Bioethical perspective of convalescent plasma therapy for COVID-19: A systematic review

Convalescent plasma therapy (CP) has long been used to prevent and treat various infectious diseases before COVID-19 such as SARS, MERS, and H1N1. Because the viral and clinical characteristics of COVID-19 share the similarities between SARS and MERS, CP treatment could be a promising treatment option to save COVID-19. With only low quality medical evidence, but massive media support and a very significant public demand for the use of convalescent plasma for COVID-19, we are now faced with an ethical dilemma. Therefore, this paper uses a structured analysis that focuses on the preferred reporting items for a systematic review of ethical issues regarding the use of Convalescent Plasma Therapy for COVID-19. The use of convalescent plasma must meet the ethical principles of autonomy; such as voluntary, informed consent, and confidentiality. Consideration of the risk-benefit ratio for potential donor recipients also needs to be considered in order to meet the beneficence and non-maleficence principles. The principle of justice also needs to be applied both to donors, donor recipients and health workers, such as determining the priority of donor recipients, due to the increasing demand for convalescent plasma amid the limited circumstances of patients who have recovered from Covid-19 who voluntarily donate.     

艾滋病医院内传播的预防进展及伦理问题

分析艾滋病在医院内传播的途径、预防措施及存在的伦理问题，提出尊重艾滋病病人和医务人员的正当权利在预防医院内艾滋病传播中具有重要作用。在科学研究的指导下，加强全社会艾滋病知识的宣传，尊重医患双方在预防艾滋病感染方面的权利、地位以及及时救治的正当性。尊重医疗权、隐私权，在知情同意前题下进行艾滋病病毒检测。同时应尊重医务人员的权利，在医院内艾滋病传播预防与控制中提供专业指导和防护设施。     

Patients' rights, quality of life, and health care system performance

The purpose of this paper is to promote the development of a social contract between patient and clinician that permits patients to state how they want to live as they survive rather than what they are willing to lose to extend their survival. To do this, patients must have sufficient leverage to affect the nature of the care they receive. This leverage, it is proposed, can be achieved by first making a Declaration of Patients Rights Relative to Their Quality of Life' and then evaluating the extent to which the patient's providers comply with this rights statement. The paper also reviews The World Health Report 2000 [Health Systems: Improving Performance Geneva: WHO, 2000] as an example of an alternative approach to defining a health care social contract and evaluating a health system's performance. Also discussed, were steps that could be taken to facilitate the integration of the patients' rights statement into medical practice and health care systems performance.     

Informed consent: how much and what do patients understand?

Objective

We sought to evaluate the degree of patients' understanding of several aspects of the informed consent process for surgery and clinical research.

Methods

We conducted a systematic search of PubMed (1961-2006) to identify relevant articles.

Results

We retrieved 23 and 30 eligible for inclusion articles regarding informed consent for surgery and clinical research, respectively. Regarding surgery, adequate overall understanding of the information provided and of the risks associated with surgery was shown in 6 of 21 (29%) and 5 of 14 (36%) studies providing relevant data, respectively. Regarding clinical research, adequate understanding of the aim of the study, the process of randomization, voluntarism, withdrawal, and the risks and the benefits of treatment was shown in 14 of 26 (54%), 4 of 8 (50%), 7 of 15 (47%), 7 of 16 (44%), 8 of 16 (50%), and 4 of 7 (57%) of studies providing relevant data, respectively. Satisfaction by the amount of the given information was shown in 7 of 12 (58%) studies involving surgery and 12 of 15 (80%) studies involving clinical research.

Conclusions

Further attention should be drawn on enhancing patients' understanding regarding several components of the informed consent process for surgery and clinical research.     

医学生生命伦理教育缺陷的思考

针对医学生"玩耍人体标本"行为进行思考,认为个别医学生在生命态度、生命意识方面存在着的严重问题,不能因为事件的极端性,而忽视了对教育和社会的反思,亟需医学院校、社会乃至家庭给予足够的重视和积极的干预。文章提出在医学生成长的重要时期,加强医学生生命伦理教育,对于医学生建立正确的生命伦理认知,提高生命意义感,树立尊重生命的职业道德观具有现实意义。     

Psychosocial evaluation of candidates for living related kidney donation

Living kidney donation has raised practical and ethical questions since renal transplantation became possible 50 years ago. Nevertheless, living donors are a common source for badly needed organs in the pediatric population. The safety and well being of the living donor are important concerns. Among the risks of living donation are those of a psychological and social nature. To protect these donor interests, psychosocial evaluations of donors are done at some transplant centers, but there is a lack of consistency regarding standardization of the evaluation, the content of the evaluation, and the role of the interviewer. Goals of the overall living donor evaluation for kidney transplantation at The Children’s Hospital of Philadelphia, and the components of the psychosocial evaluation protocol in particular, are presented. The protocol’s strengths are discussed, including the standardization of evaluations for all potential donors; the broad spectrum of psychosocial domains assessed; the psychometric measures administered; the systematic handling of negative results and some donors’ desire to opt out; and the protection of confidentiality. Future directions with regard to long-term psychosocial outcomes and research protocols are discussed.     

生命伦理怀:医科院校思想政治理论课教学新视角

在医科院校思想政治理论课教学中进行融入生命伦理关怀教育的初步探索,以此教学新视角试图唤起医科院校学生对生命的真正尊敬与热爱,帮助学生重新审视自身,树立科学正确的人生观、价值观、道德观,体会尊重生命、关爱生命、敬畏生命的现代意义,从而更好地面对目前的医学专业学习及日后的医疗服务、实践活动.     

大学生体验式生命伦理教育活动的设计与实践

关爱生命、尊重生命、善待生命已经成为当前社会的基本共识.从大学生轻视生命、伤害生命的现状谈起,论述了在大学生群体中开展生命伦理教育的必要性,阐述了大学生体验式生命伦理教育活动的设计与实践过程,并从中探讨了体验式生命伦理教育的特点与机制,即一方面,体验式教学的特点与生命伦理教育的原则相契合,能使生命伦理教育的开展更为有效;另一方面,生命伦理教育中的体验活动能激发大学生的生命情感,构建大学生正确的生命伦理观.     

Using pharmacogenetics and pharmacogenomics in the treatment of psychiatric disorders: some ethical and economic considerations

Current pharmacotherapies for psychiatric disorders are generally incompletely effective. Many patients do not respond well or suffer adverse reactions to these drugs, which can result in poor patient compliance and poor treatment outcome. Adverse drug reactions and non-response are likely to be influenced by genetic polymorphisms. Pharmacogenetics holds some promise for improving the treatment of mood disorders by utilising information about genetic polymorphisms to match patients to the drug therapy that is the most effective with the fewest side effects. Pharmacogenomics promises to facilitate the development of new drugs for treatment. However, these technologies raise many ethical, economic and regulatory issues that need to be addressed before they can be integrated into psychiatry, and medicine more generally. We discuss ethical and policy issues arising from pharmacogenetic testing and pharmacogenomics research, such as informed consent, privacy and confidentiality, research on vulnerable persons and discrimination; and economic viability of pharmacogenetics and pharmacogenomics. We conclude with recommendations for the regulation and distribution of pharmacogenetic testing services and pharmacogenomic drugs.     

Rehabilitation: disability ethics versus Peter Singer

This commentary discusses utilitarian bioethics currently articulated by Peter Singer, one of the most widely known bioethicists of the 21st century. His controversial concepts of personhood and replaceability have important implications for people with disabilities, caregivers, and rehabilitation in general. Singer suggests that people with severe disabilities should not be considered persons and therefore have no rights or status in ethical issues. In addition, he argues that, although some people with less severe disabilities qualify as persons, their potential quality of life is significantly compromised by disability and therefore it may be ethically desirable to eliminate them so that their resources can be used for someone with superior potential. We reject these ideas, and suggest that those involved in rehabilitation carefully consider these ideas because they imply that rehabilitation is an immoral act unless it results in full and typical function.