Post-Christian bioethics

Agreeing in large part with Cameron, Robert D. Orr nonetheless raises some questions. He points out the theological origins of bioethics in the 1960s, while admitting that the field has since become secularized. Autonomy's challenge to Hippocratic paternalism has brought real benefits but also abuses. Bioethics addresses more than procedural matters; it deals in issues of real substance.     

Evaluating the relative effectiveness of three aversion therapies designed to reduce craving among cocaine abusers

Crack cocaine use and dependence has been steadily increasing since the mid‐1980s. Treatment approaches vary from simple psychotherapy to intensive medication regimens. One clear phenomenon that has been implicated in the continued use and abuse of crack cocaine is craving. Craving is believed to be a response that has been conditioned with previous drug using episodes, and is elicited by environmental cues. The current study investigated the use of three aversion therapies (chemical, covert sensitization, and faradic) designed to eliminate craving for cocaine. Seventy subjects were randomly assigned to one of three aversion treatments or a relaxation control condition. Results indicate that aversion therapy reduces crack cocaine craving. The use of aversion therapy as an adjunct to traditional treatment programs for reducing craving is discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

Dizziness- and Palpitations-predominant Orthostatic Panic: Physiology,Flashbacks, and Catastrophic Cognitions

In an orthostatic challenge, Cambodian patients with orthostatic panic in the last month (OP patients) sometimes panicked during orthostatic challenge, whereas those without orthostatic panic in the last month (NOP patients) did not. Also, OP patients with primarily dizziness during orthostatic challenge panic (OP_OCP-D) had a less vigorous physiological response than two other groups: (a) OP patients with primarily palpitations during orthostatic challenge panic (OP_OCP-P) and (b) NOP patients who had no symptoms during orthostatic challenge (NOP_NOCP-NS). Among the patients experiencing orthostatic challenge–induced panic (i.e., the OP_OCP-D and OP_OCP-P patients), there were prominent orthostatic challenge–induced flashbacks and catastrophic cognitions, and the severity of orthostatic challenge–induced flashbacks and catastrophic cognitions correlated with the severity of orthostatic panic in the previous month and with the severity of orthostatic challenge–induced panic.     

Patient perceptions of factors influencing adherence to medication following kidney transplant

Research has shown that most patients with end-stage kidney failure prefer treatment by transplantation. This entails taking immunosuppressant drugs daily throughout the life of the kidney. Failure to do so causes transplant rejection and a return to dialysis, or sometimes even death. Up to 50% of transplanted patients report failing to take their medication as prescribed. This qualitative study used focus groups to explore patients' lived experience in relation to medication adherence. Data were analysed using thematic analysis. The main themes to emerge were: fear of kidney failure, loyalty to the renal team and donors, health beliefs, forgetting and side-effects. Reasons for adherence were to avoid kidney failure and to acknowledge their gratitude to the renal team and donors. Participants suggested that non-adherence was largely due to forgetting.     

The Role of Christian Belief in Public Policy

It seems intuitive to the believer that God intended throughinstruction in the Law to define morality, intended to leadhumankind to "the right and the good." Further, God's love forhumankind, exemplified by the incarnation, atonement and teachingsof Jesus, and empowered by the Holy Spirit, should lead to abetter world. Indeed, the Christian worldview is a coherentand valid way to look at bioethical issues in public policyand at the bedside. Yet, as this paper explores, in a pluralisticsociety such as the United States, it is neither possible nordesirable for Christians to try to force their views on others.Still, it is obligatory for Christians to stand up and articulatetheir views in the public square. We should try to persuadeothers using either prudential or moral arguments. While wemust be willing to live with "the will of the people," at thesame time, we must not be intimidated into accepting the positionthat our voice is not valid because it has a religious basis.     

When "minimal risk" research yields clinically-significant data, maybe the risks aren't so minimal

Surveys and routine clinical procedures applied in research protocols are typically considered only minimally risky to participants. The apparent benign nature of "minimal risk" tasks increases the chance that investigators and Institutional Review Boards (IRBs) will overlook the probability that clinical tools will identify signs, symptoms, or definitive test results that are clinically-relevant to subjects' welfare. "Minimal risk" procedures may also pose a particular hazard to participants in clinical research by increasing the therapeutic misconception because the tasks mimic clinical care and are often conducted in clinical settings. Investigators should anticipate which measures could yield clinically-important findings and should describe explicit plans for data monitoring, disclosure, and follow-up. Protocols that include reliable and valid clinical measures should prompt a more detailed risk assessment by the IRB, even when the tasks meet the regulatory criteria for minimal physical, psychological, or emotional risk.     

Improving Fairness in Coverage Decisions: Performance Expectations for Quality Improvement

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups.