Abstract:
:Traditionally, surgical practice has been experiential and based on the contemporary understanding of basic mechanisms of disease. It was both a science and an art and depended to far too great an extent on the individualism and self belief of its main exponents. "Evidence based medicine" (EBM) emerged in the 1980s and a new gospel of "Rules of Evidence" was introduced. There is no doubt that the net effect of EBM has been beneficial, but over reliance on randomised controlled trials and the lack of generalisability of scientific evidence to individual patients has perhaps led to less enthusiasm for its tenets among surgeons. There are valid and spurious reasons for this that are discussed. The situation is improving but inevitable tensions remain between the surgeon committed to the individual patient here and now, and the clinical researcher whose focus is the benefit of future patients in the larger community.
journal_name
J Med Ethicsjournal_title
Journal of medical ethicsauthors
Stirrat GMdoi
10.1136/jme.2003.007054keywords:
subject
Has Abstractpub_date
2004-04-01 00:00:00pages
160-5issue
2eissn
0306-6800issn
1473-4257journal_volume
30pub_type
杂志文章,评审abstract::Students at Newcastle are exposed to patients during their first week at medical school and attached to a family within the first month. The object is to sensitise them to patients as people rather than vehicles of disease. Medical ethics is introduced as part of the multidisciplinary Human Development, Behaviour and ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.11.1.35
更新日期:1985-03-01 00:00:00
abstract::The most publicly justifiable application of human cloning, if there is one at all, is to provide self-compatible cells or tissues for medical use, especially transplantation. Some have argued that this raises no new ethical issues above those raised by any form of embryo experimentation. I argue that this research is...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.25.2.87
更新日期:1999-04-01 00:00:00
abstract::Translational research is now a critically important current in academic medicine. Researchers in all health-related fields are being encouraged not only to demonstrate the potential benefits of their research but also to help identify the steps through which their research might be 'made practical'. This paper consid...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2009.029785
更新日期:2010-04-01 00:00:00
abstract::Participants are often not informed by investigators who conduct randomised, placebo-controlled acupuncture trials that they may receive a sham acupuncture intervention. Instead, they are told that one or more forms of acupuncture are being compared in the study. This deceptive disclosure practice lacks a compelling m...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2006.016535
更新日期:2007-01-01 00:00:00
abstract:INTRODUCTION:Understanding the views of the public is essential if generally acceptable policies are to be devised that balance research access to general practice patient records with protection of patients' privacy. However, few large studies have been conducted about public attitudes to research access to personal h...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2010.037903
更新日期:2011-01-01 00:00:00
abstract::Several prominent writers including Norman Daniels, James Sabin, Amy Gutmann, Dennis Thompson and Leonard Fleck advance a view of legitimacy according to which, roughly, policies are legitimate if and only if they result from democratic deliberation, which employs only public reasons that are publicised to stakeholder...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2017-104559
更新日期:2018-06-01 00:00:00
abstract::Court-ordered caesarean sections against the explicit wishes of the pregnant woman have been criticised as violations of the woman's fundamental right to autonomy and to the inviolability of the person--particularly, so it is argued, because the fetus in utero is not yet a person. This paper examines the logic of this...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.14.4.206
更新日期:1988-12-01 00:00:00
abstract::For many people, living with genital herpes generates not just episodic physical discomfort but recurrent emotional distress, centred on concerns about how to live and love safely without passing infection to others. This article considers the evidence on herpes transmission, levels of sexual risk, when the law has in...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2012-100894
更新日期:2014-12-01 00:00:00
abstract::This essay is the text of the first Ian Ramsey Memorial Lecture delivered by the author at Oxford University in December 1986. Ramsey, Bishop of Durham from 1966 until his death in 1972, was a philosopher whose interests were contemporary ethical issues created by the interaction of law, medicine, and religion. Duns...
journal_title:Journal of medical ethics
pub_type: 传,历史文章,杂志文章
doi:10.1136/jme.13.4.189
更新日期:1987-12-01 00:00:00
abstract::With the recent developments in the Human Genome Mapping Project and the new technologies that are developing from it there is a renewal of concern about eugenic applications. Francis Galton (b1822, d1911), who developed the subject of eugenics, suggested that the ancient Greeks had contributed very little to social t...
journal_title:Journal of medical ethics
pub_type: 传,历史文章,杂志文章
doi:10.1136/jme.24.4.263
更新日期:1998-08-01 00:00:00
abstract::Fourteen experienced psychiatric nurses participated in a pilot study aimed at describing the experiential aspect of making decisions for the patient. In-depth interviews focused on conflicts, were transcribed, coded, and categorized according to the Grounded Theory method. The theoretical construct, 'modifying autono...
journal_title:Journal of medical ethics
pub_type: 杂志文章,评审
doi:10.1136/jme.20.2.101
更新日期:1994-06-01 00:00:00
abstract::A report of a problem-based learning project on the ethics of terminal care, offered as one of the options available to first year MB ChB students in Edinburgh University Medical School. The project formed part of the 'clinical correlation course' in the new curriculum. Six students took part under the supervision of ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.7.2.62
更新日期:1981-06-01 00:00:00
abstract:OBJECTIVES:This study aimed to determine attitudinal and self reported behavioural variations between medical students in different years to scenarios involving academic misconduct. DESIGN:A cross-sectional study where students were given an anonymous questionnaire that asked about their attitudes to 14 scenarios desc...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.29.2.97
更新日期:2003-04-01 00:00:00
abstract::This is a continuation of and a development of a debate between John Keown and me. The issue discussed is whether, in Britain, an unpaid system of blood donation promotes and is justified by its promotion of altruism. Doubt is cast on the notions that public policies can, and, if they can, that they should, be aimed a...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章
doi:10.1136/jme.25.6.532
更新日期:1999-12-01 00:00:00
abstract::The notion of consent which rose to the forefront in biomedical ethics as an attempt to safeguard patients' autonomy, is relatively new. The notion itself requires qualification, for it precludes neither duress nor ignorance. More seriously, I argue here that consent is redundant except in situations where paternalism...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.26.3.183
更新日期:2000-06-01 00:00:00
abstract::Direct-to-consumer (DTC) genetic services have generated enormous controversy from their first emergence. A dramatic recent manifestation of this is the Food and Drug Administration's (FDA) cease and desist order against 23andMe, the leading provider in the market. Critics have argued for the restrictive regulation of...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2014-102026
更新日期:2015-04-01 00:00:00
abstract::David Shaw's response to Hugh McLachlan's criticism of his proposed new perspective on euthanasia is ineffectual, mistaken and unfair. It is false to say that the latter does not present an argument to support his claim that there is a moral difference between killing and letting die. It is not the consequences alone ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2011.044966
更新日期:2011-12-01 00:00:00
abstract::The revised Declaration of Helsinki allows placebo-controlled trials to be used even when there is an established therapy, provided there are adequate 'methodological' reasons for doing so. This seems to violate the principle of beneficence: where there is an established therapy, physicians treating patients with a pl...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2016-103970
更新日期:2017-08-09 00:00:00
abstract:PURPOSE:Explore public attitudes towards the trade-offs between justice and medical outcome inherent in organ allocation decisions. BACKGROUND:The US Task Force on Organ Transplantation recommended that considerations of justice, autonomy and medical outcome be part of all organ allocation decisions. Justice in this c...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2006.018291
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:By providing healthcare to adolescents, a major opportunity is created to help them cope with the challenges in their lives, develop healthy behaviour and become responsible healthcare consumers. Confidentiality is a major issue in adolescent healthcare, and its perceived absence may be the main barrier to a...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2005.011932
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVES:Potentially life-shortening medical end-of-life practices (end-of-life decisions (ELDs)) remain subject to conceptual vagueness. This study evaluates how physicians label these practices by examining which of their own practices (described according to the precise act, the intention, the presence of an expli...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2013-101854
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Although genetic research into Alzheimer disease (AD) is increasing, the ethical aspects of this kind of research and the differences between ethical issues related to genetic and non-genetic research into AD have not yet received much attention. OBJECTIVES:(1) To identify and compare the five ethical issue...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2008.025049
更新日期:2009-02-01 00:00:00
abstract:OBJECTIVES:To explore mental health service users' views of existing and proposed compulsory powers. DESIGN:A qualitative study employing in-depth interviews. Participants were asked to respond to hypothetical questions regarding the application of compulsory powers under the Mental Health Act 1983 for people other th...
journal_title:Journal of medical ethics
pub_type: 杂志文章,评审
doi:10.1136/jme.2003.004861
更新日期:2005-08-01 00:00:00
abstract:OBJECTIVES:To explore British community pharmacists' views on PAS, including professional responsibility, personal beliefs, changes in law and ethical guidance. DESIGN:Postal questionnaire. SETTING:Great Britain. SUBJECTS:A random sample of 320 registered full-time community pharmacists. RESULTS:The survey yielded ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.26.5.363
更新日期:2000-10-01 00:00:00
abstract:BACKGROUND:There is little research into medical students' or doctors' attitudes to abortion, yet knowing this is important, as policy makers should be aware of the views held by professionals directly involved in abortion provision and changing views may have practical implications for the provision of abortion in the...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2007.023416
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVES:To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect. DESIGN, SUBJECTS AND SETTING:A 138-item attitudinal questionnaire completed by 469 UK...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章
doi:10.1136/jme.26.4.254
更新日期:2000-08-01 00:00:00
abstract::There is as yet no widely agreed-upon solution to the standard textbook problem whether actively shutting off a life-sustaining medical device, e.g. a respirator, and thus bringing about a patient's death amounts to active killing or just to an omission of further treatment. Apart from a range of astutely contrived ca...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2016-103495
更新日期:2016-06-01 00:00:00
abstract::This article reports on moral problems that were raised by medical students as the basis for an ethical case-conference in an obstetrics and gynaecology clerkship. After introducing the issue of teaching clinical ethics, the method of our case-conference is explained. Next, the variety of topics and related moral prob...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2007.023457
更新日期:2008-09-01 00:00:00
abstract::One theme of London University lawyer Ian Kennedy's 1980 Reith Lectures on medical ethics was the need to change the emphasis in physician patient relations from paternalism on the part of doctors to self determination on the part of patients. Bamford, a specialist in obstetrics and gynecology, demonstrates how reali...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.7.4.179
更新日期:1981-12-01 00:00:00
abstract::To many in India and elsewhere, the life and thoughts of Mohandas Karamchand Gandhi are a source of inspiration. The idea of non-violence was pivotal in his thinking. In this context, Gandhi reflected upon the possibility of what is now called 'euthanasia' and 'assisted suicide'. So far, his views on these practices h...
journal_title:Journal of medical ethics
pub_type: 传,历史文章,杂志文章
doi:10.1136/medethics-2011-100268
更新日期:2012-07-01 00:00:00