Ethical Considerations in Pediatric Surgery.

Pediatric surgeons need to learn to give as much importance to the ethical approach as they have been giving to the systemic methodology in their clinical approach all along. The law of the land and the governmental rules also need to be kept in mind before deciding the final solution. They need to always put medical problems in the background of ethical context, reach a few solutions keeping in mind the available resources, and apply the best solution in the interest of their pediatric patients.

Should Physician-Assisted Suicide or Euthanasia be Legalized in the United States? A Medically Informed Perspective.

There is a pressing debate in the United States concerning the implied physicians' obligation to do no harm and the status of legalizing physician-assisted suicide (PAS). Key issues that underpin the debate are important to consider. These include: (1) foundational medical beginnings; (2) euthanasia's historical and legal background context; and (3) the key arguments held by those for and against legalization of PAS. This paper reviews the major claims made by proponents for the legalization of PAS and the associated complexities and concerns that help underscore the importance of conscience freedoms. Relief of suffering, respect for patient autonomy, and public policy arguments are discussed in these contexts. We argue here that the emphasis by healthcare providers should be on high quality and compassionate care for those at the end of life's journey who are questioning whether to prematurely end their lives. If medicine loses its chief focus on the quality of caring-even when a cure is not possible-it betrays its objective and purpose. In this backdrop, legalization of PAS harms not only healthcare professionals, but also the medical profession's mission itself. Medicine's foundation is grounded in the concept of never intentionally to inflict harm. Inflicting death by any means is not professional or proper, and is not trustworthy medicine.

Ambivalence at 10 000 Feet.

Description The transition from medical neophyte to seasoned physician is a gradual process spanning the course of many years. However, there are various milestones throughout the experience that capture increases in decision-making capacity and responsibility, such as the switch from pre-clinical to clinical medical education. Medical students in their clinical years are endowed with an abundance of knowledge from their pre-clinical years and are just beginning to synthesize and apply that information to patient care. "Ambivalence at 10 000 Feet" captures a reflection of a third-year medical student on the theoretical decision to provide emergency medical care in the absence of other trained medical personnel.

Measurement of Humanity Among Health Professionals: Development and Validation of the Medical Humanity Scale Using the Delphi Method.

BACKGROUND: Despite the importance of humanism in providing health care, there is a lack of valid and reliable tool for assessing humanity among health professionals. OBJECTIVE: The aim of this study was to design a new humanism scale and to assess the validity of this scale in measuring humanism among Syrian health professional students. METHODS: The Medical Humanity Scale (MHS) was designed. It consists of 27 items categorized into 7 human values including patient-oriented care, respect, empathy, ethics, altruism, and compassion. The scale was tested for internal consistency and reliability using Cronbach α and test-retest methods. The construct validity of the scale was also tested to assess the ability of the scale in differentiating between groups of health professional students with different levels of medical humanity. A 7-point Likert scale was adopted. The study included 300 participants including 97 medical, 78 dental, 82 pharmacy, and 43 preparatory-year students from Syrian universities. The Delphi method was used and factors analysis was performed. Bartlett test of sphericity and the Kaiser-Meyer-Olkin measure of sample adequacy were used. The number of components was extracted using principal component analysis. RESULTS: The mean score of the MHS was 158.7 (SD 11.4). The MHS mean score of female participants was significantly higher than the mean score of male participants (159.59, SD 10.21 vs 155.48, SD 14.35; P=.008). The MHS mean score was significantly lower in dental students (154.12, SD 1.45; P=.005) than the mean scores of medical students (159.77, SD 1.02), pharmacy students (161.40, SD 1.05), and preparatory-year students (159.05, SD 1.94). However, no significant relationship was found between humanism and academic year (P=.32), university type (P=.34), marital status (P=.64), or financial situation (P=.16). The Kaiser-Meyer-Olkin test (0.730) and Bartlett test of sphericity (1201.611, df=351; P=.01) were performed. Factor analysis indicated that the proportion of variables between the first and second factors was greater than 10%, confirming that the scale was a single group. The Cronbach α for the overall scale was 0.735, indicating that the scale had acceptable reliability and validity. CONCLUSIONS: The results of this study suggest that the MHS is a reliable and valid tool for measuring humanity among health professional students and the development of patient-centered care.

'Swear by Thy Gracious Self': North American Medical Oath-Taking in 2014/2015.

Over the past century, six studies - the most recent data from 2000 - and one review have comprehensively examined the content of medical oaths and oath-taking practices, all focusing on North America, providing an insight into the ethical beliefs of each era. Our study sought to establish a new point of reference. In 2014/2015, oaths from 150 of all 153 US and Canadian medical schools were collected and analyzed. All but one school administered medical oaths and most schools administered more than one. Since 2000, student-written oaths became more popular, and new themes, such as self-care and professionalism, were identified in the oaths for the first time. However, as was identified in 2000, the oaths' contents are disparate and even conflicting at times, raising questions as to whether medicine is being taught or practiced with a coherent ethical worldview.

A Comment on Mercantilism in the Trichological Sciences.

A quasi-scientific interest in hair loss and hair care originated in a London barbershop, and became known as trichology, with the Institute of Trichologists being founded. Other corporations successively followed, offering paid courses by home-study for training of initiates who desire more knowledge about hair. Trichologists are not medically qualified but are taught the practice of care and treatment of the hair and scalp in health and disease within their restricted but specialized role. With the advent of opportunities in the social media, and of epiluminiscence microscopy, a procedure practiced by the guild of trichologists long before its nominal introduction as trichoscopy into dermatologic practice, representatives of the medical profession are following the example of the trichologists in offering online courses, though with a better understanding of clinical-pathological correlations based on their academic learning. Despite the enthusiasm emerging with its establishment as a dermatologic tool in the diagnosis of hair and scalp disorders, caution is warranted not to elevate trichoscopy to something like a fetish status. As a diagnostic procedure, trichoscopy is to be understood as representing an integral part of a comprehensive dermatological examination. The Hippocratic Oath is one of the oldest binding documents in history, allegedly still held sacred by physicians: to treat the ill to the best of one's ability, to preserve a patient's privacy, and to teach the secrets of medicine to the next generation without fee. And yet, as in no other field of medicine, paid online courses on trichoscopy are flourishing and with a primary commercial aim. However, dermato-trichology, or trichiatry require the same due diligence as any other medical discipline, with respect to its practice and its ethics. Medical artistry is neither reducible to a single hand-held diagnostic technique nor is it negotiable.

Venture of a Tertiary Care Neurosurgical Center in Course of COVID-19 Lockdown without RT-PCR.

"I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient." Obliged by the aforementioned oath, no medical practitioner shall sit in a moral judgment on any patient but will treat their illness to the best of their ability whatever the circumstances. A clear concord was yet to be authorized after the World Health Organization (WHO) declared the global pandemic of severe acute respiratory syndrome coronavirus 2infection. As a diagnostic modality, WHO recommended real-time reverse transcription-polymerase chain reaction (RT-PCR) as a reliable test; however, its availability in a deprived nation like ours became a major restraining factor. Despite an asset of having high specificity, RT-PCR for coronavirus disease 2019has its own liability of having low sensitivity. Henceforth, as time passed by, the validity of the rapid diagnostic tests was put into question. In later months, a few centers around our periphery started conducting RT-PCR, but the time taken to obtain the result was long-drawn-out process and the patient who needed urgent neurosurgical intervention at Annapurna Neurological Institute and Allied Sciences had to wait. We would like to share our expedition through peaks and valleys of managing 215 patients during the vicious circle of lockdown and global pandemic.

Hippocratic Oath and current medical oaths.

The so-called Hippocratic Oath is based on a standardized form of oath in the ancient world and is undoubtedly the most famous, most discussed and most commented part of the Corpus Hippocraticum, collection of medical writings whose authorship is traditionally attributed to the legendary physician Hippocrates. The study will first introduce the nature of this brief text and the various theories about the origins of the Oath, as well as the evidence for its earliest use. The second part of the study focuses on the history of medical oaths in Czechoslovakia since 1918, especially on the changes in the text of the oaths after 1948 (mainly on the basis of so far unpublished documents from the archives), and presents the form of current medical oaths in the Czech Republic, with reference to the formulations of the Hippocratic Oath itself; an overview table lists both the Czech and Latin versions of the current medical oaths.

Practical Considerations and Recommendations for "a Revised Hippocratic Oath for the Era of Digital Health".

The Hippocratic Oath (the "Oath") is a longstanding body of ethical tenets that have undergone several amendments to accommodate changes and evolutions in the practice of medicine. In their recent perspective entitled, "A Revised Hippocratic Oath for the Era of Digital Health," Meskó and Spiegel offered proposed amendments to the Oath to address both challenges and needs that follow digital health implementation in clinical practice. In this commentary, we offer additional thoughts and considerations to Meskó and Spiegel's proposed amendments to accomplish two goals: (1) reflect on the shared goals and values of all digital health stakeholders and (2) drive home the focus on affirming patient choice, autonomy, and respect.

A Revised Hippocratic Oath for the Era of Digital Health.

Physicians have been taking the Hippocratic Oath for centuries. The Oath contains a set of ethical rules designed to guide physicians through their profession; it articulates a set of true north principles that govern the practice of medicine. The Hippocratic Oath has undergone several revisions, most notably in 1948 by the World Medical Association. However, in an era of rapid change in medicine, we believe it is time to update the Oath with modest but meaningful additions so that it optimally reflects 21st century health care. The rise of digital health has dramatically changed the practice of medicine in a way that could not have been easily predicted at the time Hippocrates outlined his ethical principles of medicine. Digital health is a broad term that encompasses use of digital devices and platforms, including electronic health records, patient-provider portals, mobile health apps, wearable biosensors, artificial intelligence, social media platforms, and medical extended reality, to improve the process and outcomes of health care delivery. These technologies have driven a cultural transformation in the delivery of care. We offer modest suggestions to help prompt discussion and contemplation about the current Oath and its relevancy to our changing times. Our suggestions are not meant to be a definitive set of final recommendations. Rather, we propose new text that bodies such as the World Medical Association might consider integrating into an updated Oath, just as previous changes were adopted to ensure the Oath remains relevant and impactful for all physicians and their patients.

Juramento de Hipócrates: análise crítica / Hippocratic Oath: a critical analysis / Juramento de Hipócrates: un análisis crítico

Resumo O Juramento de Hipócrates é, talvez, o mais importante texto de ética médica do mundo ocidental. Amplamente discutido desde a Idade Média por estudantes e filósofos, mesmo com o dito fim da medicina hipocrática em favor do método científico, o documento suscita questões éticas essenciais e é adotado, com variações, em diversas instituições de ensino pelo mundo. Esta revisão procura analisar os textos transmitidos no original, apresentar algumas das interpretações que recebeu ao longo da história e suas leituras e versões em diferentes línguas, além de oferecer uma tradução moderna e comentada do original em grego. Por fim, discute-se sua adoção em escolas de medicina na atualidade.

Abstract The Hippocratic Oath is, perhaps, the most important text of medical ethics in the Western world. Widely discussed since the Middle Ages by students and philosophers, even with the so-called end of Hippocratic medicine in favor of the scientific method, the document still raises essential ethical questions and is adopted, with variations, in various educational institutions worldwide. This review analyzes the original texts, presents some of the interpretations it received throughout history and its readings and versions in different languages, and offers a modern and commented translation of the original in Greek. Finally, its adoption in medical schools today is discussed.

Resumen El Juramento de Hipócrates quizás sea el texto de ética médica más importante en el mundo occidental. Desde la Edad Media se viene discutiendo este documento entre estudiantes y filósofos, incluso con el objetivo de la medicina hipocrática a favor del método científico, además de plantear aspectos éticos esenciales, es utilizado con sus variaciones por diversas instituciones educativas. Esta revisión busca analizar los textos en el original, presentar algunas de las interpretaciones que había recibido a lo largo de la historia, sus lecturas y versiones en diferentes idiomas, así como exponer una traducción moderna y comentada del original en griego. Por último, se discute la actual utilización de este documento en las facultades de medicina.

The Hippocratic Oath.

The Hippocratic Oath is the oldest and wisest description of our profession. It contains profound wisdom on the nature of health, healing, and the relationships both within and without that are necessary to the good practice of medicine. The practices described in its lines are antidotes for much of what ails modern medicine.

The Hippocratic Oath across the interfaith spectrum.

Almost every medical school's graduation ceremony includes some sort of professional medical oath. The Hippocratic Oath, written over 2400 years ago, is the oldest and most well-known of these vows. The essential components of modern medical ethics-beneficence, nonmaleficence, autonomy, and justice-outlined in the Hippocratic Oath persist to this day. The substance of the Hippocratic Oath has been altered and its authorship questioned, yet the major world religions, Baha'i, Buddhism, Christianity, Confucianism, Hinduism, Islam, Jainism, Judaism, Shinto, Sikhism, Taoism, and Zoroastrianism, had versions of the Hippocratic Oath to emphasize the importance of beneficence, nonmaleficence, autonomy, and justice for newly initiated physicians. By investigating these alternative versions of the Hippocratic Oath, similarities between different faiths emerge, reinforcing a common thread of humanity that spans across time.

Does teaching medical ethics ensure good knowledge, attitude, and reported practice? An ethical vignette-based cross-sectional survey among doctors in a tertiary teaching hospital in Nepal.

BACKGROUND: Importance of awareness of medical ethics and its integration into medical curriculum has been frequently highlighted. Study 1 aimed to assess the knowledge, attitude, and reported practices of medical ethics among clinicians at Patan Academy of Health Sciences, a tertiary care teaching hospital in Nepal. Study 2 was conducted to assess whether there was a difference in knowledge, attitude, and reported practices of medical ethics among doctors who received formal medical ethics education during undergraduate studies and those who did not. METHODS: Two cross-sectional surveys using self-administered questionnaires were conducted. Study 1 included 72 participants; interns, medical officers, and consultants working at Patan Academy of Health Sciences. Study 2 was a comparative study conducted among 54 medical officers who had received formal medical ethics education (Group 1) and 60 medical officers who did not (Group 2). RESULTS: Participants who had completed post-graduate education had higher knowledge (p = 0.050), practice (p < 0.001), and overall combined scores (p = 0.011). Participants with ethics education had higher knowledge (p < 0.001), attitude (p = 0.001), practice (p < 0.001), and overall score (p < 0.001). Most participants preferred consulting colleagues if an ethical dilemma arose. Fewer participants had heard of the Declaration of Helsinki. Most participants thought doctors to be most capable of judging what is best for the patient (Study 1: 70.42%, Study 2 Group 1: 42.59%, Group 2: 80%). Case scenarios in which participants demonstrated poor practice were ethical issues concerning truth-telling, end-of-life decisions, treating HIV/AIDS patients, treating a minor, and reporting colleague's errors. CONCLUSIONS: This study found that participants who have received medical ethics education have higher knowledge, attitude, and practice scores. The results further justify the need for medical ethics education to be a part of the core medical curriculum. A blame-free environment where seniors can be approached for advice should be created. Research ethics should also be given attention. During medical ethics training, ethical issues where doctors perform poorly should be given more priority and should be discussed in a country-specific context.

The Hippocratic Oath and the physician's pledge and their potential role early in medical education.

This is a short view point on a possible role of physician's pledges in today's medical careers. The history of the Hippocratic Oath and the Geneva Declaration was depicted and its relevance for education in Anatomy was mooted. Anatomy is taught very early in the medical curriculum and anatomists should behave in an exemplary manner with respect to the dead bodies as well as to medical students as future colleagues.

La ética ante las crisis sanitarias a propósito de la COVID-19 / Ethics facing health crises related to COVID-19

La ética está presente en múltiples escenarios, pero frente a una pandemia, se destacan los inherentes al sistema de salud. Este artículo tiene como objetivo, identificar momentos cruciales del enfrentamiento a una crisis sanitaria en los que proliferan los dilemas éticos. Se analizan: el modo de actuar del personal de la salud; aspectos de la organización y las decisiones que se toman. Estos temas se abordan desde varias aristas, entre ellas: la ética en la formación de sus recursos humanos, papel y lugar del juramento hipocrático, posiciones que critican el quebrantamiento de la ética profesional y la urgencia en su restablecimiento. Se examinan posiciones en torno al triaje como sistema de selección y clasificación de pacientes en los servicios de urgencia, los planes de contingencia y los dilemas éticos. Antes de forzar a los médicos a decidir quién vive y quién muere, los gobiernos deben trabajar para disponer de sistemas sanitarios que permitan prevenir las enfermedades, disminuir los contagios masivos y atender los casos clínicos de forma digna con los recursos necesarios. Entre las estrategias a implementar es vital la acertada planificación ante contingencias, que eviten arribar a las fases de saturación y colapso de los servicios médicos, momentos en los que se multiplican los dilemas éticos(AU)

Ethic is present in multiple settings, but when faced with a health crises, those inherent to the health system stand out. This article aims to identify crucial moments in the confrontation with a health crisis in which ethical dilemmas proliferate. Crucial moments of direct confrontation with a health crisis are analyzed: the way of acting of health personnel; organizational aspects and decisions made directly related to the health sector. These issues are approached from several angles, among them: ethics in the formation of its human resources, the role and place of the Hippocratic Oath, positions that criticize the breach of professional ethics and the urgency in its restoration. Positions regarding triage as a system for selecting and classifying patients in emergency services, contingency plans and ethical dilemmas are addressed. Before forcing doctors to decide who lives and who dies, governments must work to have health systems that prevent diseases, reduce mass infections and treat clinical cases with dignity with the necessary resources. Among the strategies to be implemented, correct contingency planning is vital, to avoid reaching the saturation and collapse phases of medical services, moments in which ethical dilemmas multiply(AU)

Against Scientism: Corrupted Science and the Fight for Medicine's Soul.

This article maintains that via the current form of evidence-based medicine, scientism (a pseudo-religious belief in science that is itself not scientific) has been allowed to encroach into medicine. By setting out the philosophical limits of what it is science can do, the effects of this encroachment are discussed in terms of upsetting the balance between the necessarily conflicting art AND science of medicine. In this context, one effect of the Covid-19 pandemic might be to act as a timely reminder - as if it was needed - of the importance of the Hippocratic Oath, which is and always has been the soul of medicine.

The Hippocratic Oath: A Radiologic Perspective.

OBJECTIVE. The purpose of this article is to revisit the Hippocratic Oath, the oldest extant document of medical ethics, and refamiliarize ourselves with the foundation of our profession of radiology. CONCLUSION. Many radiologists have taken the Hippocratic Oath. However, for many, it has been years, even decades, since they last read it. At a time when the field of radiology is undergoing rapid changes, it is important for radiologists to ponder the ethical foundation of radiology.

Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm!

BACKGROUND: Although deficient procedures performed by impaired physicians have been reported for many specialists, such as surgeons and anesthesiologists, systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic encephalopathy. Yet gastroenterologists, like any individual, can rarely suffer acute-changes-in-mental-status from medical disorders, and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their workday. CASE SUMMARIES: Among 181767 endoscopies performed by gastroenterologists at William-Beaumont-Hospital at Royal-Oak, two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic encephalopathy. Case-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps, and absurdly "pressed" endoscopic steering dials to "take" endoscopic photographs; Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum, and wildly turned steering dials and bumped endoscopic tip forcefully against antral wall. Endoscopy nurses recognized endoscopists as impaired and informed endoscopy-unit-nurse-manager. She called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies (fulfilling ethical imperative of "physician, first-do-no-harm"), and go to emergency room for medical evaluation. Both endoscopists complied. In-hospital-work-up revealed toxic encephalopathy in both from: case-1-urosepsis and left-ureteral-impacted-nephrolithiasis; and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified stranger. Endoscopists rapidly recovered with medical therapy. CONCLUSION: This rare syndrome (0.0011% of endoscopies) may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy. Recommended management (followed in both cases): 1-recognize incident as medical emergency demanding immediate action to prevent iatrogenic patient injury; 2- inform Chief-of-Gastroenterology; and 3-immediately intervene to abort endoscopy to protect patient. Syndromic features require further study.