Ethical issues in palliative care

The relief of suffering is one of the aims of health care. Pain relief is a moral obligation in health care, not an optional extra. Doctors have moral obligations to strive to relieve pain, to be competent in basic pain control, and to endeavour to give patients an adequate understanding of their illness and painkillers. The most common moral problem in pain control in terminally ill patients is the conflict between the obligation to relieve suffering and the obligation to prolong life. The law prohibits intentionally causing the death of another person. Debates follow as to what constitutes an intention to cause death, and what actually constitutes a cause of death. At present, doctors are legally permitted to give sedatives and analgesics to terminally ill patients with the intention of relieving suffering, even if life is shortened. The moral principle of the ‘double effect’ relates to this and is explained. It relies on a distinction between intended and foreseen effects of treatment. Some people dispute the distinction between intended and foreseen effects and claim that the principle of double effect allows doctors who intend euthanasia to carry it out under cover of the law. This debate is explored in the article. Finally, is it ever morally justifiable to end the patient’s life on the grounds that this is the only way to end pain? Even if it is, should euthanasia be legalised? A brief comment on these issues, and the roles of law and morality, are made.     

Ethical issues in evidence-based surgery

Evidence-based medicine, although ostensibly concerned with the research evidence underlying claims of efficacy for surgical procedures,has a direct connection with the ethics of surgical decision making.Questions of whether new procedures should ever be performed on patients outside of a formal research protocol, what the patient should be told about the uncertainties inherent in the use of nonvalidated innovative procedures, when formal evaluation is necessary, what form that evaluation should take, and how the burdens and results of such research can be distributed fairly all involve balancing competing ethical principles. Good ethics requires good facts, and evidence from well-controlled experiments provides best information upon which to base decisions in these areas and to build ethical surgical practice.     

人卵子冷冻技术的伦理思考

辅助生殖技术发展日新月异,近年来快速发展的人卵子冷冻技术为妇女生育力的保存提供了新的手段,为那些手术或放化疗后可能丧失卵巢功能、有卵巢功能早衰倾向、已经促排卵采集到卵母细胞而男方取精失败的妇女,以及因各种因素推迟生育年龄的妇女带来了生育力保险,也为卵子捐赠带来了新的希望。但卵子冷冻技术的发展同时也带来了伦理的困惑:可否为单身育龄女性提供卵子冻存服务;冷冻卵子的所有权、使用权归属;冷冻卵子者及出生子代的权益等。建议生殖医学机构在提供卵子冷冻技术前,应充分知情同意,告知技术的限制和可能的风险,进行心理评估,并预先确定卵子的归属权。生殖医学机构在提供生育策略与卵子冷冻技术服务过程中,应遵循有利于患者、知情同意、保护后代、社会公益、保密、严防商业化、伦理监督等原则。     

Ethical issues in surgical research

Higher standards of evidence for surgical procedures are likely to be demanded in the future by health insurance providers. Consequently, more formal and rigorous surgical research, including RCTs, will become more prevalent. Facing the ethical challenges of surgical research requires understanding of the ethically significant differences between surgical practice and research and the ways in which the ethical standards appropriate for the design and conduct of clinical research differ from the ethics of clinical care.     

Ethical issues in patient safety

Making progress in patient safety poses many challenges, practical and theoretical, to the way physicians practice medicine. The ethical challenges are among the most profound. They include the ethical imperative to do all things practical to prevent errors and injury to patients, the need to respond appropriately when things go wrong to find new methods to prevent recurrence, the requirement for honesty and openness in dealing with our patients when things go wrong, and taking responsibility for ensuring that all of our colleagues are safe and competent. This is an immense challenge. It is not easy to "first, do no harm." But only we as a profession can meet this challenge. No one else can do it; we must.     

Ethical issues in penile transplantation

This article provides an overview of the ethical issues associated with penile transplantation, a form of composite tissue allografting. There is only one reported case of human penile transplantation, and, as such, this technique is considered to be experimental. The ethical issues at stake involve both the graft donor and the graft recipient. With regard to the recipient, there are significant concerns relating to surgical risks and benefits, informed consent, body image （including surgical expectations and outcomes） and compliance. Donor issues may include family consent and privacy, as well as graft harvesting （leaving the donor cadaver without a penis）. Many of these ethical issues can be explored during the recipient＇s assessment and consent process. Because no medium-term or long-term outcome data for this procedure exist---only one such operation has ever been performed--the burdens and ethical issues concerning penile transplantation remain unknown.     

Ethical issues in pediatric orthopaedics

The orthopaedist who treats children confronts the usual ethical issues of educating patients, obtaining informed consent, and making choices among unproven outcomes. When dealing with children, the issue of informed consent is confounded because the person giving the consent is not the person who will bear the consequences of the treatment. When the patient is a teenager, the issues of education, consent, and treatment decisions require patience, tact, and perseverance by the physician.     

Ethical issues in palliative care

Ethical concerns are common in palliative care settings. Rather than provide an exhaustive list of possible ethical problems one may come upon, this article describes areas of concern that are frequently encountered by perioperative health care providers, especially anesthesiologists, in the palliative care arena.