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Indian Journal of Medical Ethics

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https://read.qxmd.com/read/30683633/section-377-and-the-mental-healthcare-act-2017-breaking-barriers
#1
Arjun Kapoor, Soumitra Pathare
The Supreme Court of India recently decriminalised homosexuality by passing a landmark judgment in the case of Navtej Johar and Others v. Union of India. In its judgment, the Court held that Section 377 of the Indian Penal Code, 1860 is unconstitutional in as much as it criminalises consensual sexual acts between two adults. The Court held that Section 377 discriminates against persons of the LGBTIQ community based on their sexual orientation and violates their fundamental rights guaranteed by the Constitution of India...
November 26, 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30683634/cochrane-and-the-new-mccarthyism
#2
Tom Jefferson
Srivatsan's powerful commentary in this journalis an important reminder that we live in an era of new McCarthyism1 . The issue of the sacking of Peter Gøtzche from Cochrane is complex and has two linked aspects. The first is the fact of his dismissal and the second is our work on Human Papillomavirus (HPV) vaccines.
November 24, 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30683645/whither-cochrane
#3
Meryl Nass, John H Noble
The ouster of Professor Peter Gotzsche who headed the Nordic Cochrane Centre, from Cochrane, a respected international research organisation, has provoked a crisis of confidence in the organisation's future. Disputant and bystander reactions on this issue are presented, as well as concerns regarding conflicts of interest and the reliability of Cochrane reviews. Cochrane's crisis mirrors the larger crisis of confidence that pervades the entire enterprise of medical research. We note that within weeks after Gotzsche was expelled from Cochrane, the HPV vaccine (whose Cochrane review he had publicly criticised for conflicts of interest and poor science) received a license expansion in the United States that might be worth billions of dollars to the manufacturer...
November 19, 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30474610/conducting-controlled-human-infection-model-studies-in-india-is-an-ethical-obligation
#4
Saumil Y Dholakia
Weighing competing obligations and achieving the "greatest balance" of right over wrong guides an individual, an agency or a country in determining what ought to be done in an ethically challenging situation. Conducting controlled human infection model (CHIM) studies in India is one such situation. The ethical challenge in conducting a CHIM study lies in completing the difficult task of introducing standardised, attenuated strains of micro-organisms into normal healthy volunteers, at the same time ensuring the safety of these healthy individuals from potential and completely informed risks in a fashion that is transparent and accountable...
November 8, 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30474611/the-crisis-in-cochrane-evidence-debased-medicine
#5
David Healy
The mission of the Cochrane Collaboration, established in 1993, was to systematically review medical evidence with a view to producing the best quality and trustworthy evidence. Twenty-five years later, it is in a crisis that centres on the dismissal one of its founders and the question of access to clinical trial data. The original mission aimed at improving health. In the face of stalling life expectancies, the stakes in the current crisis could not be higher. This essay looks at the crisis in the context of the disastrous effects of medication for paediatric depression on children as a consequence of the suppression of adverse findings from clinical trials...
November 5, 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30474612/cooperation-in-confidential-withholding-of-hiv-status-from-partners-of-sexually-active-patients-a-role-for-organisational-moral-agency
#6
Peter A DePergola Ii
An increasingly blurred understanding of the conditions under which clinicians may withhold HIV seropositive status from partners of patients who are sexually active and who do not intend to disclose suggests a critical need to revisit the relationship between the principle of confidentiality, the moral and legal duties to warn at-risk third parties, and the organisational ethics surrounding licit cooperation with wrongdoing in the effort to uphold professional moral responsibility. This essay grounds its argument in two, straightforward premises: (i) the ethical principle of cooperation is an indispensable measure of the moral licitness of instances of complicity with wrongdoing; (ii) some instances of material organisational complicity vis-à-vis confidential withholdings of HIV seropositive status from partners of sexually active patients both meet and successfully employ the standards of the ethical principle of cooperation...
October 29, 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30473496/storm-in-a-teacup-general-implications-of-the-cochrane-crisis
#7
R Srivatsan
The crisis that has emerged around the expulsion of Peter Gøtzsche from the Cochrane Board seems at first sight to be the outcome of a typical power play. However, the structural issues that have led to the crisis have emerged in a more technical criticism. These include lack of transparency, lack of cooperation of the pharma industry and hostility of institutions. Thus, the watchdog institution for efficacy and effectiveness of pharmaceutical drugs has itself now been hobbled by inefficacy and lack of effectiveness in its operation...
October 20, 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30473495/critical-reflections-on-health-sector-reforms-in-india-a-seminar-report
#8
Asima Jena, Madhumita Biswal
The papers presented at a recent seminar-"Rethinking gender and body in times of health sector reforms in India"-highlighted the urgent need to integrate gender studies into critical health research in order to understand the complex scenario brought about by the health reforms, and its impact on different categories of people. They also stressed on the need for tracing the historiography of public healthcare in India and the need to scrutinise values not just facts, and develop a dialogic process of learning in order to fully grasp multiple issues...
October 11, 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30473492/relationship-between-autonomy-and-moral-distress-in-emergency-nurses
#9
Mohsen Abdolmaleki, Sima Lakdizaji, Akram Ghahramanian, Atefe Allahbakhshian, Mozhgan Behshid
Reducing nurses' autonomy can impair their decision-making and ability for appropriate interventions. Lowered independence hinders ethical reasoning, which may lead to moral distress. This descriptive correlation study investigates the relationship between professional independence and moral distress in 173 nurses working in emergency departments in Tabriz, Iran. Data were collected using questionnaires designed to assess professional autonomy and moral distress and analysed using descriptive and inferential statistics via the SPSS 13 software...
October 6, 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30683644/authors-response-to-commentaries-on-emergency-care-in-rural-settings
#10
Himmatrao Saluba Bawaskar, Pramodini Himmatrao Bawaskar
We are grateful to Kattula and Jain, Patil and Phutke for their comments on our article on rural emergency medical care and our real problems in rural practice, their management and the threat to our survival. We agree with most of their points and the solutions they have advocated.
October 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30683643/response-to-jain-et-al-on-emergency-healthcare-in-low-resource-areas
#11
Prabir Chatterjee
"Sustaining for-profit emergency healthcare services in low resource areas" by Jain et al is an excellent reply to the Bawaskars. Clearly, the state must prevent both patients from going bankrupt and practitioners from running into negative balances.
October 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30683642/public-communication-about-chim-what-is-the-role-of-the-media
#12
Sandhya Srinivasan
The possibility of introducing the Controlled Human Infection Model of research into India is being discussed by some Indian scientists in order to develop biomedical technologies such as vaccines. CHIM studies involve the deliberate introduction of an infectious agent into a healthy person in order to observe the development and progression of the disease, or test potential treatments. This idea will be alarming to the Indian public who will demand the assurance that CHIM is needed and safe. Health communication is viewed by researchers as vital to getting communities on board in public health programmes...
October 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30683641/public-engagement-in-the-context-of-a-chim-study
#13
Manjulika Vaz
Public engagement especially in new and contested areas of medical research is an essential ethical requirement. It helps to build trust, to embed ethical discourse in public beliefs and values and widen the accountability and the governance of biomedical research. Historically, ethical codes resulted from public protest following unethical medical research practices. Unethical practices do continue to a certain extent, primarily among unempowered communities. The need for public awareness, public deliberation and public advocacy are even more important in a country like India, where "research" is not understood, where paternalism on the part of the health professional, and the non-questioning attitude of the patient/participant have been customary, followed in recent times, by mistrust and an expectation of corruption in the public mind when dealing with a healthcare set up...
October 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30683640/law-and-ethics-in-consensual-harm
#14
Veena Johari
In recent times there has been an emerging interest in conducting Controlled Human Infection Model studies in low-and-middle-income countries, in which healthy human beings are infected with weakened pathogen strains under controlled conditions. These volunteers are monitored closely so that cures and prevention methods can be developed for the disease. Such studies call into question the legal sophistry of taking consent to harm a person by justifying it for the greater good or advancement of science. This paper analyses the law on the subject and the ethics of obtaining consent to harm another human being as in the context of Controlled Human Infection Models...
October 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30683639/protecting-challenge-study-participants-in-low-and-middle-income-settings
#15
Olinda Timms
With India only just emerging out of a period of extreme concern and apprehension over clinical trials, the introduction of Controlled Human Infection Model (CHIM) studies calls for the need to proceed with caution, particularly with regard to protection of participants; especially vulnerable populations. In the Indian context, persons can be vulnerable due to circumstances of poverty, ignorance about clinical research and lack of access to education and healthcare. This paper will look at possible ways to provide protection to participants, starting with review and selection, through the trial period and after it is completed...
October 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30683638/the-ethics-of-volunteer-selection-and-compensation-in-controlled-human-infection-models-in-india
#16
Anuradha Rose
Controlled human infection model studies, or challenge studies, involve the intentional infection of a consenting healthy human volunteer with a virulent organism under controlled conditions Such studies differ from clinical trials in that though both involve healthy volunteers, in challenge studies the potential harm experienced by participants is intended, not merely potentially foreseen, as in clinical trials. Given the special nature of CHIM studies, careful consideration of participant selection and compensation is essential...
October 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30683637/theme-editorial-controlled-human-infection-models-exploring-the-landscape-in-india
#17
Vijayaprasad Gopichandran, Gagandeep Kang
Controlled Human Infection Models (CHIMs) refers to the intentional introduction of an infectious agent into a healthy volunteer to deliberately induce the infection under regulated conditions. These studies can be useful in discovering the origin and development of a disease, its immunological responses and natural course, as well as in the evaluation of interventions. CHIMs have yielded data that have informed the development process of several vaccines in recent years. Infectious diseases contribute substantially to the global burden of disease and therefore research and development in the context of infectious diseases is a high priority...
October 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30683636/ways-of-dying
#18
Sanjay Nagral
How do we die? Is it an event or a process? Does everyone die in the same way or are there different ways of dying? Even with humankind's claims to gigantic strides in knowledge, death still remains one of the great mysteries for the living. And that makes it the subject of profound and perennial philosophical and religious enquiry. Modern medical science, however, had no option but to engage with it in its bodily form and try to define the precise nature of the process of death. Things were rather easy when death was equal to stoppage of the heart...
October 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30683635/health-for-all-in-an-unequal-world-obligations-of-global-bioethics
#19
Sunita Vs Bandewar, Leni Chaudhuri, Lubna Duggal, G D Ravindran, Thelma Narayan, Sarojini N, Sunita Simon Kurpad, Manjulika Vaz, Deepa Venkatachalam
The theme of the joint 14th World Congress of Bioethics and 7th National Bioethics Conference Congress "Health for all in an unequal world: Obligations of global bioethics" is of critical relevance in the present global context. Although the world is better off in terms of improved health status of people by many measures than before, there exist colossal gaps across and within populations. Much needs to be done to respond to the lack of access to healthcare, poor quality of living and working conditions, and deteriorating quality of overall environment which affects more adversely the already deprived...
October 2018: Indian Journal of Medical Ethics
https://read.qxmd.com/read/30473491/demystifying-the-practice-of-khafd-in-the-dawoodi-bohra-community-a-commentary-on-the-wespeakout-report-from-india
#20
Anika Khan, Sualeha Siddiq Shekhani, Aamir Jafarey
In this commentary, we critique a recent report on female genital cutting (FGC) in the Indian Dawoodi Bohra community titled "The Clitoral hood a contested site: Khafd or female genital mutilation/cutting (FGM/C) in India." Published against the backdrop of possible legislation against FGC in India, the report makes good recommendations and is a useful addition to global literature on FGC. We critique specific sections of the document using relevant literature and informal conversations with the Bohra community in Pakistan, thereby highlighting both its strengths and weaknesses...
September 28, 2018: Indian Journal of Medical Ethics
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