Indian Bioethics: the Issue of Female Foeticide and Infanticide. A Sikh Perspective

A specific bioethical problem which India encounters today, in the era of prenatal diagnostics, is the problem of the foeticide or infanticide of female children. This problem has also been discussed at various international bioethical conferences as it was the case in February 2003 at the 8th International Bioethical Roundtable (TRT8) in the Japanese Science City of Tsukuba, and in March 2002 in Leiden (Netherlands) at the Asian Genomics – Cultural Values and Bioethical Practice conference. This paper presents some of the key theses resulting from the discussion at the above conferences, and also warns of the serious problem of the misuse of modern medical technology and diagnostics, which should primarily be used for a timely detection of various genetically conditioned diseases or disorders of the course of the intra-uterus life of the baby, rather than, as it is the case in India, to enable the (de)termination of the foetus according to sex. That is, the Indian society is dominated by men, and male children are highly valued, whereas female children are exceptionally discriminated against. This dicrimination is manifested through female children not being provided adequate nutrition or medical care, along with pronounced emotional deprivation. The most recent and, in the same time, worst form of discrimination is exactly female foeticide or infanticide, which – this should be specifically mentioned – is most often carried out in the Indian state Tamil Nadu

HEALTH STATUS, LIFESTYLE, USE OF HEALTH SERVICES, SOCIAL CAPITAL AND LIFE SATISFACTION AS PREDICTORS OF MENTAL HEALTH - COMPARATIVE ANALYSIS OF WOMEN THAT RECEIVE AND DO NOT RECEIVE PUBLIC ASSISTANCE IN CROATIA

Background: The connection between socio-economic status and health is documented, yet not fully understood. The goal of this research was to analyze the relationship between socio-economic status, lifestyle and health status, availability of health-care, social capital, and satisfaction with life. Subjects and methods: Subjects were 1117 women aged 25-65 years divided in two groups. Group 1 consisted of women who receive public assistance (N1=591), while Group 2 consisted of women who do not (N2=526). The sample was stratified by random choice into multiple stages based on six regions of Croatia, residential area size, and the age of respondents. Visiting nurses surveyed the deprived population, while in Group 2 self-interviewing was conducted. A questionnaire entitled “Inequalities in health” was used. The respondents participated in this research voluntarily and anonymously. Results: Socially deprived women consume spirits and wine more often (p<0.001). There is no difference between groups regarding tobacco consummation. Working women perform significantly less strenuous physical tasks (p<0.001). Deprived women are significantly less engaged in physical activities (p<0.001). Health conditions in deprived women more commonly limit their physical activity (p<0.001). There is a significant difference in utilization of health-care among groups (p<0.001). Younger women who are married, with a higher number of household members, a larger income, and with higher education are generally more satisfied with life (p<0.001). Although deprived women are significantly less satisfied with their lives, feel less free, are less physically active, and less likely to consume spirits or beer, they are significantly happier than working women (p<0.001). Conclusions: Personal health status and lifestyle, access to health-care services, and life satisfaction have a high importance as predictors and protective factors of mental health in women - recipients of state-provided financial welfare

Informed consent – conceptual, empirical and normative issues

Informirani pristanak je izjava bolesnika ili ispitanika nekog znanstvenog istraživanja koja liječnika ili medicinskog istraživača opunomoćuje da provede određene mjere, terapiju ili da uključi ispitanika u istraživački protokol. Kako u svojim teorijskim (pret)postavkama, tako i u praktičnoj primjeni u svakodnevnoj kliničkoj praksi, suvremena medicinsko-etička doktrina informiranog pristanka susreće se s tri vrste problema: konceptualni problemi (pokušati razlučiti značenje i (pred)uvjete informiranog pristanka), empirijski problemi (pokušati saznati, primjerice, koliko vremena treba da bismo dali informaciju u određenim uvjetima i koliko je data informacija shvatljiva za bolesnika ili rodbinu) i normativni problemi (pokušati ustanoviti kada, kako i čijom obvezom smatrati informirani pristanak). Derivirajući (formalno i sadržajno) koncept informiranog pristanka iz (bio)etičkih principa dobročinstva i autonomije, te pronalazeći uporište u domaćoj i međunarodnoj medicinsko-etičko- pravnoj regulaciji informiranog pristanka (Zakon o zaštiti prava pacijenata RH, Helsinška deklaracija, UNESCO-va opća deklaracija o bioetici i ljudskim pravima) prepoznaje se prisustvo višedimenzionalnog okvira za pristup razrješavanju pitanja opterećenih moralnim vrijednostima, prisutnih unutar sustava zdravstvene skrbi.Informed Consent is a statement of the patient or subjects of a scientific research, which empowers physicians or medical researchers to conduct a certain medical procedure, therapy, or enroll subjects in the scientific-research protocol. In its theoretical settings, as well as in practical application in everyday clinical practice, modern medical-ethical doctrine of informed consent encounters three types of issues: conceptual issues (try to discern the meaning and (pre)conditions of informed consent), empirical issues (try to find out, for example, how much time should be given to disclose information in certain circumstances, and how the information is understandable to the patient or his/her relatives) and normative issues (try to establish when, how, and whose obligation should informed consent be considered). Derivation (formal and contextual) of the concept of informed consent from the ethical principles of beneficence and autonomy, and finding of a ground floor in the domestic and international medical-ethical-legal regulation of informed consent (Law on protection of patients’ rights, Helsinki Declaration, UNESCO’s Universal declaration on bioethics and human rights) recognizes the presence of multidimensional framework for resolving morally burdened issues present within the health care system

Repopulation of the fan mussel Pinna nobilis Linnaeus, 1758, in the Rovinj area

Plemenita periska sesilni je organizam, filtrator koji u osnovi nastanjuje gole pomične podloge, te pomične podloge obrasle morskim cvjetnicama. U posljednjih je nekoliko desetljeća uočena drastično smanjenje populacija diljem Sredozemnog mora. Pretpostavlja se da je tome glavni uzrok upravo ljudska aktivnost. U posljednjih nekoliko godina uočeno je povećanje brojnosti plemenite periske u priobalju Rovinja, čime se stvorila potreba za kvantitativnu analizu stanja populacija. Na tri lokacije u priobalju Rovinja odreĎeni su gustoća populacije, veličinski razredi, te starosne skupine. U svrhu odreĎivanja veličinskih razreda i starosne skupine, na svakoj od tri lokacije izmjereno je po 30 jedinki čime je sveukupno istraživanjem obuhvaćeno 90 jedinki. Rezultati istraživanja ukazuju kako su istraživane populacije iznimno zdrave. U budućim istraživanjima bilo bi potrebno obuhvatiti i druge lokacije u priobalju Rovinja u svrhu usporedbe rezultata sa različitih lokacija.The fan mussel Pinna nobilis is a sessile organism, a filter feeder inhabiting bare soft-bottom areas and areas overgrown by seagrass meadows. In the past few decades a drastic population decrease was noted all along the Mediterranean sea shores. The assumptions are that the cause for this population reduction is stress, which in general comes from human activities. In the past few years population growth was noted in the coastal area of Rovinj. The need for quantitative analysis was created. On three locations in the Rovinj coastal area, population density, size classes and age classes were determined. On each location 30 specimens were measured for the size and age classes determination, which makes 90 specimens all together. The results of the research show that the populations in the Rovinj coastal area are healthy. Further quantitative investigations on other locations in the Rovinj coastal area are needed for the comparison of results from different areas

Bioethics Consultations

Konzultacije u zdravstvenoj skrbi su usluge koje pruža pojedinac ili grupa s ciljem pomaganja pacijentu, obitelji, skrbnicima, zdravstvenim djelatnicima, te svim ostalim uključenim stranama pri suočavanju s neizvjesnostima ili sukobima vezanim uz pitanja opterećena moralnim vrijednostima prisutna unutar sustava zdravstvene skrbi. Dijele se na dvije osnovne grupacije: kliničke etičke konzultacije (bioetičke konzultacije) i organizacijske etičke konzultacije. Sustav bioetičkih konzultacija prepoznaje tri razine: etička povjerenstva (rad u većim grupama, obično 12-15 članova), timske konzultacije (manje grupe za savjetovanje, kao npr. podgrupe etičkih povjerenstava, obično 3-4 člana), te individualne konzultacije (tj. licem u lice). Individualni bioetičar-konzultant treba posjedovati specifična znanja i vještine, (kliničko) iskustvo, te „poželjan karakter“ (osobne moralne kvalitete). Brojna literatura govori u prilog liječniku kao bioetičkom konzultantu jer će njegova preporuka biti lakše prihvaćena i imati će veći kredibilitet među liječnicima i ostalim zdravstvenim djelatnicima s obzirom da imaju isto kliničo iskustvo i govore istim „kliničkim jezikom“, te jer liječnik najbolje razumije moralnu dimenziju odnosa liječnik-pacijent. Glavna svrha bioetičkih konzultacija je poboljšanje provođenja i ishoda zdravstvene skrbi kroz identifikaciju, analizu i rješavanje etičkih pitanja i problema koji se pojavljuju u kliničkim slučajevima unutar zdravstvenih institucija. Predstavljaju neku vrstu „osigurača“ za poštivanje i promicanje bioetičkih standarda u svrhu postizavanja najviše razine zdravstvene skrbi u pluralističkom vrijednosnom sustavu.Healthcare Ethics Consultations (HEC) are a service provided by an individual or a group to help patients, families, surrogates, healthcare providers, or other involved parties address uncertainties or conflicts regarding value-laden issues which emerge in healthcare. They can be divided in two basic subgroups: clinical ethics consultations (CEC) (bioethics consultations) and organizational ethics consultations. Bioethics consultations system recognizes three levels: ethics committee (work in larger groups, 12-15 members), team consultations (smaller counseling groups, such as ethics committees\u27 subgroups, 3-4 members), individual consultation (face to face). Individual bioethics consultant should possess specific knowledge and skills, (clinical) experience and “suitable character” (personal moral qualities). Numerous references indicate that physician should perform as a bioethics consultant. In such case recommendations should be easily accepted, with higher level of credibility among healthcare providers, having the same clinical experience and talking the same „clinical language“ as the physician - bioethics consultant. Namely, a physician is the one who understands best the moral dimension of the physician - patient relationship. Bioethics consultations’ main purpose is the improvement of the provision of healthcare and its outcomes through the identification, analysis and resolution of ethical issues as they emerge in clinical cases in healthcare institutions. They represent a form of assurance that bioethical standards will be promoted and respected, aiming for the highest level of healthcare in a pluralistic value system

Repopulation of the fan mussel Pinna nobilis Linnaeus, 1758, in the Rovinj area

Plemenita periska sesilni je organizam, filtrator koji u osnovi nastanjuje gole pomične podloge, te pomične podloge obrasle morskim cvjetnicama. U posljednjih je nekoliko desetljeća uočena drastično smanjenje populacija diljem Sredozemnog mora. Pretpostavlja se da je tome glavni uzrok upravo ljudska aktivnost. U posljednjih nekoliko godina uočeno je povećanje brojnosti plemenite periske u priobalju Rovinja, čime se stvorila potreba za kvantitativnu analizu stanja populacija. Na tri lokacije u priobalju Rovinja odreĎeni su gustoća populacije, veličinski razredi, te starosne skupine. U svrhu odreĎivanja veličinskih razreda i starosne skupine, na svakoj od tri lokacije izmjereno je po 30 jedinki čime je sveukupno istraživanjem obuhvaćeno 90 jedinki. Rezultati istraživanja ukazuju kako su istraživane populacije iznimno zdrave. U budućim istraživanjima bilo bi potrebno obuhvatiti i druge lokacije u priobalju Rovinja u svrhu usporedbe rezultata sa različitih lokacija.The fan mussel Pinna nobilis is a sessile organism, a filter feeder inhabiting bare soft-bottom areas and areas overgrown by seagrass meadows. In the past few decades a drastic population decrease was noted all along the Mediterranean sea shores. The assumptions are that the cause for this population reduction is stress, which in general comes from human activities. In the past few years population growth was noted in the coastal area of Rovinj. The need for quantitative analysis was created. On three locations in the Rovinj coastal area, population density, size classes and age classes were determined. On each location 30 specimens were measured for the size and age classes determination, which makes 90 specimens all together. The results of the research show that the populations in the Rovinj coastal area are healthy. Further quantitative investigations on other locations in the Rovinj coastal area are needed for the comparison of results from different areas

Informed consent – conceptual, empirical and normative issues

Informirani pristanak je izjava bolesnika ili ispitanika nekog znanstvenog istraživanja koja liječnika ili medicinskog istraživača opunomoćuje da provede određene mjere, terapiju ili da uključi ispitanika u istraživački protokol. Kako u svojim teorijskim (pret)postavkama, tako i u praktičnoj primjeni u svakodnevnoj kliničkoj praksi, suvremena medicinsko-etička doktrina informiranog pristanka susreće se s tri vrste problema: konceptualni problemi (pokušati razlučiti značenje i (pred)uvjete informiranog pristanka), empirijski problemi (pokušati saznati, primjerice, koliko vremena treba da bismo dali informaciju u određenim uvjetima i koliko je data informacija shvatljiva za bolesnika ili rodbinu) i normativni problemi (pokušati ustanoviti kada, kako i čijom obvezom smatrati informirani pristanak). Derivirajući (formalno i sadržajno) koncept informiranog pristanka iz (bio)etičkih principa dobročinstva i autonomije, te pronalazeći uporište u domaćoj i međunarodnoj medicinsko-etičko- pravnoj regulaciji informiranog pristanka (Zakon o zaštiti prava pacijenata RH, Helsinška deklaracija, UNESCO-va opća deklaracija o bioetici i ljudskim pravima) prepoznaje se prisustvo višedimenzionalnog okvira za pristup razrješavanju pitanja opterećenih moralnim vrijednostima, prisutnih unutar sustava zdravstvene skrbi.Informed Consent is a statement of the patient or subjects of a scientific research, which empowers physicians or medical researchers to conduct a certain medical procedure, therapy, or enroll subjects in the scientific-research protocol. In its theoretical settings, as well as in practical application in everyday clinical practice, modern medical-ethical doctrine of informed consent encounters three types of issues: conceptual issues (try to discern the meaning and (pre)conditions of informed consent), empirical issues (try to find out, for example, how much time should be given to disclose information in certain circumstances, and how the information is understandable to the patient or his/her relatives) and normative issues (try to establish when, how, and whose obligation should informed consent be considered). Derivation (formal and contextual) of the concept of informed consent from the ethical principles of beneficence and autonomy, and finding of a ground floor in the domestic and international medical-ethical-legal regulation of informed consent (Law on protection of patients’ rights, Helsinki Declaration, UNESCO’s Universal declaration on bioethics and human rights) recognizes the presence of multidimensional framework for resolving morally burdened issues present within the health care system