Heart transplantation without informed consent: discussion of a case

OBJECTIVE: To discuss informed consent to heart transplantation in the case of an intensive care unit (ICU) patient: relatives' informed consent was refused by the patient himself whose cognitive ability appeared to be reasonable for the purpose. SETTING: ICU of a university teaching hospital. PATIENT: A 62-year-old man who underwent myocardial revascularization had in the immediate post-operative hemodynamic instability, continuous serious arrhythmias, ventilatory support, fentanyl infusion. Heart transplantation could be the only chance for his survival. INVENTION: Heart transplantation. RESULTS: Despite patient's refusal, we decided to hold the relative's consent as valid, and transplantation was accordingly performed, to the subsequent satisfaction of the patient. CONCLUSIONS: Our decision was based on two beliefs: (1) the severity of the patient's clinical condition may have impaired his cognitive abilities; (2) the very same conditions may mask impairment and certainly make reliable assessment of cognition and judgment impossible. This being so, the preservation of life assumes priority

Deep Cover HCI

The growing popularity of methodologies that turn "to the wild" for real world data creates new ethical issues for the HCI community. For investigations questioning interactions in public or transient spaces, crowd interaction, or natural behaviour, uncontrolled and uninfluenced (by the experimenter) experiences represent the ideal evaluation environment. We argue that covert research can be completed rigorously and ethically to expand our knowledge of ubiquitous technologies. Our approach, which we call Deep Cover HCI, utilises technology-supported observation in public spaces to stage completely undisturbed experiences for evaluation. We complete studies without informed consent and without intervention from an experimenter in order to gain new insights into how people use technology in public settings. We argue there is clear value in this approach, reflect on the ethical issues of such investigations, and describe our ethical guidelines for completing Deep Cover HCI Research

Legal Aspects of Medical Action Without Informed Consent in ER Jember Lung Hospital in 2020

Before working on a medical action, the doctor must provide information and get approval from a competent patient or next of kin, in the form of informed consent documents. The formulations of these research problems are a) How is the implementation of informed consent for emergency patients at Jember Lung Hospital Emergency Room (ER)? and b) What are the legal aspects of working on a medical action without informed consent in handling the emergency patients? The research  method that  is used  is juridically normative with the method of legal approach. The data sources are from primary and secondary legal sources, and interview results. The research site is at Emergency Room of Jember Lung Hospital. During January to March 2020 there were 956 emergency patients who received medical action at the Emergency Room of Jember Lung Hospital. Four of the 956 emergency patients were taken without informed consent.Keywords: emergency, informed consent and medical treatmen

Informed Consent and Dual Purpose Research

The ethical treatment of human participants in psychological research is regulated by both federal guidelines and the ethical standards of the American Psychological Association (APA). Under certain circumstances, however, both APA standards and federal regulations allow for exceptions for informed consent. In spite of the possibility of exception, a number of factors have made it difficult to conduct and publish research that does not incorporate informed consent. The authors consider these factors and propose 2 approaches that may reduce reluctance to consider exceptions to informed consent under appropriate circumstances. First, journals should not rely on informed consent as the only method of screening research for the ethical treatment of human participants. Second, efforts must be made to work with institutional review boards and other units that review psychological research to ensure that their members are aware of the conditions under which informed consent is considered reasonable. Failure to consider ethical research without informed consent may have serious ethical consequences for research

Awareness, attitudes and perceptions regarding HIV and PMTCT amongst pregnant women in Guinea-Bissau- a qualitative study.

BACKGROUND: The human immunodeficiency virus (HIV) continues to be a major cause of maternal and infant mortality and morbidity in sub-Saharan Africa. Prevention of mother-to-child transmission of HIV (PMTCT) strategies have proven effective in decreasing the number of children infected in utero, intrapartum and during the breastfeeding period. This qualitative study explores knowledge and perceptions of HIV amongst pregnant women, healthcare workers' experiences of the national PMTCT services, and barriers to PMTCT, during a period of programme scale-up in urban Guinea-Bissau (2010-11). METHODS: In-depth interviews were undertaken amongst 27 women and 19 key informants at local antenatal clinics and the national maternity ward in Bissau, Guinea-Bissau. RESULTS: Amongst women who had been tested for HIV, awareness and knowledge of HIV and PMTCT remained low. Testing without informed consent was reported in some cases, in particular when the test was performed around the time of delivery. Possible drivers of inadequate counselling included lack of confidentiality, suboptimal healthcare worker training, lack of time, and perceived occupational risk. Demand-side barriers to PMTCT included lack of HIV and PMTCT knowledge, customary and cultural beliefs associated with HIV and ill-health, HIV stigma and discrimination, and fear of partnership dissolution. CONCLUSIONS: Socio-cultural and operational challenges, including HIV testing without informed consent, present significant barriers to the scale-up of PMTCT services in Bissau. Strengthening local capacity for effective counselling and testing in the antenatal setting is paramount. Further research into local customary beliefs relating to HIV is warranted

Registration of Births and Induced Abortions in the Nordic Countries

All the five Nordic countries have a long tradition in health statistics and health monitoring. The cornerstone of the national health information systems is register information. There are, for example, complete population-based registration of births and deaths, cancers, hospital care, and medication (Cappelen and Lysol 2004, Gissler and Haukka. 2004, Mortensen 2004, Otterblad Olausson et al. 2004). The main prerequisites for a functioning register system are its completeness and high quality. These are facilitated by the Nordic legislation allowing mandatory reporting from public and private sector without informed consent and the existence of unique person identity number system

Conducting Industrial and Organizational Psychological Research: Institutional Review of Research in Work Organizations

Although informed consent is a primary mechanism for insuring the ethical treatment of human participants in research, both federal guidelines and APA ethical standards recognize that exceptions to it are reasonable under certain conditions. But agreement about what constitutes reasonable exceptions to informed consent sometimes is lacking. The research presented the same protocols to samples of respondents drawn from four populations –Institutional Reviewer Board (IRBs) members, managers, employees, and university faculty who were not members of IRBs. Differences in perceptions of IRB members from the other samples with respect to the risks of the protocols without informed consent and on the feasibility of conducting the research in employment organizations are discussed in terms of implications for industrial and organizational psychology research

HIV Testing Policy and Serious Mental Illness

Objectives. Using opinion data from experts, we examined the context of the argument for mandatory testing of psychiatric patients. Methods. Vignettes were distributed to experts on HIV and mental illness. Respondents were asked to provide appropriateness ratings for different hypothetical clinical decisions regarding HIV management. Results. Respondents were reluctant to impose testing without informed consent in most circumstances. The presence of risk factors or danger to another increased appropriateness ratings modestly. Conclusions. Despite experts’ tendency to emphasize individual rights, public reluctance to mandate testing is unlikely to extend to people with serious mental illness. No argument for mandatory testing can be persuasive if improved voluntary testing can achieve adequate detection rates. Voluntary testing protocols should be studied to determine which successfully identify infected individuals. (Am J Public Health. 2002;92: 1931–1939

Under the Circumstances: \u3cem\u3ePadilla v. Kentucky\u3c/em\u3e Still Excuses Fundamental Fairness and Leaves Professional Responsibility Lost

The Supreme Court’s decision in Padilla v. Kentucky includes within the Sixth Amendment’s right to the effective assistance of counsel advice on immigration, but still falls short of attaining fundamental fairness and legal professional responsibility. Where Padilla’s recognized representation standard only requires an attorney to advise when the immigration consequences of a guilty plea are “truly clear” —allowing the attorney to “do no more” when not clear—the guiding hand of an attorney remains fractured and will force a noncitizen client to proceed in plea bargaining without informed consent. Rather than giving a private practitioner an excuse to “do no more,” the private practitioner should simply study and provide the applicable immigration law under the circumstances. A public defender not knowledgeable in immigration law, however, should be allowed to do no more based on their uncontrollable caseload, provided an immigration lawyer is also appointed