Should family doctors counsel patients on genetic testing and screening?

Family Doctors are in an ideal situation to counsel patients on most medical technologies and new developments. In this sense they are in the best position to guide and counsel patients on genetic testing and screening. Indeed most often it is the patient who seeks counsel from the Family Doctor (General Practitioner). The special nature of genetic tests and the potential to exploit people's money with dubious testing puts the doctor in a special situation. Whilst it is argued that the Family Doctor maintains a strategic position to impart information to the patient, it is also argued that the new nature of genetic tests and the way the family may be affected, (including the multitude of ethical dilemmas these tests may pose), favours the position that Family Doctors should be the health professionals who should impart generic genetic counselling. Specialised genetic counsellors may then continue to dedicate their time to special cases. Tests should not be made available over-the-counter. It is the onus of the Family Doctor to refer patients for further counseling should this be necessary. Colleges and Academies of Family Physicians are in the ideal place to outpace industry especially in second and third world countries.peer-reviewe

Kritische Stellungnahme zur Einführung von Ethikausschüssen an kroatischen Krankenhäusern: Neue Chancen oder eine bürokratische Einbahnstraße?

The objective of our investigation was to study the work and membership structure of the hospital ethics committees in Croatia. The main goals were examining the knowledge and attitudes of participants and everyday functioning of hospital ethics committees. Results show that the structure and composition of the hospital ethics committees are highly legalistic and formal. Most of them were established after the introduction of the legal provisions for ethics committees in Croatia. In the majority of cases, the number of members and their occupation are an exact replica of the structure of the committees required by law. Consistent with previous surveys, our data also shows that the main task of ethics committees in hospitals was an analysis of research protocols, thus neglecting the other functions important for a hospital ethics committee. The level of the members\u27 knowledge is average but insufficient for the complicated tasks that they are supposed to perform. Their views on certain issues and bioethical dilemmas display a high level of paternalism and overprotectiveness of their patients. The majority of respondents are 50 years and older with, in most cases, no formal education in the field of bioethics.Cilj istraživanja bio je proučiti rad i strukturu članstva etičkih povjerenstava zdravstvenih ustanova u bolnicama u Hrvatskoj, uz provjeru znanja i stavova ispitanika te analizu svakodnevnoga funkcioniranja bolničkih etičkih povjerenstava. Rezultati pokazuju da je pristup strukturi i sastavu bolničkih etičkih povjerenstava izrazito legalistički i formalan. Većina povjerenstava osnovana je nakon uvođenja zakonske regulative za etička povjerenstva. Struktura članstva povjerenstava preslikana je iz zakonske regulative. Kao što su pokazala i neka prethodna istraživanja, glavna funkcija bolničkih etičkih povjerenstava jest analiza protokola kliničkih istraživanja, zanemarujući ostale važne funkcije koje bi ona trebala obavljati. Ispitanici su pokazali zadovoljavajući stupanj znanja s područja bioetike, ali je razina znanja još uvijek preniska za složene zadatke koje bi oni kao članovi povjerenstva trebali svakodnevno obavljati. Stavovi ispitanika o nekim bioetičkim pitanjima pokazivali su visok stupanj paternalizma i pretjerana zaštitničkog odnosa prema pacijentima. Većina članova bolničkih etičkih povjerenstava koja je sudjelovala u ovome istraživanju pripadala je dobnoj skupini od 50 godina i više i nije imala formalnog obrazovanja s područja bioetike.Mit dieser Arbeit sollten die Tätigkeit und das Profil der Mitglieder von Ethikausschüssen an kroatischen Krankenhäusern untersucht werden. Die Hauptpunkte der Untersuchung waren Wissensstand und Ansichten der Befragten, ferner eine Analyse des Arbeitsalltags von Ethikausschüssen. Die Untersuchungsergebnisse zeigen, dass man bei der Zusammensetzung und Struktur der Ethikausschüsse an Krankenhäusern ausgesprochen legalistisch und formalistisch verfahren hatte. Die meisten Ausschüsse wurden nach Verabschiedung der entsprechenden Gesetzesgrundlage zur Regelung der Tätigkeit von Ethikausschüssen ins Leben gerufen. Die Zusammensetzung der Ausschüsse lehnt sich an die Empfehlungen der Gesetzesgrundlage an. Wie bereits aus einigen früheren Untersuchungen hervorging, besteht die Hauptfunktion von Ethikausschüssen an Krankenhäusern in der Analyse von Protokollen zu klinischen Untersuchungen, wobei aber andere wichtige Aufgaben beiseite gelassen werden. Die Befragten zeigten zufriedenstellende Kenntnisse aus dem Bereich der Bioethik, doch reicht dieses Wissen nicht aus, um den komplexen Aufgaben, mit denen die Mitglieder von Ethikausschüssen tagtäglich konfrontiert sind, gewachsen zu sein. Die Ansichten der Untersuchungsteilnehmer zu einigen bioethischen Fragen zeigten ein hohes Maß an Paternalismus und ein übertriebenes Beschützerverhältnis bezüglich der Patienten. Die meisten Mitglieder von Ethikausschüssen an Krankenhäusern, die an dieser Untersuchung teilnahmen, gehören zur Altersgruppe der etwa 50-Jährigen und haben keine formale Ausbildung auf dem Gebiet der Bioethik

Handbook of global bioethics

This chapter provides a brief description about the history and current standings of Bioethics in Malta. The author not only discusses the legal point of view of bioethics but also takes into account three issues which have sparked public debate. This issues are In Vitro Fertilization (IVF), hydration and nutrition (euthanasia), and abortion.peer-reviewe

Erasmus Mundus Master of Bioethics: a case for an effective model for international bioethics education

Designing bioethics curriculum for international postgraduate students is a challenging task. There are at least two main questions, which have to be resolved in advance: (1) what is a purpose of a particular teaching program and (2) how to respectfully arrange a classroom for students coming from different cultural and professional backgrounds. In our paper we analyze the case of the Erasmus Mundus Master of Bioethics program and provide recommendations for international bioethics education. In our opinion teaching bioethics to postgraduate international students goes beyond curriculum. It means that such a program requires not only well-defined goals, including equipping students with necessary skills and knowledge, but also it should first and foremost facilitate positive group dynamics among students and enables them to engage in dialogue to learn from one another

Catholic Healthcare Organizations and the Articulation of Their Identity

Contains fulltext : 69947.pdf (publisher's version ) (Open Access

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Education of ethics committee members: experiences from Croatia

OBJECTIVES: To study knowledge and attitudes of hospital ethics committee members at the first workshop for ethics committees in Croatia. ----- DESIGN: Before/after cross-sectional study using a self administered questionnaire. ----- SETTING: Educational workshop for members of hospital ethics committees, Zagreb, 2003. ----- Main outcome measurements: Knowledge and attitudes of participants before and after the workshop; everyday functioning of hospital ethics committees. ----- RESULTS: The majority of the respondents came from committees with at least five members. The majority of ethics committees were appointed by the governing bodies of their hospitals. Most committees were founded after the implementation of the law on health protection in 1997. Membership structure (three physicians and two members from other fields) and functions were established on the basis of that law. Analysis of research protocols was the main part of their work. Other important functions-education, case analysis, guidelines formation-were neglected. Members' level of knowledge was not sufficient for the complicated tasks they were supposed to perform. However, it was significantly higher after the workshop. Most respondents felt their knowledge should be improved by additional education. Their views on certain issues and bioethical dilemmas displayed a high level of paternalism and over protectiveness, which did not change after the workshop. ----- CONCLUSIONS: The committees developed according to bureaucratic requirements. Furthermore, there are concerns about members' knowledge levels. More efforts need to be made to use education to improve the quality of the work. Additional research is necessary to explore ethics committees' work in Croatia especially in the hospital setting

The challenges of global bioethics

The Covid-19 pandemic is associated with an increase in ethics publications and an upsurge of interest in global bioethics. This commentary argues that global bioethics is broader than international bioethics, as defined by Macklin, because the nature of moral problems is determined by processes and practices of globalization, and because a broader theoretical perspective is required. Such perspective acknowledges the connectedness and relationality of human beings, as assumed in the care-based feminist bioethics defended by Tong. The commentary finally claims that a rights-based approach is not opposed to but reinforces a care-based global bioethics