Laws in China relating to HIV disclosure are inconsistent. After a patient has tested HIV-positive, service providers struggle to dec.

There is a growing interest in ethical competence-building within nursing and health care practising. This tendency is accompanied by a remarkable growth of ethical guidelines. Ethical demands have also been laid down in laws. Present-day practitioners and researchers in health care are thereby left in a virtual cross-fire of various legislations, codes, and recommendations, all intended to guide behaviour. The aim of this paper was to investigate the role of ethical guidelines in the process of ethical competence-building within health care (...) practice and medical research. A conceptual and critical philosophical analysis of some paragraphs of the Helsinki Declaration and of relevant literature was performed. Three major problems related to ethical guidelines were identified, namely, the interpretation problem (there is always a gap between the rule and the practice, which implies that ethical competence is needed for those who are to implement the guidelines); the multiplicity problem (the great number of codes, declarations, and laws might pull in different directions, which may confuse the health care providers who are to follow them); and the legalisation problem (ethics concerns may take on a legal form, where ethical reflection is replaced by a procedure of legal interpretations). Virtue ethics might be an alternative to a rule based approach. This position, however, can turn ethics into a tacit knowledge, leading to poorly reflected and inconsistent ethical decisions. Ethical competence must consist of both being (virtues) and doing (rules and principles), but also of knowing (critical reflection), and therefore a communicative based model is suggested. (shrink)

In the last quarter of 2024 four articles on survival after death were published online ahead of print in the International Review of Psychiatry. Two of these included gratuitous attempts to discredit the work of a well-known survival critic. After correcting these misrepresentations, in this response Keith Augustine lays out how those who appeal to survival research to support their beliefs bungle their purportedly scientific assessments of the evidence concerning whether or not individual human minds survive death in a discarnate (...) state (without a normal physical body). The response also lays out why the still-common arguments that the late eminent thanatologist Robert Kastenbaum offered in favor of a discarnate afterlife are fallacious. It canvasses erroneous tropes about discovering white crows and the supposed impossibility of proving negatives, how scientific facts are established as highly probable, how psychical research is grounded on fallacious arguments from ignorance, and when all else fails, how survival researchers resort to psychologizing their critics rather than address their critics' arguments. Their collective failure to engage their critics' actual arguments raises the issue of whether survival proponents are able to adequately answer them—and if not, why not. Augustine submits that they are unable to answer their critics because the scientific evidence against their afterlife beliefs is incredibly strong. 1. Introduction -- 2. Gregory Shushan -- 3. Andreas Sommer -- 3.1 The Irrelevance of My Work to Sommer’s Thesis -- 3.2 How My Use is Comparable to What Robert Kastenbaum Intended -- 3.3 Sommer’s Characterization of The Myth of an Afterlife -- 3.4 The Context of What Kastenbaum was Trying to Do -- 3.5 Where Kastenbaum Fell on the Survival Question—and Why -- 3.5.1 Fallacious White Crows -- 3.5.2 Proof, Certainty, and Proving Negatives -- 3.5.3 Causal Ignorance is not Causal Evidence -- 3.5.4 Psychologizing Opponents -- 4. Conclusion: A Belief in Search of Evidence, or Evidence-Driven Belief? (shrink)

Medical personnel sometimes face a seeming conflict between a duty to respect patient confidentiality and a duty to warn or protect endangered third parties. The conventional answer to dilemmas of this sort is that, in certain circumstances, medical professionals have an obligation to breach confidentiality. Kenneth Kipnis has argued, however, that the conventional wisdom on the nature of medical confidentiality is mistaken. Kipnis argues that the obligation to respect patient confidentiality is unqualified or absolute, since unqualified policies can save more (...) lives in the long run. In this paper, I identify the form of Kipnis’s argument and present a challenge to it. I conclude that, as matters stand now, a qualified confidentiality policy is the more rational choice. (shrink)

While it is acknowledged that there is a need for more qualitative research on suicide, it is also clear that the ethics of undertaking such research need to be addressed. This article uses the case study of the authors’ experience of gaining ethics approval for a research project that asks people what it is like to feel suicidal to (a) analyse the limits of confidentiality and anonymity and (b) consider the ways in which the process of ethics review can shape (...) and constrain suicide research. This leads to a discussion of the ways in which ethics committees assess and monitor qualitative research more generally and some preliminary suggestions for how this might be improved. (shrink)

Confidentiality is a core value in medicine and public health yet, like other core values, it is not absolute. Medical ethics has typically allowed for breaches of confidentiality when there is a credible threat of significant harm to an identifiable third party. Medical ethics has been less explicit in spelling out criteria for allowing breaches of confidentiality to protect populations, instead tending to defer these decisions to the law. But recently, issues in military detention settings have raised the profile of (...) decisions to breach medical confidentiality in efforts to protect the broader population. National and international ethics documents say little about the confidentiality of detainee medical records. But initial decisions to use detainee medical records to help craft coercive interrogations led to widespread condemnation, and might have contributed to detainee health problems, such as a large number of suicide attempts several of which have been successful. More recent military guidance seems to reflect lessons learned from these problems and does more to protect detainee records. For the public health system, this experience is a reminder of the importance of confidentiality in creating trustworthy, and effective, means to protect the public's health. (shrink)

CITATION: Ewuoso, C., Hall, S. & Dierickx, K. 2017. How do healthcare professionals manage ethical challenges regarding information in healthcare professional/patient clinical interactions? a review of concept- or argument-based articles and case analyses. South African Journal of Bioethics and Law, 10:75-82, doi:10.7196/SAJBL.2017.v10i2.610.

The American Journal of Bioethics, Volume 11, Issue 11, Page 44-45, November 2011.

In his deftly argued, “A Defense of Unqualified Confidentiality” (Kipnis 2006), Kenneth Kipnis challenges the received view that a physician's duty of confidentiality must be balanced against a dut...

Kenneth Kipnis (2006) presents a normative defense of strict confidentiality, but it follows from an empirical claim that allowing breach would result in all parties being worse off, including, par...

Laws in China relating to HIV disclosure are inconsistent. After a patient has tested HIV‐positive, service providers struggle to decide who should be informed first: patients, family members, or both. To understand service providers' attitudes and practices regarding the HIV notification process in China, 1101 service providers from a southwestern province of China were surveyed. Opinions were gathered from providers at five different levels of health care facilities (provincial, city, county, township and village). A mixed methods approach was used to (...) analyze perceptions of informing family members of a patient's HIV status. Quantitative analysis was used to examine whether providers held a favorable attitude toward notifying family members first and qualitative analysis was used to explore the reasons and consequences of notifying family members first. Nearly half of service providers felt family members should be informed of a patient's HIV status first. Providers who were older, had contact with HIV patients, or had less medical education were more likely to agree with a family‐first notification practice. Psychological pressure, concern about protecting family members, the need for family support, and consideration for local regulations were cited as the main reasons for this practice. There is an immediate need to re‐examine HIV notification policies so that there are consistent guidelines and procedures for providers throughout China. (shrink)

Ethical questions about confidentiality arise when patients refuse to inform relatives who are at risk of a genetic condition. Specifically, healthcare providers may struggle with the permissibility of breaching confidentiality to warn patients’ at-risk relatives. In exploring this issue, several authors have converged around the idea that genetic cases differ from non-genetic cases (e.g., involving a threat of violence or the spread of an infectious disease) along two related dimensions: (1) In genetic cases, the risk of harm is already present (...) in an at-risk third party, whereas in non-genetic cases, it is not; and (2) In genetic cases, the patient does not create a risk of harm to a third party, whereas in non-genetic cases, the patient does. I argue that these distinctions do not exclusively differentiate genetic from non-genetic cases and should not bear on the permissibility of breaching confidentiality. Instead, such determinations should be based on other considerations. (shrink)

The American Journal of Bioethics, Volume 11, Issue 11, Page 31-38, November 2011.

From the beginning, a code of ethics for bioethicists has been conceived of as part of a movement to professionalise the field. In advocating for such a code, Baker repeatedly identifies ‘having a code of ethics’ with ‘professionalization’. The American Society of Bioethics and Humanities (ASBH) echoes this view in their code of ethics for healthcare ethics consultants (HCECs)1 and the subsequent publication in the American Journal of Bioethics.2 Taking for granted that a code of ethics could be a valuable (...) asset for HCECs, this essay has two aims. First, there are good reasons to doubt that the label ‘profession’ has significant meaning for HCECs. Attempts to accurately conceive of a profession fall into two broad camps: substantive and formal. Substantive conceptions should be rejected. Specifically, substantive conceptions beg the question about what it means to be a profession, which produces devastating problems for practical application. Formal conceptions of profession (eg, Davis’ conception3) avoid begging the question, but do so at the cost of identifying the responsibilities of a profession. Using the term ‘professional responsibilities’, then, requires additional explication and classifying HCECs as professionals requires the identification of their role-specific responsibilities.i Second, this essay will critique the ASBH code of ethics for HCECs as a first articulation of these responsibilities. As written, this code of ethics has limited value for HCECs because most of the responsibilities identified in this code do not identify HCEC-specific responsibilities. In closing, some important strategies to improve upon this initial attempt to define the responsibilities of HCECs are identified. For at least the last decade, Baker has encouraged bioethicists to adopt a code of ethics. Throughout this effort, Baker intertwines having a code of ethics with becoming a profession: ‘Is it time for bioethics to assert its integrity by developing …. (shrink)

Much attention has been devoted to ethical issues related to randomized controlled trials for HIV treatment and prevention. However, there has been less discussion of ethical issues surrounding families involved in observational studies of HIV transmission. This paper describes the process of ethical deliberation about how best to obtain informed consent from sex partners of injection drug users (IDUs) tested for HIV, within a recent HIV study in Eastern Europe. The study aimed to assess the amount of HIV serodiscordance among (...) IDUs and their sexual partners, identify barriers to harm reduction, and explore ways to optimize intervention programs. Including IDUs, either HIV-positive or at high risk for HIV, and their sexual partners would help to gain a more complete understanding of barriers to and opportunities for intervention. (shrink)

Are physicians sometimes morally required to ease caregiver burden? In our paper we defend an affirmative answer to this question. First, we examine the well-established principle that medical care should be centered on the patient. We argue that although this principle seems to give physicians some leeway to lessen caregivers' suffering, it is very restrictive when spelled out precisely. Based on a critical analysis of existing cases for transcending patient-centeredness we then go on to argue that the medical ethos should (...) indeed contain a rule requiring physicians to alleviate caregiver burden under certain circumstances. Finally, we apply our findings to deep brain stimulation (DBS) for Parkinson's disease. We present empirical data from a recent study of DBS indicating that spousal caregivers of Parkinson patients treated with DBS are sometimes deeply troubled by the effects of the therapy and discuss what moral obligations the treating physicians may have in such cases. (shrink)

While it is acknowledged that there is a need for more qualitative research on suicide, it is also clear that the ethics of undertaking such research need to be addressed. This article uses the case study of the authors’ experience of gaining ethics approval for a research project that asks people what it is like to feel suicidal to (a) analyse the limits of confidentiality and anonymity and (b) consider the ways in which the process of ethics review can shape (...) and constrain suicide research. This leads to a discussion of the ways in which ethics committees assess and monitor qualitative research more generally and some preliminary suggestions for how this might be improved. (shrink)