Ethical Issues in the Application of IVF from the Perspective of Females Undergoing IVF / 中国医学伦理学

Infertile women experience complex biological and social experiences in the process of receiving IVF. From the perspective of females undergoing IVF, it is helpful to analyze the ethical and social problems that IVF may face more intuitively and concretely. In this study, 213 women who were undergoing IVF were randomly selected to carry out a questionnaire survey. The results showed that the choice of IVF for infertile women was driven by multiple pressures from family and society, not entirely on their own; They are not aware of the technology, but have a positive attitude, and are eager to be fully informed in the treatment process. In addition, the treatment brings great economic pressure to women who were undergoing IVF and has no significant impact on the relationship between husband and wife. Only by paying attention to the above problems and solving them can we benefit more infertile women and help them realize their reproductive wishes.

Ethical Issues in the Development of Smart Healthcare / 中国医学伦理学

Smart healthcare is the outcome of integration and application of the internet, Internet of things (IOT), big data analysis and artificial intelligence (AI) in the medical field. Smart healthcare has been developed rapidly in China. However, smart healthcare has both advantages and risks, thus, it faces challenges and ethical issues in practice. Technological restrictions of smart healthcare increase the risk of privacy disclosure and delayed treatment. Besides, it also induce some ethical issues.Smart healthcare turns the "justice" issue of regional equity into the population equity of medical benefits. In addition, balancing between humanities and science technology should be considered. Smart healthcare should follow the basic ethical principles and the experience of clinical medical ethics. To give full play to the advantages of smart healthcare, the ethical challenges during its development must be regulated at the legal level, and simultaneously governed through ethical norms and guidance.

Research on Ethical Hotspots of Assisted Reproductive Technology in China: A Review of Quantitative Research in the Past Two Decades / 中国医学伦理学

【Objective:】 The data of the literature of the research progress on the assisted reproductive technology (ART) ethical issues in China in the past two decades were summarized to explore the research hotspots and frontiers of ethical issues in this field. 【Methods:】 The relevant literature records of China National Knowledge Infrastructure (CNKI) were retrieved from January 1, 2002 to October 30, 2022. CiteSpace 6.1.R2 software was used to visually analyze the authors, institutions, keywords, etc. 【Results:】 A total of 1274 papers were included, and the number of papers was on the rise. The hot topics covered three dimensions: surrogacy, ethics issues and laws of ART, and measures of ART. 【Conclusion:】 The combination of theory and practice on the ethical issues of ART is not close enough, the cooperation network of researchers need to be further strengthened. The relevant research on surrogacy, reproductive rights, gene editing, and embryo ownership has become a major hotspot and difficulty in recent years, which should be given full attention.

Analysis on Ethical Issues in Off-label Use of Antitumor Drugs / 中国医学伦理学

The phenomenon of off-label use of antitumor drugs in the treatment of malignant tumors is relatively common. Although it is conducive to the development of clinical medical practice, but it is still necessary to pay attention to ethical issues such as medication risks and inadequate implementation of informed consent. Therefore, to effectively avoid ethical risks and standardize the rational use of off-label antitumor drugs, this paper proposed that pharmacists should actively participate in the process of off-label use of antitumor drugs, improve the evidence level of evidence-based medicine, implement patients’ right to informed consent, and improve the hospital’s supervision system of off-label drug use, so as to ensure the reasonable and legal use of drugs by patients.

Ethical Issues and Norms of Human-animal Chimerism Technology / 中国医学伦理学

Since the 21st century, with the rapid development of biomedicine, research and discussion on human-animal chimerism technology have attracted wide attention. The general research of human-animal chimeras is to introduce human stem cells into animal embryos that remove organ genes, aiming to cultivate human organs in human-animal chimeras to solve the shortage of human organ donors and provide experimental materials for the development of related scientific research. However, due to its technology involves cross-species genetic modification, which destroys the species boundary and the naturalness of ecological niche, it has caused various ethical issues such as threatening species safety and harming human dignity. The development of human-animal chimerism technology is the choice of the times for technological progress, with its inevitability and rationality. It should not be absolutely prohibited, but must abide by the ethical principles such as safety, benefit, respect, and justice, and operate harmoniously under strict and orderly ethical norms.

A Review on Medico legal and Ethical aspects of Orthopaedic Practice

Medico-legal issues in orthopaedic practice are increasing day by day. With the tremendous metamorphosis in the healthcare sector, incidents of lawsuits against orthopaedic surgeons and hospitals, in the name of medical negligence is on the rise. With every consumer redress forum being more inclined in protecting the consumers, it is imperative for practising Doctors to be more informed on the Medico-legal aspects of their field of practice. Most orthopaedic cases that lead to medico-legal cases result from trauma. Besides, these cases are seen in the Emergency Room, thereby resulting in critical and uncertain decisions. Unlike in other fields where the patient has an existing relationship before any complications occur, rapport-building has to begin much after the treatment has begun. Technological advances in the orthopaedic field, availability of online information on platforms like Google, lack of communication, cutthroat competition among orthopaedic surgeons, awareness about the consumer protection act, mob psychology, interference by anti-social elements and local politicians etc have brought orthopaedic practice at this stage. Following ethical aspects, keeping good repo with patients and society, keeping our documentation perfect and precise, and doing transparent and honest practice can save orthopaedic surgeons in long run. Having empathy towards patients and society, keeping workload in our control, helping each other in crisis, and no medical jousting are also important measures to do safe medical practice in the present era. Keeping in mind the mantra of coming together, working together, and working in harmony is of utmost importance for an orthopaedic practice in recent times.

Ethical analysis and countermeasures of artificial intelligence application in clinical trials / 中国临床药理学与治疗学

The development of artificial intelligence is becoming more and more mature, and has penetrated into every field of clinical trials. Artificial intelligence has brought new development opportunities for clinical trials. However, the application of artificial intelligence in clinical trials is still in the exploratory stage, facing many ethical issues, including trial risk caused by data quality, privacy protection caused by data regulation, and contradiction between data authorization and informed consent. We should precisely position the realizable application of artificial intelligence in clinical trials, understand its practical ethical issues, and formulate corresponding coping strategies to ensure the maximum improvement of the whole process performance of clinical trials, including strengthening data quality management and reducing clinical trial risks; optimizing data monitoring mechanisms to ensure data security and privacy; building a data authorization platform and improving judicial protection of informed consent, etc.

Ethical Issues and Ethical Review of Human Genetic Resource Management in Real-world Studies / 中国医学伦理学

Human genetic resources are an important strategic resource for the development of science and technology in China. In order to fully utilize and effectively protect human genetic resources in real-world studies, through analyzing the status and characteristics of real-world studies, this study found that the number of real-world studies was increasing year by year, and with some characteristics, such as many uncontrollable factors, strict requirements for evidence formation, and easy information acquisition and disclosure. Combined with the characteristics of real-world studies, the ethical issues of human genetic resource management in real-world studies were summarized into three aspects, including scientific and value of research development, informed consent and privacy protection of subjects, and fairness and justice in benefit sharing. Accordingly, the key points of ethical review were proposed as scientific rationality, fully informed consent and privacy, as well as data security and stakeholders. In addition, it is necessary to give full play to the role of ethical review in research access and process supervision responsibilities, guide researchers to make full use of human genetic resources by strengthening training and process management, and further promote the standardization of real-world studies.

Ethical and clinical challenges when providing medical care during the COVID-19 pandemic in Colombia: A global perspective to contribute to the local context / Problemas ético-clínicos en la atención médica durante la pandemia por COVID-19 en Colombia: una mirada global para un aporte local

Abstract The COVID-19 pandemic has posed many challenges, particularly for health systems, which may be forced to ration the resources available to treat patients with this disease. With its ethical implications, this decision forces health care institutions to choose, among patients with similar vital needs, who will receive the scarce available life support resources in the emergency room or intensive care units based on prognostic criteria. This utilitarian approach aims to achieve the greatest benefit for the largest possible number of patients; however, in Colombia, its implementation faces several obstacles, such as the medical ethos, the instruments used to define the prognosis, the prioritization criteria, the legal-constitutional precepts, and the economic nature of the provision of intensive care services in the country. This article aims to reflect on these aspects and propose a model for patient prioritization based on the creation of multidisciplinary teams that make decisions within a transparent, humane, plural, impartial, equitable, and fair methodological framework. In the context of the current pandemic, these multidisciplinary teams should be guided by four ethical-clinical principles: (a) treat all persons equally, (b) prioritize patients with the worst condition, (c) maximize the benefits that can be obtained from the scarce resources available and (d) preferably select patients with instrumental value. If these four principles are followed, the guidelines drawn up by the Colombian Government concerning the care of COVID-19 patients would be fulfilled within a context of ethical medical autonomy and scientific and professional practice determined by a utilitarian perspective.

Resumen La pandemia por COVID-19 ha generado muchas dificultades, sobre todo en los sistemas sanitarios, los cuales podrían verse obligados a racionar los recursos disponibles para la atención de pacientes con esta enfermedad. Lo anterior obliga a las instituciones de salud a escoger quién puede acceder a los escasos recursos de soporte vital disponibles en los servicios de urgencias o en las unidades de cuidado intensivo, una decisión de connotación ética que debe tomarse desde una perspectiva utilitarista, entre pacientes con necesidades vitales similares y según los criterios pronósticos de cada individuo. La aproximación utilitarista busca el mayor beneficio para el mayor número posible de pacientes; sin embargo, en Colombia su implementación enfrenta varios obstáculos, tales como el ethos médico, los instrumentos empleados para definir el pronóstico, los criterios de priorización, los preceptos jurídico-constitucionales y la naturaleza económica de la prestación de servicios de cuidados intensivos. Dado el panorama, los objetivos de este artículo son reflexionar sobre los aspectos relacionados con la asignación de los recursos de cuidado intensivo a pacientes con COVID-19 ante una posible escasez de los mismos y proponer un modelo de aproximación para dicha asignación basado en la creación de equipos multidisciplinarios que tomen estas decisiones dentro de un marco metodológico transparente, humano, plural, imparcial, equitativo y justo. En el contexto de la actual pandemia, estos equipos podrían guiarse por cuatro principios ético-clínicos para tomar las decisiones de asignación de los equipos: i) tratar a todas las personas por igual, ii) priorizar a los pacientes cuya condición sea peor, iii) maximizar los beneficios que puedan obtenerse a partir de los escasos recursos disponibles y iv) darle prelación a aquellos pacientes con un valor instrumental. Si se siguen estos cuatro principios, la atención de pacientes con COVID-19 se daría dentro de un marco de autonomía médica ética, además la práctica científica y profesional estaría determinada por una perspectiva utilitaria.

Analysis of ethical issue in the application of artificial intelligence medical devices / 中国临床药理学与治疗学

With the rapid development of artificial intelligence in the medical field, artificial intelligence medical devices not only improve the efficiency of diagnosis and treatment which bring great convenience to patients, but also initiate ethical issues of medical safety, data security, algorithm bias and individual autonomy, etc. By proposing enhanced regulation and quality control, soften bias, increased transparency and improved technology as the breakthrough point, plus more respect for the autonomy of patients and doctors, this paper explored in depth the ethical issues of artificial intelligence theory and practice in hope of providing referential ideas for the regulation and supervision of artificial intelligence medical device.

Ethical issues in the prevention and control of Coronavirus Disease 2019 / 中国临床药理学与治疗学

Public health emergency is a huge challenge for all countries or regions. It is impossible for any country or region to make adequate preparations in advance. How to effectively prevent and control the spread of the epidemic is an unprecedented challenge for China and even the whole international community. This paper holds that the current prevention and control measures and efforts of the Chinese government are effective and important for preventing and controlling the disease rapidly, but the ethical concerns cannot be ignored. In fact, good ethical practices can help to achieve long-term prevention and control goals. Based on the current situation of the epidemic, we propose six ethical points to further stimulate dialogue on how to implement disease prevention and control measures to better protect public safety, protect personal privacy, prevent stigma and discrimination, and guide society to follow the right ethical value orientation.

Usos, contexto regulatorio y ético de la talidomida en Costa Rica

En las últimas décadas, el descubrimiento de las propiedades antinflamatorias, antiangiogénicas e inmunorreguladoras de la talidomida, ha propiciado su utilización como terapia alternativa o de segunda elección para diversas patologías. El medicamento forma parte de la Lista Oficial de Medicamentos y Normativa de la Caja Costarricense de Seguro Social. El resurgimiento del medicamento y sus análogos, los cambios en el comportamiento reproductivo de la población, avances en las técnicas de reproducción asistida, investigación biomédica y la judicialización de la medicina, hacen necesaria una revisión de sus indicaciones actuales, y medidas de seguridad para prevenir el efecto adverso más grave: la teratogénesis. El objetivo de esta investigación fue presentar los resultados de una revisión bibliográfica relacionada con los usos actuales, así como el contexto regulatorio y ético de la talidomida en Costa Rica.

In recent decades, thalidomide´s anti-inflammatory, anti-angiogenic and immunoregulatory properties have led as an alternative or second-choice therapy for various pathologies. It is currently included in the Official List of Medicines and Regulations of the Costa Rican Social Security (LOM). However, thalidomide´s resurgence and its analogues, reproductive behavior changes, assisted reproduction technology, biomedical research and medical judicialization, indicates that a review of the current indications and safety measures are necessary to prevent the most serious adverse effect: teratogenesis. In this research, we aim to summarize thalidomide´s current uses, regulatory and ethical context in Costa Rica.

Moral Distress, Sign of Ethical Issues in the Practice of Oncology Nursing: Literature Review / Angustia moral, señal de problemas éticos en la práctica de enfermería oncológica: revisión de literatura / Angústia moral, sinal de problemas éticos na prática de enfermagem oncológica: revisão de literatura

ABSTRACT Objective: To describe the factors that influence the emergence of moral distress in oncology nurses. Methodology: integrative review of the literature whose search will be performed in Web of Science databases, CINAHL (EBSCO), Scielo, Proquest, Pubmed and PsycInfo using the keywords moral distress and oncology nursing and their similes in Spanish, without restriction for years of publication until 2017. Results: The results of this review were grouped into three groups of factors each with subgroups: 1) Organizational factors: ethical climate, evasive culture and resources for ethics delivered by the organization. 2) Particular clinical situations: pain management, information delivery, futile treatment, and assistance to the patient and their family in the process of death, 3) Interpersonal relationships: poor communication, power relations, trust in the team's competence. Conclusion: the three factors described are triggers of moral distress in oncology nurses. When there are ethical problems and the nurses do not participate in the deliberation process, these problems can be hidden and be normalized, which can diminish the moral sensitivity of the professionals, as well as the possibility of acting as moral agents.

RESUMEN Objetivo: describir los factores que influyen en el surgimiento de la angustia moral en enfermeras oncológicas. Metodología: revisión integradora de la literatura cuya búsqueda se realizó en las bases de datos Web of Science, CINAHL (EBSCO), Scielo, Proquest, Pubmed y PsycInfo, a partir del uso de las palabras clave moral distress y oncology nursing y sus símiles en español, sin restricción por años de publicación hasta 2017. Resultados: se clasificaron en tres grupos de factores, cada uno con subgrupos: 1) factores organizacionales: clima ético, cultura evasiva y los recursos para la ética que entrega la organización; 2) situaciones clínicas complejas: el manejo del dolor, la entrega de información, el tratamiento fútil, y la asistencia al paciente y su familia durante el proceso de muerte; 3) relaciones interpersonales: una comunicación deficiente, las relaciones de poder, la confianza en la competencia del equipo. Conclusión: los tres factores son desencadenantes de angustia moral en las enfermeras oncológicas. Cuando existen problemas éticos, y las enfermeras no participan del proceso de deliberación, estos pueden quedar ocultos y, así, disminuir la sensibilidad moral de los profesionales, así como la posibilidad de actuar como agentes morales. Es necesario explorar la relación entre la angustia moral y las implicancias en el cuidado del paciente.

RESUMO Objetivo: descrever os fatores que influenciam no surgimento da angústia moral em enfermeiras oncológicas. Metodologia: revisão integradora da literatura cuja pesquisa foi realizada nas bases de dados Web of Science, CINAHL (EBSCO), Scielo, Proquest, Pubmed e PsycInfo, a partir do uso das palavras-chave moral, distress e oncology nursing e seus pares em espanhol, sem restrição por ano de publicação até 2017. Resultados: criou-se três grupos de fatores, cada um deles com subgrupos: 1) fatores organizacionais - clima ético, cultura evasiva e recursos para a ética que a organização entrega; 2) situações clínicas complexas - o tratamento da dor, a entrega de informação, o tratamento fútil e a assistência ao paciente e à sua família durante o processo de morte; 3) relações interpessoais - uma comunicação deficiente, as relações de poder, a confiança na competência da equipe. Conclusão: os três fatores são desencadeantes de angústia moral nas enfermeiras oncológicas. Quando existem problemas éticos e as enfermeiras não participam do processo de deliberação, estes podem ficam ocultos e, assim, diminuir a sensibilidade moral dos profissionais, bem como a possibilidade de atuar como agentes morais. É necessário explorar a relação entre a angústia moral e suas implicações no cuidado do paciente.

Decision-making under uncertainty in environmental health policy: new approaches

Decision-making in environmental health policy is a complex procedure even in well-known conditions. Thus, in the case of uncertainty, decision-making becomes a hurdle race. We address scientific uncertainty, methods to reduce uncertainty, biomedical doubt and science communication, and the role of stakeholders, activists, lobbies and media that together influence policy decisions. We also consider the major responsibility and role of the medico-scientific community in this process. This community can and should teach the principle of scientific uncertainty to all stakeholders, advise policy-makers and underline the ethical issues, considering that our brains are not only the deposit of our humanity but also the route to environmental health and societal harmony.

Ethical Issues In Epidemiological Studies

Epidemiology is the study of the distribution and determinants of health related states and events in populations, and its application to the control of health problems. An epidemiological studies involve the population and as such ethical issues are an important aspect of it which need to be properly understood and adhered to. These issues can relate to informed consent, appropriate sample size, selection of participants, confidentiality, conflict of interest etc. Studies like therapeutic trial have also a lot of ethical issues which differ from issues pertaining to non-therapeutic trials. The source of funding for the study can have implication. Fabrication of data, manipulation during analysis, intentional changes in the result to obtain a pre desired outcome are some grey areas which need to be addressed. Another ethical issue is publication in certain Journals with monetary involvement. Lastly but not the least, author-ship also have certain ethical issues. Attention to ethical issues can facilitate the effective planning, implementation, and growth of a variety of public health programs and research activities. Moreover with advancement in Epidemiol-ogylikemolecularepidemiology,geneticepidemiologyetc.theethicalissuesbecomemorecomplicated

SWOT analysis of medical institution and ethical issues of medical consortium in view of human resource management / 医学研究生学报

From the view of human resource management, SWOT method was applied in the article to analyze the advantages, disadvantages, opportunities and threats of three-tier hospitals and grassroots medical institutions in medical consortium and discuss the unfair resource allocation, unbalanced responsibility and interest, uneven division of labor and lack of ethical education in managers. The article put forward countermeasures and suggestions guided by management ethics including establishing diversified resource sharing channels and long-term technical support mechanism, overall coordination of interests and responsibility, establishing a fair and reasonable personnel flow mechanism, and building efficient information service cloud and strengthening management ethics education and propaganda in order to realize complementary advantages, resource sharing and mutual benefit among all levels of medical institutions in medical consortium. In this way, we can promote the development of medical consortium to be more standardized, orderly and fair regular, create harmonious and win-win medical environment with mutual trust, and provide excellent service to people.

Radiología médico-legal: un dilema ético para el técnico en radiología / Medical-legal radiology: an ethical dilemma for radiology technician / Radiologia médico-legal: um dilema ético para o técnico de Radiologia

Resumen: Las exploraciones radiológicas médico-legales incluyen exposiciones médicas a radiaciones que se realizan por orden judicial a una persona que no está enferma. El técnico o tecnólogo médico en radiología tiene el deber de minimizar las dosis a pacientes y a la población en su conjunto; por ello, realizar este tipo de exploraciones entra en conflicto con las máximas de la protección radiológica y de su código ético. Presentamos un estudio de revisión donde se analiza si estas prácticas médicas son contrarias a la ética profesional del técnico en radiología.

Abstract: The medico-legal, radiological examinations include those medical exposures to radiation conducted by court order a person who is not sick. The radiologic technologist has a duty to minimize the dose to patients and the population as a whole, therefore, make this type of exploration conflicts with the maximum of Radiation Protection and its ethical code. We present a review study where we analyze whether these medical practices are contrary to professional ethics of the Radiologic technologist.

Resumo: As explorações radiológicas médico-legais incluem aquelas exposições médicas a radiações que se realizam por ordem judicial a uma pessoa que não está doente. O técnico ou tecnólogo médico em radiologia tem o dever de minimizar a dose para os pacientes e a população como um todo; portanto, realizar este tipo de exploração entra em conflito com os princípios da proteção radiológica e de seu código de ética. Apresentamos um estudo de revisão no qual analisamos se estas práticas médicas são contrárias à ética profissional do técnico em radiologia.

Exploration on the Ethical Issues of Nanotechnology in Medical Application / 中国医学伦理学

The nanotechnology has been successfully applied in the diagnosis and treatment of diseases and develops rapidly.As a cutting-edge technique,there exist a series of ethical issues when applying nanotechnology in human body,such as risk management,benefit assessment,privacy protection and informed consent.Clinical trials initiated by researchers also face ethical challenges.Therefore,it should study on the ethical issues when using nanotechnology in medicine.To insure the healthy development of nanotechnology in medical application,the regulations and rules should be improved,the assessment of risks and benefits should be strengthened,the ethical review should be reinforced,and the awareness level of the researchers should be enhanced.

Survey and Reflection on the Ethical Cognition of Human Sperm Bank among Sperm Donors / 中国医学伦理学

Objective:To investigate the ethical cognition of human sperm among the volunteers who intend to donor sperm,and to analyze the voluntteers' thoughts for donor behavior and its countermeasures.Methods:A questionnaire survey was conducted to investigate the volunteers who were the first time consulted sperm donation in the human sperm bank of the affiliated reproductive hospital of Shandong university.The cognition on the purpose of sperm,the causes of sperm shortage,privacy protection of the offspring,and the future of sperm banks in China were collected.Results:Donors were not well known the uses of sperm and privacy protection of the offspring.They thought traditional values and ethical worry caused sperm shortage and worried about the future of human sperm banks in China.Conclusion:The overall cognition on the sperm bank of the volunteers still exist certain one-sidedness and blind,which has seriously affected the enthusiasm of volunteers to donate sperm.The relevant departments should pay more attention to this,focus on promoting the propaganda and supervision work of ethical system of human sperm bank,construct objective,justice,and dedicative atmosphere for sperm donation,in order to dispel the volunteers' psychological concerns,and promote the healthy,fast and sustainable development of human sperm bank.

Discussion on the Common Ethical Issues in Clinical Pharmacy / 中国医学伦理学

This paper summarized the common medical ethical issues in clinical pharmacy service and analyzed them from the perspective of medical ethics.It put forward some countermeasures to solve these problems,such as helping clinical pharmacists to establish a patient-centered service mode,improving their occupation accomplish-ment,and avoiding moral issues and medical disputes caused by ethical issues under the premise of ensuring pa-tients' safety and rational use of drugs,and thus to comprehensively improve service level of clinical pharmacists.