The Ban on US Government Funding Research Using Human Fetal Tissues: How Does This Fit with the NIH Mission to Advance Medical Science for the Benefit of the Citizenry?

Some have argued that human fetal tissue research is unnecessary and/or immoral. Recently, the Trump administration has taken the drastic--and we believe misguided--step to effectively ban government-funded research on fetal tissue altogether. In this article, we show that entire lines of research and their clinical outcomes would not have progressed had fetal tissue been unavailable. We argue that this research has been carried out in a manner that is ethical and legal, and that it has provided knowledge that has saved lives, particularly those of pregnant women, their unborn fetuses, and newborns. We believe that those who support a ban on the use of fetal tissue are halting medical progress and therefore endangering the health and lives of many, and for this they should accept responsibility. At the very least, we challenge them to be true to their beliefs: if they wish to short-circuit a scientific process that has led to medical advances, they should pledge to not accept for themselves the health benefits that such advances provide.

Not Above the Law: A Legal and Ethical Analysis of Short-Term Experiences in Global Health.

BACKGROUND: Persons from high-income countries have multiple opportunities today to participate in "short-term experiences in global health" (STEGHs) in low-resourced countries. STEGHs are organized through religious missions, service learning, medical internships, global health education, and international electives. An issue of increasing concern in STEGHs is "hands-on" participation in clinical procedures by volunteers and students with limited or no medical training. To address these concerns, best practices and ethical standards have been developed. However, not all STEGH organizations adhere to these guidelines, and some actively or tacitly allow unethical and potentially illegal practices. OBJECTIVES: This paper considers the legal framework within which STEGHs operate. It assesses whether certain STEGH practices break laws in the US and/or host countries or violate international "soft" legal norms. Two activities of particular concern are: practicing medicine without a license and drug importation and distribution. CONCLUSIONS: Many activities undertaken in STEGHs would be illegal if they took place on US soil. In addition, these same activities are often illegal in the host countries where STEGHs operate, although compliance is unevenly enforced. Many STEGH activities violate World Health Organization guidelines for ethical conduct in humanitarian activities. RECOMMENDATIONS: This paper encourages STEGH organizations to end unethical and potentially illegal activities; urges regulatory and non-regulatory stakeholders to alter policies that motivate participation in illegal or unethical STEGH activities; and encourages host countries to enforce their local and national health laws.

Contribución de la mujer en misiones internacionales de las Fuerzas Armadas / Contribution of women on Armed Forces’ international missions

ANTECEDENTES: Hasta hace apenas una década, las mujeres han estado generalmente excluidas para participar en la guerra como sujetos activos. Después de la Resolución 1325 del Consejo de Seguridad de las Naciones Unidas (UN) de Octubre del 2000, se ha generalizado su incorporación a los ejércitos en procesos de paz y reconstrucción posconflicto; siendo el principal objetivo del Plan de Acción del Gobierno de España aprobado en 2007 «Potenciar la participación de mujeres en misiones y órganos de toma de decisiones». OBJETIVO: Determinar el nivel de cumplimiento con respecto a la participación de las mujeres del ejército español en procesos de paz y reconstrucción posconflicto. MATERIAL Y MÉTODO: DISEÑO: se trata de un estudio observacional descriptivo longitudinal retrospectivo. Ámbito: Fuerzas Armadas Españolas, durante el periodo comprendido entre enero de 1993 y diciembre de 2015. Población: Mujeres que han ingresado en las Fuerzas Armadas Españolas durante el periodo de estudio y que han participado en misiones internacionales. RESULTADOS: durante el periodo de estudio se observó un incremento de mujeres en los diferentes ejércitos que participaron en misiones internacionales, siendo el año 2014 el de máxima participación con un 12,5% de mujeres. CONCLUSIONES: Se observó un incremento en la proporción de mujeres participantes en misiones internacionales (FAS), así como su acceso a los cargos de mayor responsabilidad

BACKGROUND: Until just a decade, women have been largely excluded from participating in war as active subjects. After the 1325 Resolution of the UN Security Council in October 2000, incorporation of women to armies in peace-keeping missions and post-conflict reconstruction has been generalized, being the main objective of the «Action Plan of Government of Spain» approved in 2007 to «Enhance Women's Participation in Missions and Decision-Making Bodies». OBJECTIVE: To determine the level of compliance in relation to the participation of women in the Spanish army in peace-keeping processes and post-conflict reconstruction. MATERIALS AND METHODS: DESIGN: It is an observational, retrospective, descriptive and longitudinal study. Ambit: Spanish army, during the period between January 1993 and December 2015. Population: women who have joined the Spanish army during the studied period and have participated in international tours of duty. RESULTS: During the studied period, an increase of women in the different armies that participated in international missions has been observed, being 2014 the year with maximum participation of women, 12.5%. CONCLUSIONS: An increase in the proportion of women participating in international missions (FAS), as well as their access to positions of greater responsibility has been observed

Planning a pharmacy-led medical mission trip, part 1: focus on medication acquisition.

Pharmacists can be involved in many functions of the medical mission team. Particularly, they can play a large role in formulary development, acquisition of medications, and organization of medications before and during the mission trip. Important factors for consideration in formulary development and logistical planning include the group's budget; importation laws and regulations of the country being visited; transportation and storage of medications and supplies; disease states anticipated; whether controlled substances will be included; whether medical or surgical procedures will be provided; age distribution and languages of the population to be treated; whether sample medications will be used; handling of unused medications and supplies after the trip; and considerations of the population's cultural beliefs. Various organizations are available to provide medications for medical mission efforts at little to no cost, and knowledge of these organizations will help to facilitate the process of medication acquisition. Additionally, pharmacists can provide insight regarding the logistical set-up and workflow considerations during the mission experience.

Protected health information on social networking sites: ethical and legal considerations.

BACKGROUND: Social networking site use is increasingly common among emerging medical professionals, with medical schools even reporting disciplinary student expulsion. Medical professionals who use social networking sites have unique responsibilities since their postings could violate patient privacy. However, it is unknown whether students and residents portray protected health information and under what circumstances or contexts. OBJECTIVE: The objective of our study was to document and describe online portrayals of potential patient privacy violations in the Facebook profiles of medical students and residents. METHODS: A multidisciplinary team performed two cross-sectional analyses at the University of Florida in 2007 and 2009 of all medical students and residents to see who had Facebook profiles. For each identified profile, we manually scanned the entire profile for any textual or photographic representations of protected health information, such as portrayals of people, names, dates, or descriptions of procedures. RESULTS: Almost half of all eligible students and residents had Facebook profiles (49.8%, or n=1023 out of 2053). There were 12 instances of potential patient violations, in which students and residents posted photographs of care they provided to individuals. No resident or student posted any identifiable patient information or likeness in text form. Each instance occurred in developing countries on apparent medical mission trips. These portrayals increased over time (1 in the 2007 cohort; 11 in 2009; P = .03). Medical students were more likely to have these potential violations on their profiles than residents (11 vs 1, P = .04), and there was no difference by gender. Photographs included trainees interacting with identifiable patients, all children, or performing medical examinations or procedures such as vaccinations of children. CONCLUSIONS: While students and residents in this study are posting photographs that are potentially violations of patient privacy, they only seem to make this lapse in the setting of medical mission trips. Trainees need to learn to equate standards of patient privacy in all medical contexts using both legal and ethical arguments to maintain the highest professional principles. We propose three practical guidelines. First, there should be a legal resource for physicians traveling on medical mission trips such as an online list of local laws, or a telephone legal contact. Second, institutions that organize medical mission trips should plan an ethics seminar prior the departure on any trip since the legal and ethical implications may not be intuitive. Finally, at minimum, traveling physicians should apply the strictest legal precedent to any situation.

[Laws relevant to international missions of health cooperation]. / Le norme applicabili a missioni di cooperazione sanitaria internazionale.

Both medical doctors and humanitarian operators engaged in health relief or development missions abroad, are called to respect the general principles of international law, that is to say, customary law that is legally compulsory for the International Community and rules deriving from Treaties and International Conventions. Humanitarian operators have to observe also the rules and regulations of the hosting country. They have to respect all rules applying to their humanitarian action and they have to take responsibility towards beneficiaries and donors alike.

Family physicians and human rights: a case example from former Yugoslavia.

BACKGROUND: The role of family physicians in the protection of human rights is unclear. The purpose of this article is to explore this role through examination of the specific case of former Yugoslavia. METHODS: In January/February 1993, we investigated medical aspects of human rights abuses as part of a fact-finding mission for the Physicians for Human Rights organization. We used primarily qualitative methods, including direct observation, key informant interviews, focus groups, and key document review. RESULTS: We observed pervasive violations of medical neutrality, as indicated by the shelling of Kosevo Hospital, the major tertiary care hospital in Sarajevo. Forty-one percent of former prison camp detainees from north Bosnia housed at the Karlovac, Croatia, refugee camp had scars consistent with physical abuse. Civilians in north central Bosnia and Sarajevo were targeted through physical violence, artillery shelling, and strangulation of the public health infrastructure--food, water, electricity, heat, and medical supplies. CONCLUSIONS: Physicians can be uniquely useful in the investigation of human rights. The flexibility of family physicians and their attention to the biopsycosocial aspects of health can be especially useful. Family physicians should become actively involved in the protection of human rights.