Assuntos
Disciplina no Trabalho/legislação & jurisprudência , Licenciamento em Medicina/legislação & jurisprudência , Médicas/provisão & distribuição , Médicas/tendências , Médicos/estatística & dados numéricos , Má Conduta Profissional/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Vítimas de Crime/psicologia , Disciplina no Trabalho/ética , Ética Médica , Feminino , Humanos , Liderança , Licenciamento em Medicina/ética , Masculino , Princípios Morais , Exame Físico , Médicos/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Papel Profissional , Fatores Sexuais , Delitos Sexuais/legislação & jurisprudência , Estados UnidosRESUMO
The aim of this section is to expand and accelerate advances in curriculum developments and in methods of teaching bioethics.
Assuntos
Educação Médica/ética , Realidade Virtual , Simulação por Computador/economia , Custos e Análise de Custo , Educação Médica/economia , Humanos , Licenciamento em Medicina/éticaAssuntos
American Medical Association , Códigos de Ética , Ética Médica , Publicidade/ética , Pessoal Técnico de Saúde/ética , Confidencialidade/ética , Conflito de Interesses , Correio Eletrônico/ética , Emprego/ética , Ética nos Negócios , Ética em Enfermagem , Ética Profissional , Honorários Médicos/ética , Acessibilidade aos Serviços de Saúde/ética , Experimentação Humana/ética , Humanos , Consentimento Livre e Esclarecido/ética , Reembolso de Seguro de Saúde/ética , Internet/ética , Relações Interprofissionais/ética , Licenciamento em Medicina/ética , Relações Médico-Paciente/ética , Médicos/ética , Prática Profissional/ética , Relações Públicas , Encaminhamento e Consulta/ética , Alocação de Recursos/ética , Estados UnidosAssuntos
Conflito de Interesses , Indústria Farmacêutica/ética , Educação Médica Continuada/ética , Viés , Revelação , Educação Médica Continuada/economia , Educação Médica Continuada/normas , Medicina Baseada em Evidências , Licenciamento em Medicina/ética , Política Organizacional , Médicos , Guias de Prática Clínica como Assunto , Controle de Qualidade , Confiança , Estados UnidosRESUMO
Genetic testing for inherited susceptibility to breast and ovarian cancer can be compared with similar testing for colorectal cancer as a "natural experiment." Inherited susceptibility accounts for a similar fraction of both cancers and genetic testing results guide decisions about options for prophylactic surgery in both sets of conditions. One major difference is that in the United States, Myriad Genetics is the sole provider of genetic testing, because it has sole control of relevant patents for BRCA1 and BRCA2 genes, whereas genetic testing for familial colorectal cancer is available from multiple laboratories. Colorectal cancer-associated genes are also patented, but they have been nonexclusively licensed. Prices for BRCA1 and 2 testing do not reflect an obvious price premium attributable to exclusive patent rights compared with colorectal cancer testing, and indeed, Myriad's per unit costs are somewhat lower for BRCA1/2 testing than testing for colorectal cancer susceptibility. Myriad has not enforced patents against basic research and negotiated a Memorandum of Understanding with the National Cancer Institute in 1999 for institutional BRCA testing in clinical research. The main impact of patenting and licensing in BRCA compared with colorectal cancer is the business model of genetic testing, with a sole provider for BRCA and multiple laboratories for colorectal cancer genetic testing. Myriad's sole-provider model has not worked in jurisdictions outside the United States, largely because of differences in breadth of patent protection, responses of government health services, and difficulty in patent enforcement.
Assuntos
Neoplasias da Mama/genética , Neoplasias do Colo/genética , Predisposição Genética para Doença/genética , Testes Genéticos/ética , Licenciamento em Medicina/ética , Neoplasias Ovarianas/genética , Patentes como Assunto/ética , Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias da Mama/diagnóstico , Neoplasias do Colo/diagnóstico , Análise Custo-Benefício , Feminino , Genes , Testes Genéticos/economia , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/ética , Humanos , Masculino , Neoplasias Ovarianas/diagnósticoRESUMO
Genetic testing for Tay-Sachs and Canavan disease is particularly important for Ashkenazi Jews, because both conditions are more frequent in that population. This comparative case study was possible because of different patenting and licensing practices. The role of DNA testing differs between Tay-Sachs and Canavan diseases. The first-line screening test for Tay-Sachs remains an enzyme activity test rather than genotyping. Genotyping is used for preimplantation diagnosis and confirmatory testing. In contrast, DNA-based testing is the basis for Canavan screening and diagnosis. The HEXA gene for Tay-Sachs was cloned at the National Institutes of Health, and the gene was patented but has not been licensed. The ASPA gene for Canavan disease was cloned and patented by Miami Children's Hospital. Miami Children's Hospital did not inform family members and patient groups that had contributed to the gene discovery that it was applying for a patent, and pursued restrictive licensing practices when a patent issued in 1997. This led to intense controversy, litigation, and a sealed, nonpublic 2003 settlement that apparently allowed for nonexclusive licensing. A survey of laboratories revealed a possible price premium for ASPA testing, with per-unit costs higher than for other genetic tests in the Secretary's Advisory Committee on Genetics, Health, and Society case studies. The main conclusion from comparing genetic testing for Tay-Sachs and Canavan diseases, however, is that patenting and licensing conducted without communication with patients and advocates cause mistrust and can lead to controversy and litigation, a negative model to contrast with the positive model of patenting and licensing for genetic testing of cystic fibrosis.
Assuntos
Doença de Canavan/diagnóstico , Triagem de Portadores Genéticos , Testes Genéticos/ética , Licenciamento em Medicina/ética , Patentes como Assunto/ética , Doença de Tay-Sachs/diagnóstico , Amidoidrolases/genética , Doença de Canavan/enzimologia , Doença de Canavan/genética , Genes , Testes Genéticos/economia , Humanos , Judeus/genética , Licenciamento em Medicina/economia , Doença de Tay-Sachs/enzimologia , Doença de Tay-Sachs/genética , Cadeia alfa da beta-Hexosaminidase/genéticaRESUMO
There are many issues of concern regarding the legal and ethical aspects of telemedicine. These include the responsibilities and potential liabilities of the health professional, the duty to maintain the confidentiality and privacy of patient records, and the jurisdictional problems associated with cross-border consultations. There is also the issue of reimbursement for care provided using a telemedicine service. Telemedicine allows the transmission of health information across the borders of nation states. Cross-border telemedicine services have begun, particularly in specialties such as teleradiology, but questions of jurisdiction and registration have yet to be answered definitively. While this may be true of many of the legal and ethical aspects of telemedicine generally, it is also the case that health-care professionals who undertake telemedicine in a prudent manner will minimize the possibility of medicolegal complications.
Assuntos
Telemedicina , Confidencialidade/ética , Confidencialidade/legislação & jurisprudência , Europa (Continente) , Humanos , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência , Responsabilidade Legal , Licenciamento em Medicina/ética , Licenciamento em Medicina/legislação & jurisprudência , Telemedicina/economia , Telemedicina/ética , Telemedicina/legislação & jurisprudênciaRESUMO
Complementary and alternative medicine has become an important section of healthcare. Its high level of acceptance among the general population represents a challenge to healthcare professionals of all disciplines and raises a host of ethical issues. This article is an attempt to explore some of the more obvious or practical ethical aspects of complementary and alternative medicine.