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J Law Med ; 27(4): 981-984, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32880414


Clinical issues involving ethical dilemmas arise daily and confound physicians as they provide medical care. These dilemmas require difficult decisions as physicians must respect patients' values, lifestyles, and freedom of choice while protecting life and promoting health. This is made more challenging as values and lifestyles become more diverse, making third-party support necessary to accommodate the wishes of stakeholders, particularly patients. Collaborative work is important for addressing clinical ethics issues. Government agencies and professional organisations should discuss individual cases as public policy concerns and release guidelines based on their deliberations. Medical institutions should refer to such guidelines in their own discussions on ethically challenging cases. This is not the case today as each organisation creates its own guidelines; there is no consensus on how clinical ethics committees or consultations should be conducted. Support systems that are public in nature are needed to protect patients' rights and freedoms in medical care.

Tomada de Decisão Clínica , Médicos , Ética Médica , Liberdade , Humanos , Japão , Direitos do Paciente
Nagoya J Med Sci ; 82(2): 193-204, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32581400


We investigated the differences in Japanese and United States medical and legal professional opinions on ethical support for clinical ethical issues using the refusal of blood transfusions on the grounds of religious principles as an example of a clinical ethical issue. In ethical support systems for medical institutions in Japan, 95.0% of "clinical training designation hospitals" have hospital ethics committees, and 63.1% have medical safety divisions; clinical ethical support is provided in accordance with their scale and function. In terms of clinical ethical support limits the discretion of physicians, 59.2% of lawyers responded "No" and 54.4% of doctors responded "Yes". In addition, on the feasibility of government or academic guidelines in clinical practice, 37.7% of lawyers responded "Yes" and 63.0% of doctors responded "No". In terms of "relative transfusion-free" policy, 83.2% of lawyers and 76.8% of doctors responded that it is "unavoidable," while 81.6% of U.S. committee heads responded that it is a "violation of rights." In terms of hospital transfers due to a hospital being unable to treat patients refusing blood transfusion, 62.6% of lawyers reported that it is "unavoidable" while 57.1% of U.S. committee heads reported that it "should be avoided". The results of this study indicate that medical and legal professionals and U.S. ethics committee heads recognize clinical ethical issues in slightly different ways.

Nagoya J Med Sci ; 81(3): 501-509, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31579340


The survey involves examining the applications from 142 institutions that have consented to make available all certification applications from 2015 and 2016 to a research project for building a certification system for an ethics committee run by the Agency for Medical Research and Development. The number of certified institutions is 20 (14.1%). In the applications from uncertified institutions, there are cases in which requirements of ethics guidelines are unmet, and there is insufficient information provided on regulation and procedure. An analysis of the committee members who can contribute as members of the general public (general public committee members) has indicated that the number of committee members who do not belong to an institution in which an ethics committee is instituted (external committee members) is 41 (95.7%) among the certified institutions and 224 (84.5%) among the uncertified institutions. The proportion of general public committee members drawn internally from institutions tends to be higher among uncertified institutions. While a separate committee examined conflicts of interest in research in 19 certified institutions (95.0%), such conflicts were found in 41 uncertified institutions (33.9%) by the ethics committee. The survey confirms that the challenge lies in increasing the number of external committee members and in further improving the system to manage conflicts of interest, and the education and training regime.

Comitês Consultivos/estatística & dados numéricos , Comitês de Ética em Pesquisa/estatística & dados numéricos , Pesquisa Biomédica/ética , Revisão Ética , Humanos , Japão
Rinsho Shinkeigaku ; 51(11): 830-3, 2011 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-22277384


Clinical research is guided by ethical principles promulgated in several statements, principally the Nuremberg Code, the Helsinki Declaration of the World Medical Association etc. In Japan, clinical research of medical products, principally trial of new pharmaceutical products is regulated by GCP (good clinical practice). Other types of clinical research are regulated by some ethical guidelines for clinical researches. The result is a regulatory position that is a complex combination of legislation and ethical guidelines. In the Ethical Guideline for Clinical Studies revised in 2008, clinical research is classified into intervention research and observational research. When researchers plan clinical research, they must determine the type of clinical research and appropriate ethical guideline for the type of clinical research. Advances in health informatics and genetic research have produced a new and very rich body of raw material for clinical research in the form of gene banks and genome-wide association study etc. The use of human tissue and medical information in the course of clinical research raises issues under the ethical regulations for research with human subjects.

Ética em Pesquisa , Revisão Ética , Genoma Humano , Guias como Assunto , Humanos
Nagoya J Med Sci ; 71(1-2): 63-9, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19358476


The duty of risk disclosure in medical treatment contracts is examined first through comparison with securities exchange contracts, second, by examining the contract as dealt in judicial precedent, ensued by an analysis and proposal by the author. In both types of contracts, the number of judicial judgments finding for the plaintiff based solely on violation of the duty of risk disclosure is increasing. Different explanations, however, should apply for the increase. In the case of the securities exchange contracts, the duty to inform is understood as a means of providing material for informed choice and self-determination, thus supporting the argument for self-discipline. Whereas, in the case of medical treatment contracts, adding to the argument for self-determination, another line of reasoning is given: disclosure of relevant information as a means by which the medical services secure the life and physical well-being of the patient. The reason the principle of self-determination is not in full play is analyzed as a case in which higher norms of the professional ethics of the medical staff is functioning. Thus, in providing medical information of possible treatments to the patient, the physician is exonerated from legal liability, but remains burdened with the ethical responsibility to provide appropriate care. As the overlap of the two types of responsibility seems not to be fully realized, further investigation and dissemination of findings of this issue is proposed.

Contratos/ética , Ética Médica , Consentimento Livre e Esclarecido/ética , Gestão de Riscos/ética , Revelação da Verdade/ética , Humanos