A study was carried out to ascertain the views of parents regarding the performance of lumbar punctures on their children admitted for febrile seizures. One hundred and seventeen (117) children with febrile seizures were recruited over nine months. Either one of the parents was interviewed a day after admission. In most cases, this was usually the mother. The ethnic groups of the patients were Malays (62.4%), Indians (26.5%), Chinese (8.5%) and others (2.6%). Lumbar punctures were requested by the doctor in attendance in only 28 (23.9%) patients This showed that the rate of request for lumbar punctures in febrile seizures was low. Parents of eight of them refused. The main reasons for the refusal were: fears that the child might be paralysed, advice from relatives and fear that the child might die from the procedure, or might find it too painful. All the parents who refused were Malays. A lumbar puncture was also more likely to be refused in a girl. Those who consented to lumbar puncture did so because they wanted the doctor to get to the diagnosis. Another reason given was that it might be therapeutic. Parents whose children did not require a lumbar puncture also thought that lumbar puncture may cause paralysis. The main sources of information on lumbar punctures for the parents were their relatives and/or friends. In only 85% of the cases were the reasons for the lumbar puncture explained to the parent. In 71.4% of the time the explanation was done by the medical officer, and in only 4.8% of the time was the consultant involved.(ABSTRACT TRUNCATED AT 250 WORDS)
The significance of informed consent in research involving humans has been a topic of active debate in the last decade. Much of this debate, we submit, is predicated on an ideology of individualism. We draw on our experiences as anthropologists working in Western and non Western (Iban) health care settings to present ethnographic data derived from diverse scenes in which consent is gained. Employing classical anthropological ritual theory, we subject these observational data to comparative analysis. Our article argues that the individualist assumptions underlying current bioethics guidelines do not have universal applicability, even in Western research settings. This is based on the recognition that the social world is constitutive of personhood in diverse forms, just one of which is individualistic. We submit that greater attention must be paid to the social relations the researcher inevitably engages in when conducting research involving other people, be this in the context of conventional medical research or anthropological field work. We propose, firstly, that the consenting process continues throughout the life of any research project, long after the signature has been secured, and secondly, that both group and individual dimensions of consent, and the sequence in which these dimensions are addressed, should be carefully considered in all cases where consent is sought.
Recognition and articulation of patient rights are core issues in the medical jurisprudence of most nations. While the nature of rights in medical care may vary from country to country, reflecting the idiosyncrasies of domestic law and health delivery, there are commonalities in this area of law that cut across borders. This paper presents five case studies in the patient rights area from Malaysia, Ireland, South Africa, Indonesia and the United States, respectively. The case discussions range from ongoing and fundamental concerns over broad patient rights issues, such as access to health care and informed consent, to rights concerns of those suffering from HIV/AIDS, to a novel consideration over ethical and legal issues concerning ownership of infant organs. It is the hope of the authors that individually, and collectively, the cases will provide helpful insights into this core area of medical law.
The right of a person to control his body is a concept that has long been recognized in Malaysia under the law of torts. The purpose of requiring informed consent is to preserve that right in medical decision-making. Informed Consent is a relatively new concept in medical litigation cases. However in the late 1990's, it has become one of the important claims under negligence made against the doctor for failure to disclose relevant information to patients in respect of the treatment proposed. Whether Malaysia has begun to recognize patient's right to decision-making is yet to be seen. Furthermore the social-cultural relationship between doctors and patients had to be considered. In this respect, the researcher had conducted interviews with doctors and patients to gauge their reaction towards a shared process of decision-making, which is the central issue in the doctrine of informed consent. Findings suggest that in society where primary health care is the main thrust to achieve health for all, the possibility of recognition of the rights of patients to receive information before making decisions about treatment appears remote. The findings also underscore the importance of incorporating aspects of informed consent as part of providing quality service to patients.
The author reviews the legal theory and practice of the requirements for informed consent. He uses a discussion of relevant cases and judgements from courts in the UK, USA, Australia and Malaysia to illustrate apparently conflicting attitudes exemplified by these cases. From this he aims to form some consensus in their application to everyday practice.
Hysterectomy is performed for a wide range of benign and malignant conditions, such as fibroids, menorrhagia and pelvic pain, and gynaecological malignancies. One in four women has a chance of undergoing hysterectomy in her lifetime. Conventionally abdominal hysterectomy is done through the open approach. However, many patients assume that the modern laparoscopic hysterectomy is superior to the standard approach. Laparoscopic surgical centres are mushrooming in major cities. This article presents ethical considerations involved in the decision-making process of choosing from the surgical options available.
Several studies on job stress have been conducted among nurses, teachers, clerks, lecturers, laboratory technicians, petroleum and automotive workers and the calculated prevalences ranged from 20-35%; associated factors identified include high job demand, low job control and poor social support. Thus, the aim of the present study was to determine the prevalence and associated factors of stress in dental healthcare workers of an institution of higher learning in Kelantan. A cross-sectional study of the prevalence and associated factors of stress in 54 dental healthcare workers of an institution of higher learning in Kelantan [response rate of 63.5 percent] was conducted in March 2006. The Malay version of the validated Depression, Anxiety and Stress Scale and Karasek’s Job Content Questionnaire were used as research instruments in this study. Informed consents were obtained from all participants. The prevalence of stress was 22.2%. One (1.9%) staff member experienced severe stress whilst 20.4% experienced mild to moderate stress. After controlling for age, sex, marital status and duration of work, psychological job demand (adj. b 0.61, 95% CI 0.21, 1.00, p=0.003), toxic exposures (adj. b 1.41, 95% CI 0.47, 2.35, p=0.004) and overtime work (adj. b 5.67, 95% CI - 1.18, 10.16, p=0.015) were directly associated with reported stress in dental healthcare workers. High psychological job demand, increased toxic exposures at work and increased overtime work were significantly associated with stress in dental healthcare workers. These findings can be used to guide preventive measures to reduce stress in dental healthcare settings.
Informed consent is now accepted as the cornerstone of medical practice, with reasonable patient standards typically considered to be appropriate in the developed countries; however it is still challenged in many developing countries. The objective of this descriptive study was to evaluate the perceptions and practices among attending medical professionals in matters relating to informed consent in selected hospitals.
Optimal patient care varies considerably from place to place and is influenced by scientific as well as social developments. The purpose of this study was to investigate awareness and pertinent issues regarding informed consent among hospitalised patients and to determine lapses, in order to improve the standard of care.
The doctrine of informed consent has the effect of allowing the mentally competent adult patient to exercise individual choice in any proposed medical treatment. The ethical principles primarily inherent in this doctrine would be the principles of autonomy and beneficence. However, it is argued in this essay that the concept and meaning of autonomy might be vastly different between western and eastern communities. Consequently the doctrine of informed consent will lead to a different meaning in these different societies. The essay also raises the implication of transplanting legal doctrines into societies which might not be fully prepared to implement the ideal contained in the doctrine of informed consent.
Informed consent [IC] is a recognized socio-legal obligation for the medical profession. The doctrine of IC involves the law, which aims to ensure the lawfulness of health assistance and tends to reflect the concept of autonomy of the person requiring and requesting medical and/or surgical treatment. Recent changes in the health care delivery system and the complex sociological settings, in which it is practiced, have resulted in an increase in judicial activity and medical negligence lawsuits for physicians. While IC is a well-established practice, it often fails to meet its stated purpose. In the common law, the standard of medical care to disclose risks has been laid down by the Bolam test- a familiar concept to most physicians, but it has been challenged recently in many jurisdictions. This paper aims to discuss some important judgments in cases of alleged medical negligence so as to familiarize doctors regarding their socio-legal obligations. We also propose to discuss some factors that influence the quality of IC in clinical practice.
Citation:
Guidelines on health research involving minors. Kuala Lumpur: National Institute of Health, Ministry of Health Malaysia; 2011 [MREC DOC.01-2010]
Matched MeSH terms: Informed Consent; Informed Consent By Minors
The pandemic of obesity is of great concern as its associated co-morbidities are devastating; causing lifelong burden to individual’s health and is economically costly to a country. Factors that lead to obesity are a combination of environmental and genetic factors. The Pro-opiomelanocortin (POMC) gene resides in chromosome 2p23.3, and its protein is composed of 241 amino acids which is responsible for the production of polyhormones that regulate appetite and food intake. The study aimed to investigate the prevalence of the RsaI single nucleotide polymorphism (SNP) site in the 5’-untranslated region (UTR) of POMC and its possible association with obesity among 302 multi-ethnic Malaysian subjects (142 obese, 160 non-obese; 120 males, 182 females) from the Kampar Health Clinic. Subjects were recruited by convenience sampling with informed consent and socio-demographic data as well as anthropometric measurements were taken. Subjects were genotyped by polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) analysis using DNA extracted from blood. The distribution of the RsaI genotypes was significantly different among the different ethnicities, but the mutated RsaI (- / -) genotype was rare as it only occurred in 8.9% of the subjects. With the frequency of the RsaI (-) allele of 0.31, it was associated with the percentage of skeletal muscles (p
A good adhesive is an important factor to consider in orthodontic bonding. Frequent bracket failure prolongs treatment duration and causes inconvenience to patient and operator. This study aimed to compare the effectiveness of two bonding agents, i.e. the self etching primer (SEP) and the conventional etch and bond (CEB) by monitoring the incidence, time and
sites of bracket failure. Eighty orthodontic patients were recruited after informed consent were obtained. A randomized split mouth technique was used where one side was bonded with CEB agent, while the other side was bonded using SEP agent. All bonded brackets were examined every 4 weeks for 20 months. Incidence of bracket failure was noted and
comparison between the two groups was done using paired t-test. Time and frequent site of failure were also assessed. Out of 1314 brackets, only 33 brackets were debonded with 16 from SEP group and 17 from CEB group which statistically insignificant (p>0.05). Almost 55% of bracket failure occurred during the first 3 months after bonding for both adhesives
with lower premolars was most the frequent site to fail in both adhesives (39.4%). Bracket bonded on the left side failed significantly compared to the right side. In conclusion, both self-etching primer and conventional acid-etch bonding agents are equally effective in retaining brackets clinically. Bracket failure mostly occurres during the first 3 months after bonding. The premolar brackets and the left side are mostly debonded when compared to other sites.