Medical Ethics

ISSN Print 2713-0894 ISSN Online 2713-0908

BIOMEDICAL JOURNAL OF ERMC EASTERN EUROPEAN

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Kazanova AM, Zyryanov SK

Currently preterm births are the leading causes of newborn mortality in developed countries. There is growing concern in the medical community about the moral and ethical implications of therapeutic care for these patients. The article raises the problem of joint decision-making by neonatologists and parents on the treatment of premature newborns. Including the question of who is most qualified to make decisions regarding the initiation, termination or withdrawal of life-sustaining treatment for preterm infants. The rest of the life of surviving premature newborns may be associated with inconvenience and suffering in everyday life, and understanding of responsibility for the life of the patient and the child greatly complicates the decision. Another important issue is the relationship between intensive care nurses and parents in caring for premature newborns. The article describes the life experience and ethical and moral problems that medical personnel face during caring for premature newborns.

Received: 2023-02-06

Published online: 2023-05-30

DOI: 10.24075/medet.2023.012

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VIEWS 1187

Ushkalova EA, Zyryanov SK, Butranova OI

Pregnant women are a very special category of patients. The risk-benefit ratio of using various drugs in this case presents a significant medical, social and ethical problem. The increase in the age of onset of the first pregnancy is associated with the increasing prevalence of chronic pathology. Obesity, cardiovascular diseases, diabetes mellitus, hypo- or hyperfunction of the thyroid gland, as well as many other conditions contribute to the active use of drugs of various pharmacological groups throughout the entire period of pregnancy, including early periods. The current practice of pharmacotherapy in pregnant women is based mainly on the use of drugs with an uncertain teratogenic risk. Not including pregnant women in clinical trials is an ethical issue as significant as their potential inclusion. Previously, for a long time, vulnerable categories included generally all women of reproductive age, whose inclusion in clinical trials became possible only in the mid-1990s. Pregnant women were considered vulnerable until 2019. The orphan status of pregnant women in terms of inclusion in clinical trials limits their right to receive highly effective and safe medical care, which makes it relevant to review the existing ethical principles in relation to this category of patients and a to perform a detailed analysis of existing barriers for certain types of drug trials.

Received: 2023-01-30

Published online: 2023-05-23

DOI: 10.24075/medet.2023.011

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VIEWS 1163

Pantuev PA, Gumarova AN

The published review is devoted to ten-volume edition entitled Bioethics Library published by Veche publishing house. The series was edited by Academician Chuchalin AG. It consisted of various works related to bioethical issues. The edition is mainly intended for students and teachers of bioethics of Russian medical universities. The series has a wide historical framework. It examines the works by Avicenna and Immanuel Kant, translated books by Sweden researchers Johansson I and Lynøe N. Texts by Russian physicians and thinkers (Berdyayev NA, Veresayev VV, Uglov FG, Botkin ES, Voyno-Yasenetsky VF (St. Luka Krymsky), Pirogov NI, Pavlov IP, Koni AF, Ilyin IA, Metropolitan Antony Surozhsky, etc.) are published as well. A collection of official documents on bioethical regulation is presented as a separate volume. The edition comprises self-evaluation questions. The texts included into the Bioethics Library make the readers familiar with the history of bioethics building and formation as an anthropologic project. Bioethics is based on the value of life and human integrity, it protects the human being and society, and, as a result, possesses regulatory functions. In the edition, special attention is paid to Russian authors and their view of bioethical issues. It is assumed that examination, popularization and content analysis of the series are particularly relevant within the context of national bioethics development.

Received: 2023-01-27

Published online: 2023-05-22

DOI: 10.24075/medet.2023.010

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VIEWS 1070

Kazakov AS, Zyryanov SK

Dementia raises many ethical issues associated with stages of dementia such as the appearance of preclinical and asymptomatic patients who are, however, at risk of dementia. Thus, physicians come across ethical issues about preventive measures, disclosure of risks and protection from stigmatization and discrimination. Despite efforts to prevent dementia, it is also necessary to solve ethical issues related to the study of ways to alleviate the symptoms of clinical dementia, with the need for additional protection of patients with dementia when prescribing pharmacotherapy. One of the possible ways to solve these issues should be to use an integrated approach to conducting clinical trials and analyzing the ethical, legal and social consequences of dementia, for which it is necessary to include the collection of ethics-related data in the design of the dementia study itself.

Received: 2023-04-17

Published online: 2023-05-18

DOI: 10.24075/medet.2023.009

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VIEWS 1210

Zyryanov SK, Baibulatova EA

Older adults consume a disproportionate amount of medicinal products. Polypharmacy may increase the risk of adverse effects, result in poor medication adherence and unfavorable outcomes. There is considerable evidence that older adults are prescribed unnecessary or excessive medications. Treatment outcomes can be improved owing to controlled discontinuation of medicinal products. The deprescribing principles include analysis of all current prescriptions, detecting the medications that must be discontinued, dosage replacement or reduction, discussing the deprescribing regimen together with a patient, patient’s control and support. Clear comprehension of indications and benefit of the conducted pharmacotherapy, objective risk assessment by prescribing physicians and by a patient, and a deliberate deprescribing plan can improve treatment outcomes of the elderly.

Received: 2023-02-02

Published online: 2023-03-13

DOI: 10.24075/medet.2023.008

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VIEWS 1280

Ziganshina LE, Ziganshin AU

A half a century ago Archibald Cochrane, British physician and researcher, emphasized the necessity for critical assessment and a more elaborated approach to biomedical research results. Evidence-based medicine, which is designed to protect a patient from using scientifically unjustified technologies in healthcare, was widely developed subsequently. However, it soon became evident that numerous essential scientific researches contain a substantial proportion of costly but less informative and unjustified trials. They do not add any significant knowledge (wastes or unnecessary spending in research). In 2014, like-minded investigators have joined together in the international community of Evidence-based research. They suggested a plan of actions and algorithm for evidence-based research denoting the liability of all subjects. It is essential that the processes were under supervision of the scientific and medical society.

Received: 2023-02-07

Published online: 2023-03-13

DOI: 10.24075/medet.2023.007

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VIEWS 1382

Fitilev SB, Vozzhaev AV, Shkrebniova II, Kliuev DA, Saakova LN

Early phase clinical research is an essential step in the development of novel medicinal products. Its main subjects are healthy volunteers. The research quality and outcomes directly depend on how and among whom healthy volunteers are selected and how well the volunteers follow the requirements. Selection of healthy volunteers for participation in early phase clinical research can be influenced by a number of various factors and ethical problems. Better comprehension of volunteer’s expectations, potential fears, limiting factors and motives will promote adherence to respective ethical standards and, as a rule, result in qualitative research practice. In this article, authors have tried to analyze the attitude of healthy volunteers towards various aspects of participation in clinical research using own research experience and available literature data. Surveys of healthy volunteers, individual observations and interviews of researchers with participants represented data to be analyzed. Basic variables of interest included the social and demographic portrait of a healthy volunteer, motivation and barriers to research participation, perception of risks by volunteers and their attitude to adverse events, and financial aspects.

Received: 2023-02-02

Published online: 2023-03-06

DOI: 10.24075/medet.2023.006

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VIEWS 1316

Butranova OI, Zyryanov SK

Considering patients of elderly and senile age, pronounced discrimination continues to be observed, expressed in their insufficient inclusion or non-inclusion in randomized clinical trials. As a result, the clinical recommendations based on the results of such studies cannot be fully applicable to this category of patients. The problems of inclusion/non-inclusion of older people in clinical trials are numerous. The reasons for their occurrence and solutions affect, among other things, the ethical sphere. Compliance with basic ethical principles such as respect for persons, beneficence and justice should underlie the decision to include a patient in a study. In general, when evaluating these ethical principles from the point of view of the well-being of the entire population of elderly and senile patients, it is necessary to rethink the principles according to which this category of patients was excluded from clinical trials.

Received: 2023-01-30

Published online: 2023-03-06

DOI: 10.24075/medet.2023.005

Comments 0

VIEWS 1414