Ethical and legal issues in caring for asylum seekers and refugees in the UK

Inward migration to the UK remains topical and controversial as numbers continue to increase. Many immigrants have specific health care needs and may shoulder a large burden of infectious disease. Imposition of legal constraints can have a huge impact on the medical care afforded to immigrants. Currently UK policy is to treat, free of charge and with NHS resources, those who fulfil specific criteria. However an increasing number are being asked to pay for their treatment. Many health care professionals are confused as to current legal restrictions and require guidance on the associated ethical issues. We concentrate on provision of care to HIV positive individuals and use cases to illustrate some of the issues. However these issues are equally pertinent to practitioners in all branches of medicine.     

The ethics of experimental heroin maintenance.

In response to widespread concern about illegal drug use and the associated risk of the spread of HIV/AIDS, a study was undertaken to examine whether it was, in principle, feasible to conduct a trial providing heroin to dependent users in a controlled manner. Such a trial involves real ethical issues which are examined in this paper. The general issues examined are: should a trial be an experiment or an exercise in public policy?; acts and omissions; countermobilization; termination of a trial, and payment for drugs and for a trial. The specific issues examined are: selection of trial participants; privacy; issues for staff working on a trial; coupling the trial with other treatment, and issues for researchers. A number of alternative approaches to the various ethical issues are presented and discussed.     

医学新成果引发的医学伦理问题探讨

现代医学在将诸多过去认为不可能的事变为现实的同时，也将更多的社会伦理问题摆在人们的面前，从文化对策上就如何正确处理二者的关系进行了初步探讨。     

Using HIPE data as a research and planning tool: limitations and opportunities: A response

The paper by O’Loughlin et al (2005) 1 raises a number of issues in regard to the operation of the Hospital Inpatient Enquiry that require clarification and/or a response. In our view, there are many potential applications for these data that are not explored in this paper; our comments here, however, are of necessity limited to those issues raised by O’Loughlin et al (2005) in an attempt to ensure that a more balanced perspective on the operation of this system may be portrayed.     

Autonomy, welfare and the treatment of AIDS.

Many AIDS-related issues are polarised. At the social level, civil rights or liberties are seen as being in conflict with general utility, and an analogous distinction is often assumed to exist at the one-to-one, individual level at which doctors work. In this paper the latter form of the distinction is argued to be false. By seeing autonomy as part of welfare, doctors can think more directly about such issues as paternalism, confidentiality, and consent. A number of these issues are discussed in the light of the revised conception of welfare, in the form of simplified case studies.     

医院网络安全问题及对策

医院信息化建设的快速发展,不仅为医生提供了医疗、科研等多方面的便利,也为患者就诊提供了更为方便、快捷的渠道,但是这种基于网络的信息系统的建设也不可避免地产生了各种网络安全问题。本文对医院网络信息系统存在的安全问题及其产生的原因进行分析,有针对性地从设备、技术和用户3个角度提出解决网络安全问题的建议和对策,以期对医院网络安全工作者提供决策参考。     

The design and assessment of questionnaires in clinical research

Questionnaires are one of the most commonly used tools for data collection in clinical research. Despite its simplicity and convenience of use, the design of questionnaire instruments that accurately measure health status and their determinants is nevertheless a difficult and challenging task.We review the two most important issues which are reliability and validity. Reliability can be defined as the degree to which a measure gives 'consistent' or 'reproducible' values when applied in different situations. Validity refers to the extent in which the true value of a variable is correctly measured by the instrument. For different types of questionnaire measurement instruments, specific issues of content, construct and criterion validity should be appropriately addressed. Accuracy in questionnaire-based measurement in clinical studies is achieved by paying attention to the relevant specific issues of reliability and validity during development and testing of such questionnaires.     

Ethical questions must be considered for electronic health records

National electronic health record initiatives are in progress in many countries around the world but the debate about the ethical issues and how they are to be addressed remains overshadowed by other issues. The discourse to which all others are answerable is a technical discourse, even where matters of privacy and consent are concerned. Yet a focus on technical issues and a failure to think about ethics are cited as factors in the failure of the UK health record system. In this paper, while the prime concern is the Australian Personally Controlled Electronic Health Record (PCEHR), the discussion is relevant to and informed by the international context. The authors draw attention to ethical and conceptual issues that have implications for the success or failure of electronic health records systems. Important ethical issues to consider as Australia moves towards a PCEHR system include: issues of equity that arise in the context of personal control, who benefits and who should pay, what are the legitimate uses of PCEHRs, and how we should implement privacy. The authors identify specific questions that need addressing.     

Ethical and policy issues relating to progenitor-cell-based strategies for prevention of atherosclerosis

OBJECTIVE: To examine important ethical and societal issues relating to the use of progenitor-cell-based strategies for disease prevention, particularly atherosclerosis. BACKGROUND: Several nascent lines of evidence suggest the feasibility of using progenitor cells to reverse the health consequence of atherosclerosis. Such potential uses of progenitor cells are scientifically exciting, yet they raise important ethical and societal issues. METHOD: The Working Group on Ethics of Progenitor Cell-based Strategies for Disease Prevention met to discuss the relevant issues. Several drafts of a report were then circulated to the entire Working Group for comments until a consensus was reached. RESULTS: Scientific evidence suggests the appropriateness of using progenitor-cell-based strategies for some rare conditions involving atherosclerosis, but additional preclinical data are needed for other, more prevalent conditions before human trials begin. All such trials raise a set of ethical issues, especially since trials aimed at prevention rather than treatment may involve persons who do not yet have disease but will be exposed to the risks of interventions. In addition, enrolment in prevention trials may be hazardous and harmful if participants erroneously believe experimental interventions will necessarily prevent disease. Finally, given the high prevalence of atherosclerosis, there are some important public policy implications of taking such an approach to prevention, including the sources of progenitor cells for such interventions as well as the allocation of health resources. CONCLUSION: Potential uses of progenitor-cell-based strategies for preventing atherosclerosis must be considered in the context of a range of social and ethical issues.     

HMD式光学穿透技术在医学增强现实中的研究进展

增强现实技术在医学中的应用是目前一个研究热点。首先介绍了医学增强现实系统的概念以及各组成部分的功能;然后针对基于HMD式光学穿透技术的增强现实系统的主要研究内容,对目前在HMD的标定、跟踪和配准几方面进行分类综述,并给出系统误差分析方面的研究工作;最后指出需进一步研究的问题和可能的方向。     

'These sorts of people don't do very well': race and allocation of health care resources.

Recent literature has highlighted issues of racial discrimination in medicine. In order to explore the sometimes subtle influence of racial determinants in decisions about resource allocation, we present the case of a 53-year-old Australian Aboriginal woman with end-stage renal failure. The epidemiology of renal failure in the Australian Aboriginal population and amongst other indigenous peoples is discussed. We show that the use of utilitarian outcome criteria for resource allocation may embody subtle racial discrimination where consideration is not given to issues of justice, race, culture and gender. It is only where the processes by which resources are allocated are transparent, clearly defined and based upon consultation with individual patients that issues and justice are likely to be adequately addressed.     

Genetics and the British insurance industry

Genetics and genetic testing raise key issues for insurance and employment. Governmental and public concern galvanised the British insurance industry into developing a code of practice. The history of the development of the code, issues of genetic discrimination, access to medical information, consent and the dangers of withholding information and the impact on the equity of pooled risk are explored. Proactive steps by the Association of British Insurers suggest that moral reflection not legislation is the way forward.     

亲权鉴定中的伦理和法律问题

由于亲子鉴定涉及伦理、法律、家庭、社会等各方面的问题,所以开展这项工作要抱审慎态度。在当事人教育程度不足以理解亲权鉴定会涉及伦理和法律问题时,要微到当事人知情同意也是不可能的;在没有其他方案替代时,从事司法鉴定人员应该建议当事人放弃亲子鉴定的申请。我国司法部门应该着手制定亲子鏊定技术标准和颁布亲子鉴定司法程序,以保障当事人在亲权鉴定时享有知情同意权和自主权。     

A Roadmap for Designing a Personalized Search Tool for Individual Healthcare Providers

Each year, a large percentage of people change their physicians and other individual healthcare providers (IHPs). Many of these people have difficulty identifying a replacement they like. To help people find satisfactory IHPs who are likely to be good at managing their health issues and serve their needs well, in a previous paper we proposed a high-level framework for building a personalized search tool for IHPs. There are many issues regarding designing a personalized search tool for IHPs, of which only a small portion are mentioned in our previous paper. This paper surveys various such issues that are not covered in our previous paper. We include some preliminary thoughts on how to address these issues with the hope to stimulate future research work on the new topic of personalized search for IHPs.     

Feminism and public health ethics

This paper sketches an account of public health ethics drawing upon established scholarship in feminist ethics. Health inequities are one of the central problems in public health ethics; a feminist approach leads us to examine not only the connections between gender, disadvantage, and health, but also the distribution of power in the processes of public health, from policy making through to programme delivery. The complexity of public health demands investigation using multiple perspectives and an attention to detail that is capable of identifying the health issues that are important to women, and investigating ways to address these issues. Finally, a feminist account of public health ethics embraces rather than avoids the inescapable political dimensions of public health.     

Killing and allowing to die in medical practice.

This paper examines some of the issues related to the distinction between acts and omissions. It discusses the difficulties involved in deciding whether there is any moral significance in this distinction, particularly when it is applied to cases which involve killing or allowing to die. The paper shows how this problem relates to some of the current issues in medical ethics. It examines the issues raised by the widely publicised cases of selective treatment of handicapped children and argues that such decisions are taken and have to be taken in the context of wider ethical theories.     

Critical notice--defending life: a moral and legal case against abortion choice by Francis J Beckwith

Francis Beckwith's Defending life: a moral and legal case against abortion choice defends the pro-life position on moral, legal and political grounds. In this critical notice I consider three key issues and argue that Beckwith's treatment of each of them is unpersuasive. The issues are: (1) whether abortion is politically justified by the principle that we should err on the side of liberty in the face of reasonable disagreement over the moral status of the fetus; (2) whether the fetus's natural capacity or genetic propensity to develop rationality and communication is sufficient to give it a moral right to life; and (3) whether abortion is morally justified on the basis of bodily rights. I also show that Beckwith's book fails to consider several important issues and arguments.     

学术史视域下的近代中国民商法学研究

近代学者对民商法学之研究，就纵向角度而言，数量众多、视角多元；就横向角度而言，涌现出具有时代特征的若干代表作，如陈瑾昆的《民法通义总则》、戴修瓒的《民法债编总论》以及王宠惠的《比较民法概要》。这些著作构建了近代民商法学科，开启了现代民商法学的发展。总体而言，近代民商法学史具有三大特征：研究集中于基础理论问题，注重总则部分的探究；实体法和具体制度成为研究热点，程序法成果较少；国别研究、比较法研究是其一大特色。     

Effect of television violence on children and youth.

One hundred forty-six articles in behavioral science journals, representing 50 studies involving 10,000 children and adolescents from every conceivable background, all showed that violence viewing produces increased aggressive behavior in the young and that immediate remedial action in terms of television programming is warranted. Four major issues are covered: effects on learning, emotional effects, the question of catharsis, and effects on aggressive behavior. The research findings regarding each of these issues are summarized, as well as the controversial 1972 Surgeon General's report, Television and Social Behavior. The time is long past due for a major, organized cry of protest from the medical profession in relation to what, in political terms, I consider a national scandal.