he'd lost his insurance coverage. Unable to afford care on his own, he'd stopped being treated. In the fifteen months since I'd last seen him, he'd developed serious urinary tract problems. Despite his progressive illness and pain, Mr. Waite had worked as much as he could to support his family. It was an all-too-familiar pattern-many patients in similar painful physical and financial straits proudly refuse public assistance. As his untreated prostate cancer grew, his

In this chapter, we reflect on the aim and objectives of the textbook and address known gaps in our theory coverage. We reinforce the importance of theory in health informatics and review the varying disciplinary origins of the theories considered in the book. We discuss the question of what makes a good theory and how to know which one is relevant for a given study. We recognize the limitations of the body of theory that we have presented and suggest what might be regarded as "native" theory that is original to health informatics. Finally, we propose topics to form a research agenda for theory in health informatics.

Objectives: To set the scientific context and then suggest principles for an evidence-based approach to secondary uses of clinical data, covering both evaluation of the secondary uses of data and evaluation of health systems and services based upon secondary uses of data. Method: Working Group review of selected literature and policy approaches. Results: We present important considerations in the evaluation of secondary uses of clinical data from the angles of governance and trust, theory, semantics, and policy. We make the case for a multi-level and multi-factorial approach to the evaluation of secondary uses of clinical data and describe a methodological framework for best practice. We emphasise the importance of evaluating the governance of secondary uses of health data in maintaining trust, which is essential for such uses. We also offer examples of the re-use of routine health data to demonstrate how it can support evaluation of clinical performance and optimize health IT system design. Conclusions: Great expectations are resting upon "Big Data" and innovative analytics. However, to build and maintain public trust, improve data reliability, and assure the validity of analytic inferences, there must be independent and transparent evaluation. A mature and evidence-based approach needs not merely data science, but must be guided by the broader concerns of applied health informatics.

Systematic health IT evaluation studies are needed to ensure system quality and safety and to provide the basis for evidence-based health informatics. Well-trained health informatics specialists are required to guarantee that health IT evaluation studies are conducted in accordance with robust standards. Also, policy makers and managers need to appreciate how good evidence is obtained by scientific process and used as an essential justification for policy decisions. In a consensus-based approach with over 80 experts in health IT evaluation, recommendations for the structure, scope and content of health IT evaluation courses on the master or postgraduate level have been developed, supported by a structured analysis of available courses and of available literature. The recommendations comprise 15 mandatory topics and 15 optional topics for a health IT evaluation course.

Medical practitioners and philosophers both debate what the proper criterion for death is, that is, what empirical signs indicate that a human person ceases to be. This paper considers that debate in light of the Aristotelian-Thomistic or hylomorphic conception of the human person, the view on which we are composites of matter and intellectual soul. After presenting and defending the main ideas of this metaphysics, especially the claims that the soul is the form of an organism's matter, the telos of that matter, and the motor of the body, the paper develops a hylomorphic account of death as loss of functioning, organization, and teleology. It then considers issues of the unity and persistence of the soul, and the idea of the primary organ. The views of other hylomorphists on the brain death and circulatory-respiratory criteria for death are considered, along with the thought experiments often employed by philosophers to consider these criteria, especially Alan Shewmon's cerebrum transplant thought experiments. The paper ultimately contends that, on a hylomorphist view, the in normal situations the best criterion for death is the cessation of the capacity for circulation of oxygenated nutrient-bearing blood, not the cessation of functioning of the whole brain. The hylomorphist can also solve Shewmon's thought experiments, without treating a cerebrum transplant in the same way as a persistent vegetative state or the state of whole brain death, and without encountering the metaphysical problems into which other metaphysics of the human person fall.

Medical negligence remains an underdeveloped yet critical aspect of healthcare law in Nigeria, with many victims unable or unwilling to pursue legal redress despite suffering significant harm. This article examines the legal framework governing medical negligence in Nigeria, with particular focus on the application of the Bolam principle in determining the standard of care expected of medical practitioners. It interrogates the extent to which Nigerian courts have relied on professional medical opinion in adjudicating claims, and whether such reliance adequately protects patient rights or inadvertently shields negligent conduct. The article further considers the influence of the Bolitho qualification, which permits judicial scrutiny of expert medical evidence, and evaluates its relevance within the Nigerian context. This paper highlights the challenges posed by limited judicial pronouncements, and broader socio-legal constraints. It concludes by advocating for more statutory intervention and systemic reforms to enhance accountability and access to justice in cases of medical negligence.
Keywords: Medical Negligence, Bolam Principle, Bolitho

Ebelik, mesleğin getirdiği yetkinlik alanları itibari ile obstetri ve jinekoloji alanlarında birçok adli olaylar ile karşı karşıya gelmektedir. Hukuk, tıbbi adli uygulamalar konusunda bu kadar açık iken sağlık profesyoneli olan ebelerin bu konuda yetersiz bilgiye sahip olması ve olayları tanımlayamaması olayın kendilerinin aleyhlerine dönmesine ayrıca olaylarda yer alan kişilerin zarar görmesine de sebebiyet verebilir. Bu çalışmanın amacı, ebelerin adli ebelik konusundaki bilgi ve deneyimlerini belirlemektir. Tanımlayıcı tipte olan bu çalışma, İstanbul ili Sağlık Bilimleri Üniversitesi Ümraniye Eğitim ve Araştırma Hastanesinde yürütüldü. Araştırmanın örneklemini, hastanede çalışan 117 ebe oluşturdu. Araştırma verilerinin toplanmasında, Tanıtıcı Bilgi Formu ve Ebelerin Adli Olgulara Yaklaşımda Bilgi Düzeylerini Belirlemeye Yönelik Kontrol Listesi Formu kullanıldı. Araştırma verilerinin değerlendirilmesinde tanımlayıcı istatikler, student T testi, MannWhitney-U, Oneway ANOVA, Kruskal-...

Contemporary frameworks in medicine, psychology, and bioethics have significantly improved survival, stabilization, and risk management. However, individuals frequently continue to experience fragmentation in identity, meaning, and internal organization despite receiving appropriate care. This paper identifies a structural limitation within existing ethical systems: their primary focus on protection rather than integration.
Through qualitative conceptual analysis and interdisciplinary literature synthesis, this research develops the Integrative Ethics Framework (IEF), a model that organizes six dimensions of human experience, identity, meaning, language, cognition, narrative, and systems, into a coherent structure. The framework proposes an expansion of ethical practice from boundary-setting toward alignment and internal coherence.
The model is examined across clinical settings and broader socio-economic contexts, including conditions of inequality and limited resources. The findings suggest that while stabilization remains necessary, it is insufficient for sustained human development without integration. This work contributes a theoretical framework for rethinking ethics in medicine and psychology and outlines directions for future empirical research.

The United States has long been a security ally and economic partner of ASEAN members. The strengths of the U.S.-ASEAN partnership include cooperation on regional security, economic growth, and people-to-people ties. The United States also supports ASEAN's efforts to promote regional cooperation and integration through mechanisms such as the ASEAN Regional Forum and the East Asia Summit. Moreover, the United States has demonstrated its commitment to maintaining a free and open Indo-Pacific region, which is consistent with ASEAN's own desire for a rules-based regional order. Due to its strategic presence in the Asia-Pacific region, the United States is considered to play a very important role in ASEAN's soft balance against China. ASEAN's hedging approach and bandwagoning are no longer relevant in the context of rising competition between China and the United States. This paper will explain the causes of China and ASEAN's lack of political and security cooperation. By combing and evaluating current literature discussing the political and security cooperation between ASEAN and ASEAN countries with China and the United States. ASEAN's security policy against China, in particular. This paper's main research method is to explain the adjustment of ASEAN's policy toward China in the context of great power geopolitics through the soft balance theory by analyzing the political and security cooperation between ASEAN and China and the United States, as well as the weapons imported by ASEAN countries from China and the United States.

Professor Cleaton-Jones describes the dilemma faced by South African ethics committees asked to approve clinical trials of treatments for HIV infection. We asked a member of a patient advocacy group, clinical trial coordinators, an ethicist, and a representative of a drug company to give their views Committee for Research on Human Subjects (Medical),

Professor Cleaton-Jones describes the dilemma faced by South African ethics committees asked to approve clinical trials of treatments for HIV infection. We asked a member of a patient advocacy group, clinical trial coordinators, an ethicist, and a representative of a drug company to give their views Committee for Research on Human Subjects (Medical),

There is growing interest from the pharmaceutical industry to sponsor clinical research and development in the developing nations of the world. This expansion is a direct response to the critical need for companies to reduce their development times, thus extending the time over which a product might make a financial return on investment. In supporting such research and development, industry plays an important role in developing further the healthcare systems of selected countries. Research supports the development of infrastructure and enhances the training and experience of healthcare professionals. In return, data that define the potential clinical value of new treatments are generated. This reciprocity is threatened by problems such as the ethical dilemma identified by Professor Cleaton-Jones. The continued provision of study treatment to participants of a trial, as deemed necessary by the treating clinician, after the trial has ended is clearly a complex issue. Resolution will r...

Professor Cleaton-Jones describes the dilemma faced by South African ethics committees asked to approve clinical trials of treatments for HIV infection. We asked a member of a patient advocacy group, clinical trial coordinators, an ethicist, and a representative of a drug company to give their views Committee for Research on Human Subjects (Medical),

T ill recently the management of pain in the newborn was hampered by the lack of awareness among the healthcare professionals that the neonate is capable of perceiving pain . With increasing awareness of pain in neonates, pain relieving measures are undertaken during NICU procedures like endotracheal intubation, heel-prick, chest drain insertion, etc. but not during many other routinely performed procedures . Adhesive tapes are used in neonates for several procedures like fixing of intravenous cannula, arterial lines, temperature probes and endotracheal tubes. Even a simple procedure such as removal of adhesive tape may cause pain in neonates . Currently no pain relieving measures are undertaken during adhesive tape removal in day-to-day practice. Clinical studies have shown beneficial effects of pharmacological as well as non-pharmacological interventions in decreasing neonatal pain and stress [1,3-17]. Non-pharmacological interventions are based on the implementation of neurobehaviorally supportive

Colon perforation is the most serious complication of colonoscopy, and tends to be considered as malpractice. The aim of this study was to identify the characteristics and causes of medical accidents by analyzing lawsuit cases on colon perforation during colonoscopy. We collected judgment results that were ruled from 2005 to 2015 using the keyword 'colonoscopy' in the 'Korea's Written Judgment Public Reading System' of the Supreme Court, and extracted the cases of colon perforation. Characteristics of medical accidents and the decisions of courts were analyzed from written judgments. Twenty-two lawsuits were analyzed. Most cases were ruled in favor of the plaintiff (n = 20). The allegations against defendants, as filed by the plaintiffs, were performance error (n = 22), improper monitoring after colonoscopy (n = 7), and a lack of informed consent (n = 8). The median compensation was 9335.47 US dollars; this is about 130 times the cost of a single colonoscopy in K...

Aims: Colon perforation is the most serious complication of colonoscopy, and tends to be considered as malpractice. The aim of this study was to identify the characteristics and causes of medical accidents by analyzing lawsuit cases on colon perforation during colonoscopy. Methods: We collected judgment results that were ruled from 2005 to 2015 using the keyword of 'colonoscopy' in the 'Korea's Written Judgment Public Reading System' of the Supreme Court, and extracted the cases of colon perforation. Characteristics of medical accidents and the decisions of courts were analyzed from written judgments. Results: Twenty-two lawsuits were analyzed. Most cases were ruled in favor of the plaintiff (n=20). The allegations against defendants, filed by the plaintiffs, were the performance error (n=22), the improper monitoring after colonoscopy (n=7), and the lack of informed consent (n=8). The median compensation was 9,335.47 US dollar, this is about 130 times the cost of a single colonoscopy in Korea. The greater the intestinal damage, the greater the amount of compensation (p=0.016). The time interval from procedure to diagnosis of perforation was most frequently 24 hours later (n=9). Conclusions: It is important to educate patients fully about the symptoms of colon perforation and to guide them to contact medical institutions immediately when symptoms occur. In addition, doctors should explain sufficiently the possibility of perforation before colonoscopy to the patients, not caregiver, and get an informed consent. Medical accidents can be experienced by any doctor, and especially gastroenterologists are always being exposed to risk of developing perforation during colonoscopy.

At the time of writing, parts of the United States are exploding with protests against yet another police killing of a Black man and against the 400 years of systemic oppression, abuse, deprivation, and murder of Black people in a country built on slavery. In response, some British people are calling attention to the United Kingdom's participation in the slave trade and the racial and ethnic discrimination that continues today. Concurrently, the UK COVID-19 death rates are disproportionately high among Black African, Black Caribbean, Bangladeshi, Pakistani, and Indian people, in the UK (OFN 2020; Platt & Warwick 2020), as well as among care home residents, carers, essential workers, and people living with disabilities and pre-existing conditions. The effects of the pandemic demonstrate the systemic social disparities of life and death in the UK. This is the context in which the authors consider Christian pandemic ethics.

rinde üreme endokrinolojisi ve infertilite alanında sunulan bildirilerin yayınlanma oranı ülkemizdeki diğer branşlarda yapılan kongre bildilerine kıyasla yüksek orandadır. Yine de bu oranın arttırılıp yabancı bildirilerle aynı düzeye gelmesi ve Türkiye'de gerçekleştirilen çalışmaların daha geniş çevrelere duyurulabilmesi için araştırmacıları yayına teşvik edici yöntemlerin geliştirilmesi, yayına dönüştürülme oranlarında karşılaşılan düşüklüğün olası sebeplerinin irdelenmesi ve çözülmesi gerektiğine inanmaktayız.

Due to scientific advances in modern medicine, people are now living longer. Not only these developments, but also the decline in birth rates, especially in modern societies, led to the increase of the proportion of the elderly people. As a result, societies are becoming older. While a longer life expectancy is a welcome development, it raises different problems and conflicts, particularly in the field of health care system. These problems are not only medical in nature, but they have also social and ethical dimensions. On the other hand, these problems vary according to the cultural and demographic structure of a society.
At this symposium, we will address the problems arising in the healthcare system due to the aging of societies, considering their social and ethical implications. This approach will be interdisciplinary and intercultural, and the following topics will be addressed during the symposium.
- Medical, Ethical and Social Aspects in the Treatment of the Elderly
- Medical, Ethical and Social Issues in the Treatment of People with Dementia
- Parenteral Nutrition and Ethical Issues
- Treatment of the Elderly in Intensive Care
- Aging and Medical Futility
- Advance Care Planning: Advance Directives in Health Care
- Aging and Palliative Medicine
- Aging and Psychiatry
- The Role of Clinical Ethics Committees and their Implementation
- Ethical, Legal and Social Aspects of AI and New Technologies in Aging Medicine § Interculturality and Aging Medicine

The impact of the U.S-China trade conflict extends beyond both nations' economies to the economies of trade allies and non-trading partners caught in the web of the trade impasse. This paper conducts a sectoral analysis of the trade conflict on the U.S economy using the manufacturing, agriculture, and technology sectors as metrics. We explore data from the databases of the U.S Census Bureau and the U.S Bureau of Economic Analysis from 2001 to 2019. The trade conflict has led to a significant reduction in trades between both nations. The 25% counter tariff imposed by China reduced U.S exports by $30 billion between 2018 and 2019. Primary income receipts declined 10%, and secondary income receipts declined further in the negative territory. China's counter-tariffs increased component costs for the U.S automobile industry, leading to a reduction in the number of new and used vehicles sold during the period. We identify an incentive-driven trade policy framework against the current punitive stance, the resumption of trade negotiations, and leveraging the WTO's instrumentality as measures to resolve the current trade conflict.