scholarly journals Pain Assessment: Subjectivity, Objectivity, and the Use of Neurotechnology Part One: Practical and Ethical Issues

2010 ◽  
Vol 4;13 (4;7) ◽  
pp. 305-315 ◽  
Author(s):  
James Giordano
Keyword(s):  
Pain Assessment ◽  
Subjective Experience ◽  
Ethical Issues ◽  
Social Issues ◽  
Clinical Care ◽  
Pain Syndrome ◽  
Objective Evaluation ◽  
Pain Patient ◽  
Key Words Pain ◽  
The Right

The pain clinician is confronted with the formidable task of objectifying the subjective phenomenon of pain so as to determine the right treatments for both the pain syndrome and the patient in whom the pathology is expressed. However, the experience of pain — and its expression — remains enigmatic. Can currently available evaluative tools, questionnaires, and scales actually provide adequately objective information about the experiential dimensions of pain? Can, or will, current and future iterations of biotechnology — whether used singularly or in combination (with other technologies as well as observational-behavioral methods) — afford objective validation of pain? And what of the clinical, ethical, legal and social issues that arise in and from the use — and potential misuse — of these approaches? Subsequent trajectories of clinical care depend upon the findings gained through the use of these techniques and their inappropriate employment – or misinterpretation of the results they provide — can lead to misdiagnoses and incorrect treatment. This essay is the first of a two-part series that explicates how the intellectual tasks of knowing about pain and the assessment of its experience and expression in the pain patient are constituent to the moral responsibility of pain medicine. Herein, we discuss the problem of pain and its expression, and those methods, techniques, and technologies available to bridge the gap between subjective experience and objective evaluation. We address how these assessment approaches are fundamental to apprehend both pain as an objective, neurological event, and its impact upon the subjective experience, existence, and expectations of the person in pain. In this way, we argue that the right use of technology — together with inter-subjectivity, compassion, and insight — can sustain the good of pain care as both a therapeutic and moral enterprise. Key words: pain, assessment, neurotechnology, biotechnology, neuroethics, medicine

scholarly journals A Crisis in Chronic Pain Care: An Ethical Analysis Part Two: Proposed Structure and Function of an Ethics of Pain Medicine

2008 ◽  
Vol 5;11 (10;5) ◽  
pp. 589-595 ◽  
Author(s):  
James Giordano
Keyword(s):  
Virtue Ethics ◽  
Ethical Issues ◽  
Current System ◽  
Moral Agent ◽  
Applied Ethics ◽  
Pain Patient ◽  
Pain Medicine ◽  
Key Words Pain ◽  
And Function ◽  
Pain Care

In this paper, we propose a constructive approach to an ethics of pain medicine that is animated by a core philosophy of medicine as specific and focal to the uniqueness of pain, the pain patient, and the pain clinician. This philosophy of pain medicine 1) defines the nature of pain, 2) recognizes the variability and subjectivity of its expression in the pain patient, 3) acknowledges and explicates the vulnerabilities rendered by pain, 4) describes the inherent characteristics and asymmetries of the patient-clinician relationship, and 5) defines the ends of pain care. That these ends entail the provision of “good” care links the epistemic domains of pain medicine to its anthropologic focus and ethically sound conduct. We posit that an ethics of pain medicine should define the profession and sustain the practice. Facts establish (the need for) certain duties and rules of pain medicine. These emphasize the duty to self and others, and an appreciation for relational asymmetries, and dictates that those who enter the profession of pain medicine should be generally aligned with this set of core practical and ethical affirmations and duties. To maintain contemporary relevance, rules, duties, and moral reasoning must adjust to changing conditions. Applied ethics shape the practice within the infrastructure of core rules and duties of the profession. An applied ethics of pain medicine must be pragmatic, and therefore, cannot rely upon, or be reduced to, a single principle or ethical system. A number of ethical systems (such as the use of principles, utilitarianism, casuistry, feminist/ care orientations) all have relative merit and potential limitations. We argue that the obligation to recognize ethical issues, and utilize knowledge to best reflect appropriate moral values rests upon the clinician as a moral agent, and therefore advocate the relevance and importance of an agent-based virtue ethics, recognizing that virtue ethics cannot stand alone, but must be employed within a larger system of ethical intuition. Yet, if such a structure of normative and applied ethics is to be realized, moral consideration must guide evaluation of the current system of pain care, and provide direction for the development and implementation of therapeutically and ethically integrative pain medicine for the future. Key words: Pain medicine, normative ethics, applied ethics, deontology, virtue ethics, humanities

scholarly journals Legal regulation of human anatomical materials transplantation of people

2020 ◽  
Vol 4 (4) ◽  
pp. 213-218
Author(s):  
Nataliya Yuzikova
Keyword(s):  
Health Care ◽  
Legal Status ◽  
Ethical Issues ◽  
Social Issues ◽  
Legal Regulation ◽  
Two Dimensions ◽  
Potential Health ◽  
Legal Literacy ◽  
The Law ◽  
The Right

The article considers the legal basis for transplantation of human anatomical materials. The range of legal, ethical, social issues is outlined along with different approaches to legal regulation in the field of transplantology. It has been proved that the legal regulation of transplantation of anatomical materials to a person provides normative consolidation of the legal status of the recipient, donor, doctor and other subjects of this process. The main factors that determine the legal regulation of transplantation in Ukraine are identified, which are divided into two groups: previously formed and emerged recently. The stages of legal regulation of public administration in the field of transplantation are analyzed. The legal support of transplantation of human anatomical materials in Ukraine, which is carried out in accordance with the "encouraging voluntary approach". This characterizes the "presumption of disagree-ment." Ethical issues related to donation and awareness of potential health risks are disclosed. It is estab-lished that the right to dispose of anatomical materials belongs to the holder of this right such may be delegated or after death decided by a certain group of persons in accordance with the law. Within the framework of ensuring the formation and implementation of state policy in the field of health care, the Law of Ukraine "On the use of transplantation of human anatomical materials" was analyzed. Problems that exist in the field of health care in Ukraine, it is advisable to solve in two dimensions: legal and moral and ethical. The legal dimension provides for the adoption of relevant legal acts, first of all, the codified normative legal act - the Medical Code of Ukraine, the Law of Ukraine "On Voluntary Medical Insurance". When addressing the moral and ethical issues of transplantation, it is necessary to create an effective mechanism to protect the rights of donors, recipients and medical staff. Also, it is important to focus on improving the legal literacy of society, through information and scientific support in this area.

Research Domain Criteria as Psychiatric Nosology

2017 ◽  
Vol 26 (4) ◽  
pp. 592-601 ◽  
Author(s):  
FAISAL AKRAM ◽  
JAMES GIORDANO
Keyword(s):  
Clinical Psychiatry ◽  
Subjective Experience ◽  
Ethical Issues ◽  
Social Issues ◽  
Classification Systems ◽  
Mental Illnesses ◽  
Research Domain Criteria ◽  
Social Sphere ◽  
Clinical Phenomenology ◽  
Research Domain

Abstract:Diagnostic classification systems in psychiatry have continued to rely on clinical phenomenology, despite limitations inherent in that approach. In view of these limitations and recent progress in neuroscience, the National Institute of Mental Health (NIMH) has initiated the Research Domain Criteria (RDoC) project to develop a more neuroscientifically based system of characterizing and classifying psychiatric disorders. The RDoC initiative aims to transform psychiatry into an integrative science of psychopathology in which mental illnesses will be defined as involving putative dysfunctions in neural nodes and networks. However, conceptual, methodological, neuroethical, and social issues inherent in and/or derived from the use of RDoC need to be addressed before any attempt is made to implement their use in clinical psychiatry. This article describes current progress in RDoC; defines key technical, neuroethical, and social issues generated by RDoC adoption and use; and posits key questions that must be addressed and resolved if RDoC are to be employed for psychiatric diagnoses and therapeutics. Specifically, we posit that objectivization of complex mental phenomena may raise ethical questions about autonomy, the value of subjective experience, what constitutes normality, what constitutes a disorder, and what represents a treatment, enablement, and/or enhancement. Ethical issues may also arise from the (mis)use of biomarkers and phenotypes in predicting and treating mental disorders, and what such definitions, predictions, and interventions portend for concepts and views of sickness, criminality, professional competency, and social functioning. Given these issues, we offer that a preparatory neuroethical framework is required to define and guide the ways in which RDoC-oriented research can—and arguably should—be utilized in clinical psychiatry, and perhaps more broadly, in the social sphere.

scholarly journals The ethics of genomic medicine: redefining values and norms in the UK and France

2021 ◽  
Author(s):  
Marie Gaille ◽  
◽  
Ruth Horn
Keyword(s):  
Social Contract ◽  
Ethical Issues ◽  
Social Issues ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Public Healthcare ◽  
Individual Rights ◽  
The Social ◽  
The Uk ◽  
The Impact

AbstractThis paper presents a joint position of the UK-France Genomics and Ethics Network (UK-FR GENE), which has been set up to reflect on the ethical and social issues arising from the integration of genomics into routine clinical care in the UK and France. In 2018, the two countries announced enhanced cooperation between their national strategies, Genomics England and Plan France Médecine Génomique 2025, which offers a unique opportunity to study the impact of genomic medicine and relevant policies in different national contexts. The paper provides first insights into the two national strategies and the norms, values and principles at stake in each country. It discusses the impact of genomic medicine on established relationships and existing regulations, and examines its effects on solidarity and trust in public healthcare systems. Finally, it uses the social contract as an analytical lens to explore and redefine the balance between individual rights and collective duties in the context of genomic medicine. This paper leads to three key observations: (1) despite each country’s strategy being at a different stage of implementation, the two countries face similar ethical issues; (2) each country tries to solve these issues by (re-)defining individual rights and collective duties in its own way; (3) the social contract presents a useful tool to analyse the ways the UK and France address the ethical challenges raised by genomics. This overview lays the groundwork for future in-depth comparison, and drive collaborative research, between the UK and France.

Confronting the grey zone after severe brain injury

2019 ◽  
Vol 3 (6) ◽  
pp. 707-711 ◽  
Author(s):  
Andrew Peterson ◽  
Adrian M. Owen
Keyword(s):  
Brain Injury ◽  
Ethical Issues ◽  
Vegetative State ◽  
Clinical Care ◽  
Grey Zone ◽  
Severe Brain Injury ◽  
New Methods ◽  
Legal Decision Making ◽  
Technological Developments ◽  
The Brain

In recent years, rapid technological developments in the field of neuroimaging have provided several new methods for revealing thoughts, actions and intentions based solely on the pattern of activity that is observed in the brain. In specialized centres, these methods are now being employed routinely to assess residual cognition, detect consciousness and even communicate with some behaviorally non-responsive patients who clinically appear to be comatose or in a vegetative state. In this article, we consider some of the ethical issues raised by these developments and the profound implications they have for clinical care, diagnosis, prognosis and medical-legal decision-making after severe brain injury.

The causal involvement of the right supramarginal gyrus in the subjective experience of time: A hf-tRNS study

2021 ◽  
Vol 404 ◽  
pp. 113157
Author(s):  
Giulia Prete ◽  
Chiara Lucafò ◽  
Gianluca Malatesta ◽  
Luca Tommasi
Keyword(s):  
Subjective Experience ◽  
Supramarginal Gyrus ◽  
Experience Of Time ◽  
The Right

scholarly journals How hospitalized patients evaluate and report their pain together with nurses: A scoping review

2021 ◽  
pp. 205715852110134
Author(s):  
Bente Dale Malones ◽  
Sindre Sylte Kallmyr ◽  
Vera Hage ◽  
Trude Fløystad Eines
Keyword(s):  
Scoping Review ◽  
Pain Assessment ◽  
Health Professionals ◽  
Clinical Care ◽  
Hospitalized Patients ◽  
Assessment Tools ◽  
Post Surgery ◽  
Reliable Assessment ◽  
Scoping Reviews ◽  
The Relationship

Pain assessment tools are often used by patients to report their pain and by health professionals to assess patients’ reported pain. Although valid and reliable assessment of pain is essential for high-quality clinical care, there are still many patients who experience inappropriate pain management. The aim of this scoping review is to examine an overview of how hospitalized patients evaluate and report their pain in collaboration with nurses. Systematic searches were conducted, and ten research articles were included using the PRISMA guidelines for scoping reviews. Content analysis revealed four main themes: 1) the relationship between the patient and nurse is an important factor of how hospitalized patients evaluate and report their post-surgery pain, 2) the patient’s feelings of inconsistency in how pain assessments are administered by nurses, 3) the challenge of hospitalized patients reporting post-surgery pain numerically, and 4) previous experiences and attitudes affect how hospitalized patients report their pain. Pain assessment tools are suitable for nurses to observe and assess pain in patients. Nevertheless, just using pain assessment tools is not sufficient for nurses to obtain a comprehensive clinical picture of each individual patient with pain.

scholarly journals Breathlessness and opioid prescribing in COPD in general practice: a cross-sectional, observational study

2020 ◽  
Vol 6 (2) ◽  
pp. 00299-2019
Author(s):  
David C. Currow ◽  
Miriam J. Johnson ◽  
Allan Pollack ◽  
Diana H. Ferreira ◽  
Slavica Kochovska ◽  
...  
Keyword(s):  
General Practice ◽  
Clinical Care ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Pain Patient ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Obstructive Pulmonary Disease ◽  
Health Database

Chronic breathlessness is a disabling syndrome, prevalent in people with advanced chronic obstructive pulmonary disease (COPD). Regular, low-dose, oral sustained-release morphine is approved in Australia to reduce symptomatic chronic breathlessness. We aimed to determine the current prescribing patterns of opioids for chronic breathlessness in COPD in Australian general practice and to define any associated patient and practitioner characteristics.Five years (2011 to 2016) of the Bettering the Evaluation and Care of Health database, an Australian national, continual, cross-sectional study of clinical care in general practice were used. The database included 100 consecutive clinical encounters from almost 1000 general practitioners annually (n=488 100 encounters). Descriptive analyses with subsequent regression models were generated.Breathlessness as a patient-defined reason for encounter was identified in 621 of 4522 encounters where COPD was managed. Opioids were prescribed in 309 of 4522 encounters where COPD was managed (6.8%; (95% CI) 6.1–7.6), of which only 17 were prescribed for breathlessness, and the rest for other conditions almost entirely related to pain. Patient age (45–64 years versus age 80+ years, OR 1.68; 1.19–2.36), Commonwealth Concession Card holders (OR 1.70; 1.23–2.34) and socioeconomic disadvantage (OR 1.30; 1.01–1.68) were associated with increased likelihood of opioid prescription at COPD encounters. The rate of opioid prescriptions rose over the 5 years of study.In primary care encounters for COPD, opioids were prescribed in 6.8% of cases, but almost never for breathlessness. These data create a baseline against which to compare changes in prescribing as the treatment of chronic breathlessness evolves.

Introducing Victim Impact Statement in India: Reconceptualizing Victim Status

2021 ◽  
pp. 251660692199175
Author(s):  
Devansh Dubey ◽  
Payas Jain
Keyword(s):  
Criminal Justice ◽  
Subjective Experience ◽  
Due Process ◽  
Not Given ◽  
Therapeutic Tool ◽  
Victim Status ◽  
Victim Impact Statement ◽  
The World ◽  
Due Process Of Law ◽  
The Right

The right to fair trial is inherent in the concept of due process of law, which now forms part of Article 21 of Indian Constitution after the Maneka Gandhi judgement. Pertinently attached with the same comes the responsibility of the criminal system to treat victims with increased awareness and sensitivity. However, the established convention shows that in planning and developing administration of criminal justice, proper attention is not given to the victims of crime in achieving goals of criminal justice; the major cause of it being that a victim is heard only as a witness not as a victim. A credible response to the said issue has emerged in the form of victim impact statement (VIS) in the modern legal system across the world. With that being said, the researchers through this article try to deduce the need for incorporating a VIS in India through the various jurisprudential understandings of what it means to be a victim, including the gap between the subjective experience of the sufferer and the interpretation of the same by others, and what restorative justice would mean to heal a victim. Establishing upon the same premise of victim status, the researchers try to suggest that the introduction of VIS, with the primary purpose of it being a therapeutic tool and not an instrument of changing the course of justice, will serve to make us reconsider our contours of a ‘victim’.

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