Contributions of empirical research to medical ethics

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine.     

Environmental ethics and medical ethics: some implications for end-of-life care, Part I

Heterotrimeric G proteins, consisting of alpha, beta, and gamma subunits, transduce environmental signals through coupling to plasma membrane-localized receptors. We previously reported that the filamentous fungus Neurospora crassa possesses a Galpha protein, GNA-1, that is a member of the Galphai superfamily. Deletion of gna-1 leads to defects in apical extension, differentiation of asexual spores, sensitivity to hyperosmotic media, and female fertility. In addition, Deltagna-1 strains have lower intracellular cAMP levels under conditions that promote morphological abnormalities. To further define the function of GNA-1 in signal transduction in N. crassa, we examined properties of strains with mutationally activated gna-1 alleles (R178C or Q204L) as the only source of GNA-1 protein. These mutations are predicted to inhibit the GTPase activity of GNA-1 and lead to constitutive signaling. In the sexual cycle, gna-1(R178C) and gna-1(Q204L) strains are female-fertile, but produce fewer and larger perithecia than wild type. During asexual development, gna-1(R178C) and gna-1(Q204L) strains elaborate abundant, long aerial hyphae, produce less conidia, and possess lower levels of carotenoid pigments in comparison to wild-type controls. Furthermore, gna-1(R178C) and gna-1(Q204L) strains are more sensitive to heat shock and exposure to hydrogen peroxide than wild-type strains, while Deltagna-1 mutants are more resistant. In contrast to Deltagna-1 mutants, gna-1(R178C) and gna-1(Q204L) strains have higher steady-state levels of cAMP than wild type. The results suggest that GNA-1 possesses several Gbetagamma-independent functions in N. crassa. We propose that GNA-1 mediates signal transduction pathway(s) that regulate aerial hyphae development and sensitivity to heat and oxidative stresses, possibly through modulation of cAMP levels.     

Teaching medical ethics to orthopaedic surgery residents

Orthopaedic surgery residents will be faced with a variety of ethical issues when they enter clinical practice. A previous survey suggested that they lack knowledge about how to approach several types of medical ethics dilemmas. We developed a medical ethics curriculum for orthopaedic surgery residents and presented it over a one-year period to the residents in one training program. The effect of the educational intervention on the residents' knowledge of medical ethics and their ability to handle hypothetical situations was measured by comparing their responses to a questionnaire, administered before and after the intervention, with those of residents in a training program in which the intervention was not provided. The twenty-five residents at the site of the educational intervention had a mean improvement of 0.10 in the overall score, from a mean score of 0.71 on the baseline survey to a mean score of 0.81 on the follow-up survey. This improvement was significantly greater than the mean improvement of 0.02 for the thirty residents at the control site, who had a mean score of 0.72 on the baseline survey and a mean score of 0.74 on the follow-up survey (p = 0.002). Six residents who participated in the medical ethics curriculum rated it as very useful; seventeen, as somewhat useful; one, as slightly useful; and one, as not at all useful. A medical ethics curriculum can increase orthopaedic residents' knowledge of medical ethics. Whether this curriculum also will lead to behavioral changes requires additional evaluation.     

Exploring the role of religion in medical ethics

Moths pheromones mostly consist of two or a few chemical components in a species-specific ratio. Each component is perceived by a particular type of receptor cell. Some pheromone components can inhibit the behavioral responses to other pheromone components. A single pheromone molecule is sufficient to elicit a nerve impulse. The dose-response curve of single pheromone receptor neurons increases over many decades of stimulus intensity. Pheromone receptor cells can resolve single stimulus pulses up to a frequency of 10 pulses/s. Electrophysiological and biochemical studies on perireceptor events suggest that the pheromone molecules interact with the receptor cell while bound to a reduced form of the pheromone binding protein. The enzymatic degradation of pheromone found on the antennae is much too slow to account for the decline of the receptor potential after end of stimulation. The postulated rapid deactivation of the odor molecules absorbed might be performed by an oxidation of the pheromone binding protein. Several second messenger systems seem to be involved in the cellular transduction mechanism (IP3, diacylglycerol, cGMP, Ca2+). It is, however, not excluded that pheromone molecules can gate single ion channels directly and thus elicit the elementary receptor potentials, observed at weak stimulus intensities.     

Medical investigators' views about ethics and fraud in medical research

The objective of this study was to ascertain the views and attitudes of medical investigators on medical ethics, and ethics and fraud in medical research. We sent postal questionnaires to all principal investigators whose study protocols had been assessed by their regional medical ethics committee for biomedical research (mid-Norway) in the years 1986-92 (n = 159). The response rate was 70% (n = 119). Some 80% agreed that ethical considerations had influenced their research and 12% that they would have had ethical scruples today about some of their previous projects. One in ten agreed that they might have achieved better results if they could have paid less attention to ethics. About 70% of the respondents found that the committee's comments were useful and relevant, but most agreed only in part. Around 85% agreed fully or in part that scientific quality is an important ethical element of any project and that researchers put more effort into their study protocol when they knew it would be evaluated by an ethics committee. One in six (18%) respondents agreed fully or in part that they had been exposed to scientific misconduct. Also, 27% knew about one or more cases of fraud or misconduct while 42% stated that this knowledge was not public. We concluded that ethics in medicine and medical research have an important and increasing role among investigators with little or no theoretical background and training in ethics. Scientific fraud and misconduct in medicine is a growing concern among researchers, who welcome a professional body that can manage allegations and cases of fraud.     

Current aspects and problems relating to medical ethics in oncology

A case history of a breast cancer patient is used to exemplify ethical dilemmas in medical oncology: information of a cancer patient and his family, ethical problems with genetic testing, ethical issues with do-not-resuscitate-orders, ethical dilemmas with limited resources, problems with insurance companies, ethical issues in clinical trials and questions in dying patients including physician-assisted suicide and active euthanasia. Medical oncologists have to develop skills in recognizing ethical dilemmas in patient care and must prepare to cope with the many and complex ethical issues in the care of oncology patients.     

The ethics of language and the language of ethics.

Responds to the comments of M. P. Nichols (see record 1989-40699-001) on the work of the present authors (see record 1989-40685-001), asserting that therapists work toward understanding the correctness of the view explained by the client in a never-ending process that changes both therapist and client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)