Ethics, liabilities and licensing to practice.

Medical Councils or Boards are the de facto gatekeepers of the work of medical doctors and their interaction with the public. This article examines some of the ethical and medico-legal issues that may arise when biomedical doctors are not licensed in a particular year to practice medicine. It scrutinizes pertinent sections of the Medical Act of Jamaica and considers the ethical implications of the particular predicament for patients and pharmacists who are requested to fill prescriptions written by doctors who are not in receipt of a practising certificate at the time.

Ethics, liabilities and licensing to practice / Ética, responsabilidades y autorización de licencias para la práctica médica

Medical Councils or Boards are the de facto gatekeepers of the work of medical doctors and their interaction with the public. This article examines some of the ethical and medico-legal issues that may arise when biomedical doctors are not licensed in a particular year to practice medicine. It scrutinizes pertinent sections of the Medical Act of Jamaica and considers the ethical implications of the particular predicament for patients and pharmacists who are requested to fill prescriptions written by doctors who are not in receipt of a practising certificate at the time.

Las Juntas Médicas son de hecho salvaguardas del trabajo de los doctores de medicina y su interacción con el público. El presente artículo examina algunos de los problemas éticos y médico-legales que pueden surgir cuando los doctores biomédicos no poseen licencia en un año en particular para practicar medicina. El trabajo examina cuidadosamente las secciones pertinentes del Acta Médica de Jamaica, y hace consideraciones sobre las implicaciones éticas de la difícil situación particular de los pacientes y farmacéuticos a quienes se les pide llenar prescripciones escritas por doctores que al momento de hacerlo, no han recibido todavía un certificado de autorización para la práctica.

Issues in bioethics: ethics in health policy and guidelines in healthcare.

The development of policies in health and healthcare should incorporate ethical premises as well as thoughtful consideration of the values pertinent to the particular society and the goals to be achieved by specific policies. Social inequalities, changing values, and emergent challenges to traditional beliefs, add complexities that require a thorough analysis to compile policies that are fair and equitable. This article provides some recommendations for clinicians, health administrators, policy makers and technocrats who often grapple with complex health issues.

Issues in bioethics: ethics in health policy and guidelines in healthcare / Problemas de bioética la ética en la política de salud y en las orientaciones de la atención a la salud

The development of policies in health and healthcare should incorporate ethical premises as well as thoughtful consideration of the values pertinent to the particular society and the goals to be achieved by specific policies. Social inequalities, changing values, and emergent challenges to traditional beliefs, add complexities that require a thorough analysis to compile policies that are fair and equitable. This article provides some recommendations for clinicians, health administrators, policy makers and technocrats who often grapple with complex health issues.

El desarrollo de las políticas de salud y atención a la salud deben incorporar premisas éticas, así como consideraciones sopesadas en relación con los valores pertinentes a la sociedad en cuestión y a las metas a alcanzar mediante tales políticas específicas. Las desigualdades sociales, los valores cambiantes, y los desafíos emergentes frente a las creencias tradicionales, añaden complejidades que exigen un análisis exhaustivo a fin de adoptar políticas que sean a la par justas e equitativas. Este artículo ofrece algunas recomendaciones para los médicos clínicos, los administradores, los responsables de trazar políticas, y los tecnócratas, quienes a menudos tienen que vérselas con complejos problemas en el área de la salud.

Issues in bioethics. Teaching research ethics.

All research should meet the highest ethical and scientific standards, and so persons who may be involved in conducting research should be fully conversant with the relevant ethical principles of biomedical research and its requirements. Further, scientists, academicians, physician-researchers, student-researchers, and members of research ethics committees should be able to distinguish between therapy and research, evaluate risk and benefit, be sensitive to various forms of conflicts of interest, and be fully aware of the special provisions necessary for vulnerable populations. This article recommends a number of subject areas that should be addressed as a part of this academic process.

Issues in bioethics. Ethics and professional responsibilities.

The evolution of ethics in medicine has provided the concept of the learned physician who is trained in the scientific method (studying nature and philosophy), and who is wise, modest and humane. The physician's manner, deportment and character should be above reproach, and devotion to the productive art of medicine should supersede any desire for financial gain. Professionalism provides the organizational structure through which the medical doctor performs his/her healing role, and underscores the concept that medical professionals should be moral and devoted to the public good, displaying altruism at the expense of self-interest, and providing accountability. This article examines some of the obligations that arise within this milieu.

Issues in bioethics. Teaching research ethics

All research should meet the highest ethical and scientific standards, and so persons who may be involved in conducting research should be fully conversant with the relevant ethical principles of biomedical research and its requirements. Further, scientists, academicians, physician-researchers, student-researchers, and members of research ethics committees should be able to distinguish between therapy and research, evaluate risk and benefit, be sensitive to various forms of conflicts of interest, and be fully aware of the special provisions necessary for vulnerable populations. This article recommends a number of subject areas that should be addressed as a part of this academic process

Issues in bioethics. Ethics and professional responsibilities

The evolution of ethics in medicine has provided the concept of the learned physician who is trained in the scientific method (studying nature and philosophy), and who is wise, modest and humane. The physician's manner, deportment and character should be above reproach, and devotion to the productive art of medicine should supersede any desire for financial gain. Professionalism provides the organizational structure through which the medical doctor performs his/her healing role, and underscores the concept that medical professionals should be moral and devoted to the public good, displaying altruism at the expense of self-interest, and providing accountability. This article examines some of the obligations that arise within this milieu

Issues in bioethics. Teaching medical ethics to health professionals.

New medical technologies, public concern about medical ethics, and the advent of numerous ethical dilemmas in healthcare have led many medical schools to increase their formal teaching of ethics. Ethical issues in healthcare may involve a complex mix of scientific, economic, social, cultural, religious, moral and legal issues. Education in medical ethics will therefore need to be on-going to accommodate changes that periodically occur in healthcare issues, policies, or the changing moral values of the society. This article proposes frameworks within which this process may occur.

Issues in bioethics. Teaching medical ethics to health professionals

New medical technologies, public concern about medical ethics, and the advent of numerous ethical dilemmas in healthcare have led many medical schools to increase their formal teaching of ethics. Ethical issues in healthcare may involve a complex mix of scientific, economic, social, cultural, religious, moral and legal issues. Education in medical ethics will therefore need to be on-going to accommodate changes that periodically occur in healthcare issues, policies, or the changing moral values of the society. This article proposes frameworks within which this process may occur.

Medicine and its alternatives. Health care priorities in the Caribbean.

In the Caribbean as in many other areas costly biomedical resources and personnel are limited, and more and more people are turning to alternative medicine and folk practitioners for health care. To meet the goal of providing health care for all, research on nonbiomedical therapies is needed, along with legal recognition of folk practitioners to establish standards of practice.

Ethics, medicine and society: imperatives for the future.

Historically, medicine has been a caring profession and social factors have directly and indirectly affected clinical practice, yet the social roots of disease and suffering in patients and the ethics of patient care have often been left out of medical teaching and discussions at medical conferences. As health and social problems are inseparable, ethically, medicine and medical teaching need to respond to social suffering, and should help to solve the economic problems in health care. Further, since all intervention in the lives of human beings carries ethical content through the nature of care, ethical competence involving ethical analysis, critical thinking, and problem-solving should be developed in medical students and doctors simultaneously with clinical judgement and expertise.

The impact of advanced technology on critical care. Dilemmas in the making.

Advanced technology has enhanced our ability to diagnose and treat critically ill patients, thereby assisting in prolonging life for many. However, its high cost has been prohibitive, and it may impose more burdens than benefits on some patients. Although technological advances have accelerated social change, many have also fuelled legal and ethical concerns. Consequently, the rationale for the use of advanced technology in the care of critically ill patients should be clear and ethically justified.

Cumulus cell dispersal from murine oocytes by an epididymal guanidinobenzoatase.

Guanidinobenzoatase (GB), a serine proteinase with a molecular weight of 71,000, is found both free in the epididymal fluids of the mouse and bound to the sperm surface. Microgram quantities of the enzyme, purified from epididymal fluid, will completely disperse follicle cells from freshly ovulated oocytes after 15 min of incubation. Purified GB exhibits no hyaluronidase activity as determined by the acid albumin assay. The ability of GB to disperse follicle cells is blocked by a proteinase inhibitor endogenous to the male reproductive tract. The inhibitor has no effect on bovine testicular hyaluronidase. Although the function of GB has not been defined, the observations presented here indicate that it may play a role in cumulus matrix penetration during fertilization.

Characterization of the guanidinobenzoatase in the epididymal fluids of the mouse.

Guanidinobenzoatase (GB), a proteolytic enzyme found in the epididymal fluids of mice, was purified to apparent homogeneity by molecular sieving and affinity chromatography. It has a molecular mass of 71 kDa and its enzymatic activity is heat labile and sensitive to EGTA. Its kinetic parameters (K(m) of 6.66 microM and a Vmax of 4.38 nmol/min/mg) were determined using 4-methylumbelliferyl-p-guanidinobenzoate (MUGB) as the substrate. GB activity is concentrated in the cauda epididymal region of the genital tract. Heat-solubilized whole zonae, biologically active ZP3, and several serine proteinase inhibitors, including a proteinase inhibitor endogenous to the male genital tract, effectively block the ability of GB to hydrolyze MUGB. Pretreating cumulus-free, zonae intact oocytes with purified GB reduces, in a concentration-dependent manner, the number of sperm able to bind to the zonae. The function of the soluble enzyme is not known. Its ability to bind both trypsin inhibitors and ZP3 suggests a possible role in gamete recognition.