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 placebo are withholding a known effective therapy. Because of this problem, we hypothesised that clinical researchers may be unwilling to risk violating the principle of beneficence and employ placebo-controlled trials in cases where there is an established therapy. In this paper, we began to investigate this hypothesis. After summarising the arguments for and against using placebo controls in clinical practice, we exploredthe extent to which placebo-controlled trials are used in cases where there is an established therapy. To do this, we conducted as systematic search for all placebo-controlled trials published in 2015 in the five highest impact general medical journals. We identified 70 placebo-controlled trials. Of these, 66 were for indications where there was no established effective therapy. Only four used a placebo control in spite of there being an available effective therapy. The infrequent use of placebo controlled trials where established therapy exists highlights a seeming discrepancy between what the Declaration of Helsinki allows and what clinical investigators believe to be ethically acceptable. The evidence presented in this paper suggests that the Declaration of Helsinki be reconsidered, and perhaps revised, in light of actual practice.
journal_name
J Med Ethicsjournal_title
Journal of medical ethicsauthors
Batra S,Howick Jdoi
10.1136/medethics-2016-103970subject
Has Abstractpub_date
2017-08-09 00:00:00eissn
0306-6800issn
1473-4257pii
medethics-2016-103970pub_type
杂志文章abstract::The public often believes that parents have a right to make medical decisions about their child. The idea that, in respect of children, doctors should do what parents tell them to do is problematic on the face of it. The effect of such a claim would be that a doctor who acted deliberately to harm a child would be maki...
journal_title:Journal of medical ethics
pub_type: 杂志文章,评审
doi:10.1136/medethics-2017-104705
更新日期:2018-07-01 00:00:00
abstract::It is a common feature of debates on the regulation of reproductive medicine to find law portrayed as a crude form of intervention consisting in the imposition of inflexible rules on doctors and medical researchers. This paper argues that this view must be replaced by a more accurate assessment of the law's potential ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.16.1.35
更新日期:1990-03-01 00:00:00
abstract::Prior to the second world war, most persons confined in insane asylums were regarded as legally incompetent and had guardians appointed for them. Today, most persons confined in mental hospitals (or treated involuntarily, committed to outpatient treatment) are, in law, competent; nevertheless, in fact, they are treate...
journal_title:Journal of medical ethics
pub_type: 杂志文章,评审
doi:10.1136/jme.2004.008748
更新日期:2005-02-01 00:00:00
abstract::Perimortem gamete retrieval has been a possibility for several decades. It involves the surgical extraction of gametes which can then be cryo-preserved and stored for future use. Usually, the request for perimortem gamete retrieval is made by the patient's partner after the patient himself, or herself, has lost the ca...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2013-101727
更新日期:2015-06-01 00:00:00
abstract::The Groningen protocol allows for the euthanasia of severely ill newborns with a hopeless prognosis and unbearable suffering. We understand the impetus for such a protocol but have moral and ethical concerns with it. Advocates for euthanasia in adults have relied on the concept of human autonomy, which is lacking in t...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章,评审
doi:10.1136/jme.2005.012476
更新日期:2006-03-01 00:00:00
abstract::The "Kantian ideal" is often misunderstood as invoking individual autonomy rather than rational self legislation. Le Morvan and Stock's otherwise insightful discussion of "Medical learning curves and the Kantian ideal"--for example--draws the mistaken inference that that ideal is inconsistent with the realities of med...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2005.014704
更新日期:2006-09-01 00:00:00
abstract:OBJECTIVES:to assess physicians' and patients' views in Saudi Arabia (KSA) towards involving the patient versus the family in the process of diagnosis disclosure and decision-making, and to compare them with views from the USA and Japan. DESIGN:A self-completion questionnaire (used previously to study these issues in ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2006.019638
更新日期:2008-04-01 00:00:00
abstract:BACKGROUND:Wish-fulfilling medicine appears to be on the rise. It can be defined as 'doctors and other health professionals using medical means (medical technology, drugs, and so on) in a medical setting to fulfil the explicitly stated, prima facie non-medical wish of a patient'. Some instances of wish fulfilling medic...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2013-101480
更新日期:2014-12-01 00:00:00
abstract::Values-based recruitment is used in England to select healthcare staff, trainees and students on the basis that their values align with those stated in the Constitution of the UK National Health Service (NHS). However, it is unclear whether the extensive body of existing literature within the field of moral philosophy...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2017-104503
更新日期:2018-08-01 00:00:00
abstract::The United Kingdom Central Council for Nursing, Midwifery and Health Visitors (UKCC) document, Exercising Accountability, states that the role of patient's advocate is an essential aspect of good professional nursing practice (1). The author examines the case for and against the nurse being the best person to act as a...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.20.3.152
更新日期:1994-09-01 00:00:00
abstract::The progress of the discussion about the 'indicators of humanhood' is reviewed, along with several associated problems. It is argued that a more serious problem is posed by social attitudes about mental handicap. The author concludes that an uncritical use of criteria of humanhood may simply reinforce a morally unjust...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.15.2.90
更新日期:1989-06-01 00:00:00
abstract::Most moral dilemmas in medicine are analysed using the four principles with some consideration of consequentialism but these frameworks have limitations. It is not always clear how to judge which consequences are best. When principles conflict it is not always easy to decide which should dominate. They also do not tak...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章
doi:10.1136/jme.29.5.297
更新日期:2003-10-01 00:00:00
abstract::The paper comments on Scott Dunbar's "An obstructed death and medical ethics," arguing contra Dunbar that we should not view truth-telling to the terminally ill as primarily governed by principles of veracity and respect for autonomy. All such rules are of limited value in medical ethics. We should instead turn to a...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.16.2.88
更新日期:1990-06-01 00:00:00
abstract::A successful feature of the 4th-year curriculum in the Medical Faculty of the Queen's University, Belfast has been the development of interdisciplinary teaching in a three-week joint course to which several clinical departments contribute...Co-ordinated teaching of topics of common interest in small groups included, u...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:
更新日期:1988-09-01 00:00:00
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::"No one has advanced a just and logical reason why reward for service to the public should be extended to the inventor of a mechanical toy and denied to the genius whose patience, foresight, and effort have given a valuable new [discovery] to mankind" (Katopis CJ. Patents v patents: policy implications of recent paten...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2002.000786
更新日期:2004-10-01 00:00:00
abstract::The Brisbane Supreme Court has denied an Australian woman's request to harvest and freeze her dead fiancé's sperm for future impregnation. After she was denied access to the sperm, the woman learnt that her fiancé may have been a sperm donor and she began checking to find out if his sperm was still available. Given wh...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2003.004432
更新日期:2004-08-01 00:00:00
abstract::Gabriele Badano offers three criticisms of my challenge to the orthodox family of theories of legitimacy in bioethics. First, I assumed an 'oversimplified version of the orthodoxy'. Second, I failed to appreciate its domain of application. Third, I only addressed the ways in which orthodox theorists incorporate substa...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章
doi:10.1136/medethics-2018-105030
更新日期:2019-04-01 00:00:00
abstract::This paper considers the ethics of routine antenatal HIV testing and the role of informed consent within such a policy in order to decide how we should proceed in this area--a decision that ultimately rests on the relative importance we give to public health goals on the one hand and respect for individual autonomy on...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2006.018861
更新日期:2007-08-01 00:00:00
abstract::The practice of covertly administering medication is controversial. Although condemned by some as overly paternalistic, others have suggested that it may be acceptable if patients have permanent mental incapacity and refuse needed treatment. Ethical, legal, and clinical considerations become more complex when the ment...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2003.007336
更新日期:2005-05-01 00:00:00
abstract::The research assessment exercise (RAE) forms the basis for determining the funding of higher education institutions in the UK. Monies are distributed according to a range of performance criteria, the most important of which is "research outputs". Problems to do with publication misconduct, and in particular, issues of...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.26.6.422
更新日期:2000-12-01 00:00:00
abstract:BACKGROUND:Medical tourism involves patients travelling internationally to receive medical services. This practice raises a range of ethical issues, including potential harms to the patient's home and destination country and risks to the patient's own health. Medical tourists often engage the services of a facilitator ...
journal_title:Journal of medical ethics
pub_type: 杂志文章,多中心研究
doi:10.1136/jme.2011.042374
更新日期:2011-09-01 00:00:00
abstract::A National Committee for the Ethics of Research could consider new questions arising from innovations in research or practice, deal with multi-centre trials, adjudicate when separate local committees give conflicting advice about similar projects, or oversee the work of district committees. The value of each of these ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.16.3.146
更新日期:1990-09-01 00:00:00
abstract::The issue of the allocation of resources in health care is here to stay. The goal of this study was to explore the views of physicians on several topics that have arisen in the debate on the allocation of scarce resources and to compare these with the views of policy makers. We asked physicians (oncologists, cardiolog...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2003.003681
更新日期:2004-04-01 00:00:00
abstract:UNLABELLED:The difficulties of undertaking good quality effectiveness research in palliative medicine are well documented. Much of the ethical literature in this area focuses on the vulnerability of the palliative care population. It is clear that a wider ethical approach will need to be used to justify research in the...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2007.022632
更新日期:2008-10-01 00:00:00
abstract::The emergence several years ago of SARS, with its high rate of infection and death among healthcare workers, resurrected a recurring ethical question: do health professionals have a duty to provide care to patients with deadly infectious diseases, even at some substantial risk to themselves and their families? The con...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2007.022038
更新日期:2008-06-01 00:00:00
abstract::Explorations of bioethical issues frequently raise the question of an entity's "moral standing," or its right to moral consideration by rational agents. Many contemporary philosophers subscribe to Leonard Nelson's view that only beings that have interests have moral standing. Kuhse attempts to define interests and t...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.11.3.146
更新日期:1985-09-01 00:00:00
abstract::The case of W v M and Others, in which the court rejected an application to withdraw artificial nutrition and hydration from a woman in a minimally conscious state, raises a number of profoundly important medico-legal issues. This article questions whether the requirement to respect the autonomy of incompetent patient...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2012-100907
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Patient autonomy has gradually replaced physician paternalism as an ethical ideal. However, in a medical context, the principle of individual autonomy has different meanings. More knowledge is needed about what is and should be an appropriate understanding of the concept of patient autonomy in clinical pract...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.24.6.394
更新日期:1998-12-01 00:00:00
abstract::The International Bioethics Committee (IBC) of the United Nations Educational, Scientific and Cultural Organisation (UNESCO) is currently drafting a Universal Bioethics Declaration ("the declaration"). The content and even the name of the declaration has yet to be finalized, but it is expected to range widely over hum...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2004.006502
更新日期:2005-03-01 00:00:00