Feasibility of rapid ethical assessment for the Ethiopian health research ethics review system

One of the challenges in the process of ethical medical research in developing countries; including Ethiopia; is translating universal principles of medical ethics into appropriate informed consent documents and their implementation. Rapid Ethical Assessment (REA) has been suggested as a feasible approach to meet this application gap. In the past few years REA has been employed in few research project in Ethiopia and have been found to be a useful and practical approach. Feasibility assessment of REA for the Ethiopian research setting was conducted between 2012-2013 in order to inform the subsequent introduction of REA into research ethics review and governance system in the country. REA was found to be an appropriate; relevant and feasible venture. We argue that REA can be integrated as part of the ethics review and governance system in Ethiopia. REA tools and techniques are considered relevant and acceptable to the Ethiopian research community; with few practical challenges anticipated in their implementation. REA are considered feasible for integration in the Ethiopian ethics review system

Respecting wishes and avoiding conflict: understanding the ethical basis for organ donation and retrieval.

Many people care deeply about what happens to their own and their loved ones' bodies after death. It is therefore important to capture individuals' wishes and ensure that they are respected as far as practically possible. At the same time, healthcare professionals need to feel confident that they are morally entitled to do what they need to do to ensure that someone's wishes are fulfilled. This article explores the decision to donate one's organs after death. It attempts to reconcile the way in which people are required to express their wish to donate organs with the need to reassure and support the professionals, who will care for them if they become potential donors. Current donor registration processes leave some professionals feeling that donors have not consented in the usual manner to procedures, which might be necessary before death. It is suggested that this issue could be addressed without imposing information overload on prospective donors, by changing the way in which the wish to donate is understood and expressed.

Testing the embryo, testing the fetus.

This paper stems from an ethnographic, multidisciplinary study that explored the views and experiences of practitioners and scientists on social, ethical and clinical dilemmas encountered when working in the area of PGD for serious genetic disorders. We focus here on staff perceptions and experiences of working with embryos and helping women/couples to make choices that will result in selecting embryos for transfer and disposal of 'affected' embryos, compared to the termination of affected pregnancies following PND. Analysis and discussion of our data led us to consider the possible advantages of PGD and whether a gradualist account of the embryo's and fetus's moral status can account for all of these, particularly since a gradualist account concentrates on the significance of time (developmental stage) and makes no comment as to the significance of place (in-vitro, in-utero).

Aiming towards "moral equilibrium": health care professionals' views on working within the morally contested field of antenatal screening.

OBJECTIVE: To explore the ways in which health care practitioners working within the morally contested area of prenatal screening balance their professional and private moral values. DESIGN: Qualitative study incorporating semistructured interviews with health practitioners followed by multidisciplinary discussion groups led by a health care ethicist. SETTING: Inner city teaching hospital and district general hospital situated in South East England. PARTICIPANTS: Seventy practitioners whose work relates directly or indirectly to perinatal care. RESULTS: Practitioners managed the interface between their professional and private moral values in a variety of ways. Two key categories emerged: "tolerators", and "facilitators". The majority of practitioners fell into the "facilitator" category. Many "facilitators" felt comfortable with the prevailing ethos within their unit, and appeared unlikely to feel challenged unless the ethos was radically challenged. For others, the separation of personal and professional moral values was a daily struggle. In the "tolerator" group, some practitioners sought to influence the service offered directly, whereas others placed limits on how they themselves would contribute to practices they considered immoral. CONCLUSIONS: The "official" commitment to non-directiveness does not encourage open debate between professionals working in morally contested fields. It is important that practical means can be found to support practitioners and encourage debate. Otherwise, it is argued, these fields may come to be staffed by people with homogeneous moral views. This lack of diversity could lead to a lack of critical analysis and debate among staff about the ethos and standards of care within their unit.

Conflicting perceptions of the fetus: person, patient, 'nobody', commodity?

Different constructions of the fetus lie at the centre of reproductive, abortion and disability politics. Recent developments mean that, within the same hospital, a fetus may be perceived in contrasting and potentially conflicting ways. It is also argued that the status given to the fetus is directly relevant to the status given to pregnant women. During group discussions facilitated by an ethicist, health-care staff highlighted various perceptions of the fetus which included: person; patient; 'nobody'; commodity. Perhaps not surprisingly in view of the current legal situation, staff tended to claim that it is usually the pregnant women who decides how her fetus will be constructed, and the practitioner who responds to this. However, various ways in which practitioners might influence women's perceptions of their fetus are highlighted, as are some ways in which the perceptions of staff might be influenced. This paper illustrates how sensitive health-care staff will need to be if they are indeed to respond to, rather than shape, women's constructions of their fetus.