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Medical Ethics Advisor – October 1, 2021

October 1, 2021

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  • IRBs Facing Ethically Controversial Questions on Brain Research

    The field of brain research sounds a lot like science fiction, but human neural organoids, human neural transplants, and human-animal chimeras all are imminent realities. IRBs are going to be facing some difficult decisions on whether this research can proceed. The authors of a recent report examined these issues.

  • To Eliminate Race-Based Disparities, Start by Asking Questions

    "If not the bioethicist, who else in the hospital system is going to be responsible for checking to make sure that systemic racism isn’t occurring within the hospital?"

  • IRBs Use Inconsistent Processes for Informed Consent with Non-English Speakers

    Translations, interpretation services, and other necessary accommodations for non-English speakers need to be built into study budgets

  • Ethical Concerns on Conscience Clauses in Genetic Counseling

    Of 274 genetic counselors surveyed, 90% were not even aware the conscience clauses existed. On the issue of whether genetic counselors had the right to use a conscience clause, responses were mixed: 24% said yes, 31% said no, and 45% were unsure. Ninety percent of respondents agreed counselors were ethically obligated to refer a patient to another provider if using a conscience clause.

  • IRBs Scrutinizing Recruitment of Adolescents via Social Media

    When recruiting adolescents online, investigators should think about how they would proceed if recruitment was conducted in person. Researchers would not be able to barge into an in-person group meeting without an invitation, just as they cannot post in a private Facebook group without the moderator’s permission.

  • Minority Residents’ Palliative Care Training Quality Trails Other Medical Education

    The 91 residents surveyed reported receiving less training on palliative care than they did on sepsis management. Half the residents reported receiving negative messages about palliative care. Two-thirds said they considered care for dying patients to be depressing.

  • Quality Improvement Project Reveals Reasons for Long IRB Approval Process

    Researchers analyzed minutes of IRB meetings for 33 protocols that were approved in 2019. All 33 protocols required at least two full board reviews before approval. They also evaluated 244 protocols that were reviewed faster. Most delays were attributed to protocols that did not adequately describe the research. Some consent documents are incomprehensible to people without medical backgrounds. Safety risks, duration, and allocation of cost sometimes are unclear. All this requires feedback from the IRB, to which researchers must respond.

  • Needlessly Delayed IRB Approval Raises Ethical Concerns

    Delayed study startup times obstruct the enrollment process for prospective participants in clinical trials with a therapeutic intent. That is an ethical concern. Delays in IRB approval hinder enrollment, data collection and analysis, and submissions to regulatory oversight agencies. It takes longer to learn if new therapies are effective and safe. Updated product labeling and product approvals are held up. This delays the opportunity for individuals and society at large to benefit from research.

  • Data on Ethics Programs Fill Knowledge Gap

    A survey of several hundred facilities revealed 97% of hospitals had established a healthcare ethics program. Some ethics programs included additional functions, such as ethical leadership, regulatory compliance, business ethics, and research ethics. These data are likely to be important when institutions are under financial stress, budgets are tight, institutional demands are high, and various programs are under threat.

  • Qualitative Methods Give Unique Insights on Ethics Consult Standards

    Just asking if people are satisfied with an ethics consult only raises more questions. A participant might be very satisfied, but only because of a hoped-for outcome — for instance, a specific family member was identified as the appropriate surrogate decision-maker. Conversely, someone might rate satisfaction as very low just because they did not like the case outcome. This misconstrues the purpose of an ethics consult.

  • Inconsistent Ethics Training in Undergraduate Radiologic Technology Programs

    Few programs are using case-based studies and group discussions. Such instruction gives students the opportunity to recognize, analyze, and understand ethical dilemmas. This would allow educators to evaluate how students apply their learning in the professional setting.

  • Many Nurses Hesitate to Ask for Ethics Consult

    Some nurses mistakenly believe only the attending physician can request ethics consults. Others do not even know their institution offers an active ethics consultation service. Still others worry about retaliation.

  • For Most Patients on Dialysis, Religious/Spiritual Beliefs Are Important

    Researchers surveyed 937 patients receiving dialysis at 31 facilities in Nashville and Seattle from 2015 to 2018. Those for whom religious or spiritual beliefs were more important were more likely to favor a shared decision-making role, more likely to favor resuscitation and mechanical ventilation, and less likely to have considered stopping dialysis.

  • Medical Organizations’ Ethics Statements Are Inconsistent

    Investigators analyzed the ethics statements of 22 organizations and characterized each as traditional (18%), relational (9%), or social constructionist (73%). Overall, there was significant inconsistency and lack of clarity on the direct goals of medicine. The study showed 33% to 53% of direct statements regarding the goals of medicine contained a fundamental philosophical disagreement.

  • Nurses Appreciate Training on End-of-Life Care

    It is difficult for nurses to remain hopeful and honest when caring for someone at the end of life. Still, families need physical, psychological, and spiritual care that nurses must be adept in providing.