PRECLINICAL STUDENTS' VIEWS ON MEDICAL ETHICS EDUCATION: A FOCUS GROUP STUDY IN TURKEY
We aimed to receive the opinions of the preclinical medical students on medical ethics education, and to present some suggestions for the education program.
A COMPARATIVE ANALYSIS OF BIOETHICAL ISSUES FROM VIEW POINTS OF RELIGIOUS AFFAIRS ADMINISTRATION IN TURKEY, ROMAN CATHOLICISM AND ORTHODOX JUDAISM
The arguments set forth by religious authority are important since they play a crucial role in shaping the social values of the public and influence the decision of individuals in practice pertaining to bioethical issues. The Religious Affairs Administration (RAA) was established at the inception of the Republic of Turkey in 1924 to guide religious considerations moving out of the Ottoman caliphate to a secular bioethical framework. In this article, the bioethical views of the RAA under Islamic tradition is examined and contrasted with those influenced by the Roman Catholic and Orthodox Judaic traditions. On bioethical deliberations related to the beginning and end-of-life, all three religious traditions justify sacredness of life and that of God's will in its preservation it. Assisted reproduction techniques between spouses is considered to be appropriate, although third party involvement is explicitly forbidden. Organ transplantation is approved by all three religious traditions, except uterine transplantation. Contraceptive practices are approved under certain conditions - views differ most on approaches to contraception and the appropriateness of methods. The RAA judgement on cloning is to prohibit it, like Roman Catholicism and Orthodox Judaism. In other topics, cosmetic surgery and gender determination are approved only for treatment.
THE ETHICS OF OCCUPATIONAL HEALTH AND SAFETY IN TURKEY: RESPONSIBILITY AND CONSENT TO RISK
Work-related diseases, injuries, risks and deaths are the issues that have been recently gaining importance especially in developing countries. The ethical dimensions of occupational health and safety have remained as relatively understudied areas. Concepts such as responsibility, consent, autonomy, paternalism, choice, and certain values or justifications that are used in medical ethics and bioethics are also applicable to occupational health and safety. This article examines the ethical issues of responsibility and consent to occupational risk. It will first define the concepts of consent and risk, and then different views on responsibility and consent to risk will be discussed. The article will also examine the responsibility of the society and government regarding these concepts.
Enhancing John Rawls's Theory of Justice to Cover Health and Social Determinants of Health
The vast improvements in medical technology reviled the crucial role of social determinants of health for the etiology, prevalence and prognosis of diseases. This changed the content of the right to health concept from a demand of health services, to a claim of having access to all social determinants of health. Thus, the just allocation of scarce resources of health and social determinants of health became an issue of ethical theories. John Rawls developed a theory of justice. His theory suggests that the principles of justice should be determined by individuals in a hypothetic initial position. In the initial position, individuals agree on principles of justice. Rawls puts forth that the institutions of the society should be structured in compliance with these principles to reach a fair social system. Although Rawls did not justify right to health in his theory, the efforts to enlarge the theory to cover right to health flourished quite fast. In this paper first the basic components of Rawls theory is explained. Then the most outstanding approaches to enlarge his theory to cover right to health is introduced and discussed within the discourse of Rawls theory of justice.
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This article presents the experience acquired by participating in the international ethics of biomedical and psychosocial research training program of the Interdisciplinary Center for Studies on Bioethics of the University of Chile (2003-2004) and some reflections about the integration of knowledge acquired in my posterior work at scientific ethical review committees and ethics of research academic programs. Furthermore, in the elaboration of regulations for improving scientific and ethical review.
[Experiences and impact of an ethics of research training.]
This article has the purpose to describe achievements and impact of the ethics of research training at the Interdisciplinary Center for Studies on Bioethics of the University of Chile, which has served as incentive, motivation and guide for professionals which require knowledge, regulations application and dialogue skills to reflect on problems of this discipline. Furthermore, it describes how this knowledge generates a multiplying effect in aspects such as participation in scientific ethical review committees, course organization and the creation and development of research lines, which generate publications by post degree students. It also narrates didactic contents and strategies which could be applied in ethics and bioethics courses for oral health students and concludes mentioning practical applications of this training for teaching, research and institutional development.
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Argentina ha sido un campo fértil para los intentos de reforma del sector salud, en la búsqueda por mejorar la calidad de sus servicios y, consecuentemente, la accesibilidad y la equidad del mismo. Los resultados obtenidos no han sido proporcionales a los esfuerzos desarrollados. Aunque la bioética debería, como forma de reflexión interdisciplinaria, participar en la fundamentación de nuevas políticas sanitarias y sus efectos sobre los usuarios, parece haber permanecido ajena, en general, a los graves problemas derivados de la corrupción, prefiriendo enfocarse en cuestiones vinculadas a planteos abstractos de justicia y solidaridad, atribuyendo los fracasos a la imposición de modelos económicos foráneos.
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Este artículo reporta un estudio realizado en las ciudades de La Paz, Cochabamba, y Santa Cruz en Bolivia. Interesaba saber cuál era la situación de la bioética en Bolivia y cómo se estaba protegiendo a los sujetos de investigación.Luego de revisar algunos conceptos bioéticos, la legislación boliviana y los métodos del estudio, se dan a conocer los resultados del mismo, los cuales revelan gran desconocimiento respecto de cómo proteger los derechos de los sujetos, por la casi ausencia o el inadecuado funcionamiento de los comités de ética de la investigación.
DISYUNTIVAS EN LAS CONCEPCIONES SOBRE AUTONOMÍA Y BENEFICENCIA QUE AFECTAN LA TERAPÉUTICA DEL INTENTO SUICIDA
El objetivo del trabajo es conocer las disyuntivas entre los principios de beneficencia y autonomía, que se presentan en la relación médico-paciente, durante la terapéutica del intento de suicidio.La investigación se realizó en dos hospitales psiquiátricos de la Ciudad de México. La muestra incluyó a tres sujetos con intento de suicidio, mayores de 18 años, que eran atendidos en consulta externa a causa de una lesión autoinfligida en el último año, y a tres psiquiatras que trataban a estos pacientes. La información se obtuvo previo consentimiento informado en entrevistas individuales. Se llevó a cabo un análisis de discurso argumentado para encontrar los significados que los participantes otorgaron a los principios bioéticos y las posibles disyuntivas entre éstos.Las discordancias entre la beneficencia y la autonomía estuvieron relacionadas con el beneficio del tratamiento, el respeto por los valores y las creencias de los pacientes, entre otros. Este trabajo presenta consideraciones éticas relevantes en el escenario clínico, al ofrecer al psiquiatra un análisis bioético que le permita actuar de acuerdo con la beneficencia y respetando la autonomía del paciente frente a casos de intento de suicidio y, de esta forma procurar una mejor atención para ellos.
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This study evaluates up to which degree physicians of Hospital Dr. Dario Contreras of Dominican Republic know, respect, inform and apply the General Health Law in relation to the right of Jehovah witness patients to refuse being blood transfused (respect to their autonomy). It also evaluates whether Jehovah witnesses know General Health Law and in which degree they have been benefited by putting it into practice. The study reveals that Jehovah Witnesses do not know the law.
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OBJECTIVE: To establish a diagnosis of the insertion of bioethics, ethics and humanistic values and attitudes to the program of the Medical School of ESCS - Escola Superior em Ciências da Saúde, public school of medicine, Distrito Federal, Brazil, in order to contribute to the process of curricular management. METHODOLOGY: The study is cohorte and documental. Thirty-two indicators to the thematic on ethics and twenty-four related to humanization were utilized. The educational purpose and contents of activities in modules such as thematic, abilities, interaction and attitude towards the community for teaching and services, from first to senior years as well as in boarding schools programs were all analyzed in the Medical School curriculum of ESCS (2006) and about the pedagogic project of the Course (2001). RESULTS: It was observed a greater insertion of thematic related to ethics and bioethics in the initial levels of the course, Freshman and Sophomore including boarded students, when compared to the insertion in Junior and Senior clerkship years (IC95%-alpha=0,034, pvalue=0,007). The unit on abilities and attitudes was the axle which presented greater recurrence of the thematic on humanization in programs of 1 and 4 years (IC95%-alpha=0,026, pvalue=0,013). It was observed an increase in the recurrence of the thematic on humanization developed in thematic modules and interaction community-teaching/service in the 2 year and decline in the subsequent ones. The results were very low in the 3 and 4 years. When compared with the clerkship it was observed that the first four series had greater insertion of such thematic (IC95%-alpha=0,042, pvalue=0,029). CONCLUSION: The academic program developed in the year of 2006 at ESCS presented improvements when compared to the pedagogical project of the course.
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This article examines the epistemological statute of bioethics as an academic discipline. The author claims that the epistemological statute of a dialogue determines the fundamental question that is raised and the answer that is sought, essential points of discourse. In the case of bioethics, the fundamental question is of a moral nature. Therefore, bioethics is an ethical discipline that has its epistemological roots in philosophy. The author also defends the concept of applied ethics. Finally, he suggests that bioethical methods, above all especially what is realized in our latitudes, should adopt the Hermeneutic Circle as the methodology for its philosophizing.
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This article reflects on the ten years experience of group learning processes and skills acquisition by trainees of the ethics of biomedical and psychosocial research international training program from the Interdisciplinary Center for Studies on Bioethics of the University of Chile, Fogarty Grant R25TW6056. It takes into consideration the role of bioethics in training in its transdisciplinary character.
Experiencias sobre el impacto del Programa de Formación en Ética de la Investigación Biomédica y Psicosocial en el ámbito de la salud mental y la investigación conductual
El propósito de este trabajo es presentar el impacto y la integración que los conocimientos adquiridos en el Programa Internacional de Formación en Ética de la Investigación Biomédica y Psicosocial de la Universidad de Chile han tenido en mi experiencia profesional, en el ámbito de la investigación psicosocial en un Instituto de Salud de México. Para este objetivo, expondré tres áreas en las cuales se ha podido evidenciar tal impacto: trabajo en los comités de ética, desarrollo de programas de académicos en bioética e investigación y publicación sobre ética y bioética. El motivo que me llevó a incursionar en el Programa fue que su enseñanza vincula la investigación psicosocial con la ética y la bioética, lo cual me permitió dirigir este tipo de reflexión hacia problemas como violencia, suicidio, adicciones, depresión y salud mental, y a nuevos campos como los estudios comunitarios, con poblaciones en riesgo o vulnerables, en los cuales las diversas implicaciones son difíciles de indagar.
Ethics in psychosocial and biomedical research - A training experience at the Interdisciplinary Center for Bioethics (CIEB) of the University of Chile()
This paper reviews the experience in training Latin American professionals and scientists in the ethics of biomedical and psychosocial research at the Interdisciplinary Center for Studies in Bioethics (CIEB) of the University of Chile, aided by a grant from Fogarty International Center (FIC) - National Institutes of Health from 2002 to 2011. In these 10 years of experience, 50 trainees have completed a 12-month training combining on-line and in-person teaching and learning activities, with further support for maintaining contact via webmail and personal meetings. The network formed by faculty and former trainees has published extensively on issues relevant in the continent and has been instrumental in promoting new master level courses at different universities, drafting regulations and norms, and promoting the use of bioethical discourse in health care and research. Evaluation meetings have shown that while most trainees did benefit from the experience and contributed highly to developments at their home institutions and countries, some degree of structuring of demand for qualified personnel is needed in order to better utilize the human resources created by the program. Publications and other deliverables of trainees and faculty are presented.