Informed Consent - Balance zwischen Patientenschutz und Forschungsinteressen

Forschungsethische Debatten haben sich in den letzten Jahren häufig der Frage gewidmet, ob Ausnahmen bei der strikten Forderung nach individueller Einwilligung des Patienten zulässig oder gar geboten sind. Einige Studiendesigns mit solchen Ausnahmeregelungen werden im Folgenden zur Diskussion vorgestellt

The reception and implementation of ethical guidelines of the Swiss Academy of Medical Sciences in medical and nursing practice

Questions under study: We conducted a survey among Swiss health care professionals on the reception and implementation of a number of selected ethical guidelines of the Swiss Academy of Medical Sciences (SAMS). The following guidelines were chosen for evaluation: “Care of patients in the end of life”, “Palliative care”, “Borderline questions in intensive-care medicine” and “The determination of death in the context of organ transplantation”. Methods: Anonymous questionnaires were sent to 1933 physicians (general practitioners and internists) and nurses, randomly chosen from address lists of the relevant professional associations. We conducted a statistical analysis using SPSS 16.0. Results: The response rate was 43.1%. 16.3% of the responding physicians had never heard of the guidelines “Care of patients in the end of life”, 30.5% had already heard of them, 34.1% knew some of their contents and 19.1% were familiar with the complete content of the guidelines. 60.5% of those physicians and 56.0% of those nurses who had at least heard of these guidelines utilised them in clinical practice. The guidelines “Palliative care” and “Borderline questions in intensive- care medicine” yielded similar results. By contrast, only 0.5% of responding physicians reported never having heard of the guidelines “The determination of death in the context of organ transplantation”, 2.9% had already heard of them, 24.4% knew some of their contents and the vast majority of respondents (72.2%) considered themselves to be completely familiar with the guidelines. Conclusion: Knowledge of the evaluated guidelines is fairly widespread among Swiss GPs, internists and nurses. The guidelines are utilised in clinical practice by the majority of those care providers who are aware of their existence. The guidelines “The determination of death in the context of organ transplantation”, as a legally binding document, are even better known and routinely implemented in medical practice

Synthetic Biology for Human Health: Issues for Ethical Discussion and Policy-making

Synthetic biology, the application of engineering principles to (re)design and construct novel biological systems and devices, provides an emerging focus for ethical and policy debates on emerging biotechnologies. Happily, no scandal or accident has occurred to give rise to this ethical attention. Rather, it was the researchers themselves who invited the involvement of ethicists, explaining their work and asking for ethical commentary. This proactive stance was fuelled by the intention to avoid another backlash like the one that occurred against some gene technologies. Many consumers have been and are still highly sceptical about genetically modified food, with field trials (for example) regularly being met with public protest. By engaging with the ethical implications of their work early on, many researchers in synthetic biology hoped to prevent such reactions. So far, it looks as if they have been successful, as public attitudes towards synthetic biology are largely positive

Use of placebo interventions among Swiss primary care providers

Background: Placebo interventions can have meaningful effects for patients. However, little is known about the circumstances of their use in clinical practice. We aimed to investigate to what extent and in which way Swiss primary care providers use placebo interventions. Furthermore we explored their ideas about the ethical and legal issues involved. Methods: 599 questionnaires were sent to general practitioners (GPs) and paediatricians in private practice in the Canton of Zurich in Switzerland. To allow for subgroup analysis GPs in urban, suburban, and rural areas as well as paediatricians were selected in an even ratio. Results: 233 questionnaires were completed (response rate 47%). 28% of participants reported that they never used placebo interventions. More participants used impure placebos therapeutically than pure placebos (57% versus 17%, McNemar's chi2 = 78, p<0.001). There is not one clear main reason for placebo prescription. Placebo use was communicated to patients mostly as being "a drug or a therapy" (64%). The most frequently chosen ethical premise was that they "can be used as long as the physician and the patient work together in partnership" (60% for pure and 75% for impure placebos, McNemar's chi2 = 12, p<0.001). A considerable number of participants (11-38%) were indecisive about statements regarding the ethical and legal legitimacy of using placebos. Conclusions: The data obtained from Swiss primary care providers reflect a broad variety of views about placebo interventions as well as a widespread uncertainty regarding their legitimacy. Primary care providers seem to preferentially use impure as compared to pure placebos in their daily practice. An intense debate is required on appropriate standards regarding the clinical use of placebo interventions among medical professionals