141 research outputs found
Ethics approval: Responsibilities of journal editors, authors and research ethics committees
No full textMeaningful progress of medicine depends on research that must ultimately involve human subjects. Obtaining ethical approval therefore, especially in medical sciences, should be a moral reflex for researchers. This unfortunately is not the case, with numerous researchers bypassing the ethics approval procedure, or simply unaware of its importance. Good research involves risks taken by research participants and uses tax payers’ money in the process. These mandates the research endeavor to aim at attaining the highest degree of respect for the sacrifices made by others for science. Most researchers mistake scientific clearance or approval, for ethics approval. For a study to be ethical sound, it must be scientifically sound. This is only one of the activities carried out during protocol review. It is not uncommon for sensitive ethical concerns, especially in the social sciences to be overlooked and considered not to be accompanied by any serious risks for the research participants. The researcher has the responsibility of systematically consulting the competent ethics committee for advice and consequent approvals or ethical waivers. Journal editors and reviewers have the duty to systematically evaluate the ethical soundness of manuscripts submitted for review. Capacity building in research ethics and institutional support for Research Ethics Committees to speed up protocol review could reduce the incentive of carrying out research in human subjects without ethics approvals. It is hypocritical and idle to continue to expect optimal reviews on time and of good quality, from ethics committees functioning purely on altruistic grounds. Capacity building for researchers in research ethics, and institutional reforms and support for Research Ethics Committees appear not to have received the attention they truly deserve
Revisiting the need for virtue in medical practice: A reflection upon the teaching of Edmund Pellegrino
No full textEdmund Pellegrino considered medicine as a skill, art, and perhaps most importantly, a moral enterprise. In this essay, I attempt to exemplify how the legacy and contributions of Edmund Pellegrino, as a teacher and a physician, could allow for a renaissance of medical practice in which physicians engage intellectual and moral virtue to both effect sound care, and do so in a humanitarian way, rather than in simple accordance with a business model of medicine. The virtues are viewed in a renewed light as being key characteristics of physicians, and important to patient centered care
Decision making regarding unintended pregnancies among adolescents in Jamestown, Accra, Ghana
Get PDFAdolescent pregnancies constitute a public health concern globally, especially in low and medium income countries. Most of these pregnancies are unintended, and could end up in unsafe abortions, often associated with high mortality and morbidity rates. Studies investigating the decision making process, the preferences, challenges and experiences of adolescents when faced with unintended pregnancies in Ghana rare. A systematic review to ascertain the prevalence and determinants of unintended pregnancy in Sub – Saharan Africa was carried out. This was followed by an empirical phase using qualitative (interviews and focus group discussions) and quantitative methods to ascertain adolescent and stakeholders experiences, perceptions, and attitudes towards adolescent abortions and childbirths. An ethical reflection through the lens of the principles of medical ethics proposed by Beauchamp and Childress and Immanuel Kant's aided in understanding the meaning of autonomy in adolescent pregnancy decision making. Adolescents simply have a false feeling of having taken the final decision themselves. Rendering decision making as autonomous as possible is important as trust is enhanced between the adolescents and health care providers, and they are therefore more likely to take informed decisions and adhere to the advice and recommendations of the health care providers. We propose a concept of relational autonomy that integrates the social reality in this community of embracing early adolescent pregnancies. This is grounded on the fact that a good number of adolescent pregnancies are intentional, and would require a different approach to dissuade adolescents and the community from desiring kids early in an adolescent's life course.Les grossesses chez les adolescentes constituent un problème de santé publique dans le monde, en particulier dans les pays en voie de développement. La plupart de ces grossesses ne sont pas désirées et pourraient aboutir à des avortements à risque, souvent associés à des taux de mortalité et de morbidité élevés. Les études sur la prise de décision processus, les préférences, les défis et les expériences des adolescents lorsqu'ils sont confrontés à des grossesses non désirées sont rares au Ghana. Une revue systématique pour vérifier la prévalence et les déterminants des grossesses non désirées en Afrique subsaharienne a été réalisée. Cela a été suivi par une phase utilisant des méthodes qualitatives (entretiens et groupes de discussion) et quantitatives pour vérifier les expériences, les perceptions et les attitudes des adolescents et des parties prenantes envers les adolescents avortements et accouchements. Une réflexion éthique à travers le prisme des principes de l'éthique médicale proposée par Beauchamp et Childress et Immanuel Kant a aidé à comprendre le sens d'autonomie dans la prise de décision concernant la grossesse chez les adolescentes. Les adolescents ont simplement un faux sentiment de ayant pris eux-mêmes la décision finale. Rendre la prise de décision aussi autonome que possible est importante car la confiance est renforcée entre les adolescents et les prestataires de soins de santé, et ils sont donc plus susceptibles de prendre des décisions éclairées et de se conformer aux conseils et recommandations des prestataires de soins de santé. Nous proposons un concept d'autonomie relationnelle qui intègre la réalité socioculturelle dans cette communauté. Ceci est fondé sur le fait qu'un bon nombre de grossesses d'adolescentes sont intentionnelles et nécessiteraient une approche visant à dissuader les adolescents et la communauté de désirer des enfants au début du cours de la vie
Prise de décision concernant les grossesses non désirées chez les adolescents à Jamestown, Accra, Ghana.
No full textLes grossesses chez les adolescentes constituent un problème de santé publique dans le monde, en particulier dans les pays en voie de développement. La plupart de ces grossesses ne sont pas désirées et pourraient aboutir à des avortements à risque, souvent associés à des taux de mortalité et de morbidité élevés. Les études sur la prise de décision processus, les préférences, les défis et les expériences des adolescents lorsqu'ils sont confrontés à des grossesses non désirées sont rares au Ghana. Une revue systématique pour vérifier la prévalence et les déterminants des grossesses non désirées en Afrique subsaharienne a été réalisée. Cela a été suivi par une phase utilisant des méthodes qualitatives (entretiens et groupes de discussion) et quantitatives pour vérifier les expériences, les perceptions et les attitudes des adolescents et des parties prenantes envers les adolescents avortements et accouchements. Une réflexion éthique à travers le prisme des principes de l'éthique médicale proposée par Beauchamp et Childress et Immanuel Kant a aidé à comprendre le sens d'autonomie dans la prise de décision concernant la grossesse chez les adolescentes. Les adolescents ont simplement un faux sentiment de ayant pris eux-mêmes la décision finale. Rendre la prise de décision aussi autonome que possible est importante car la confiance est renforcée entre les adolescents et les prestataires de soins de santé, et ils sont donc plus susceptibles de prendre des décisions éclairées et de se conformer aux conseils et recommandations des prestataires de soins de santé. Nous proposons un concept d'autonomie relationnelle qui intègre la réalité socioculturelle dans cette communauté. Ceci est fondé sur le fait qu'un bon nombre de grossesses d'adolescentes sont intentionnelles et nécessiteraient une approche visant à dissuader les adolescents et la communauté de désirer des enfants au début du cours de la vie.Adolescent pregnancies constitute a public health concern globally, especially in low and medium income countries. Most of these pregnancies are unintended, and could end up in unsafe abortions, often associated with high mortality and morbidity rates. Studies investigating the decision making process, the preferences, challenges and experiences of adolescents when faced with unintended pregnancies in Ghana rare. A systematic review to ascertain the prevalence and determinants of unintended pregnancy in Sub – Saharan Africa was carried out. This was followed by an empirical phase using qualitative (interviews and focus group discussions) and quantitative methods to ascertain adolescent and stakeholders experiences, perceptions, and attitudes towards adolescent abortions and childbirths. An ethical reflection through the lens of the principles of medical ethics proposed by Beauchamp and Childress and Immanuel Kant's aided in understanding the meaning of autonomy in adolescent pregnancy decision making. Adolescents simply have a false feeling of having taken the final decision themselves. Rendering decision making as autonomous as possible is important as trust is enhanced between the adolescents and health care providers, and they are therefore more likely to take informed decisions and adhere to the advice and recommendations of the health care providers. We propose a concept of relational autonomy that integrates the social reality in this community of embracing early adolescent pregnancies. This is grounded on the fact that a good number of adolescent pregnancies are intentional, and would require a different approach to dissuade adolescents and the community from desiring kids early in an adolescent's life course
Understanding the meaning of autonomy in adolescent pregnancy decision-making: lessons from Ghana
Get PDFIntroduction: adolescent pregnancy in Ghana, like in most low and middle income countries, is an issue of immense public health importance. Pregnant adolescents are faced with the stronger dilemma of either terminating the unwanted pregnancy or keeping it. This discourse which is based on findings from empirical research in Accra Ghana aims at contributing to the usefulness of understanding the meaning and scope of autonomy when it comes to providing ethically grounded, and adolescent friendly, reproductive health care services to pregnant adolescents. The aim of this work was to document the meaning and determinants of autonomous decision making among pregnant adolescents in the James Town area of Accra, Ghana.
Methods: thirty (30) semi-structured in depth interviews were conducted among adolescents who had been pregnant at least once, 23 in depth interviews among purposively selected stakeholders (parents, teachers, NGO staff working in reproductive health, community volunteers), and 8 focus group discussions among parents, teachers, adolescent students who had not been pregnant before, and adolescents who had at least one pregnancy in the past. Data were transcribed verbatim and analyzed thematically.
Results: most adolescents reported that the final decision to continue a pregnancy to term or go in for an abortion was taken by them. The partner´s willingness to take responsibility of the pregnant adolescent and baby, as well as financial considerations, were main players in deciding upon the pregnancy outcomes. Cultural desirability for children and health care provider/father paternalism (power dynamics) in the decision-making process were central considerations in the decision-making process. Unaffordable and unfriendly safe abortion services pushed adolescents to either continue pregnancies to term against their will, or opt to visit unsafe abortion care providers.
Conclusion: adolescents stand to make truly autonomous decisions if they are provided with the right information, at the right time, at the right place, by the right persons, and in the right way. Health system, economic, and cultural factors play significant roles in rendering pregnant adolescent autonomy meaningful when deciding upon their pregnancy outcomes. Continuing pregnancies to term against one´s will or being forced to go in for an abortion are ethically unjustified. Further research is required to examine the long-term consequences of forced pregnancy terminations or births
Revisiting the need for virtue in medical practice: a reflection upon the teaching of Edmund Pellegrino
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Revisiting the need for virtue in medical practice: a reflection upon the teaching of Edmund Pellegrino
No full textLegacy description not available</p
Are we doing enough for our patients with terminal cancer?: A moral imperative to step up palliative care practice in Sub-Saharan Africa
No full textMandatory pre-abortion counseling is a barrier to accessing safe abortion services
No full textEmpirical research showcases that pre-abortion counseling scarcely reverses the woman’s decision either to terminate a pregnancy or not. Growing evidence regarding the high levels of decisional certainty among women seeking abortions renders a careful rethink of the place of mandatory pre-abortion counseling packages. Mandatory counseling packages, when inscribed in the laws, at times contain false information that can deter women from going in for safe abortions. Mandatory waiting times indirectly label opting for an abortion as not being the right thing to do. In areas where abortion stigma from health care providers and communities remains highly prevalent, women are forced to incur extra expenses by travelling to other countries. I argue that pre-abortion counseling on opting-in grounds is ethically sound (enhances the woman’s reproductive autonomy), since most clients in need of abortions are certain on their decisions before the abortion care provider and do not regret these decisions after the process. Regrets are prone to be more prevalent in areas with high unsafe abortion practices, generally due to complications from excessive bleeding, pain, and post abortion infections. Allowing systematic mandatory pre-abortion counseling practice as the rule in a competent adult is unjustified ethically and empirically, is time consuming and presents the legality of abortions in most settings an oxymoron.</p
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