Medical Ethics

ISSN Print 2713-0894 ISSN Online 2713-0908

BIOMEDICAL JOURNAL OF ERMC EASTERN EUROPEAN

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Borisova EO, Eremina OE, Gulbekova OV

In this article, various designs of clinical trials used to obtain new scientific knowledge in the field of clinical medicine are considered from the position of their evidential value in studying the cause‑and‑effect relationship between the influencing factor and result of its potential effect on human health. Basic differences between observational and experimental trials, their limitations due to peculiarities of design of clinical trials are being discussed. A conclusion is made that validity of results of clinical trials should be assessed taking into account the limitations that are typical of various designs. Accuracy of clinical trials depends on many factors that can distort the obtained results as compared with true values. It is noted that observational trials are subject to systematic and accidental errors to a greater extent than experimental ones. It occurs because design characteristics do not allow observational trials to control the mistakes associated with possible incompatibility of comparison groups. They can detect a statistical relation between the phenomena, but only randomized clinical trials can prove that there is a causal relationship. Accuracy of a randomized clinical trial can be increased using systematic reviews and meta‑analysis.

Received: 2022-07-23

Published online: 2022-11-30

DOI: 10.24075/medet.2022.054

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VIEWS 616

Severova YaG, Teplova NV

The article discusses the issues related to the ethical aspects of the off-label use of medications for treatment of coronavirus infection, including in terms of conducting clinical trials of these medications. Furthermore, the article raises the issue of using drugs for treatment of coronavirus infection at the moment and discusses the related ethical principles. The major issue of this review is the ethical aspect of the search for benefits of using drugs not according to instructions in patients with emergencies and life-threatening conditions, such as COVID-19. The ethical role of the informed consent in both clinical trials and off-label prescription of drugs in general is also clarified. Several options provided in this review are proposed to address this issue.

Received: 2022-07-25

Published online: 2022-11-29

DOI: 10.24075/medet.2022.055

Comments 0

VIEWS 571

Zabolotneva YA, Gurevich KG

According to European authors, patients with multiple myeloma (MM) and high cytogenetic risk have shorter values of progression free survival (PFS) and overall survival (OS) as compared with standard hazard. More frequent hospitalizations mean potentially high expenses associated with management of patients with unfavorable cytogenetic risk. Cost and availability of treatment of oncological patients relate to one of pressing ethical issues. Another important aspect of this issue consists in an effective use of available approved modes of therapy in patients with various survival prognosis, which is especially critical for early lines of therapy. It has been proven that early administration of more effective modes based on individual characteristics both of a patient, and a disease will improve the total survival of patients. This will result in reduction of economic resources spent on selecting new modes of treatment in patients with a disease recurrence and correction of possible adverse effects and hospitalization.

Received: 2022-07-19

Published online: 2022-11-29

DOI: 10.24075/medet.2022.053

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VIEWS 621

Sokolchik VN, Klimovich АI

The burnout syndrome is a disease of modern societies. The acquired data prove that health professionals are more prone to the disease than others. Global programs supporting health professionals with this syndrome are lacking. In most severe cases, this can result in a loss of a professional. The purpose of this study was to detect socioexistential, ethical and communication conditions for emotional burnout among healthcare professionals to develop recommendations that prevent the examined syndrome. The authors consider a health worker as a significant and continuously renewable health resource (from Public Health perspective) and as a compassionate person without professional patterns of empathy. The basic study material includes data obtained during interviewing and questioning of medical workers at the Belarusian State Medical University and Belarusian Medical Academy of Postgraduate Education and content analysis of international interviews, medical chats and social networks. The principal methods include questioning, interviewing and content analysis.

Received: 2022-07-21

Published online: 2022-11-28

DOI: 10.24075/medet.2022.052

Comments 0

VIEWS 606

Pavlov ChS, Kovalevskaya VI, Litvinova TM, Volel BA

The article describes stages of medical education development in the chronological order and discusses the principal models of university organization and the process of evolution of scientific approaches to their formation throughout history. Preconditions for reviewing approaches to a subsequent change in the model of university education and direction of the search at the core of the modern educational concept are enumerated. Advantages and shortcomings of third-generation universities formed under the effect of the industrial revolution are separately discussed. The value and role of the university at the modern stage of society and economy development are being considered. It is concluded that educational needs require fundamental transformation, selection of the widest specter and most qualitative level, implemented scientific and educational programs, search for new approaches to mass and elite education. State support, protection, commercialization of knowledge, interdisciplinary integration and cooperation with the leading companies and research structures as part of national scientific laboratories will enable transfer of technologies to develop a new generation university that corresponds to modern tasks and needs of the country intensive development.

Received: 2022-07-28

Published online: 2022-09-14

DOI: 10.24075/medet.2022.051

Comments 0

VIEWS 625

Ruda MG

The article deals with legal and ethical issues of establishing the boundaries of informed consent as a basic procedure being an integral part of medical practice, biomedical and clinical human research, and a broad list of medical procedures. A comparative analysis was based on examination of the best global models of informed consent. In the future, their implementation into the Russian legislative and regulatory compliance practices is suggested. The research uses the following methods: analysis and synthesis, analogy, method of legal modelling, and method of comparative legal research. Some conclusions were made about the reception of certain legal issues considering such factors as legal mental structure, level of legal culture, etc. In this article, the following aspects are highlighted: requirement for information disclosure, requirement to understand the relationship, a researcher’s liability to enhance qualifications, a patient’s responsibility, and the issue about an informed consent form.

Received: 2022-04-20

Published online: 2022-06-30

DOI: 10.24075/medet.2022.044

Comments 0

VIEWS 675

Bogomiagkova ES

The article contains the results obtained during an empirical study of health care practices among people of a large Russian city implemented in a combined strategy in 2020–2021. Our focus remains on the reference of citizens to the procedure of DNA diagnostics as a novel instrument of health-saving behavior and attitude to genetic knowledge in general. The obtained data allow concluding that genetic testing is not widely popular among population today, as only 9,5% of those interviewed have ever done it. DNA diagnostics is more frequently used by young women and men with high income and don’t trusting modern medicine, which probably reflects the actual condition of the market of genetic services in our country. Apart from financial possibilities, involvement into consumer genomics is influenced by insufficient trust in DNA information, and suspecting that players on the market of genetic services obtain economic profit. However, the most important argument against it consists in the discovered discrepancy between perception of genetic data as something inevitable and currently popular ideology of healthy lifestyle, meaning that a person can influence the outcome of the efforts made. As a result, research participants are not willing to become the everlasting ‘patients-in-waiting’ even in case of existing symptoms, but implement their ‘right not to know’. Under these conditions, an important task includes organization of active promoting awareness that unlocks potential, capabilities and limitations of genetic diagnostics.

Received: 2022-04-24

Published online: 2022-06-30

DOI: 10.24075/medet.2022.045

Comments 0

VIEWS 652

The article deals with aspects of legal regulation of human (somatic, germline, heritable) gene editing techniques. Principal risks and problems of implementing these techniques in clinical practice are mentioned. The experience of using the techniques of genome editing and recommendations of WHO 2022 are analyzed. Special attention is paid to conflicts of interests and conflicts of liabilities while creating the concept of legal regulation of genome editing in humans. The conclusions are drawn concerning the necessary disclosure of data about the conducted research and results obtained globally to create the principles and standards of legal regulation of genome editing in humans. In spite of the existing controversies between the scientific communities and countries, it is extremely important to promote an international dialogue, as human genome editing concerns everyone and future generations, variety of human community and safe life and health.

Received: 2022-04-21

Published online: 2022-06-30

DOI: 10.24075/medet.2022.048

Comments 0

VIEWS 764