Begell House Inc.
Ethics in Biology, Engineering and Medicine: An International Journal
EBEM
2151-805X
7
1-2
2016
Ethical Considerations Regarding Disclosure of Off-Label Drug and Device Use as a Component of Informed Consent in a Resident Training Program
1-10
10.1615/EthicsBiologyEngMed.2016017204
Jordan
Fakhoury
New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Old Westbury,
New York 11568, USA
Adam
Bitterman
Department of Orthopaedics, Northwell Health,
Manhasset, New York
Christopher
Healy
Department of Orthopedic Surgery, Hofstra Northwell School of Medicine: Plainview Hospital, Plainview, New York 11803, USA
Michael
Grosso
Department of Medical Affairs, Hofstra Northwell School of Medicine: Huntington Hospital, Huntington, New York 11743, USA
James
Gurtowski
Department of Orthopedic Surgery, Hofstra Northwell School of Medicine: Huntington Hospital, Huntington, New York 11743, USA
disclosure
education
informed consent
off-label
resident training
Since the twentieth century, informed consent has been considered an ethical obligation and legal requirement. Relatively few studies have evaluated the quality of informed consent in practice settings, and where such studies have been undertaken, large gaps have been identified. The present study considers the issue of condition-specific Food and Drug Administration (FDA) approval status for drugs and devices employed in the practice of orthopedics and its relationship to informed consent. Twenty-six orthopedic surgery attending
surgeons and twenty-six orthopedic surgery resident surgeons were surveyed about their use of gabapentin, Lidoderm patches, and the Endobutton CL BTB (ECLFD, Smith and
Nephew, Memphis, Tennessee) and if they disclosed the anticipated off-label use to their patients.
In addition, orthopedists and those in training were queried regarding their disclosure of allograft utilization. We conclude knowledge deficits regarding the FDA-approved indications for drugs and devices contribute to nondisclosure of off-label use. There is also a discrepancy
regarding disclosure of allograft material among those in practice compared to those in training. Furthermore, some physicians may deem off-label disclosure unnecessary if its
particular usage has been well studied in the literature.
Shared Decision Making Still a Goal and Not a Practice: How One Physician Learned about the Other Side, The Patient's Perspective
11-19
10.1615/EthicsBiologyEngMed.2017013291
David S.
Dinhofer
Robert Wood Johnson/St. Barnabas Medical Center, Livingston, NJ, USA
shared decision making
ethics
medical ethics
case study in medical ethics
informed consent
status
Shared decision making (SDM) is the ethical standard of care in the United States. Whereas most doctors accept and understand SDM from an intellectual perspective, they find it hard not to be a paternalistic advisor. The major reason doctorc cannot let go of paternalism is that they want to do what they think is right for the patient knowing most patients do not understand the complexity of diagnosis and treatment. Other reasons include: limited time to explain due to pressure to produce, old habits are hard to change, people in power are afraid to do anything to affect their status, and doctors are afraid to look weak, or they don't
know, understand, or accept the revised ethical standard.
I witnessed these problems first hand when both of my parents fell sick and had to be hospitalized. As their health care proxy and a loving son, I felt duty bound to follow their wishes to the "T." Both of my parents were patients in major teaching hospitals in New York City.
Their respective staff members should have been well aware of the change to SDM. However, doctors often discussed options without allowing for dissension. I use my parents' stories as a means to point out decision nodes in their care and to discuss ethics of shared decision making.
Microethics and Macroethics Education of Biomedical Engineering Students in the United States
21-41
10.1615/EthicsBiologyEngMed.2017018790
Angela R.
Bielefeldt
Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, Boulder, CO
Nathan E.
Canney
Department of Civil and Environmental Engineering, Seattle University, Seattle,
WA
Christopher
Swan
Department of Civil and Environmental
Engineering, Jonathan M. Tisch College of Civic Life, Tufts University, Medford, MA
Madeline
Polmear
Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, Boulder, CO
Daniel
Knight
Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO
ethics; societal impact; ethics education; biomedical engineering; engineering education
A survey was conducted to explore ethics education in biomedical engineering programs in the United States. More than 100 responses were received from individuals representing about half of all Accreditation Board for Engineering and Technology (ABET) Engineering Accreditation Commission (EAC)–accredited biomedical engineering programs, and additional institutions where biomedical engineering is a focus. The results were compared to the responses from more than 1,200 individuals who teach other types of engineering students. The survey evaluated both traditional microethics and societal impacts (macroethics). Among
biomedical engineering instructors, only 31% felt that the education of undergraduate students on ethics and societal impact issues was adequate and 26% felt the same regarding graduate students. Most biomedical respondents taught ethics and/or societal impact related issues in one or more courses. In courses where biomedical engineering instructors reported teaching ethics and/or societal impact issues, a median of five different methods were used. In-class discussions, case studies, lectures, and examples of professional scenarios were used in at
least half of these. The results provide numerous ideas of where, what, and how to integrate macroethical issues into a wide variety of courses and cocurricular activities for biomedical engineering students.
Psychiatric Involuntary Commitment: A Brief Critique of Modern Day Policy and Practice
43-63
10.1615/EthicsBiologyEngMed.2017016317
Michael
Lozovatsky
Department of Psychiatric Medicine, Seton Hall University School of Health and Medical Sciences, Trinitas Regional Medical Center, Elizabeth, NJ
psychiatry
psychiatric medicine
involuntary commitment
civil commitment
dangerousness
need for treatment
gravely disabled
The progressive features of American psychiatric commitment laws are the embodiment of civil and legal perspectives that continue to transform this nation's perceived responsibility toward the most vulnerable members of society. These judicial standards, which are used by medical professionals to obtain an involuntary psychiatric detention, matured from
a contrasting pair of ethical standards, and the approaches taken to carrying out their intended purpose by the states have fluctuated in the face of economic and social factors to create public policies aimed at merging the contradictory ideals of individual choice and societal obligation.
These procedures have created an inconsistent system, one that often endangers both patients and the medical professionals responsible for their care and safety. This essay attempts to scrutinize the ethical issues surrounding an involuntary commitment.
Child Labor and Inhumane Treatment of Children in Pakistan
65-71
10.1615/EthicsBiologyEngMed.2017017298
Azhar
Hussain
Touro College of Pharmacy
Farwa
Ali
American University of Antigua, College of Medicine, Antigua
child labor
poverty
poor safety conditions
Child labor is a very concerning issue in southern Asian countries. This study focuses on the current situation of child labor in Pakistan. The factors that give rise to child
labor include, but are not limited to, poor education systems, laws without regulation, poverty, and a cultural norm that has been maintained for generations. Children suffer from physical, mental, and social harm that can change their lives drastically and, in some cases, permanently. Although the government has passed laws prohibiting child labor, these laws are not regulated enough to establish a child labor–free country. For many reasons, people allow their children to work for a few rupees rather than keeping them at home where they do not generate
income. Due to a lack of proper inspections and standardization, the educational institutions set up by the government are also not up to par, lacking resources, supplies, and even staff. In addition, the private educational system is expensive, creating further helplessness on the part of parents, many of whom send their children to work even before they have reached puberty. At this stage, although a child is very aware of his surroundings, he is vulnerable and can be easily manipulated. This is a dangerous time for them, because their characters can be influenced by the vicious cycle of labor creating a feeling of no way out, and they accept this
as their fate. The children of Pakistan work in different industries, shops, on the street, and in homes for little to no income and in poor safety conditions. They are challenged physically and burdened mentally, giving rise to instability and a compromised future. Educating these children from the very beginning is a key to breaking this cycle; it can allow them to believe that other options and opportunities exist, that it is not necessary to accept the fate of a life
without happiness.
Ethics in Health Information Technology Problems and Solutions
73-89
10.1615/EthicsBiologyEngMed.2017013292
Sabatini
Monatesti
National Health Data Systems, Berwick, PA
David S.
Dinhofer
Robert Wood Johnson/St. Barnabas Medical Center, Livingston, NJ, USA
Peter
Bachman
PAHISP LLC, Swarthmore, PA
Joseph P.
Lyons
Program Director, Health and Human Services Program, Youngstown State University, Youngstown, OH
health information technology (HIT)
ethics
ethical HIT
electronic health records (EHR)
patient privacy
data security
protected health information
healthcare transformation
patient empowerment
shared decision making
clinical decision support
healthcare value
All technologists and vendors involved in health information technology (HIT) have an ethical responsibility to design and build software applications and architecture that
ensure patients' health information is accurate and protected and to use decision support to promote delivery of high-value care to the patient. This goal is difficult to achieve for many reasons, but it is possible for those who know how to proceed. As a whole, ethical principles
indicate that HIT should focus on increasing value to patients (a) by protecting their privacy and making them the owners of their protected health information (PHI); (b) by educating patients and giving them an informed say in healthcare decisions; and (c) by enabling providers
to collaborate, share PHI securely, gain useful information that supports their decisions; and (d) by promoting standards-based interoperability with other third-party systems to promote ease-of-access and to facilitate the sharing of information across multiple providers. Herein,
we describe ethical criteria for judging HIT systems, and we show that ignoring ethical principles results in HIT systems that fail to increase value to the patient. We discuss how ethical HIT deployment is the only way to transform healthcare for the better, and we describe the components of an ethical HIT system that supports an ethical value chain focused on patient privacy and control, as well as improving care efficiency, effectiveness, affordability, and safety.
Exploring the Intersection of Religion, Psychology, and Ethics
91-107
10.1615/EthicsBiologyEngMed.2017021177
D. John
Doyle
Department of General Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
frontal lobes
functional neuroimaging experiments
hyper-religiosity syndromes
nature of religious experience
neuroethics
neurotheology
religious belief
We seek to introduce the reader to the neuropsychological foundations of religious belief, with a view to exploring the intersection of religion, psychology, and ethics.
Topics discussed include the nature of religious experience, possible evolutionary origins of religious belief, insights from functional neuroimaging experiments and pharmacologic interventions, and the central role of frontal lobes in religiosity. Hyper-religiosity syndromes and the problem of pathological beliefs are also discussed, drawing on insights provided by Osamu Muramoto, a contemporary clinical neurologist with an interest in the neurological basis of
religious behavior.