Ethical issues patient

Several other chapters in this book address ethical issues, which are essential for the educational programs. Pharmacogenomic analyses will multiply the challenges of explaining available tests and gaining informed consent to perform each test. In some cases, patients or relatives will be asked... 

Ethical issues and randomisation There are ethical issues with randomisation. There are two t)rpes of ethics which are associated with human, medical research - individual and collective ethics. Individual ethics recognises the primacy of the individual and is aimed at doing what is best for the subjects in the current trial. In contrast, collective ethics is aimed at doing what is best for all future patients who will benefit from the results of the current trial. Clearly, there is a tension between these two principles that is recognised in the declaration of Helsinki, which comes down on the side of the individual ... 

D. An ethical issue arises when one includes medically underserved patients in a study without providing them with the level of care available to others. Problems with noncompliance, while potentially damaging to a study, do not pose ethical problems in medically underserved populations not encountered elsewhere. Effective study design can overcome problems with generalizing from one population to the next. Subjects everywhere should be... 

A potentially promising, although very controversial, approach to the treatment of Parkinson s disease is replacement of dopaminergic neurons. The grafting of fetal substantia nigra tissue, which contains the dopamine neurons, into the striatum of parkinsonian patients has been modestly successful. The procedure will remain experimental, however, until the many practical problems and ethical issues associated with the use of fetal tissue are resolved. The discovery of pluripotent stem cells is also being viewed as a possible way of developing dopamine neurons for transplant purposes. 

A basic ethical issue in several areas of psychiatric research is whether participants are able to provide informed consent, particularly for protocols entailing medication washout and/or placebo treatment. The majority of psychiatric patients who are asked to participate in clinical trials have adequate capacity to provide consent. Thus, in a study specifically designed to examine the capacity of schizophrenic patients to give informed consent, cognitive dysfunction and negative symptoms (apathy and avolition). but not psychotic symptoms (hallucinations, delusions), were found to be associated with impaired decisional capacity (Moser et al., 2002). These features are probably not unique to schizophrenia but are likely to apply to many other forms of illness. 

The increased used of vaccines has drawn attention to ethical issues associated with safety and the risk-benefit ratio in some cases has come under scrutiny. Vaccines are usually given to patients who are otherwise healthy and have a lower tolerance for risk. Adverse reactions are either quite common ( 10%) or very rare ( 0.0001%). The question of justifiable risk in a healthy population then becomes problematic and difficult to identify. 

Not covered in this book are ethical issues, which may be harder to solve than some technical problems. Considering ethical issues, it is useful to start by contemplating the Hippocratic Code the patient, after having agreed to be treated by a physician, trusts the physician to act in the patient s best interest no other ethical problem arises. This is an entirely different situation from one in which a physician-scientist s interest is the promotion of knowledge. 

Probably the most challenging situation is to provide care for a patient who has no insurance. This often means that the patient is unemployed, between jobs, or has suffered a catastrophic loss. Many ethical issues are embedded in financial decisions about providing care. One way to address these issues is to find out what resources exist in the community for medically indigent patients. If it becomes financially impossible to continue treating a patient, therapists can still remain advocates and consultants in helping the patient find the best possible care he or she can afford—regardless of whether the therapists are compensated for their time. Some examples of this type of financial advocacy include the following ... 

Sorting out the ethical issues in relation to conducting research in disasters is a worthwhile starting point. Ownership of data can be an issue. If data are collected in a community that has just experienced a disaster, the data belongs to that community. They should have first call on the dissemination and implementation of findings. Just as in mainstream health care research where participants in the form of patient groups are heavily involved in research so too should be the case in disaster research. Nurses are in a prime position to develop this process whether they wish to use an action research approach or carry out projects that are immedi-... 

Concerns regarding confidentiality of patient information have heightened, particularly with the advent of human genetic research. There are also ethical issues that relate to accuracy of data collected and its security in a database, which relates to either technical proficiency in database management or the knowledge that a database manager needs to be part of the investigative team. 

Despite the many apparent benefits of sampling, the practice has been heavily criticized. Concerns surrounding sampling include patient safety, product integrity, security and control of samples, ethical issues, influence on prescribing habits, and costs to the healthcare sys-... 

The design of randomized clinical trials introduces ethical issues.Usually, study designs prevent the treatment from being modified because of the need to collect sufficient data to allow valid statistical inference. Ethically, clinicians are required to provide their patients with the best available treatment however, the justification for a randomized clinical trial is simply that the best treatment is not yet known. 

The modem practice of pharmacy is in a state of evolution. One important element of that evolutionary state is the inclusion within the scope of practice of some pharmacists in some jurisdictions of the right to prescribe medications to a patient. A pharmacist who undertakes the new skill of prescribing must acquire the appropriate skills consistent with the sophistication of the task or risk liability on various levels. This article will summarize critical legal and ethical issues associated with the evolving function of the pharmacist prescriber. 

This article has summarized critical legal and ethical issues associated with the evolving function of the pharmacist prescriber. The purpose of this chapter is not to discourage pharmacists interested in prescribing, but to review critical issues associated with a new role. With proper training, communication with the patient and the patient s physician, adherence to the appropriate standard of care, avoidance of ethical and criminal breaches, the modern pharmacist will be able to contribute even more to the health care team. 

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